Deep Vein Thrombosis Research Articles

Abstract 4138583: Incidence and Outcomes of Heparin-Induced Thrombocytopenia Among Patients Undergoing Left Ventricular Assist Device Implantation

Background: Left Ventricular Assist Devices (LVAD) are being increasingly used as a bridge to transplant and destination therapy for advanced (stage D) heart failure. Heparin-induced thrombocytopenia (HIT) increases the risk of thromboembolic and bleeding events. HIT is also a well-known complication in patients undergoing LVAD implantation. This study examines the incidence and impact of HIT on outcomes in LVAD implants using a nationwide database from 2016 to 2020. Methods: We queried the National Inpatient Sample database for 2016-2020 to identify all adults ≥ 18 who underwent LVAD insertion using ICD 10 codes. LVAD recipients were dichotomized into two cohorts by the presence of HIT. Our primary outcome was in-hospital mortality. Secondary outcomes included vascular complications, acute kidney injury (AKI), length of stay, and total cost. Outcomes were adjusted for demographic variables, hospital-level characteristics, and comorbidities using regression analysis. Results: A total of 19975 (95% CI: 18328 - 21622) hospitalization records for LVAD insertion were identified, out of which HIT occurred in 1.8%. There were significant differences in AKI requiring dialysis, (p < 0.03) cardiogenic shock, (p<0.01), mechanical ventilation (p<0.01), pulmonary embolism (PE) (p< 0.001) and acute deep vein thrombosis (DVT) (p< 0.001) which occurred more in HIT. In-hospital mortality was not significantly associated with HIT (adjusted odds ratio [aOR] 1.49, 95% CI :0.73-3.04, p value 0.28). Older age (aOR 1.02; 95% CI: 1.01-1.02) was associated with mortality after LVAD insertion. AKI, ischemic stroke, hemorrhagic stroke, acute coronary syndrome, arterial dissection, cardiogenic shock, and mechanical ventilation were significantly associated with in-hospital mortality. Our analysis did not show any differences in the incidence of vascular complications, stroke, intraoperative bleeding, blood transfusions and AKI between the HIT and non-HIT group. The HIT group stayed longer in the hospital 39 days (95% CI: 36- 38) vs 37 days (95% CI: 35- 44) and incurred higher total hospital cost of $1,101,638 vs. $1,245,616) although this was not statistically significant. Conclusion: Among US hospitalized patients undergoing LVAD implants, HIT was significantly associated with a higher risk of AKI requiring dialysis, PE, acute DVT, cardiogenic shock and need for mechanical ventilation. It was however not associated with a higher risk of in-hospital mortality.

Abstract 4114372: Is Takotsubo syndrome associated with a favorable in-hospital outcome among patients with cardiogenic shock? A propensity score-matched analysis of the National Inpatient Sample Data (2016-2020)

Background: Takotsubo cardiomyopathy (TTC) is characterized by impaired left ventricular function due to typical, regional wall motion abnormalities in the absence of significant obstructive coronary artery disease. Previous small-sized retrospective studies reported favorable outcomes of cardiogenic shock in patients with TTC. We aimed to investigate whether the presence of TTC is associated with a favorable in-hospital outcome among patients admitted for cardiogenic shock using a large nationally representative dataset. Methods: Utilizing data from the National Inpatient Sample (NIS) spanning from 2016 to 2020, we identified patients admitted for cardiogenic shock using ICD-10 codes. Patients with TTC were also identified using ICD-10 codes. Using sociodemographic variables, and comorbid medical conditions, and performed procedures as matching variables, we conducted a 1:1 nearest-neighbor propensity score matching to mitigate potential confounders. The success of matching was evaluated based on standardized mean differences. In-hospital mortality was the primary outcome, while in-hospital complications, length of stay (LOS), and cost of hospitalization were secondary outcomes. We employed the Cochrane-Mantel-Haenszel method to assess the odds ratio (OR) for in-hospital mortality and complications. Simple linear regression models were used to evaluate differences in LOS and cost of hospitalization. Results: The final sample included 22,594 patients, evenly distributed between the groups with and without TTC. The mean age of the cohort was 65.4 years (SD = 15.9), with 74.7% being males. Ethnic composition indicated 75.7% Whites, 9.3% Blacks, and 8.1% Hispanics. The overall in-hospital mortality rate was 32.7%. The TTS group had a lower mortality rate (38.4% Vs 27%, p<0.001). Patients with TTC had lower odds of in-hospital mortality, cardiac arrest, ventricular tachycardia, and acute kidney injury. However, they were noted to have higher odds of deep vein thrombosis, stroke, slightly higher LOS, and cost of hospitalization. Conclusion: In summary, our study suggests that Takotsubo Cardiomyopathy is associated with significantly lower in-hospital mortality rates among patients admitted for cardiogenic shock, indicating a favorable prognosis in this clinical setting.

A Case of Deep Vein Thrombosis Complicated by Right Atrial Clot-in-Transit and Pulmonary Embolism in an Alcoholic Male

A Case of Deep Vein Thrombosis Complicated by Right Atrial Clot-in-Transit and Pulmonary Embolism in an Alcoholic Male

Venous thromboembolism among gynecologic cancer patients in Zaria

Cancer is one of the most important acquired risk factors for Venous Thromboembolism (VTE) including Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). Patients with active malignancy have up to six-fold increased risk of symptomatic VTE than the general population. The risk of VTE in patients with gynecologic malignancy is especially high because of the nature of the tumor, its pelvic location, associated comorbidities, and systemic chemotherapy. The objective of this study was to determine other risk factors, incidence, clinical presentation, and immediate outcome of treatment of thromboembolism in patients with gynecologic cancers in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. It was a retrospective cross-sectional descriptive study of gynecologic cancer cases that were diagnosed with VTE while on admission from 2007-2016 in ABUTH. The overall prevalence of clinical VTE was 2.8% in gynaecologic malignancy. All were DVT. Most cases of DVT were present in ovarian cancers with left-sided preponderance. There is a need for the provision of modern imaging equipment to facilitate timely and highly sensitive diagnosis of VTE in low-resource settings. The main limitation of this study was the inability to find any confirmed case of PE.

Establishment and validation of a predictive model for lower extremity deep vein thrombosis in patients with traumatic pelvic fractures

BackgroundPatients with traumatic pelvic fracture (TPF) are at high risk for developing deep vein thrombosis (DVT). However, there is still no unified standard on how to distinguish high-risk groups for DVT in patients with TPF and how to accurately use anticoagulants at present.ObjectivesThis observational study aimed to establish a DVT risk nomogram score (DRNS) model for TPF patients, and to explore the value of the DRNS model as a clinical guideline in the prevention of DVT with low molecular weight heparin (LMWH).MethodsIndependent risk factors of lower extremity DVT were screened through Lasso regression and logistic regression. A DRNS model was established per this.ResultsThe independent risk factors of DVT included combined femoral fractures, age ≥ 40 years old, BMI (body mass index) ≥ 24 kg/m2, ISS score, fibrinogen concentration, and the minimum concentration of ionized calcium within 48 h after admission. The optimal cutoff value for DRNS was 78.5. In the low-risk population of DVT (DRNS < 78.5), there was no statistical significance of variation about the incidence of DVT progression between the LMWH once a day (qd) group and the LMWH once every 12 h (q12h) group, with P = 0.323. In the high-risk population of DVT (DRNS ≥ 78.5), the incidence of DVT progression in the LMWH qd group was significantly higher than that in the LMWH q12h group, with P = 0.002.ConclusionsThe DRNS model based on independent risk factors of DVT could stratify the risk of DVT for TPF patients, and it was able to provide more precise DVT drug prevention plans for clinicians.

Pulse Wave Doppler Ultrasound in Unmasking of Venous Obstructions Highlighting Diagnostic Utility and Clinical Implications.

Venous obstructions and thrombosis can present diagnostic challenges due to their varied presentations and potential for significant complications if untreated. Pulse wave doppler ultrasound via identification of damping or loss of cardiac pulsatility and/ or respiratory phasicity of venous waveforms serves as a practical, noninvasive, fast, and efficient diagnostic tool for identifying venous obstructions in the presence of compressible veins beyond the point of evaluation.We present two cases demonstrating the effectiveness of pulse wave doppler ultrasound in identifying significant and life-threatening venous obstructions. The first case involves a 68-year-old male with an incidental finding of a compressible left subclavian vein showing a monophasic waveform. Further investigation revealed significant compression of the left brachiocephalic vein by an aortic arch aneurysm. The second case describes a 65-year-old male with a compressible right femoral vein but a monophasic waveform, leading to the discovery of extensive thrombosis from the iliac veins to the inferior vena cava. This series proposes to always assess cardiac pulsatility and respiratory phasicity during doppler ultrasound procedure such as thyroid ultrasounds, deep vein thrombosis (DVT) evaluations, and pre-central vein catheterizations for identifying any venous obstructions, whether they are intrinsic or extrinsic, and for reducing the risk of thromboembolic complications.

Longer-term safety and efficacy of baricitinib for atopic dermatitis in pediatric patients 2 to

Background Baricitinib, an oral selective Janus kinase inhibitor, improved clinical signs and symptoms of moderate-to-severe atopic dermatitis (AD) at week 16 in the phase 3 pediatric study BREEZE-AD-PEDS. Objective To assess longer-term efficacy and safety of baricitinib in pediatric patients aged 2 to <18 years. Methods In BREEZE-AD-PEDS long-term extension, responders and partial responders (validated Investigator Global Assessment-Atopic Dermatitis [vIGA-AD®] 0/1/2) at Week 16 remained on double-blind treatment to which they were randomized (placebo, baricitinib [1-mg equivalent, 2-mg equivalent, or 4-mg equivalent); non-responders (vIGA-AD 3 or 4) at Week 16 transitioned to open-label baricitinib 4-mg equivalent. Safety was summarized for all randomized patients who received ≥1 dose of study treatment. Results In total 467 patients received baricitinib for 750.7 patient-years. Proportion of responders/partial responders (at Week 16) who achieved vIGA-AD 0/1 at Week 52 was greater for baricitinib 4-mg equivalent (56.8%) versus all other treatment groups (42.2%, 47.7%, and 39.7% for 2-mg equivalent, 1-mg equivalent, and placebo, respectively). Most treatment-emergent adverse events were mild/moderate in severity. No deaths, pulmonary emboli, deep vein thromboses or arterial thrombotic events, major adverse cardiovascular events, malignancies, tuberculosis events, or gastrointestinal perforations were reported. Conclusions Baricitinib demonstrated sustained long-term efficacy. No new safety signals were identified. Trial Registration ClinicalTrials.gov Identifier: NCT03952559

Venous thromboembolism is associated with increased all-cause mortality in ALK-positive non-small cell lung cancer

BackgroundVenous thromboembolic events (VTE) are often diagnosed in ALK-positive lung cancer although it has not been demonstrated how their co-occurrence affects patients' survival.MethodsThe study included patients with ALK-positive lung cancer recognized in metastatic stage in the period 2017–2022. All received treatment with ALK inhibitors at The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw. The main aim of the study was to assess overall survival (OS) in relation to VTE occurrence. The additional purpose was to define predictors of VTE and OS.ResultsThe study included 54 patients in median age 60 years, men were a minority (25 / 46.3%). VTE was diagnosed in 12 (22.2%) patients: 9 (16.7%) cases with pulmonary embolism (PE), 2 cases with thrombosis in vena cava superior, one case with deep vein thrombosis and thrombosis in vena cava inferior. Among patients with PE: 2 patients died directly due to the first PE episode and one due to a recurrent PE. Patients with VTE had significantly shorter overall survival (median 11.7 vs. 37.4 months, log-rank test p = 0.003). The risk of all-cause mortality was increased significantly in both: VTE (HR = 3.47; 95%CI: 1.61—7.49; p = 0.0016) or alone PE (HR = 2.41; 95%CI: 1.06—5.50; p = 0.037). The risk of VTE diagnosis was significantly increased during active treatment with crizotinib (HR = 8.72; p = 0.0004) or alectinib (HR = 21.47; p = 0.000002). Metastases to liver and baseline leukocyte count > 11 × 10⁹/L were significant predictors of VTE and OS. Khorana score ≥ 3 points predicted OS (HR = 2,66; 95%CI: 1,05—6,75; p = 0,04), but remained insignificant for VTE.ConclusionThe diagnosis of any type of VTE or alone PE was associated with significantly worse overall survival in patients with ALK-positive non-small cell lung cancer.

Effect of muscle strength on deep vein thrombosis: A Mendelian randomization study.

Deep vein thrombosis (DVT) is a serious condition characterized by blood clots in deep veins, posing a significant public health burden. Muscle strength has been implicated as a potential risk factor for DVT due to its influence on venous return. This study aims to investigate the causal association between muscle strength and DVT using a Mendelian randomization (MR) approach, leveraging genetic variants as instrumental variables (IVs). We conducted a 2-sample MR analysis using genome-wide association study (GWAS) data for hand-grip strength and DVT. IVs were selected based on their significant associations with muscle strength and DVT, as well as their linkage disequilibrium patterns. We employed statistical methods including inverse-variance weighting (IVW), MR-Egger, and weighted median to address pleiotropy bias. Sensitivity analyses were conducted to evaluate the robustness of the results. A total of 21 and 14 independent IVs were identified for hand grip strength (EWGSOP) and hand grip strength (FNIH), respectively. IVW analysis revealed a consistent causal and negative association between both definitions of hand grip strength and DVT (EWGSOP: OR = 0.702, 95% CI: 0.511-0.964, P = .029; FNIH: OR = 0.715, 95% CI: 0.570-0.898, P = .004). No directional pleiotropy was detected in MR-Egger and MR-PRESSO analyses for either definition (EWGSOP: MR-Egger Intercept P = .516; MR-PRESSO global test P = .162; FNIH: MR-Egger Intercept P = .569; MR-PRESSO global test P = .371).Sensitivity analyses demonstrated the stability of the causal effect estimates, with little influence from individual IVs. The MR analysis provided evidence of a causal association between muscle strength and DVT risk, suggesting that increasing muscle strength may have a protective effect. These findings have implications for preventive strategies and the promotion of resistance exercises and muscle-strengthening activities. Further research and validation of these results could inform clinical guidelines and interventions for DVT prevention.

Deep vein thrombosis in response to stress induced by earthquakes in Japan: a meta-analysis of possible exacerbating factors

The principal goal of this study was to assess factors associated with deep vein thrombosis (DVT) in the aftermath of earthquakes in Japan. We searched PubMed, Google Scholar, Web of Science, and Cochrane Library for articles published in English or Japanese regarding indicators for DVT associated with Japanese earthquakes. We calculated pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs) for patients with DVT (the DVT group) as compared with the non-DVT group for potential predictors. Ultimately, 7 articles were included in the analysis, comprising 6,637 subjects (DVT, 895; and non-DVT, 5,742). The following factors proved statistically significant: female gender (OR = 1.48, 95% CI; 1.20–1.81, p = 0.0002), greater age (MD = 4.44, 95% CI; 1.62–7.25, p = 0.002), hypertension (OR = 1.44, 95% CI; 1.18–1.75, p = 0.0003), heart disease (OR = 1.45, 95% CI; 1.07–1.97, p = 0.02), previous history of DVT (OR = 9.23, 95% CI; 2.94–28.91, p = 0.0001), sleeping pill use (OR = 1.81, 95% CI; 1.37–2.38, p = 0.0001), lower leg varix (OR = 1.63, 95% CI; 1.17–2.28, p = 0.004), and soleal vein dilatation ≥ 8 mm (OR = 2.13, 95% CI; 1.32–3.42, p = 0.002). Our findings furnish insights that can aid in making informed choices about healthcare and policy in the context of earthquake-induced stress.

Supra-Prophylactic Doses of Enoxaparin Reduces Fibrin Deposition Without Exacerbation of Intracerebral Hemorrhage in a Rat Model of Penetrating Traumatic Brain Injury.

Deep vein thrombosis and pulmonary embolism prophylaxis is an important part of trauma care. Despite an increased risk of thrombotic complications, the use of venous thrombosis chemoprophylaxis in penetrating traumatic brain injury (pTBI) patients is met with reluctance from neurosurgeons because of concern for the exacerbation of intracerebral hemorrhage. The objective of this study was to provide initial pre-clinical evidence of the effects of Lovenox (LVX) administration following pTBI with significant intracerebral hemorrhage. Sprague-Dawley rats received a penetrating ballistic-like brain injury. Animals were randomly divided into two groups following injury: LVX (25 mg/kg) or vehicle (VEH, saline). LVX or vehicle was administered subcutaneously beginning 24 h after the injury and continued daily for 7 days post-injury. A neurological assessment was performed daily and magnetic resonance imaging (MRI) was performed at baseline, 1, 2, 3, and 7 days post-injury. Following the final MRI, brains were isolated and prepared for histological analysis. Thromboelastography demonstrated dramatic anticoagulation effects which were confirmed by significant increases in partial thromboplastin time (p < 0.001). Daily neurological assessment revealed no worsening of functional deficits following LVX treatment. MRI analysis demonstrated no differences in cerebral edema or intracranial hemorrhage volumes between treatment groups at any tested post-injury time points. However, LVX elicited a significant reduction in fibrin deposition in the ipsilateral striatum and lesion site at 7 days post-injury (p < 0.05). Serum levels of beta-amyloid were decreased at 7 days following LVX treatment (p < 0.05) which may indicate neuroprotective effects but was not correlated to brain levels. The results presented indicate that administration of LVX at a dose capable of inducing anticoagulation is safe in a rodent model of pTBI without exacerbation of intracerebral hemorrhage within the first 7 days of injury.

Effects of Predictive Nursing Process on Elderly Patients with Total Hip Arthroplasty.

Elderly individuals represent a significant demographic undergoing total hip arthroplasty, with distinct risks and complications. The study aimed to determine whether predictive nursing, guided by risk assessment, could reduce these risks and improve patient outcomes. A total of 191 elderly patients undergoing total hip arthroplasty were included in the study, with 142 patients randomly assigned to either the control or observation groups. The control group received routine care, while the observation group received predictive nursing based on comprehensive risk assessment. Various assessment tools were employed to evaluate risks such as venous thrombosis, pressure injuries, falls, joint dislocation, infections, and psychological factors. The primary outcomes included functional improvement measured by the Harris Hip Score, Activities of Daily Living (ADL), anxiety levels, and patient satisfaction. Our study demonstrated that predictive nursing interventions, guided by comprehensive risk assessment, yielded significant reductions in postoperative complications, particularly deep vein thrombosis, in elderly patients undergoing total hip arthroplasty. In addition, patients who received predictive nursing care experienced notable benefits, including shorter hospital stays, heightened satisfaction levels, enhanced hip function, improved ADL scores, and reduced anxiety levels compared with those receiving standard care. The study underscores the substantial benefits of predictive nursing interventions guided by risk assessment in improving outcomes for elderly patients undergoing total hip arthroplasty, highlighting the potential of individualized nursing care to optimize postoperative recovery and enhance patient well-being.

Large inferior vena cava thrombosis in a 25-year-old female patient: A case report.

The incidence of venous thromboembolism is increasing, and it is more common in older than in younger patients. Inferior vena cava (IVC) thrombosis is a rare subtype of deep vein thrombosis, and it is associated with a high incidence of arterial and venous thrombosis in patients with systemic lupus erythematosus (SLE). We present the case of a 25-year-old female patient with a large IVC thrombosis caused by SLE that was intractable to thrombolytic therapy. A 25-year-old previously healthy female patient presented to the emergency department with a 5-day history of fever. Her computed tomography revealed a large thrombus with an approximate length 25 cm extending from the suprarenal IVC to the right common iliac vein and the left external and internal iliac veins. We decided to perform intravenous thrombolysis (alteplase 65 mg) because of the massive thrombus burden followed by an infusion of intravenous heparin. However, the size of the thrombus did not showed reduction 3 days after treatment. For the next step, the catheter-directed thrombolysis (CDT) was performed; however, no changes were observed. She was diagnosed with SLE, and the large IVC thrombus gradually improved after primary treatment for SLE, including immunosuppressive drugs combined with anticoagulant. We found a large IVC thrombus secondary to SLE in a young female patient. In this case, systemic thrombolysis or CDT did not improve the thrombus. The thrombus only improved after immunosuppressive treatment for SLE. Our case highlights the importance of treatment for etiologic disease in an intractable thrombosis developed by provoked cause.

Non-pharmacological Methods of Deep Vein Thrombosis Prophylaxis in Orthopaedic Wards

Non-pharmacological Methods of Deep Vein Thrombosis Prophylaxis in Orthopaedic Wards

Diagnostic value of systematic compression ultrasonography for the detection of unrecognized venous thromboembolism in patients admitted to an internal medicine ward for dyspnea.

The diagnosis of venous thromboembolism (VTE) is complex, and many cases of pulmonary embolism (PE) and deep vein thrombosis (DVT) go undetected despite validated diagnostic algorithms. This study evaluated the diagnostic performance of compression ultrasound (CUS) when systematically performed in patients admitted to an internal medicine department for dyspnea and/or respiratory failure. We conducted a prospective observational cohort study of consecutive adult hospitalized patients admitted for dyspnea and/or respiratory failure with at least one of the following: tachycardia (> 100bpm), tachypnea (> 20/min), chest pain, cough, syncope, or hemoptysis. Patients with a previous diagnosis of VTE or who underwent computed tomography pulmonary angiography (CTPA) or CUS during evaluation in the emergency department were excluded. The study included 263 patients (50.2% women, average age 84years). CUS was positive in 31 patients (11.8%); Bilateral DVT was diagnosed in two patients and unilateral DVT in 29 patients. Of these, 10 underwent CT scan, with PE confirmed in 9 cases. Using the Wells score for DVT (cut-off ≥ 2), only 8 patients (25.8%) were at high risk. The accuracy of the Wells score in identifying PE was suboptimal, as 5 of 9 patients (55.5%) with confirmed PE were in the low-risk group (three-level interpretation) and 8 (89.9%) were in the "EP unlikely" group (two-level interpretation). The systematic use of CUS as a point-of-care tool can improve the diagnostic accuracy for VTE in patients admitted to internal medicine departments with dyspnea/respiratory failure.

Postmarketing Surveillance of Inferior Vena Cava Filters Among US Medicare Beneficiaries

Inferior vena cava filters (IVCFs) are commonly used to prevent pulmonary embolism in selected clinical scenarios, despite limited evidence to support their use. Current recommendations from professional societies and the US Food and Drug Administration endorse timely IVCF retrieval when clinically feasible. Current IVCF treatment patterns and outcomes remain poorly described. To evaluate temporal trends and practice patterns in IVCF insertion and retrieval among older US patients and report the incidence of periprocedural and long-term safety events of indwelling and retrieved IVCFs. Prespecified, retrospective, observational cohort of Medicare Fee-for-Service (FFS) beneficiaries, leveraging 100% of samples of inpatient and outpatient claims data from January 1, 2013, to December 31, 2021. First-time IVCF insertion while insured by Medicare FFS. The primary safety outcome was the composite of all-cause death, filter-related complications (eg, fracture, embolization), operating room visits following filter-related procedures, or new diagnosis of deep vein thrombosis (DVT). Events were considered periprocedural if they occurred within 30 days of IVCF insertion or retrieval and long-term if they occurred more than 30 days after. Among 270 866 patients with IVCFs placed during the study period (mean age, 75.1 years; 52.8% female), 64.9% were inserted for first-time venous thromboembolism (VTE), 26.3% for recurrent VTE, and 8.8% for VTE prophylaxis. Of these patients, 63.3% had major bleeds or trauma within 30 days of IVCF insertion. The volume of insertions decreased from 44 680 per year in 2013 to 19 501 per year in 2021. The cumulative incidence of retrieval was 15.3% at a median of 1.2 years and 16.8% at maximum follow-up of 9.0 years. Older age, more comorbidities, and Black race were associated with a decreased likelihood of retrieval, whereas placement at a large teaching hospital was associated with an increased likelihood of retrieval. The incidence of caval thrombosis and DVT among patients with nonretrieved IVCFs was 2.2% (95% CI, 2.1%-2.3%) and 9.2% (95% CI, 9.0%-9.3%), respectively. The majority (93.5%) of retrieval attempts were successful, with low incidence of 30-day complications (mortality, 0.7% [95% CI, 0.6%-0.8%]; filter-related complications, 1.4% [95% CI, 1.2%-1.5%]). In this large, US real-world analysis, IVCF insertion declined, yet retrievals remained low. Strategies to increase timely retrieval are needed, as nonretrieved IVCFs may have long-term complications.

Low incidence of deep vein thrombosis after double-balloon endoscopy and colorectal submucosal dissection: Multicenter, prospective study

Background and study aims: Although deep vein thrombosis (DVT) and pulmonary embolism (PE) are major postoperative complications, risk of DVT/PE after endoscopic procedures remains unknown. This study aimed to identify risks of DVT/PE after colorectal endoscopic submucosal dissection (ESD) and double-balloon endoscopy (DBE). Patients and methods: Patients who were scheduled to undergo DBE and colorectal ESD were prospectively enrolled in this study. Before enrollment, all patients were confirmed to have no DVT on whole-leg ultrasonography (US) or contrast-enhanced computed tomography (CECT). All patients routinely underwent whole-leg US after ESD or DBE. The primary endpoint was incidence of DVT after colorectal ESD and DBE. The preplanned sample size was 170 patients in the colorectal ESD group and 75 in the DBE group. Results: Between September 2020 and June 2022, 170 patients who had colorectal ESD and 75 who had DBE were recruited for this study; however, 238 patients (ESD, n = 167; DBE, n = 71) were analyzed. Of these 238 patients, DVT occurred in only one patient after colorectal ESD and incidence of DVT was 0.4% (95% confidence interval [CI] 0-1.2) in total, including 0.6% (95% CI 0-1.8) after colorectal ESD and 0% after DBE. Conversely, no PE occurred in the entire cohort. Conclusions: This prospective study demonstrated that risk of DVT/PE following highly invasive endoscopic procedures including colorectal ESD and DBE is very low.

Antithrombotic Agents After Free Tissue Transfer in the Pediatric and Adolescent Population.

Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear. We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study. Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3%, 21.9%, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). 58.9% of the population received post-operative antithrombotic agents. The rate of flap revision surgery was similar (11.6% and 10.0%, respectively), with and without antithrombotic treatment (p>0.05). There were no major bleeding complications or deep vein thrombosis. The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.

Lower Blood Loss with Bicruciate-Retaining Total Knee Arthroplasty Compared with Bicruciate-Stabilized Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is a common surgical procedure to treat end-stage knee osteoarthritis. This study compared blood loss volume and other clinical outcomes between bicruciate-retaining (BCR) and bicruciate-stabilized (BCS) TKA. Ninety-seven participants who underwent unilateral TKA were enrolled. The BCS-TKA and BCR-TKA groups comprised 78 and 19 participants, respectively. Blood loss was calculated using preoperative and postoperative hematocrit values, height, weight, and sex. Measurements were taken immediately after surgery, on days 1 and 7, and total blood loss was calculated up to day 7. Operation time, range of motion at 7 and 14 days postoperatively, blood transfusion requirement, and postoperative complications such as infection, hematoma, and deep vein thrombosis were compared between the groups. Blood loss was comparable between groups at all time points (125.7 vs. 105.4 mL, 57.9 vs. 43.5 mL, and 68.2 vs. 41.7 mL for immediate, day 1, and day 7 postoperatively, respectively; all p > 0.05) except for total blood loss, which was significantly lower in the BCR group compared with the BCS group (190.7 vs. 251.1 mL; p < 0.05). The BCR group also had a longer operation time than the BCS group (131.2 vs. 112.4 minutes; p < 0.05). No other significant differences were observed in other outcomes. Total blood loss up to 7 days postoperatively was significantly lower in the BCR group than in the BCS group despite a longer operation time. This may be attributed to the reduced bone resection and greater soft tissue preservation, including the anterior cruciate and posterior cruciate ligaments, in the BCR technique.

Right iliac deep vein thrombosis and pulmonary embolism associated with recreational nitrous oxide: a case report

BackgroundThe recreational use of nitrous oxide is becoming increasingly common among teenagers and young adults. Since 2018, the use of nitrous oxide has increased exponentially and has become a public health problem.Case presentationA 23-year-old patient was referred to accident and emergency (A&E) by his general practitioner for deterioration in general condition, vomiting, diarrhea and febrile headache at 39 °C.He reported that he had been partying for a month and consuming alcohol, cannabis and nitrous oxide. Three days before the consultation, he reported increased abdominal pain in the right iliac fossa. His homocysteine concentration was 51.9 μmol/L, and his plasma methyl malonate concentration increased to 4.45 μmol/L. A thoracic and abdominal CT scan revealed right iliac venous thrombosis associated with bilateral pulmonary embolism.ConclusionNitrous oxide inhibits the activity of methionine synthetase. We therefore observed an increase in plasma homocysteine and 5-methyl-THF. The increase in homocysteine could be responsible for the pro-thrombotic activity resulting from nitrous oxide intoxication. At present, no threshold or duration of exposure has been identified as being particularly likely to cause complications. It is likely that other factors coexist, such as coagulation disorders and polymorphisms of the MHTFR gene, which can lead to hyperhomocysteinaemia, cannabis consumption, inflammatory conditions and others. Treatment is based on vitamin B12 supplementation and curative anticoagulation. Some authors also recommend folate supplementation.Consumption of nitrous oxide could be associated with arterial and venous thromboembolic disease.