Developed Deep Venous Thrombosis Research Articles

Venous Thromboembolism Risk Factors in Women With Obesity Who Undergo Cesarean Delivery.

Venous thromboembolism (VTE) is a leading cause of maternal mortality. Obesity and cesarean delivery are established risk factors for pregnancy-related VTE. We identified additional risk factors among patients with obesity who underwent a cesarean delivery to identify those who need VTE prophylaxis. We conducted a secondary analysis of data from the Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry Database using a case-control design. Cases were identified as women with obesity having a pre-pregnancy body mass index of >30 kg/m2, who underwent cesarean delivery and subsequently developed deep venous thrombosis (DVT) or pulmonary embolism (PE). These women were compared to a control group of women with obesity who underwent cesarean delivery but did not develop DVT or PE. Analysis of risk factors associated with VTE was performed using Chi-Square test and Fisher's exact test. We identified 43 VTE cases and 172 controls in the MFMU database. Increased risk of VTE was noted in women with endometritis (OR of 4.58 [95% CI: 1.86-11.2, P = .0004]), receiving a blood transfusion (OR 17.07 [95% CI: 4.46-65.3, P = .0001]), having a coagulopathy (OR 27.73 [95% CI: 3.24-237.25, P = .0003]), and urinary tract infection (OR 2.39 [95% CI: 1.08-5.28, P = .03]). Important risk factors for VTE in women with obesity who undergo cesarean delivery include endometritis, intra- or post-operative transfusion, coagulopathy, and urinary tract infection. The presence of one or more of these factors may help guide provider decision-making regarding whether to administer thromboprophylaxis.

Deep venous thrombosis and hyponatremia associated with citalopram use for behavioral symptoms in Parkinson’s disease: a case report

BackgroundEvidence is limited regarding the optimal therapeutic approach for neuropsychiatric symptoms associated with Parkinson’s disease dementia (PDD). Selective serotonin reuptake inhibitors (SSRIs) are widely used for mood disorders and behavioral symptoms in older adults with cognitive impairment, but they have limited efficacy in patients with PDD. The effect of SSRIs on hemostasis is also unclear. This report describes a patient with PDD who developed deep venous thrombosis (DVT) and hyponatremia after initiating citalopram treatment.Case presentationAn 86-year-old woman with PDD presented to our emergency department with altered mental status, generalized weakness, and left lower leg swelling. Citalopram was begun 4 weeks previously for behavioral changes and was discontinued 2 days before presentation because of excessive fatigue. At presentation, her plasma sodium level was 123 mg/dL. Brain computed tomography showed age-related changes. Doppler ultrasound revealed a DVT in the left lower leg. The patient was treated with hypertonic saline and intravenous heparin. After normalization of her sodium, she was discharged on donepezil and apixaban. At follow-up, her sodium remained normal, and her cognition and behavior were noticeably improved.ConclusionOlder adults with Parkinson’s disease are sensitive to adverse effects of psychotropic agents, including SSRIs, which are not recommended first-line agents for behavioral symptoms in PDD. Upon initiating SSRIs in older patients with functional decline and multiple comorbidities, physicians need to evaluate the patient’s risk factors for bleeding or thrombosis. Physical activities should also be maintained as much as possible.

Primary Total Knee Replacement: A Recipe for Dry Dressing.

To evaluate surgical outcomes using sets of techniques to achieve single dry dressing for two weeks post total knee replacement (TKR) at Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia. A prospective study comprised of 110 consecutive unilateral total knee replacements was conducted at the orthopedic department of Dr. Sulaiman Al-Habib Hospital, Suwaidi, Riyadh, KSA. Patients of both genders underwent knee replacement surgery due to primary knee osteoarthritis, Kellgren-Lawrence grades 3 and 4. Routine investigations and fitness evaluations of patients were carried out preoperatively. Preoperative minimal use of a tourniquet and release prior to arthrotomy closure; intravenous tranexamic acid, no drains; capsule infiltration with local anesthetics without adrenaline; tight closure with barbed sutures up to the skin in three layers; skin glue; Aquacel dressing; adductor canal block; and continuation of oral anticoagulant for four weeks. A total of 110 cases were included, of which 81 (73.6%) were females and 29 (26.4%) were males. The mean age of the study population was 60.5+10.3 years (48 to 88 years). The mean BMI in our patients was 30.57+10.5 kg/m2. Most patients were morbidly obese 13 (30.95%). The mean preoperative Hb% was 13.07+1.6 g/dl, while the mean postoperative Hb% was 12.58+1.9 mg/dl with a p-value of 0.28, which was non-significant statistically. Only two patients needed a change of Aquacel wound dressing for ooze. None of our patients developed deep venous thrombosis (DVT) or an infection. A sequential use of sets of techniques is observed to be associated with improved outcomes in terms of blood loss, wound infection, mobility, and patient satisfaction, leading to the ultimate end point of dry Aquacel wound dressing.

A prospective study to evaluate the use of surveillance venous ultrasonography to detect incidence of deep venous thrombosis following neurosurgical excision of brain tumors.

Patients with brain tumors are prone to develop deep venous thrombosis (DVT) following neurosurgical excision of tumor. However, there is a deficiency of knowledge about the screening method, optimum frequency, and duration of the surveillance to diagnose DVT in the post-operative period. The primary objective was to find the incidence of DVT and associated risk factors. The secondary objectives were to find the optimum duration and frequency of surveillance venous ultrasonography (V-USG) in patients undergoing neurosurgery. Hundred consecutive adult patients undergoing neurosurgical excision of brain tumors were included after their consent, over a period of 2 years. The risk factors for DVT were assessed in all the patients preoperatively. All patients underwent surveillance duplex V-USG of the upper and lower limbs at pre-planned time intervals in the perioperative period, by experienced radiologists and anesthesiologists. The occurrence of DVT was noted using the objective criteria. The association between the perioperative variables and the incidence of DVT was assessed using univariate logistic regression analysis. The most common prevalent risk factors were - malignancy (97%), major surgery (100%), and age >40 years (30%). Asymptomatic DVT was detected in the right femoral vein in one patient who underwent suboccipital craniotomy for high-grade medulloblastoma, on the 4th and 9th postoperative day, making the incidence of DVT 1%. The study found no association with perioperative risk factors and could not suggest the optimum duration and frequency of surveillance V-USG. A low incidence of DVT (1%) was detected in patients undergoing neurosurgeries for brain tumors. Prevalent thromboprophylaxis practices and a shorter period of post-operative surveillance could be the reasons for the low incidence of DVT.

Asymptomatic deep venous thrombosis identified on routine screening in patients with hospitalized neurological diseases

PurposePatients with neurological diseases are potentially at high risk for developing deep venous thrombosis (DVT). We sought the prevalence and clinical background of patients with neurological diseases in whom DVT was detected during hospitalization. MethodsConsecutive patients admitted due to neurological diseases were prospectively registered. Those who were at risk for DVT were screened using venous duplex ultrasonography of the lower extremities. Predictors for DVT detection were analyzed. ResultsDuring the study period, 192 of 785 patients received duplex ultrasonography. There were 34 patients with DVT identified (18%, age 63 ± 17 years). Three patients had DVT in the popliteal or femoral vein and the others had below the knee; all of the DVT were asymptomatic. DVT was observed most frequently in patients with systemic vasculitis, followed by demyelinating disease. In patients with DVT, the median D-dimer level was 2.1 µg/mL. On multiple logistic regression analysis, female ([odds ratio, 95% confidence interval] 3.2, 1.2–8.4), supine or sitting position for > 48 h (5.3, 1.8–15.0), D-dimer level ≥ 2.0 µg/mL (6.2, 2.3–16.4), and white blood cell count ≥ 7,600 (4.2, 1.6–11.3) were independent predictors of DVT detection at the first screening ultrasonography. DVT was detected in 1, asymptomatic pulmonary embolism was detected in 2, and both in 1 on chest computed tomography. ConclusionDVT is not rare in patients with neurological diseases. Clinicians should be mindful of subclinical DVT in hospitalized neurological disease patients with decreased daily activity and elevated D-dimer levels or blood cell counts, especially in women.

Deep venous thrombosis in patients with neurological diseases: A multicenter, prospective study

ObjectivePatients with neurological diseases are liable to develop deep venous thrombosis (DVT) due to various factors. We investigated the prevalence, related factors, and prognosis of DVT in patients with neurological diseases. MethodsPatients admitted to four hospitals due to neurological diseases were prospectively recruited. Those with cerebrovascular diseases were excluded. To screen for DVT, ultrasonography was performed in patients with possible DVT risk, such as D-dimer > 1.0 µg/dL, recent surgery, active malignant diseases, recent bone fracture, decreased activity, or treatment with immunoglobulin or steroid therapy. Clinical characteristics were compared between patients with and without DVT. ResultsA total of 106 patients (54 women, median 71 years old) were included. DVT was detected in 27 patients (26.0%) at the first assessment. All had DVT only in the calf; encephalopathy/meningitis (n = 4, 40.0%) had the highest prevalence of DVT among the underlying neurological diseases, followed by parkinsonian syndrome (n = 6, 37.5%). Independent predictors for DVT detection were malignant diseases (odds ratio, 11.7; 95% confidence interval, 1.0–301.4), modified Rankin Scale score ≥ 4 (5.4; 1.9–16.6), and D-dimer ≥ 2.0 µg/dL (5.7; 2.1–16.7). Ten patients were treated with anticoagulants, and no patients developed a symptomatic pulmonary embolism. No clinically evident pulmonary embolisms, systemic embolisms, or severe bleeding complications were observed in patients with DVT. ConclusionsAsymptomatic DVT is not rare in patients with neurological diseases, especially in those with malignancy, decreased activity, or elevated D-dimer. The overall prognosis is favorable, but the potential risk of development of a pulmonary embolism should be recognized.

Homocysteine is potential serological marker for predicting the risk of deep venous thrombosis of the lower extremities in patients received operation of lower limb fracture

Abstract Objective The aim of the study is to investigate the correlations among serum homocysteine (Hcy), D-dimer, and the risk of developing deep venous thrombosis (DVT) of the lower extremities in patients who underwent operation for lower limb fracture. Methods Seventy-five cases who underwent operation for lower limb fracture were included and further divided into DVT group (n = 26) and control group (n = 49) based on post-DVT diagnostic criteria. The serum Hcy and D-dimer were examined 48 h after operation. The serum Hcy and D-dimer levels were compared between the two groups. The correlation between serum Hcy and D-dimer was investigated by the Pearson correlation test. The receiver-operating characteristic (ROC) curve was applied to evaluate the diagnostic performance of serum Hcy and D-dimer as serological markers for DVT. Results The serum Hcy concentrations were 11.96 ± 3.98 μmol/L and 7.92 ± 3.27 μmol/L for DVT and control groups, respectively, with statistical difference (t = 4.72, P < 0.01). The serum D-dimer in the DVT group was significantly higher than that of the control group (8.99 ± 4.50 vs 1.70 ± 2.11) μg/mL with statistical difference (t = 9.56, P < 0.01). Line regression analysis indicated that serum Hcy was positively correlated with serum D-dimer concentration and can be demonstrated by the equation of Y = 0.6651*X + 1.036 for the DVT group. Using serum Hcy as the biomarker for predicting DVT, the prediction sensitivity and specificity were 76.92 and 71.44%, respectively, with the AUC of 0.7804 under the cut-point of 9.54 μmol/L. For serum D-dimer, the prediction sensitivity and specificity were 96.15 and 73.47%, respectively, with the area under the ROC (AUC) of 0.9455 under the cut-point of 1.66 μg/mL. Conclusion Serum Hcy was significantly elevated in DTV patients, and hence, it can be applied as a serological marker for DVT prediction in patients who underwent operation for lower limb fracture. However, the DVT prediction performance of serum Hcy was inferior to D-dimer especially for diagnostic sensitivity.

Evaluating the effectiveness of using enoxaparin to prevent venous thromboembolism in hip replacement patients: A retrospective cohort study

Introduction: Our research aims to evaluate the effectiveness of thromboprophylaxis using enoxaparin in patients undergoing hip replacement.
 Methods: A retrospective cohort study was conducted based on medical records of patients aged 40 years and older undergoing hip replacement. Exclusion criteria included patients who had used anticoagulants to prevent other diseases, patients with a history of chronic renal failure, liver failure, cancer or allergy to anticoagulants, and patients with indicated mechanical prophylaxis. In our study, 65 patients were randomized into 2 groups - the control group and the venous thromboembolism (VTE) prophylaxis group (receiving subcutaneous enoxaparin 40 mg daily for 7 - 14 days). Preventive effectiveness was evaluated based on the comparison of VTE incidence after surgery between the groups.
 Results: In our study, most of the patients were over 60 years old (79.2%). No case of pulmonary embolism was recorded. There were 11 patients in the control group (17.2%) who developed deep venous thrombosis (DVT) versus 2 patients in the prophylaxis group (3.1%). After adjusting for postoperative hospital stay, use of enoxaparin reduced the risk of DVT by 89.7% (OR 0.103, 95% confidence interval 0.019-0.569, p=0.009), especially in patients over 60 years old (OR 0.147, 95% confidence interval 0.026 - 0.822, p = 0.029).
 Conclusion: This study demonstrates that using enoxaparin significantly reduces the incidence of DVT in patients undergoing hip replacement, especially in patients over 60 years old.

SEATED-IMMOBILITY THROMBOEMBOLISM SYNDROME COMPLICATING CORONAVIRUS DISEASE 2019 OUTBREAK QUARANTINE

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months Worldwide, Health care officials are calling for social distancing and quarantine policies to limit the spread of COVID-19 This means most people will have to spend much, if not all, of their time at home Home environment offers abundant opportunities to be sedentary( sitting and reclining) The link between Immobility and increased risk of venous thromboembolism (VTE) has long been established We present a case of a young healthy patient who developed deep venous thrombosis (DVT) and bilateral acute pulmonary embolism following prolonged sitting during (COVID-19) outbreak quarantine CASE PRESENTATION: A 45-year-old male presented to our hospital with right leg pain and dyspnea of 1-week duration He denied fever, chest pain, cough, trauma, sick contact or recent travel He has no past medical history and never smoked Due to COVID-19 outbreak “stay home” orders, and, for four weeks prior to hospital presentation, he was spending about eight uninterrupted hours daily seated using his computer at home Initial vitals were Temp 98 3 F, heart rate 81 beat/min, respiratory rate 18 cycles/min, blood pressure 142/65 mmHg and oxygen saturation 100% on ambient air Physical exam was remarkable only for right calf swelling and tenderness BMI was 24 kg/m2 Laboratory data were notable for a D-dimer of 3035 (ref range;0-243 ng/ml DDU) and a creatinine of 1 5 ( ref range;0 7-1 2 mg/dl) Complete hemogram and coagulation profiles were normal Chest x ray was normal Ultrasound of the leg showed right popliteal vein DVT (Figure 1) CT angiogram of the chest confirmed multiple bilateral acute pulmonary emboli (Figures 2&3) Factor V Leiden mutation was negative and there was no protein C, S or antithrombin III deficiency Provoked VTE secondary to seated immobility was diagnosed The patient was started on enoxaparin and was thereafter transitioned to rivaroxaban on discharge DISCUSSION: Seated immobility thromboembolism (SIT) syndrome is the term used to describe VTE secondary to poor mobility due to prolonged seating Travel is a well-recognized risk factor for (SIT) syndrome A Less recognized forms of prolonged sitting are computer use, watching TV and video-gaming Many cases of VTE were described in these settings with most patients being young without other risk factors for VTE Having frequent breaks to walk and frequently moving legs is strongly advised during these activities to minimize the risk of VTE In our case, prolonged seating during computer use for more than eight hours a day is blamed for development of VTE Our patient had none of the other traditional risk factors CONCLUSIONS: People should be reminded that seated immobility, in its many and varied forms, is a risk factor for VTE During times of quarantine, maintaining active life style is good for physical as well as mental health Reference #1: 1 Beasley R, Heuser P, Raymond N SIT (seated immobility thromboembolism) syndrome: a 21st century lifestyle hazard N Z Med J 2005;118(1212):U1376 Reference #2: 2 Aldington, S , Pritchard, A , Perrin, K , James, K , Wijesinghe, M , & Beasley, R (2008) Prolonged seated immobility at work is a common risk factor for venous thromboembolism leading to hospital admission Internal Medicine Journal, 38(2), 133–135 Reference #3: 3 Healy B, Levin E, Perrin K, Weatherall M, Beasley R Prolonged work- and computer-related seated immobility and risk of venous thromboembolism J R Soc Med 2010;103(11):447-454 DISCLOSURES: No relevant relationships by Abdulla Ali, source=Web Response No relevant relationships by louisa Asare, source=Web Response No relevant relationships by Mohanad Gabani, source=Web Response No relevant relationships by Ibrahim Omore, source=Web Response No relevant relationships by Muhammad Riaz, source=Web Response

Early Detection of Deep Venous Thrombosis in Trauma Patients.

BackgroundThis study was performed to determine whether trauma patients are at an increased risk of developing deep venous thrombosis (DVT) within the first 48 hours of hospitalization.Materials and methodsA retrospective review was performed using a prospectively maintained database of patients admitted to a trauma center during a five-year time period. Patients hospitalized for greater than 48 hours who received a screening venous duplex for DVT were included in the study.ResultsThere were 1067 venous duplex scans obtained, 689 (64.5%) within the first 48 hours of admission (early DVT group), 378 (35.4%) after the first 48 hours (late DVT group). Only 142 (13.2%) patients had a positive duplex scan for DVT, 55 (early group), 87 (late group). Comorbid conditions of congestive heart failure (P = 0.02), pelvic fractures (P = 0.04), and a lower initial systolic blood pressure on presentation (p = 0.04) were associated with early DVT. Head trauma (P < 0.01), mechanical ventilation (P < 0.001), and transfusion of blood products (P < 0.001), were predictors of DVT in the late group.ConclusionsTrauma patients are at an increased risk of developing venous thrombosis early in the hospital course due to comorbidities associated with trauma. Whereas, venous thrombosis in trauma patients diagnosed after the first 48 hours of hospitalization appears to be associated with prolonged patient immobility.

The Preoperative Prognostic Nutritional Index Predicts the Development of Deep Venous Thrombosis After Pancreatic Surgery.

Pancreatic surgery is associated with a high risk of developing deep venous thrombosis (DVT) and malnutrition. We aimed to evaluate the factors predicting the development of DVT, focusing on nutrition assessment tools. One hundred patients who underwent pancreatic surgery were postoperatively examined for DVT. We assessed the risk factors for the development of DVT after surgery. Postoperative DVT was detected in 11 patients (11%). Patients who developed DVT after surgery were significantly older (p=0.016) and had higher preoperative D-dimer levels (p=0.005) than those who did not. The preoperative prognostic nutritional index (PNI) was mostly associated with the development of DVT (p=0.079). Furthermore, PNI ≤44.3, BUN >20 mg/dl, D-dimer ≥1.9 μg/ml were independent predictors for the development of DVT after surgery. A poor nutrition status and dehydration should be preoperatively improved for patients who are identified, as having a high risk of developing DVT after pancreatic surgery.

Venous Thromboembolism in Lower Extremity Amputees: A Systematic Review of the Literature

Patients undergoing lower extremity amputation (LEA) are at risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE), but no generally accepted prevention guidelines exist. This systematic review aimed at understanding the incidence of VTE with or without thromboprophylaxis in adult patients with major lower extremity amputation (LEA). Primary outcomes were onset of DVT, PE, or mortality. Secondary outcomes were any major adverse events due to treatment. We searched English language full-text papers in multiple databases using keywords, including amputation/adverse effects, amputation/complications, venous thromboembolism, deep vein thrombosis, and pulmonary embolism. Twenty-eight studies providing observations for 4,841 patients were selected. The fatal PE risk was 2.6% without prophylaxis and significantly decreased to a non-zero residual risk of 0.9% with VTE prophylaxis. Above-knee amputees were at greatest risk of VTE and subsequent complications. The risk was not confined to the amputated stump and can involve the contralateral limb. The role of compression ultrasonography screening in asymptomatic patients remains controversial in various populations at risk for VTE. All patients undergoing major LEA should be considered at high risk for the development of VTE, even after discharge from hospital. We recommend prophylactic anticoagulation (if not contraindicated) and clinical surveillance in all patients undergoing LEA and further studies to determine the optimal prophylactic strategy. Disclosures No relevant conflicts of interest to declare.

Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical Patients

Deep venous thrombosis and pulmonary embolism are life-threatening complications after surgery, warranting prophylaxis. However prophylaxis is not uniformly practiced among cardiac surgical patients. This study aimed to characterize the national incidence, mortality, and costs associated with thromboembolism after cardiac surgery. The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing coronary artery bypass grafting or valve surgery. International Classification of Disease codes were used to identify patients with deep venous thrombosis and pulmonary embolism. Of approximately 3 million patients undergoing cardiac surgery, 1.62% developed deep venous thrombosis and 0.38% pulmonary embolism. Those with deep venous thrombosis and pulmonary embolism were more commonly women (33.2% and 36.2 vs 31.2%, P < .001), older (68.1 and 66.0% vs 65.7 years, P < .001), and had a higher Elixhauser comorbidity index (4.0 and 4.7 vs 3.7, P < .001). Deep venous thrombosis and pulmonary embolism were associated with increased mortality (4.95% and 14.8% vs 2.67%, P < .001). After adjustment for baseline differences, deep venous thrombosis was associated with an incremental increase in cost of $12,308, whereas pulmonary embolism was associated with $13,879 cost increase after cardiac surgery. Pulmonary embolism was an independent predictor of mortality (adjusted odds ratio, 3.39; 95% confidence interval, 2.74-4.18). The mortality and financial burden related to thromboembolism in cardiac surgery are significant. Prophylaxis may be indicated in cardiac surgery patients to improve quality of care and reduce healthcare costs. Future controlled randomized trials investigating the benefit of thromboembolism prophylaxis in cardiac surgery are warranted.

Role of rehabilitation in prevention of early thromboembolic complications in hemorrhagic stroke

Hemorrhagic strokes (ICH) affects mainly young active people, with increasing incidence in developing countries. Mortality is high in acute phase, and patients are prone to complications related to stroke itself and to coexisting medical conditions. Patients with ICH are at high risk in developing deep venous thrombosis (DVT) with secondary pulmonary embolism (PE). Prevention of venous thrombotic events in hemorrhagic stroke patients requires intermittent pneumatic compression and preventive doses of low molecular weight heparins (LMWH) in high-risk patients. If DVT and /or PE occurs, the therapeutic management should balance the risk of recurrent cerebral bleeding and the life-threatening risk of PE, making the decision to start anticoagulation challenging. We present a case of a young patient with a large hypertensive capsulo-lenticular hemorrhage, who was diagnosed with pulmonary embolism 21 days after stroke onset. The decision was for anticoagulant treatment initial with LWMH, and switch to direct oral anticoagulants (DOAC) after 10 days; strict control of vascular risk factors of the patients (hypertension, diabetes and obesity) was achieved. Rehabilitation treatment, delayed until day 21, was recommended with progressive intensity. Evolution of the patient was favorable, with complete hematoma resorbtion under DOAC treatment at 10 weeks follow-up and important motor recovery. Rehabilitation program was intensive during this interval, and strongly contributive to neurologic improvement.

Predictors of Successful Discharge of Patients on Postoperative Day 1 After Craniotomy for Brain Tumor

Shorter hospital stays have been associated with decreased complication rates, fewer hospital-acquired infections, and lower costs. We evaluated an optimized treatment paradigm for patients undergoing craniotomy allowing for postoperative day 1 (POD1) discharge if the criteria were met. We compared the complication and readmission rates between the POD1 patients and those with longer stays, and examined the patient and surgical variables for predictors of POD1 discharge. We performed a retrospective review of craniotomies performed for tumor from 2011 to 2015. Craniotomies for tumors were included, and laser ablations and biopsies were excluded. A total 424 of patients were included, 132 (31%) of whom had been discharged on POD1. The mean length of stay was 6 days. The POD1 patients had had significantly better preoperative Karnofsky performance scale scores (P < 0.0001) and modified Rankin scale scores (P < 0.0001). Patient frailty, measured using the modified frailty index, was negatively predictive of POD1 discharge (P= 0.0183). Surgical factors predictive of early discharge were awake surgery (P < 0.0001) and supratentorial location (P < 0.0001). No POD1 patients experienced deep venous thrombosis (DVT), pulmonary embolus (PE), or urinary tract infections. However, of the patients with a length of stay >1 day, 4.4% and 2.7% developed DVT or PE (P=0.0119) and urinary tract infections (P= 0.0202), respectively. Multivariate regression identified patient factors (male gender, low preoperative modified Rankin scale score), tumor factors (right-sided, supratentorial, smaller size), lower modified frailty index score, and operative factors (lack of a cerebrospinal fluid drain, awake surgery) as independent predictors of successful early discharge. Patients with good functional status can be safely discharged on POD1 after tumor craniotomy if the appropriate postoperative criteria have been met. Patients with early discharge had lower 30-day readmission and DVT/PE rates, likely owing to better baseline health status.

Anti-Xa guided enoxaparin dose adjustment improves pharmacologic deep venous thrombosis prophylaxis in burn patients

IntroductionPatients recovering from burn injury are at high risk of developing deep venous thrombosis (DVT). While 30-mg twice-daily enoxaparin is accepted as the standard prophylactic dose, recent evidence in injured patients suggests this dosing strategy may result in sub-optimal pharmacologic DVT prophylaxis. We hypothesized that standard enoxaparin dosing would result in inadequate DVT prophylaxis in burn patients. MethodsA retrospective review of an ABA-verified Burn center’s registry from January 2012 — December 2016 identified patients with peak plasma anti-Xa levels to monitor the efficacy of pharmacologic DVT prophylaxis. Patients ≥18 years old were included if they received at least 3 doses of enoxaparin and had appropriately timed peak anti-Xa levels. We analyzed data including patient demographics, body weight, body mass index (BMI) and total body surface area burn (TBSA). Diagnosis of DVT was collected. ResultsDuring the study period, 393 patients were screened with a plasma anti-Xa levels. Of the 157 patients that met inclusion criteria, 81 (51.6%) achieved target peak plasma anti-Xa levels (0.2–0.4 IU/mL) on standard 30-mg twice-daily prophylactic enoxaparin and 76 (48.4%) had sub-prophylactic levels. Sub-prophylactic patients were more likely to be male, have increased body weight and elevated BMI. 49 of the 76 sub-prophylactic patients received a dose-adjustment in order to reach target anti-Xa levels; 37 patients required 40mg twice-daily, 10 required 50mg twice-daily and 2 required 60mg twice-daily. The overall DVT rate was 3.8%. ConclusionsThe current recommended prophylactic dose of 30-mg twice-daily enoxaparin is inadequate in many burn patients. Alternate dosing strategies should be considered to increase the number of burn patients achieving target prophylactic anti-Xa levels. Determining whether prophylactic enoxaparin dose adjustment decreases DVT rates in burn injured patients should be evaluated in future prospective trials.

Treatment of chronic long-bone infections by dissolvable antibiotic beads (pure synthetic calcium sulfate impregnated with vancomycin and gentamicin)

Background This study reviews the clinical results using synthetic calcium sulfate impregnated with vancomycin and gentamicin dissolvable beads in 70 patients who suffered from chronic long-bone infection that was not responding to several trials of treatment. Patients and methods All patients prepared for surgical debridement and calcium sulfate impregnated with vancomycin and gentamicin beads were inserted into the wound. Results The main follow-up was 12 months; the mean age of the patients was 37.94. Staphylococcus aureus was the organism that had been reported in 45.71% of all swabs. In the final results 61 (87.14%) patients were completely healed while only nine (12.86%) patients still had infection. Complication Blood loss occurred in 15 (21.42%) patients and five (7.15%) patients developed deep venous thrombosis (DVT). Conclusion Dissolvable beads of calcium sulfate impregnated with vancomycin and gentamicin are an effective and safe tool for the treatment of chronic long-bone infections.

Impact of Splanchnic Vein Thrombosis on Mortality in Patients with Advanced Pancreatic Cancer

Abstract BACKGROUND: The incidence of venous thromboembolism in pancreatic cancer is high. Pancreatic cancer patients who develop deep venous thrombosis (DVT) or pulmonary embolism (PE) have increased mortality compared to those without. Pharmacological anticoagulation mitigates the increased mortality in these patients thus providing rationale for treatment. The incidence of splanchnic vein thrombosis (SVT) in pancreatic cancer is also high ~8% (Pachon JCO 2015, Sogaard Blood 2015). However, the correlation between SVT and mortality in pancreatic cancer is not well established. Current guidelines recommend anticoagulation for SVT on a case-to-case basis, assessing the risk-benefit of treatment and patient prognosis (Khorana J Thromb Thrombolysis 2016). Hence, we conducted the largest study to date to evaluate the impact of SVT on mortality in a cohort of United States Veterans with advanced pancreatic cancer. METHODS: Study Population: We identified patients in the Veterans Administration Central Cancer Registry (VACCR) diagnosed with unresectable or metastatic pancreatic cancer (stage II, III, IV) between October 1st, 1998 and December 31st, 2014 using ICD-O3 codes. We then identified the pancreatic cancer patients who developed SVT using ICD-9/10 codes and the CPT codes for relevant diagnostic imaging. Patients with DVT, PE and atrial fibrillation were excluded. Statistical Analyses: We compared baseline patient characteristics between pancreatic cancer patients with SVT and those without using Chi-square and Cochrane-Mantel-Haenszel tests for categorical variables, and unpaired Student's t-tests for continuous variables. Using Cox proportional hazard models, we assessed the association between SVT and overall survival in patients with pancreatic cancer while adjusting for significant prognostic indicators including: age, gender, body mass index (BMI), Charlson comorbidity index, stage of cancer (stage IV vs. stage II/III), white blood cell count (WBC), estimated glomerular filtration rate (eGFR), use of radiation or chemotherapy. A two-tailed alpha significance level of 0.05 was used for all analyses. Statistical analyses were performed using SAS version 9.2 (SAS Institute, Cary, NC). RESULTS: We identified 6296 patients with unresectable or metastatic pancreatic cancer within the VACCR, of whom 170 were diagnosed with SVT. Baseline demographics of patients with and without SVT are shown in Table 1. The median OS of the patients with SVT was 140 days as compared to 92 days for those without SVT, Figure 1. After adjusting for potential confounders, patients with SVT had a 16% reduction in mortality compared to those without (HR 0.84, p = 0.03). In addition, increasing age, male gender, BMI &lt; 18.5, increasing comorbidities, eGFR &lt; 45 mL/min, WBC &gt; 10 x 109/L, metastatic disease (stage IV) were associated with increased risk of death, while receipt of chemo or radiation therapy and BMI ≥ 25 were associated with a reduced risk of death. DISCUSSION/CONCLUSION: In this large retrospective study of patients with advanced pancreatic cancer, we found no association between SVT and increased mortality in patients with pancreatic cancer. A significant number of SVTs are detected incidentally on surveillance scans, and are thus asymptomatic at diagnosis. Anticoagulation is associated with an increased risk of hemorrhage which can be fatal in some cases. Given the lack of association between SVT and death in pancreatic cancer, future studies should assess the impact of anticoagulation on outcomes in this population with consideration given to observation only to reduce the risk of hemorrhage. Disclosures Sanfilippo: BMS/Pfizer: Speakers Bureau.

Risk Factors Associated with Venous Thromboembolism after Lung Cancer Surgery: A Single-center Study

背景与目的肺癌术后静脉血栓栓塞症（venous thromboembolism, VTE）的发生率并非少见，本研究旨在分析肺癌术后VTE相关危险因素，为进一步防治VTE提供临床依据。方法本研究为单中心研究。选择2016年7月-2017年12月在首都医科大学附属北京朝阳医院胸外科接受手术治疗的肺癌患者，除术前常规检查外，所有患者均在手术前后行下肢多普勒超声以明确有无新发下肢深静脉血栓（deep venous thrombosis, DVT）。患者术前术后均未接受预防性抗凝治疗。按照术后是否发生VTE将患者分为VTE组和对照组，比较两组间的基线资料、手术相关资料（手术类型、术式等）、肿瘤病理相关资料（病理分型、血管浸润、病理分期等）。结果按照纳入标准，本研究共对339例接受肺癌手术的患者进行了分析，其中男性166例，女性173例，年龄范围23岁-86岁。术后共39例发生VTE，发生率为11.5%。比较两组年龄、性别、体质量指数（body mass index, BMI）、美国麻醉医师协会（American Society of Anesthesiologists, ASA）、吸烟状况、基础疾病等，除年龄有显著性差异外，其他指标均无显著性差异；比较两组术前血常规、血生化、凝血、肿瘤标记物、肺功能、下肢静脉超声等，术前癌胚抗原（carcinoembryonic antigen, CEA）水平、术前D-二聚体水平、肺功能水平及下肢肌间静脉扩张比率两组有显著性差异，其他指标均无显著性差异；比较两组手术时长、手术方式、出血量、病理类型、病理分期、血管侵犯等，手术时长、手术方式（开胸vs胸腔镜）、出血量等因素有统计学差异，其他指标均无显著性差异。单因素分析结果显示：VTE组在年龄、术前CEA水平、术前D-二聚体水平、肺功能水平、下肢肌间静脉扩张比率、开胸手术比率、手术时长、出血量均与对照组有显著差异（P < 0.05）。而病理分期、病理类型等因素与VTE发生无显著相关性。多因素Logistics回归分析显示，第1秒用力呼气量（forced expiratory volume in one second, FEV1）、手术方式、下肢肌间静脉扩张是肺癌术后合并VTE的独立危险因素（P < 0.05）。结论本研究结果提示患者FEV1、手术方式以及下肢肌间静脉扩张是肺癌术后合并VTE的独立危险因素。

Prevention of Deep Venous Thromboembolism.

The nature of many combat wounds puts patients at a high risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE), which fall under the broader disease category of venous thromboembolism (VTE). In addition to the hypercoagulable state induced by trauma, massive injuries to the extremities, prolonged immobility, and long fixed wing transport times to higher echelons of care are unique risk factors for venous thromboembolism in the combat-injured patient. These risk factors mandate aggressive prophylaxis for DVT and PE that can effectively be achieved by the use of lower extremity sequential compression devices and low dose unfractionated heparin or low molecular weight heparin. In addition, inferior vena cava filters are often used for PE prophylaxis when chemical DVT prophylaxis fails or is contraindicated. The following Department of Defense (DoD) Joint Trauma System (JTS) Clinical Practice Guideline (CPG) discusses the current recommendations for the prevention of DVT and PE including the use of inferior vena cava filters (IVCFs).