Frequency Of Deep Vein Thrombosis Research Articles

Frequency and Risk Factors of Deep Venous Thrombosis in Aged Patients with Intertrochanteric Fracture on Admission.

To investigate the frequency of deep vein thrombosis (DVT) in patients aged over 80 years on admission after intertrochanteric femur fracture and to explore the risk factors of DVT. Descriptive study. Place and Duration of the Study: Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China, from 1st January 2019 to 31st December 2022. A group of patients aged over 80 years with intertrochanteric fracture were included according to the presence or absence of DVT confirmed by ultrasonography on admission. The patients were divided into the non-DVT and DVT groups. Clinical data were retrospectively compared between the two groups and analysed by multivariate logistic regression to screen risk factors of DVT. A total of 130 patients meeting the inclusion criteria were enrolled, and 37 of them had DVT on admission, with a prevalence of 28.5%, including 25 (67.6%) distal peripheral DVT, 11 (29.7%) proximal central DVT, and 1 (2.7%) mixed DVT. The American Society of Anaesthesiologists (ASA) classification, Charlson comorbidity index, the serum levels of D-dimer, fibrinogen degradation products, albumin, potassium, inorganic phosphorus, and calcium showed significant differences between the two groups (p <0.1). Multivariate analysis identified increased D-dimer (>6.005 mg/L), decreased albumin (<36.45 g/L), and reduced potassium (<3.650 mmol/L) as independent factors for DVT in aged intertrochanteric fracture patients (AIFPs). A high incidence of DVT was revealed in AIFPs, and elevated D-dimer levels, reduced albumin levels, and reduced potassium concentrations were shown to be correlated to DVT. Intertrochanteric fracture, Deep vein thrombosis, Aged patients, Risk factor, Multivariate logistic regression.

Pulmonary thromboendarterectomy in hospitalized versus elective patients with chronic thromboembolic pulmonary hypertension

ObjectiveWe sought to characterize outcomes in patients undergoing pulmonary thromboendarterectomy electively versus after acute presentation. MethodsThis is a retrospective analysis of patients who underwent pulmonary thromboendarterectomy from October 2015 to April 2022. Patients were divided into 2 groups depending on elective surgery or surgery during the same hospitalization as their presentation. ResultsIn total, 69 patients were included: 45 in the hospitalized group and 24 in the elective group. Patients in the hospitalized group were less likely to have chronic lung disease, history of pulmonary embolism and hypertension, be on anticoagulation and medication for pulmonary hypertension, and present with >1 month of respiratory symptoms. They were more likely to have worse preoperative right ventricular function. Among other demographics, risk factors for venous thromboembolism were similar between both groups. Thirteen patients in the hospitalized group required preoperative extracorporeal membrane oxygenation. There was no difference in disease classification and operative, cardiopulmonary bypass, and hypothermic circulatory arrest durations between both groups. Postoperative complications were similar between both groups, except for greater frequency of deep vein thrombosis in the hospitalized group (26.7% vs 4.2%, P = .03). In-hospital and intensive care unit length of stay were similar between both groups. Overall, in-hospital mortality was 4.3% and was similar between both groups; P = .28. ConclusionsOur series shows that pulmonary thromboendarterectomy can be safely performed in patients presenting acutely, with comparable postoperative complications and in-hospital mortality to an elective setting. Such patients present with worse right ventricular function, sometimes requiring temporary mechanical support.

Impact of COVID-19 “Stay at home!” Restrictions on the Prevalence of Deep Vein Thrombosis in the Geriatric Population: A Retrospective Controlled Study

Objective: The restrictions during the coronavirus disease 2019 (COVID-19) pandemic period may have caused an increase in the incidence of deep vein thrombosis (DVT) in the elderly population. We aimed to evaluate whether the frequency of DVT increased in the geriatric population due to the restrictions of COVID-19 pandemic period and to emphasize the importance of exercise in this population. Materials and Methods: Patients over the age of 65 who applied to our hospital, who underwent lower extremity venous doppler ultrasonography in the last year before the pandemic and in the first year with pandemic restrictions, were retrospectively analyzed from the database. The records of a total of 1531 patients were scanned. Patients with DVT were recorded. Results: Forty-nine DVT cases in the last year before the pandemic, and 53 DVT cases in the first year of the restrictions were detected. The incidence of DVT in the elderly was found to be higher in the restrictions period. Conclusion: Although the “Stay at home!” restrictions reduced the rate of spread of the disease, it may also have prepared the ground for serious conditions such as DVT in this population. Home exercise programs are important especially for the elderly population during the pandemic period.

The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement

Orthopedic and trauma surgery carries a high risk of deep vein thrombosis (DVT) in the lower limbs and acute pulmonary embolism (APE). In traumatology, the greatest risk is in hip fractures of the proximal extremity of the femur, especially those of the neck, and intertrochanteric fractures. In orthopedics the risk of thromboembolic complications (TEC) is particularly high in hip and knee surgery, especially in prosthetic replacement, as general factors are associated with local factors such as trauma to vessels and / or blood stasis which further aggravate the perioperative imbalance of the coagulation system. In particular, hip replacement surgery is the one that shows a higher frequency of DVT (especially affecting the proximal large vessels), and of TEC, so much so that pulmonary embolism is one of the main causes of death after this intervention. In this paper, we review the different instruments used for the diagnosis of DVT such as phlebography, radiolabeled fibrinogen collection test, impedance, plethysmography, ultrasound, nuclear magnetic resonance and computed tomography. We also discuss the different prophylaxis methods for DVT and subsequent PE prevention. Then, we performed an experimental study on 420 patient’s operated on for total hip replacement at the 1st Orthopedic Clinic of the University of Florence and other private clinics in the period between 1994-1996. These are 286 first cemented implants, 36 first hybrid implants, 38 first cementless implants and 60 hip replacement reviews. This study showed the importance of color doppler ultrasonography in the prevention of DVT in hip replacement patients and subsequent APE prophylaxis. Significant relationship was found between APE and the protocole used to follow up with the patients (Pvalue 0.0007). Patients in group 2 in which only clinical control (no preoperative color doppler ultrasonography assessment) was performed have higher risk for APE To Occur Than patients in group 1 to whom pre and post-operative color doppler ultrasonography was routinely applied.

Is it sufficient to evaluate COVID‐19 infected critically ill patients only in terms of VTE risk factors? What about disease severity?

Dear Editor, We read with great interest the study by Wang et al.1 which was published online and being ahead of print in the Clinical Respiratory Journal. At the beginning of the corona virus disease 2019 (COVID-19) pandemia in their single-centre retrospective, observational study, they retrospectively analysed 138 COVID-19 patients and researched the factors for in-hospital venous thromboembolism (VTE) and bleeding. They found that 16.7% of patients with COVID-19 had high risk for VTE according to Pauda Prediction Score; 6.5% of patients had high risk of bleeding for VTE prophylaxis according to Improve Prediction Score. They identified thrombotic events in four patients (2.9%), all of them had deep vein thrombosis (DVT). They found the incidence of VTE as 20% and one major haemorrhage was happened in critically ill patients during VTE treatment. They defined critically ill patients as those admitted to intensive care unit (ICU) who required mechanical ventilation or had a fraction of inspired oxygen (FIO2) of at least 60% or more. They used lower extremity compression ultrasound to detect DVT for all critically ill patients with a high risk of VTE and high level of D-dimer. If ultrasound was positive, patients underwent computed tomography pulmonary angiogram.1 This is an important issue, but there are some practical questions to be answered for a proper clinical extrapolation. First, COVID-19 leads coagulation disorders that are triggered by increased level of procoagulant substances. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) are the main causes of coagulation associated mortality in critically ill patients. The SIC criteria established by the International Society on Thrombosis and Haemostasis (ISTH) is often used to guide anticoagulant therapy in hospitalised patients.2 Nevertheless, DVT occurs in majority of patients with critically ill COVID-19. COVID-19 is an acute viral infection which primarily affects respiratory system and if it progresses to acute respiratory distress syndrome (ARDS) and leads other organ failures, as well. Although Wang et al.1 used Padua Prediction Score and found 16.7% of the patients were at high risk for VTE, VTE was determined in 20% of the patients. According to Padua Prediction Score, patients with chronic conditions such as malignancy, reduced mobility, and thrombophilia get higher risk scores whereas common disorders during COVID-19 course such as heart and respiratory failure, acute myocardial infarction, or ischaemic stroke result in minor score increase. This is the most likely reason of low prediction rate which is reported in the previous study.1 Moreover, apart from thromboembolic situation such as DVT, in patients with COVID-19, pulmonary inflammation may lead susceptibility to embolism.2 Therefore, not only suspicion for DVT, presence of ARDS, elevated D-dimer levels, or worsening in oxygenation should make clinicians consider pulmonary thrombosis and perform chest imaging. Second, it has shown by many studies that severity of COVID-19 is a risk factor for VTE and elevated ferritin, C-reactive protein, D-dimer, and interleukin-6 levels are associated with thromboembolic events and poor prognosis.3 In the previous study by Wang et al.,1 there is not enough data on duration and severity of disease. We believe that considering these factors together with Padua Prediction Score provides better prediction rates for VTE. Third, to determine COVID-19 associated thromboembolism, Sequential Organ Failure Assessment (SOFA) score that is one of the disease severity and organ failure scores has been evaluated by some previous studies.4, 5 These studies suggest that in critically ill COVID-19 patients, higher SOFA scores are associated with higher DVT frequency, D-dimer levels, duration of disease, hypoalbuminemia, and duration of disease.4 Other previous study5 reported that higher ISTH SIC scores which include SOFA score, prothrombin time–international normalised ratio (PT-INR), and platelet levels are associated with higher mortality and patients with ISTH SIC score higher than 3 had 3.05-fold increased mortality risk. Both haemodynamic situation and arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FIO2) are components of SOFA score. PaO2/FIO2 ratio is a main determinator of ARDS severity and also reflects the severity of COVID-19. Finally, we believe that further prospective clinical trials need to develop an effectual risk prediction score including disease severity to determine VTE earlier in COVID-19 patients. The authors declare that the letter was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All authors contributed equally to the letter. Data sharing is not applicable to this article as no new data were created or analyzed in this study. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Abstract TP116: The Frequency And Associated Factors Of Deep Vein Thrombosis At Admission Of Acute Stroke

Introduction: Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission of acute stroke, IPC of the legs with DVT may cause migration of the thrombi resulting in pulmonary emboli. Therefore, whole-leg ultrasonography to detect DVT should be performed at admission; however, it is not always done in many institutions. Therefore, risk factors to estimate DVT presence at admission are necessary. Hypothesis: The frequency of DVT at admission is high, and IPC should not be used in patients with significant factors of DVT presence at admission. Methods: We included patients admitted within 24 h of stroke onset between 2016 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers. We evaluated variables with significant differences between groups of DVT presence and absence, excluded variables with multicollinearity, and conducted multiple logistic regression analyses to identify independent discriminants of DVT presence from absence. The threshold values of discriminants were identified by receiver operating characteristic curves. Results: Of 1936 stroke patients, 1461 met our inclusion criteria. DVT was detected in 255 patients (17.5%). Compared to patients without DVT (n=1206), patients with DVT were older, female sex, lower body weight, higher C-reactive protein levels, lower albumin or triglyceride levels, higher National Institutes of Health Stroke Scale score, and higher pre-stroke modified Rankin stroke scale score. Female sex, low albumin, high C-reactive protein, low triglycerides, and old age were independent DVT-presence discriminants. The threshold values of albumin, C-reactive protein, triglycerides, and age were ≤ 37g/L, ≥ 3450 ug/L, ≤ 1.569 mmol/L, and ≥ 79 years, respectively. Conclusion: The DVT-presence frequency of 17.5% at admission was high, and significant DVT-presence factors at admission were female sex, low albumin, high C-reactive protein, low triglyceride levels, and old age. Therefore, in patients with the five significant factors, IPC should be avoided, or whole-leg ultrasonography should be performed before IPC.

Prophylactic hypogastric arterial ligation before cesarean hysterectomy for controlling complications in pregnant women with placenta adherent abnormality: A randomized controlled clinical trial.

Placenta adherent abnormality (PAA) is abnormal attachment of the placenta to the myometrium. This abnormal placenta binding has severe clinical consequences for the mother and the fetus. We investigated the outcomes of hypogastric arterial ligation (HAL) before hysterectomy compared to hysterectomy alone in pregnant women with PAA. In this randomized controlled clinical trial, 70 patients were randomly allocated to HAL along with hysterectomy and hysterectomy alone groups (35 in each Group). The total amount of intraoperative blood loss, the need for intraoperative blood products transfusion, frequency of deep vein thrombosis, duration of surgery, duration of hospitalization, and visceral trauma were compared between 2 Groups. Finally, 64 patients completed the study protocol with mean age of 33.84 ± 4.25 years. The study groups were comparable in terms of basic baseline demographic and clinical characteristics. Visceral trauma was less frequently occurred in HAL group compared to hysterectomy alone (0% vs. 15.6%; P = 0.02). Intraoperative blood loss (1525 ± 536.41 cc vs. 2075 ± 889.36 cc; P = 0.001) and were significantly lower in HAL group compared to hysterectomy alone. Duration of operation (179.06 ± 36.28 vs. 197.66 ± 39.47; P = 0.05) and hospitalization (4.97 ± 2.20 vs. 6.10 ± 2.39; P = 0.03) also were significantly lower in HAL group. Our findings suggest that prophylactic HAL has a protective effect on the reduction of blood loss and less visceral trauma in pregnant women with PAA.

Abstract 10943: Deep Vein Thrombosis Frequency at Acute Stroke Admission

Introduction: Intermittent pneumatic compression (IPC) is used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if existing DVT is not examined during admission, IPC massage of the legs with DVT may cause migration of the thrombi. Hypothesis: The frequency of DVT at acute stroke admission is high and significant factors indicate the presence of DVT at acute stroke admission. Methods: We included patients admitted within 24 hours of stroke onset, between 2017 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers such as D-dimer and lipids. Results: Of 1129 stroke patients, 907 met our inclusion criteria. DVT was detected in 159 patients (17.5%). Compared to patients without DVT (n=748), patients with DVT were older, females, with lower body weight, higher D-dimer and C-reactive protein levels, lower albumin or triglyceride (TG) levels, and higher National Institutes of Health Stroke Scale score. Multiple logistic regression analysis showed that sex, D-dimer, and TG were independent DVT-presence variables. Conclusions: DVT occurred in 17.5% of acute stroke patients at admission, and significant DVT-presence factors were female sex, high D-dimer level, and low TG level. Patients with the three significant factors at admission must immediately undergo whole-leg ultrasonography to detect DVT.

Frequency of deep vein thrombosis at admission for acute stroke and associated factors: a cross-sectional study

BackgroundIntermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission, IPC of the legs with DVT may cause migration of the thrombi, resulting in pulmonary emboli. Whole-leg ultrasonography (wl-US) is a practical tool to detect DVT; however, wl-US is not always performed at admission in all stroke patients. This retrospective cross-sectional study aimed to investigate DVT frequency and identify significant factors indicating the presence of DVT at admission for acute stroke.MethodsWe included patients admitted within 24 h of stroke onset between 2017 and 2019. Patients who did not undergo blood tests for D-dimer or wl-US within 72 h of arrival were excluded. We collected patient data on age; sex; anthropometric variables; presence of DVT on wl-US; and biomarkers such as D-dimer, high-sensitivity C-reactive protein (hs-CRP), and lipids.ResultsOf 1129 acute stroke patients, 917 met our inclusion criteria. DVT was detected in 161 patients (17.6 %). Patients with DVT were older; were more likely to be female; had lower body weight; had higher D-dimer and hs-CRP levels; had lower albumin, hemoglobin, and triglyceride levels; and had higher National Institutes of Health Stroke Scale and pre-stroke modified Rankin scale scores than patients without DVT (n = 756). In addition, multiple logistic regression analysis showed that sex (female) and D-dimer levels (≥ 1.52 µg/mL) were independent significant factors for the presence of DVT. Among 161 patients with DVT, 78 (48.4 %) had both these significant factors. Among 756 patients without DVT, 602 (79.6 %) had no or one significant factor. The odds ratio of the presence of DVT in patients with both significant factors was 6.29, using patients without any significant factors as the group for comparison.ConclusionsThe frequency of DVT is high in acute stroke patients at admission. Female sex and a high D-dimer level were independent significant factors for the presence of DVT. Therefore, in patients with these two significant factors at admission, IPC should be avoided or wl-US should be performed before IPC.

Clinical Relevance of VEGFA (rs3025039) +936 C>T Polymorphism in Primary Myelofibrosis: Susceptibility, Clinical Co-Variates, and Outcomes.

We evaluated the association of VEGFA rs3025039 polymorphism with clinical co-variates and outcomes in 849 subjects with primary myelofibrosis (PMF) and 250 healthy controls. Minor T-allele frequency was higher in subjects with JAK2V617F compared with those without JAK2V617F (18% vs. 13%; p = 0.014). In subjects with JAK2V617F, the TT genotype was associated at diagnosis with lower platelet concentrations (p = 0.033), higher plasma LDH concentration (p = 0.005), higher blood CD34-positive cells (p = 0.027), lower plasma cholesterol concentration (p = 0.046), and higher concentration of high-sensitivity C-reactive protein (p = 0.018). These associations were not found in subjects with PMF without JAK2V617F. In subjects with the TT genotype, risk of death was higher compared with subjects with CC/CT genotypes (HR = 2.12 [1.03, 4.35], p = 0.041). Finally, the TT genotype was associated with higher frequency of deep vein thrombosis in typical sites (12.5% vs. 2.5%; OR = 5.46 [1.51, 19.7], p = 0.009). In conclusion, in subjects with PMF, the VEGFA rs3025039 CT or TT genotypes are more common in those with JAK2V617F than in those without JAK2V67F mutation and are associated with disease severity, poor prognosis, and risk of deep vein thrombosis.

Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8.

Background and importanceA higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.ObjectiveWe investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.MethodsWe retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.ResultsWe identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23–1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45–1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03–2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77–2.45).ConclusionsDVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.

Role of Complete Duplex Ultrasound to Diagnose Deep Vein Thrombosis in COVID-19 Critical Patients.

An increased risk of deep vein thrombosis (DVT) has been reported in critical COVID-19 patients, despite adequate thromboprophylaxis, and most of DVT are probably asymptomatic. As a screening approach has been advocated, the best examination protocol is unknown. The objective of this study is to assess the role of a Complete Duplex Ultrasound (CDUS) examination in detecting DVT in a large population of COVID-19 patients admitted to intensive care unit (ICU) for respiratory failure. Single-center retrospective study of 145 COVID-19 patients admitted to ICU. DVT was assessed with a CDUS performed by experienced radiologist after ICU admission. DVT was confirmed in 38 patients (26%). Most DVT were distal to the knee (66%), while only 16% were proximal. At the time of the examination, 55% of the patients received full-dose anticoagulation, while 45% received thromboprophylaxis, and there were no differences in anticoagulation regimen between positive and negative patients. Patients with DVT had higher dimers compared with those with negative CDUS (P < .002). The observed frequency of DVT is high despite adequate anticoagulation. A comprehensive and experienced ultrasound examination protocol can allow to recognize a large number of distal DVT otherwise missed, albeit their clinical significance is unknown.

Tranexamic acid for upper gastrointestinal bleeding

Background. In patients with trauma and significant bleeding or risk of significant bleeding it is advised to administer tranexamic acid (TXA) intravenously as early as possible at a loading dose of 1 g for 10 minutes, followed by 1 g for 8 hours. The effectiveness of TXA has been proven in various pathological conditions in large trials. TXA has been shown to reduce the need for blood transfusions.&#x0D; Objective. To describe the use of TXA for upper gastrointestinal tract (GIT) bleeding.&#x0D; Materials and methods. Analysis of literature sources on this topic.&#x0D; Results and discussion. The mechanism of TXA action is to inhibit plasminogen activation and reduce fibrin degradation, however, its features are not clear. With the use of TXA, the strength of the blood clot and its resistance to lysis increases. The use of TXA in gastrointestinal bleeding was analyzed in the Cochrane Review (2012) of seven randomized controlled trials involving 1,654 patients. TXA was compared with placebo, lansoprazole or cimetidine. There was a lower mortality in the TXA group, however, after taking into account possible bias, this trend did not persist. A randomized placebo-controlled study of HALT-IT included 12,009 patients with gastrointestinal bleeding who were prescribed TXA (loading dose of 1+3 g for 24 hours) or placebo. The primary endpoint was death from bleeding within 5 days. There were no differences in mortality or re-bleeding. The TXA group had a higher frequency of deep vein thrombosis and pulmonary embolism. One of the reasons for the lack of benefits of TXA in gastrointestinal bleeding is that the onset of such bleeding is difficult to detect immediately, and to achieve the effect of TXA as early as possible administration is necessary. In this case, &gt;80 % of patients sought medical help &gt;3 hours after the onset of bleeding. In addition, in 50 % of patients, the bleeding was due to esophageal varices due to liver disease. It is known that most coagulation factors are synthesized in the liver, so liver failure is a common cause of coagulopathies. When the liver is affected, the levels of vitamin-K-dependent procoagulants (coagulation factors II, VII, IX and X), coagulation factor V, as well as anticoagulants (proteins C and S, antithrombin) decrease. Levels of fibrinogen and acute phase proteins remain normal or increase. In case of liver failure, hyperfibrinolysis occurs and at the same time the risk of thrombosis increases significantly. In such patients there is a decrease in hemostatic blood reserve. In general, contraindications to the use of TXA include severe renal failure, seizures, disseminated intravascular coagulation without bleeding, arterial or venous thromboembolism, active bleeding from the upper urinary tract.&#x0D; Conclusions. 1. TXA is effective for most types of bleedings, however, there are some exceptions. 2. One should remember the side effects of TXA and follow the recommended method of administration. 3. TXA is not suitable for the treatment of gastrointestinal bleeding.

Assessment of the effect of education on correct prophylaxis of deep vein thrombosis among patients admitted to intensive care unit

Background: Thromboembolism is a serious complication in patients admitted to the intensive care unit. Education of the effective prophylaxis guidelines by physicians can be reduces the incidence of this illness in at-risk patients. The purpose of this study was to investigate the effect of education on the correct prophylaxis of deep vein thrombosis in patients admitted to the intensive care unit of Imam Khomeini Hospital in Urmia. Methods: This cross-sectional study was carried out on 252 patient records. In this study, the correct prophylaxis of deep vein thrombosis, according to the Harrison Principles of Internal Medicine Textbook, 19th edition (2015), was taught. This education was given to the physicians in the intensive care unit in terms of prophylaxis indications, proper dosage, type of prophylaxis and unnecessary prophylaxis. Results: Most of the patients were male (51.59%). Their age in pre and post intervention groups was 58.12 and 56.58 years respectively. After the training intervention, unnecessary prophylaxis (from 7.9% to 4.8% (p=0.54)], inappropriate administration of anticoagulant dose [from 51.6% to 18.2% (p = 0.025), and type of anticoagulant [from 10.3% to 4% (p=0.038)] were reduced. Correct prophylaxis frequency was increased from 30.2% to 73% (p= 0.045). Conclusion: Education sessions on the prophylaxis of venous thrombosis in high-risk patients can lead to the use of correct prophylaxis and maybe it reduces the frequency of deep vein thrombosis and its complications

PREVALENCE, DISTRIBUTION AND DETERMINANTS OF DEEP VEIN THROMBOSIS IN ADULT INDOOR STROKE POPULATION OF PESHAWAR DIVISION, PAKISTAN

Background: Stroke is a devastating public health problem worldwide, considered as the third leading cause of death in developed countries, and the leading cause of disability among adults. Deep vein thrombosis (DVT), including pulmonary embolism (PE) as a sequel, is a serious complication of various medical conditions including stroke. The purpose of this study was to determine frequency of deep vein thrombosis among patients presented with stroke. Materials and methods: This study was descriptive (cross-sectional) study, conducted in the Department of Neurology, Lady Reading Hospital, Peshawar over 6 months. In the study a total of 196 patients were observed. Base line investigations were done and ultrasound was carried out to diagnose deep vein thrombosis. All the laboratory investigations and ultrasound were done by single experience pathologist and sonologist having minimum of five years of experience respectively. Observation and examination was done by neurologist who was not aware about the study and data was recorded in a predesigned proforma. To control confounders and bias in the study results, strict exclusion criteria had been followed. Results: In this study mean age was 63 years with standard deviation ± 28.34. Forty two percent patients were male and 58% patients were female. More over 8% patients had deep vein thrombosis. Conclusion:Our study concludes that the frequency of deep vein thrombosis was 8% among patients presented with stroke.

Outcome after Interdisciplinary Treatment for Aneurysmal Subarachnoid Hemorrhage-A Single Center Experience.

Background and Objectives: To identify predictors of outcome after aneurysmal subarachnoid hemorrhage (aSAH) in our interdisciplinary setting. Materials and Methods: 176 patients who had been treated for aSAH by a team of neurosurgeons and neuroradiologists between 2009 and 2017 were analyzed retrospectively. Age, gender, clinical presentation according to the Hunt and Hess (H&H) grading on admission, overall clot burden, aneurysm localization, modality of aneurysm obliteration, early deterioration (ED), occurrence of vasospasm in transcranial Doppler ultrasonography, delayed cerebral ischemia (DCI), spasmolysis, decompressive craniectomy (DC), cerebrospinal fluid (CSF) shunt placement, deep vein thrombosis (DVT), pulmonary embolism (PE), severe cardiac events (SCE), mortality on Days 14, and 30 after admission, and outcome at one year after the hemorrhage according to the Glasgow Outcome Scale (GOS) were recorded. Chi square, Fisher’s exact, Welch’s t, and Wilcoxon rank sum served as statistical tests. Generalized linear models were fitted, and ordered logistic regression was performed. Results: SCE (p = 0.049) were a significant predictor of mortality at 14 days after aSAH, but not later during the first year after the hemorrhage. Clipping as opposed to coiling (p = 0.049) of ruptured aneurysms was a significant predictor of survival on Day 30 after aSAH, but not later during the first year after the hemorrhage, while coiling as opposed to clipping of ruptured aneurysms was significantly related to a lower frequency of DVT during hospitalization (p = 0.024). Aneurysms of the anterior circulation were significantly more often clipped, while aneurysms of the posterior circulation were significantly more often coiled (p < 0.001). Age over 70 years (p = 0.049), H&H grade on admission (p = 0.022), overall clot burden (p = 0.035), ED (p = 0.009), DCI (p = 0.013), DC (p = 0.0005), and CSF shunt placement (p = 0.038) proved to be predictive of long-term outcome after aSAH. Conclusion: Long-term results after clipping and coiling of ruptured aneurysms appear equal in an interdisciplinary setting that takes aneurysm localization, available staff, and equipment into account.

Coagulation System Disorders and Thrombosis Prophylaxis During Laparoscopic Fundoplications.

The aim of this study was to assess and recommend the optimal deep vein thrombosis (DVT) prophylaxis regimen during and after laparoscopic fundoplication according to the blood coagulation disorders and the rate of DVT in 2 patient groups, receiving different DVT prophylaxis regimens. This was a prospective randomized, single-center clinical study. The study population, 121 patients, were divided into 2 groups: group I received low-molecular-weight heparin 12 hours before the operation; group II received low-molecular-weight heparin only 1 hour before the laparoscopic fundoplication. Both groups received intermittent pneumatic compression during the entire procedure. Bilateral Doppler ultrasound to exclude DVT was performed before the surgery. Venous phase computed tomographic images were acquired from the ankle to the iliac tubercles on the third postoperative day to determine the presence and location of DVT. Hypercoagulation state was assessed by measuring the prothrombin fragment F1+2 (F1+2), the thrombin-antithrombin complex (TAT), and tissue factor microparticles activity (MP-TF) in plasma. The hypocoagulation effect was evaluated by measuring plasma free tissue factor pathway inhibitor (fTFPI). F1+2, TAT, and MP-TF indexes increased significantly, whereas fTFPI levels decreased significantly during and after laparoscopic fundoplication, when molecular-weight heparin was administered 12 hours before the operation. Computed tomography venography revealed peroneal vein thrombosis in 2 group I patients on the third postoperative day. Total postsurgical DVT frequency was 1.65%: 3.6% in group I, with no DVT in group II. Molecular-weight heparin and intraoperative intermittent pneumatic compression controls the hypercoagulation effect more efficiently when it is administered 1 hour before surgery: it causes significant reduction of F1+2, TAT, and MP-TF indexes and significant increases of fTFPI levels during and after laparoscopic fundoplication.

Frequency and risk factors for venous thromboembolism after gastroenterological surgery based on the Japanese National Clinical Database (516217 cases).

AimTo investigate the frequency and risk factors of perioperative, symptomatic venous thromboembolism (VTE) after gastroenterological surgery.MethodsWe assessed the frequency of and risk factors for VTE after eight gastroenterological procedures (total 516 217 cases including, gastrectomy, total gastrectomy, hepatectomy, esophagectomy, right hemicolectomy, low anterior resection, pancreaticoduodenectomy, and acute pan‐peritonitis surgery) based on data from the National Clinical Database. Data collected between 2011 and 2013 (382 124 cases) were used as a test set, and data from 2014 (134 093 cases) were used as a validation set.ResultsThe frequency of deep vein thrombosis (DVT) was 0.3% (382 124 cases), and the incidence of pulmonary embolism (PE) was 0.2% (382 124 cases) ranging from 0.1% to 0.7% for DVT and from 0.1% and 0.3% for PE among eight surgeries, respectively. Analyses using pre‐and intra‐operative factors identified the top three risk factors for VTE as esophagectomy, pancreaticoduodenectomy, and hepatectomy. Using pre‐, intra‐, and postoperative factors, the second through fourth risk factors were sepsis, prolonged ventilation >48 hours and readmission within 30 days. The highest risks factor for PE using pre‐, intra‐, and postoperative factors were any cardiac events. Unplanned intubation was the fourth risk factor.ConclusionThe risk for DVT and PE differed for each surgical procedure. VTE and PE risk factors changed after considering postoperative factors. It may be necessary to reconsider the prophylaxis depending on whether the complication occurs after surgery, particularly breathing and cardiac complications.

PB2438 DEEP‐VEIN THROMBOSIS IN PATIENTS WITH FACTOR XI DEFICIENCY FROM THE SOUTH OF TUNISIA

Background:Clotting factor XI (FXI) plays a separate role in hemostasis and in thrombosis. Recently, researches had shown that a FXI plasmatic activity (FXI: Act) greater than 95% could represent a thrombotic risk factor. FXI deficiency belongs to the rare bleeding disorders. However, in some reports, a reduced incidence of deep‐vein thrombosis (DVT) has been noticed in patients with a FXI defect.Aims:The aim of this study was to study the frequency of DVT and to evaluate the incidence of the most common prothrombotic molecular risk factors in FXI deficiency in the South of Tunisia.Methods:This study was carried out in 30 FXI deficient patients. The FXI: Act was performed by the coagulometric method. Genotyping for the G1691A Factor V Leiden (FVL) polymorphism was conducted using PCR‐AS (polymerase chain reaction‐specific allele) and the MTHFR C677T polymorphism was performed by PCR‐RFLP (polymerase chain reaction ‐ Restriction fragment length polymorphism). Our findings were compared to some prominent population‐based reports.Results:The mean age of our series was 36.7 years ± 18 and the sex ratio was about 0.43. 19 cases / 30 patients (63.3%) had a moderate FXI deficiency (FXI: Act between 20 and 59%) while 11 cases (36.6%) had a severe FXI defect (FXI: Act &lt;20%). Our study revealed only two incident cases of DVT (6.6%) comparing to the meta‐analysis of Naess et al. which revealed a DVT's frequency over 10.9% (234 cases /2136 healthy controls). This result was actually lower than expected, leading to a lower risk of thrombosis in our patients. In regard to the prothrombotic molecular profile, the G1691A FVL polymorphism was noticed in four heterozygous patients (13.3%). Being similar to the expected incidence : 13.6% (34 cases /250 healthy blood donors from southern Tunisia (31 heterozygous variants and 3 homozygous variants), the FVL reduced incidence, couldn’t imply a lower risk of having a mutated FVL allele in our patients. Concerning the MTHFR C677T polymorphism, 11 patients had mutated alleles (nine heterozygous (34.6%) and two homozygous variants (7.7%)). The MTHFR C677T heterozygosity was slightly lower than in the controls’ incidence (51 heterozygous variants/ 100 healthy controls from northern Tunisia (51%)). However, two patients had presented the homozygous form of the MTHFR C677T polymorphism (7.7%) without any thrombosis symptom, whereas no homozygous variants were noticed in the controls’ group.Summary/Conclusion:Our study highlighted, as shown in the literature, that the FXI deficiency might protect against the DVT's occurrence. Indeed, the expected incidence of thrombotic events was higher than the results found in our series. Concerning the molecular exploration of the most common prothrombotic risk factors, our findings showed a lower incidence of the C677T MTHFR heterozygous form in FXI deficient patients comparing to the controls’ group, which leads to a lower predisposition to DVT, while the G1691A polymorphism of FVL's incidence was less conclusive. Added to that, the result of the two patients with a homozygous MTHFR genotype that had never presented any thrombotic or stroke accident, may confirm that the FXI deficiency provides a thrombotic protection to the patients. For this reason, the other prothrombotic markers such as the prothrombin G20210A mutation must be explored. Larger data and case‐control studies are mandatory to obtain better statistics especially that experimental studies are focusing on FXI as a new therapeutic target with anticoagulant properties in order to prevent postoperative thrombosis.

Proximal and isolated distal deep vein thrombosis and Wells score accuracy in hospitalized patients.

Deep vein thrombosis (DVT) is an important cause of morbidity and mortality in hospitalized patients. The Wells score for DVT pretest probability (PTP) was validated in outpatients, but its utility for inpatients is unclear. The aim of this study was to establish the prevalence of inpatient proximal and distal DVT and the Wells score performance in inpatients. A single-center cross-sectional study was conducted in a university hospital. During 183 days, all inpatients with suspected lower-extremity DVT were evaluated with the Wells score and whole-leg ultrasound. Among 634 inpatients (age 77.5 ± 13.8 years, males 39.3%), 507 (80.0%) were from medical wards and 127 (20.0%) from surgical wards. During the study period, there were 11,662 hospital admissions in the surgical/medical services. Whole-leg ultrasound detected 128 DVTs (20.2%); 51 (39.8%) were proximal and 77 (60.1%) were isolated distal DVTs. Estimated DVT prevalence in hospital setting was 1.09% (95% CI 0.93–1.31), and isolated distal DVT prevalence was 0.66% (95% CI 0.53–0.82). DVT frequency in low-, moderate-, and high-PTP groups was 9.8%, 24.3%, and 41.5%, respectively (p = 0.001). The area under the receiver operating characteristic curve for the Wells score was 0.67 ± 0.03 for all DVTs and 0.75 ± 0.04 for only proximal DVTs. A high PTP had a sensitivity of 24% (95% CI 14–37%) and a specificity of 93% (95% CI 91–95%) for proximal DVT diagnosis. In hospitalized patients, isolated distal DVT has a higher incidence than expected, and the Wells score accuracy for proximal DVT is similar to that found in outpatients.