Deep Vein Thrombosis Research Articles

Prevalence and Risk Factors of Deep Vein Thrombosis with Acute Stroke: A Cross-sectional Study

Background: Deep vein thrombosis (DVT) is a serious complication in stroke patients and may lead to the devastating consequences of a pulmonary embolism. The risk factors for DVT in acute stroke are advanced age, high National Institute of Health Stroke Scale (NIHSS) score, hemiparesis, immobility, female gender, atrial fibrillation. The present study is aimed at identifying the prevalence and risk factors for DVT in acute stroke patients. Methods: This was a prospective cross sectional study conducted in of Dhaka Medical College and Hospital from January 2022 to December 2023. Data was collected in a preformed questionnaire. Statistical analysis was performed using IBM SPSS version 26.0. Continuous variables were analyzed in the form of the means with standard deviations (Mean ± SD). Categorical variables were shown as numbers and proportions. Continuous data were analyzed using the independent samples t-test. Categorical data were analyzed using the chi-squared test. Univariate variables with a p-value of <0.05 were retained in a binary logistic regression model. Receiver operating characteristic (ROC) curve analysis was performed by identifying the area under the ROC curve (AUC) to evaluate the performance of the logistic regression model. Statistical significance was defined as a p-value of < 0.05. Results: A total of 106 patients with acute stroke (AS) were included in the study. The included patients were divided into two groups: DVT and non-DVT group. Out of 106 patients, 34(32.07%) patients presented with DVT. Patients with DVT were older than those without DVT (62.7 ± 10.7 vs. 56.5 ± 11.9 years, p < 0.05). Females were more affected by DVT (58.88% vs. 26.85%, p<0.05). In the DVT group, the level of D-dimer was significantly higher than that in the non- DVT group (2.2 ± 1.7 vs. 0.45 ± 1.1, p < 0.05). Elevated CRP and low serum albumin level were also observed in DVT group which was statistically significant. (p<0.05). Multiple logistic regression analysis showed that age>60years, NIHSS score>25 and a D-dimer level of ≥ 1.52 μg/mL and caprine score >6 were independent factors for the presence of DVT at the time of stroke admission. Odds ratio for age, Caprini RAM score, NIHSS score and elevated d-dimer were 1.043(1.000–1.075, p=0.029),1.43(0.85-0.1.96, p=0.001),1.266(1.168-1.284, p=0.008) and1.446 (1.130–1.849, p=0.003) respectively. Conclusion: The present study has showed that advanced age, high NIHSS and caprini score and raised serum D-dimer levels are independent predictors of DVT in stroke patients. A further large multicenter study should be done to provide a better management to the patients of DVT in stroke patients.

Association between abnormal systemic coagulation inflammation index and recurrence of deep venous thrombosis as well as quality of life: A retrospective study.

Deep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. A retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. The recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. The study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Adverse Events of Factor Xa Inhibitors in Pediatric Patients: A Meta-analysis and Pharmacovigilance Study.

This study aimed to provide a comprehensive review of adverse events (AEs) associated with factor Xa (FXa) inhibitors in pediatric patients. We searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and the European Union Clinical Trials Register for English-language records from the establishment of the database up to October 17, 2023. Both randomized controlled trials and single-arm trials were included. AEs were analyzed using a Bayesian hierarchical model. For the pharmacovigilance study, data from the US Food and Drug Administration Adverse Event Reporting System from January 1, 2007, to December 31, 2023, were obtained. The proportional imbalance method and the Medicines and Healthcare products Regulatory Agency method were used to detect AE signals. Further characterization of patients presenting with AEs was performed. Of 451 records identified, 12 eligible studies were included. A total of 50.6% (95% Bayesian credible interval [CrI] 33.1-67.2, τ = 0.796) of patients experienced at least one AE, and 9.9% (95% CrI 3.9-19.5, τ = 0.552) developed at least one serious AE. Major and clinically relevant non-major bleeding occurred in 2.4% (95% CrI 0.8-4.8, τ = 1.61) of patients. The most common bleeding AEs were epistaxis (8.4% [95% CrI 3.9-14.9, τ = 1.96]), subcutaneous hematoma (6.4% [95% CrI 0.5-26.2, τ = 0.54]), and wound hemorrhage (3.7% [95% CrI 0.4-13.3, τ = 0.55]). Non-hemorrhagic AEs were pyrexia (9.2% [95% CrI 4.6-15.3, τ = 1.18]), vomiting (7.8% [95% CrI 4.0-12.3, τ = 0.08]), and abdominal pain (7.4% [95% CrI 1.5-19.4, τ = 0.84]). A total of 39 AE signals were detected in the pharmacovigilance study. The top three highest overall relative odds ratio (ROR) for AEs were observed for haemorrhoidal hemorrhage at 1211.82 (95% CI, 312.69-4696.29), thrombophlebitis at 134.64 (95% CI, 42.18-429.81), and deep vein thrombosis at 68.3 (95% CI, 42.53-109.68). Patients experiencing bleeding AEs had received a mean dosage of rivaroxaban 0.16 mg/kg and apixaban 0.08 mg/kg. Systematically quantified AEs of FXa inhibitors in clinical trials and real-world studies provide an important guide for clinicians. The use of FXa inhibitors in pediatric patients is associated with an acceptable rate of AEs. The most common bleeding AE was epistaxis. Pediatric patients treated with FXa inhibitors were more prone to hemorrhoidal hemorrhage. A safe approach may involve prior use of other anticoagulants followed by careful administration of FXa inhibitors, with a dosing regimen tailored to age and weight. Close monitoring is recommended for peri-procedural anticoagulation and vomiting.

Care pathway for patients hospitalized with venous thromboembolism.

Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a potentially fatal disease with a multifactorial nature, impacting different medical and surgical specialties. Recently, new guidelines and direct oral anticoagulants facilitated early discharge for most DVT patients and non-severe PE patients. The aim of this study is to illustrate the distribution of VTE patients throughout the hospital and map their care pathway from Emergency Department (ED) to hospital discharge. This multicenter retrospective cross-sectional study included all hospitalized patients with a VTE code from 39 hospitals between 2018 and 2019. Data were analysed using JupyterLab, with subgroup analyses based on mode of entry, diagnosis location and thrombosis site. A total of 23,199 hospitalizations were analysed, involving 17,718 patients a median age 66 years [52-78] and man-to-women ratio 1.05. Among these, 10,747(46.3%) had PE and 4176(18.0%) had lower limb DVT. The ED was the primary entry point for 31.2% of cases, followed by gastroenterology, surgery, geriatrics, and internal medicine. Patients admitted through ED patients were most frequently transferred to internal medicine, cardiovascular and intensive care units (ICU). The median hospital stay was 9 days [4-21], with ICU stays being the longest (mean 15 days [8-27]). Notably, 1357 patients (18.8%) of VTE patients were discharged within 48 h of ED admission. This study is the first to portray the distribution and care pathways of VTE patients across hospital departments. Despite recent clinical guidelines, many patients still require inpatient management, highlighting the need for dedicated care pathway.

Use of generative large language models for patient education on common surgical conditions: a comparative analysis between ChatGPT and Google Gemini.

There is a growing importance for patients to easily access information regarding their medical conditions to improve their understanding and participation in health care decisions. Artificial Intelligence (AI) has proven as a fast, efficient, and effective tool in educating patients regarding their health care conditions. The aim of the study is to compare the responses provided by AI tools, ChatGPT and Google Gemini, to assess for conciseness and understandability of information provided for the medical conditions Deep vein thrombosis, decubitus ulcers, and hemorrhoids. A cross-sectional original research design was conducted regarding the responses generated by ChatGPT and Google Gemini for the post-surgical complications of Deep vein thrombosis, decubitus ulcers, and hemorrhoids. Each response was evaluated by the Flesch-Kincaid calculator for total number of words, sentences, average words per sentence, average syllables per word, grade level, and ease score. Additionally, the similarity score was evaluated using QuillBot and reliability using a modified discern score. These results were then analyzed by the unpaired or two sample t-test to compare the averages between the two AI tools to conclude which one was superior. Chat GPT required a higher education level to understand as suggested by the higher grade levels and lower ease scores. The easiest brochure was for deep vein thrombosis which had the lowest ease score and highest grade level. ChatGPT displayed more similarity with information provided on the internet as calculated by the plagiarism calculator-Quill bot. The reliability score via the Modified Discern score showing both AI tools were similar. Although there is a difference in the various scores for each AI tool, based on the P values obtained there is not enough evidence to conclude the superiority of one AI tool over the other.

Unexplained Multi-Site Thrombosis: A Step-by-Step Strategy for Factor V Leiden Detection in a Hypercoagulable Patient

Thrombotic manifestations involve the development of blood clots within blood vessels. These conditions can occur unexpectedly in different areas and are often linked to life-threatening situations, presenting challenges for both diagnosis and treatment. We present a case of multi-site thrombosis in a patient with a confirmed hypercoagulable state, resulting from a positive factor V Leiden mutation. The patient’s medical history included hypertension, chronic obstructive pulmonary disease, previous thrombotic events, and changes in anticoagulant therapy. This case highlights the challenges associated with multisystem thrombosis and underscores the necessity of employing various diagnostic techniques, such as echocardiography, computed coronary angiography, and Doppler ultrasonography. In this instance, the patient presented with a history of unprovoked lower limb deep vein thrombosis and multiple arterial thromboses. The patient’s treatment regimen comprised anticoagulants, antiplatelet drugs, and vasodilators. While a reduction in thrombus size was noted, complete revascularization could not be attained. Effective diagnosis and treatment of venous and arterial thrombosis often require multimodal imaging. Selective blood test screening can be beneficial in diagnosing or detecting inherited or acquired abnormalities linked to thrombosis development.

Type 1 Diabetes Mellitus and Thromboembolism in Pregnancy.

Objective The impact of type 1 DM (T1DM) on thromboembolism in pregnancy is uncertain. We hypothesized that T1DM is associated with higher rates of thrombotic events during pregnancy and the postpartum period. Study Design This is a retrospective cohort study utilizing the National Inpatient Sample database from HCUP/AHRQ for 2017-2019. Pregnant and postpartum patients with a history of T1DM were compared to those without. The primary outcome was a composite diagnosis of any thrombotic disease (pulmonary embolism (PE), deep vein thrombosis (DVT), cerebral vascular thrombosis (CVT), or other thromboses). Secondary outcomes were the diagnosis of each individual type of thrombo-embolic event. Groups were compared via Student's test, chi-squared, and logistic regression analyses, controlling for confounders including age, race, obesity, tobacco use, cHTN, asthma, anemia, and cesarean section. Results A total of 2,361,711 subjects met criteria. Patients with T1DM encompassed 0.4% of subjects (N=9,983). T1DM subjects were more likely to be younger, non-Hispanic white, obese, tobacco users, chronic hypertensive, asthmatic, and have a history of cesarean (all p<0.001). They were less likely to be in the top income quartile. Thrombo-embolic events occurred more frequently in those with T1DM (0.45% vs 0.20%, p<0.001). DVT was the most common event (0.25%). After controlling for confounders, T1DM remained independently associated with any thromboembolic event in pregnancy (aOR 2.19, 95%CI 1.49-3.23), PE (aOR 3.59, 95%CI 1.65-7.82), and DVT (aOR 2.43, 95%CI 1.43-4.14). Conclusion T1DM is associated with an increased risk of thrombo-embolic events in pregnancy. Key Words Type 1 Diabetes Mellitus, VTE, thromboembolism, pregnancy.

The impact of preoperative venous thromboembolism on patients undergoing TURBT: Perioperative outcomes and healthcare costs from US insurance claims data

AbstractObjectivesTo assess the impact of a positive history of venous thromboembolism (VTE) on perioperative outcomes, including length of in‐hospital stay, readmission rates, 90‐day postoperative complications, and healthcare costs in bladder cancer (BCa) patients undergoing transurethral resection of bladder tumour (TURBT) in the United States.Patients and MethodsPatients aged ≥18 years with a BCa diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de‐identified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between diagnosis of VTE before TURBT and 90‐day complication rates, new postoperative VTE events, re‐hospitalization, and total hospital expenditures (2021 US dollars). Sensitivity analyses on VTE severity (pulmonary embolism [PE], deep venous thrombosis [DVT] or superficial thrombophlebitis/phlebitis [SVT]), as well as TURBT extent (minor vs. major) were additionally examined.ResultsIn total, 139 800 patients were identified, with 5.3% having preoperative VTE, including DVT (n = 3112, 42.20%), PE (n = 2046, 27.74%) and SVT (n = 2217, 30.06%). A history of preoperative VTE predicted higher rates of any complication (adjusted odds ratio [aOR] 1.28, 95% CI 1.14–1.43) and also higher rates of infectious and haemorrhagic complications. Additionally, preoperative VTE increased the risk of novel VTE events following TURBT (aOR 17.30, 95% CI 16.05–18.65), hospital length of stay (aOR 2.23, 95% CI 1.90–2.62), readmissions (aOR 1.47, 95% CI 1.39–1.56), and hospital associated costs (aOR 1.17, 95% CI 1.12–1.23). DVT and non‐minor TURBT procedures did not increase the risk of any, infectious, or haemorrhagic complications, but other associations were maintained regardless of the severity of VTE (PE, DVT, SVT) or TURBT extent (minor/major).ConclusionsA history of VTE before undergoing transurethral procedures for BCa is associated with significantly worse perioperative outcomes and higher healthcare costs. These findings may help us to counsel on the risks of the intervention and hopefully improve our ability to mitigate such risks.

Comparison of Different Thromboprophylaxis Regimens in Elderly Patients Following Hip Arthroplasty

Aims/Background Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. Methods The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. Results Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention (p &gt; 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups (p &gt; 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group (p &lt; 0.05). Conclusion The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile.

Caprini score combined with thrombotic molecular markers for predicting DVT in patients with traumatic fractures

Deep vein thrombosis (DVT) is one of the important factors leading to death in patients undergoing fracture surgery. This study aims to investigating the predictive value of the Caprini score combined with thrombus molecular markers for the risk of DVT in patients after traumatic fracture surgery. A total of 342 patients who underwent surgery for traumatic fractures were included in the study. The patients were divided into two groups based on the occurrence of DVT after surgery: the DVT group (n = 57) and the non-DVT group (n = 285). A univariate analysis and logistic regression analysis were conducted on clinical factors and laboratory indicators that might be associated with DVT in patients with traumatic fractures. A predictive model for DVT risk was then constructed by combining thrombus molecular markers with the Caprini score. The median age of all patients was 65 years (54–75 years), the postoperative Caprini score was 9 (6–11), and the length of hospital stay was 11 days (8–16 days). In univariate analysis, age (P = 0.029), postoperative Caprini score (P < 0.001), and length of hospital stay (P = 0.009) were significantly associated with the occurrence of DVT. Logistic regression analysis showed that the risk of developing DVT increased with higher postoperative Caprini scores (P < 0.001), longer hospital stays (P = 0.024), and higher PIC levels (P = 0.046). Among these, the postoperative Caprini score was the most effective factor for diagnosing DVT, with an area under the curve (AUC) of 0.814 (P < 0.001) and a diagnostic cutoff of 11 points. The overall diagnostic efficacy of individual thrombus molecular markers from highest to lowest was TM, DD, PIC, t-PAIC, and TAT, with all except TAT showing statistical significance. The combined diagnostic efficacy of the postoperative Caprini score and PIC also showed statistical significance (AUC = 0.869, P < 0.001). Thrombus molecular markers combined with the postoperative Caprini score have potential predictive value for the risk of DVT in patients after traumatic fracture surgery.

Post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture: a meta-analysis.

The number of patients with hip and femoral fractures is increasing and is expected to further increase in upcoming years due to the ageing population and the life expectancy of the general population. In this analysis, we aimed to systematically assess the post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture. Common online databases: Google Scholar, Web of Science, MEDLINE, Cochrane database, EMBASE ( www.sciencedirect.com ), and http://www. gov were searched for English-based studies which reported post-operative outcomes in patients with versus without the use of Aspirin prior to surgery for hip or femoral fracture. The endpoints of this analysis included cerebro-vascular attack, acute coronary syndrome/cardiovascular complications, hematoma, deep venous thrombosis, pulmonary embolism, patients requiring blood transfusion, bleeding events, and in-hospital mortality. RevMan software 5.4 was the statistical software used for this meta-analysis. Risk ratio (RR) with 95% confidence intervals (CI) was used to represent the post-analytical result. A total number of 2823 participants were included in this analysis whereby 821 were assigned to Aspirin prior to surgery. Results of this analysis showed that post-operatively the risk of cerebrovascular attack (RR: 1.62, 95% CI 0.29-9.20; P = 0.58), cardiovascular complication (RR: 1.86, 95% CI 0.62-5.52; P = 0.27), pulmonary embolism (RR: 2.45, 95% CI 0.77-7.77; P = 0.13), bleeding events (RR: 1.24, 95% CI 0.39-3.96; P = 0.71), and in-hospital mortality (RR: 0.95, 95% CI 0.47-1.91; P = 0.89) were not significantly higher in those patients who were and who were not taking Aspirin pre-operatively. The risk of deep venous thrombosis (RR: 1.82, 95% CI 0.23-14.60; P = 0.57), hematoma formation (RR: 1.57, 95% CI 0.11-21.49; P = 0.74) and patients requiring blood transfusion post-operatively (RR: 1.22, 95% CI 0.99-1.52; P = 0.07) were not significantly different in patients who were on Aspirin and those who were not on Aspirin pre-operatively. The post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture were apparently not significantly different when compared to patients who were not on Aspirin. Therefore, Aspirin should not be considered an absolute contraindication in patients undergoing surgery for hip or femoral fracture. Hence, an early or emergency surgery for hip or femoral neck fracture in patients on Aspirin therapy should apparently not pose any problem. Further larger trials should be able to confirm this hypothesis.

Clinical course and neurological outcomes of cerebral venous sinus thrombosis: A single center retrospective observational study.

Cerebral venous sinus thrombosis (CVST) is a rare type of thrombosis that affects the cerebral venous system. The data on neurological outcomes are limited. This study aimed to investigate the neurological outcomes of CVST, contributing factors, clinical presentation, treatment and mortality. This was a single-center, retrospective study at a university-based referral hospital in Thailand. Consecutive patients diagnosed with CVST between January 2010 and December 2020 were included. Outcomes were neurological outcomes measured by modified Rankin Scale (mRS), anticoagulant treatment, recurrence, and mortality. One hundred and seven CVST patients were included with a mean age (± SD) of 42.7 ± 20.4 years. Following the treatment, neurological outcomes significantly improved, with the proportion of patients with mRS 0-1 increasing from 18.7% at diagnosis to 83.2% and 85.1% at three and six months, respectively (P < 0.001). Clinical variables were associated with residual neurological symptoms (mRS≥1) included age ≥ 50 years (OR 4.1, 95% CI; 1.7-9.4, P 0.001), male sex (OR 3.0, 95%CI; 1.4-6.6, P 0.006), the thrombus involvement in deep sinus system (OR 6.1, 95%CI; 1.1-76.9, P 0.04) and cerebral vein and dural sinus thrombosis (CVT) risk score ≥ 1 (OR 3.1, 95%CI; 1.3-7.5, P 0.014). Patients whose CVST was associated with hormonal therapy were found to have a lower risk of residual neurological symptoms (OR 0.2, 95%CI 0.1-0.6, P 0.004). Hormonal therapy was associated with anticoagulant discontinuation (OR 2.7, 95% CI 1.1-7.0; P = 0.04). The presence of malignancy increased the risk of bleeding (OR 5.8, 95% CI 1.4-24.1; P 0.016). Overall mortality was 2.8%. Of which 50% were related to major bleeding. A significant improvement in neurological outcomes was observed at 3 and 6 months after diagnosis. Older age, male sex, thrombus involvement in deep sinus system were associated with residual neurological symptoms.

Safety of accessing brachial veins for large-bore upper extremity venous thrombectomy using ClotTriever Thrombectomy System

PurposeTo evaluate access site adverse events following ClotTriever-mediated large-bore mechanical thrombectomy via small upper extremity deep veins (< 6-mm).Materials and methodsTwenty patients, including 24 upper extremity venous access sites, underwent ClotTriever-mediated large-bore thrombectomy of the upper extremity and thoracic central veins for symptomatic deep vein obstruction unresponsive to anticoagulation. Patients without follow-up venous duplex examinations (n = 3) were excluded. Patients who had > 6-mm diameter veins accessed (n = 3) were excluded. Temporary purse-string sutures and manual pressure were used for access site hemostasis in all patients. Vein access site and diameter, technical success (defined as placement of the 13.5-French ClotTriever sheath followed by thrombectomy), and early (< 30-days) and late (> 30-days) access site-related adverse events (according to the Adverse Event Classification by the Society of Interventional Radiology criteria) were recorded.ResultsFourteen patients (8 males, 6 females; mean age 51.7 ± 13.6 years) comprising 16 upper extremity venous access sites were included in this study. Access sites included: right brachial (n = 7), left brachial (n = 5), and bilateral brachial (n = 2) veins. The mean access site diameter was 4.3-mm ± 0.67-mm. Technical success was achieved via all access sites. Six (42.9%) patients underwent stent reconstruction following thrombectomy through the same accesses. After the procedure, all purse-string sutures were removed within 24 h. Three (21.4%) patients experienced small access site hematomas that did not require transfusion, intervention, or prolonged hospitalization. Initial follow-up venous duplex ultrasounds were performed at 29.3 ± 21.7 days following intervention. The mean follow-up interval to the second and third venous duplex ultrasounds were 124.3 ± 64-days and 225.1 ± 80.1 days, respectively. One (7.1%) patient developed right arm swelling six days after the procedure and was found to have thrombosis of the previously accessed right brachial vein. No other clinically or sonographically significant access site adverse events were observed.ConclusionClotTriever-mediated large-bore thrombectomy via small upper extremity veins is safe with minimal access site adverse events.

Early mobilization program with nonweight-bearing brace improves functional capacity after diabetic foot ulcer surgery: a randomized controlled trial

PurposeThis study aimed to evaluate the effectiveness of early mobilization program with nonweight-bearing braces in improving functional outcomes and clinical indicators after diabetic foot ulcer surgery.MethodsWe conducted a randomized trial involving patients with diabetic foot ulcers (DFUs) who underwent surgery at a tertiary university hospital. Participants were randomized to receive either early mobilization with nonweight-bearing braces or standard rehabilitation care. The primary outcome was the ability to walk a distance of three meters without human assistance upon hospital discharge. Secondary outcomes included activity of daily living (ADL), measured by the Barthel Index survey; reduction in lean body mass, assessed via thigh circumference on postoperative day 10 (POD 10); length of stay (LOS); and the incidence of postoperative complications such as deep venous thrombosis (DVT), pain, and wound dehiscence.ResultsA total of 46 patients were enrolled, with 23 assigned to the early mobilization program with nonweight-bearing braces (intervention group) and 23 to the standard rehabilitation care group (control group). The primary outcome was achieved in 16 patients (69.6%) in the intervention group and 6 patients (26.1%) in the control group [RD43.5%, 95%CI (17.5%,69.5%); P = 0.003]. The intervention group demonstrated improved outcomes in ADL. Additionally, the intervention facilitated earlier discharge with a LOS of 12 days in the intervention group compared to 18 days in the control group.ConclusionAn early postoperative mobilization program with nonweight-bearing brace is demonstrated to be feasible and effective in improving functional capacity in patients with diabetic foot ulcers undergoing surgery.

Impact of Baseline Thrombocytopenia on Early Outcomes in Patients With Acute Venous Thromboembolism.

Managing acute venous thromboembolism (VTE) in patients with thrombocytopenia is challenging. We used data from the RIETE registry to investigate the impact of baseline thrombocytopenia on early VTE-related outcomes, depending on the initial presentation as pulmonary embolism (PE) or isolated lower-limb deep vein thrombosis (DVT). From March 2003 to November 2022, 90 418 patients with VTE were included. Thrombocytopenia was categorized as severe (< 50 000/μL, n = 303) or moderate (50 000-99 999/μL, n = 1882). The primary outcome, fatal PE within 15 days after diagnosis, and secondary outcomes, including major bleeding and recurrent VTE, were analyzed using multivariable-adjusted models. Among 52 703 patients with PE, the 15-day case-fatality rates from PE were 5.8% for severe thrombocytopenia, 4.5% for moderate thrombocytopenia, and 1.1% for normal platelet counts. In 37 715 patients with isolated DVT, the cumulative incidence of fatal PE were 0, 0.2%, and 0.05%, respectively. Multivariable analysis revealed a five-fold increase in the risk for fatal PE in severe thrombocytopenia (adjusted HR: 4.89; 95%CI: 2.55-9.39) without significant differences between severe and moderate thrombocytopenia. Thrombocytopenia, either moderate or severe, was also associated with increased risk for both, major bleeding and recurrent VTE at 15 days. Initial presentation with PE substantially worsened prognosis compared to isolated DVT. In conclusion, in patients with acute VTE, thrombocytopenia at baseline was associated with increased risk of early death from PE, a finding that was driven by the subgroup whose initial presentation was PE.

Recurrent Haemoptysis Revealing Hughes-Stovin Syndrome

Hughes-Stovin Syndrome (HSS) is a rare and severe disorder characterized by the combination of pulmonary artery aneurysms and deep vein thrombosis. We report the case of a 42-year-old male presenting with recurrent hemoptysis revealing HSS. Management consisted of high-dose corticosteroids and cyclophosphamide. The patient showed marked clinical and radiological improvement. HSS, as a rare form of Behçet’s disease, is associated with high morbidity and mortality due to thrombosis and potential rupture of aneurysms. Immunosuppression remains the cornerstone of management. Anticoagulation is controversial and requires careful consideration. Early diagnosis and prompt treatment are critical in managing HSS.

Effects of COVID-19 on short-term outcomes of hip arthroplasty: a multicenter, retrospective, propensity score matched study

PurposeThe Coronavirus Disease 2019 (COVID-19) pandemic delayed elective procedures such as total joint arthroplasty. As surgical volumes return to prepandemic levels, understanding the implications of COVID-19 becomes imperative. This study explored the effects of COVID-19 on the short-term outcomes of hip arthroplasty.MethodsThis multicenter, retrospective, case–control study included patients who had undergone hip arthroplasty between 2020 and 2022. Propensity score matching (PSM) was performed to compare demographic characteristics, primary outcomes, and secondary outcomes between patients with a history of COVID-19 (COVID-19 cohort) and those without it (control cohort). The primary outcomes were surgical site infection, periprosthetic joint infection (PJI), dislocation, prosthesis loosening, deep vein thrombosis, and pulmonary embolism. The secondary outcomes were intraoperative blood loss, nerve injury, renal injury, urinary tract infection (UTI), pneumonia, and acute coronary syndrome.ResultsThe COVID-19 and control cohorts comprised 153 and 4925 patients, respectively. After PSM, significant between-cohort differences were observed in the incidence of pneumonia (p < 0.001) and UTI (p = 0.0424). The odds ratio for PJI was 1.62, which is not significant (p = 0.3238) but the culture-negativity rate is higher in the COVID-19 cohort (25%).ConclusionOur findings suggest that COVID-19 only elevated risks of postoperative pneumonia and UTI after hip arthroplasty. This disease significantly increases the risk of postoperative pneumonia but not of 90-day mortality or any major perioperative complication. On the other hand, PJI still remains a concern because its treatment is challenging owing to its culture-negativity, often necessitating the Girdlestone procedure.

Predictive Factors for Post-Thrombotic Syndrome in Patients with Deep Vein Thrombosis Treated with AngioJet Pharmacomechanical Thrombectomy: A Retrospective Single-Center Study.

BACKGROUND Deep venous thrombosis (DVT) is one of the most common peripheral vascular diseases. AngioJet pharmacomechanical thrombectomy has been widely used to treat DVT. This study evaluated outcomes of patients with DVT after pharmacomechanical thrombectomy and determined potential risk factors associated with prognosis. MATERIAL AND METHODS A retrospective review was conducted to enroll patients with DVT who received AngioJet pharmacomechanical thrombectomy from July 2018 to May 2020. Clinical data and outcome measures, including baseline demographic information, procedure details, adverse events, incidence of post-thrombotic syndrome (PTS), and Villalta scores were collected. The logistic regression modeling began with a univariate analysis to identify factors with statistically significant differences. Multivariate analysis revealed predictive factors of the development of PTS. RESULTS Eighty-nine patients were recruited and divided into 2 groups according to the presence of PTS: 22 patients in the PTS group and 67 patients in the non-PTS group. All cases were technically successful. Total median dosage of thrombolytic agents was 260 million units (range, 160-440 million units) and median duration of hospital stay was 5 days (range, 2-15 days). No major adverse events were observed. Univariate analysis showed statistical significance for all factors tested, except age, sex, and leg varicosities at baseline between the groups. Multivariate logistic regression confirmed that only time from onset to treatment (OR=1.745; 95% CI=1.316-2.315) was associated with incidence of PTS after pharmacomechanical thrombectomy. CONCLUSIONS AngioJet pharmacomechanical thrombectomy is an effective therapeutic approach for DVT. Time from onset to treatment was an independent factor in predicting development of PTS.

Development and validation of the nomogram of high fascial compartment pressure with pilon fracture.

High Fascial Compartment Pressure (HCP) is one of the most common complications in ankle fractures. This study aimed to investigate the incidence of HCP in pilon fracture and analyze the risk factors of HCP in order to closely monitor its further development into Acute Compartment Syndrome. A nomogram is constructed and validated to predict HCP in patients with pilon fracture. We collected information on 1,863 patients with pilon fracture in the 3rd Hospital of Hebei Medical University Hospital from January 2019 to March 2024. Patients with HCP were assigned to the HCP group and those without HCP to the non-HCP group. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury types, and laboratory biomarkers. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with HCP. The selected predictors were then entered into R software for further analysis, and Nomogram construction. The rate of HCP was 11.57%. Several predictors of HCP were found, including Body Mass Index (BMI) (p<0.001), Deep Vein Thrombosis (p < 0.001), occurrence of Fracture Blister (FB) (p < 0.001), use of Dehydrating Agent (p < 0.001), duration of limb immobilization (p < 0.001),and Systemic Immune-inflammation Index (SII) (p < 0.001). In addition, BMI (p < 0.001, OR 1.52, 95% CI 1.35 to 1.71), DVT (p < 0.001, OR 4.35, 95% CI 2.51 to 7.52), duration of limb immobilization (p < 0.01, OR 1.66, 95%CI 1.25 to 2.20) and SII (p < 0.01, OR 1.00, 95%CI 1.00 to 1.00) were correlated with increased HCP risk. Meanwhile, FB (p < 0.001, OR 0.23, 95% CI 0.13 to 0.39) and Dehydrating Agent (p < 0.001, OR 0.10, 95% CI 0.06 to 0.19) were associated with decreased HCP risk. The nomogram was established based on six predictors independently related to HCP. Our investigation has shown that, compared with tibial diaphyseal fractures, pilon fractures are more prone to HCP because of their high energy injury characteristics. This research also shows BMI, DVT, occurrence of FB, use of Dehydrating Agent, duration of limb immobilization, and SII are independent risk factors for HCP in patients with pilon fracture. We have also devised a nomogram grounded in these identified predictors. In particular, this study found for the first time that SII is an independent risk factor for HCP, which provides a basis for clinical and basic science research on fascial immunology in the future.

Central Catheter Complicated with Fatal Pulmonary Embolism in a Patient under Chronic Hemodialysis: A Case Report

Introduction: The use of central venous catheter is a common practice in hemodialysis in Mali. Its use exposes to risks such as infection, stenosis, thrombosis among others. Pulmonary embolism is a rare but serious complication. The aim of our work was to offer advice on the diagnosis, risk factors, treatment and prevention of deep vein thrombosis following the placement of a central catheter. Observation: This was a 56-year-old woman, a housewife living in the city of Bamako. She had been on chronic hemodialysis for 6 months due to nephroangiosclerosis, at a rate of two four-hour sessions per week through a right femoral catheter. Before her hospitalization, she had a fever, physical asthenia, anorexia, a feeling of heavy leg on the right and abdominal pain. The clinical examination found a conscious patient, with little color and normal parameters, a swelling of the right leg with pain and redness. The biological assessment revealed hypochromic microcytic anemia, Procalcitonin at 2.75ng/l. The Doppler of the right lower limb confirmed deep vein thrombosis. The pulsed cardiac Doppler and the ECG confirmed the diagnosis of pulmonary embolism. Curative treatment of venous thrombosis was started. The immediate aftermath was marked by respiratory problems requiring oxygen therapy, acute circulatory failure syndrome with coldness of the extremities. The outcome was unfavorable with the death of the patient. Conclusion: The use of central venous catheter for hemodialysis as first-line treatment remains frequent in Mali. Patients should benefit from increased monitoring and prophylactic treatment to prevent the occurrence of thromboembolic events.