Incidence Of Thromboembolic Disease Research Articles

Thrombosis in severely ill patients admitted in ICU due to COVID-19 pneumonia. Data from a Greek Hospital

Background: SARS-CoV-2 can lead to a prothrombotic state and the activation of the body's coagulation mechanism, resulting in thrombotic episodes, especially in critically ill patients. The rates of thromboembolic disease in patients with COVID-19 vary and range from 10-40%, while in Greece the existing epidemiological data on the incidence of thromboembolic disease in the ICU are limited. Aim This study aimed to determine the proportion of hospitalized COVID-19 patients who developed thromboembolic disease (pulmonary embolism, deep vein thrombosis, or arterial embolism). It was also crucial to investigate at the relationship between the incidence of VTE (venothrombosis-VTE) and Covid infection in ICU patients. After 28 days from ICU admission, the survival rate of patients with Covid infection admitted to ICUs within the specified time frame was also noted. Method and Material: The study included 85 patients with Covid-19 infection who were hospitalized in two ICU departments in a large adult hospital in Athens between June and September 2021. The occurrence of VTE was diagnosed by computed tomography angiography, regarding the pulmonary embolism and with triplex veins of the lower extremities. Various epidemiological factors, laboratory findings and characteristics of the patients' hospitalization in the Intensive Care Unit were recorded. Results: The incidence of VTE in patients with Covid-19 infection admitted to the Intensive Care Unit was 14% (12/85 patients). Patients who experienced VTE during their hospitalization in the Intensive Care Unit had more days on mechanical ventilation support, more days on vasoconstrictor drugs, and had been transfused more times with blood plasma. In the multivariate analysis that followed, it was found that total days of mechanical ventilation (p=0.02), total days of vasoconstrictor administration (p=0.03) and plasma transfusion (p=0.03) were still statistically significant. Conclusion: In patients with Covid-19 infection and hospitalization in the Intensive Care Unit, longer stay on mechanical respiratory support, more days of vasoconstrictor drug administration and plasma administration are independent predisposing factors for the occurrence of VTE.

Is periodontal infection a risk factor for thromboembolic disease? A systematic review.

Venous thromboembolism (VTE) is a rising major health problem comprising pulmonary embolism (PE) and deep vein thrombosis. It is of concern due to premature mortality, increased morbidity, and associated healthcare costs and hospitalization. Periodontitis can increase the risk of VTE by way of systemic inflammation induced by infection that can contribute to hypercoagulability and platelet aggregation. This systematic review aims to synthesize all the evidence concerning periodontal infection as a risk factor for thromboembolic disease. A search for articles published from 1967 till December 2020 was conducted in the PubMed (MEDLINE), Scopus, and EMBASE data bases. Five hundred and five articles were retrieved after running search strategies in PubMed, Scopus, and EMBASE search databases. Based on the inclusion criteria, three clinical studies, two case series, and ten case reports were included for qualitative analysis. The presence of periodontal disease was reported to influence the occurrence of venous thromboembolic disease with a statistical significance of <0.010. Case series and case reports of septic PE due to periodontal disease showed complete resolution of lung lesions and subsiding of symptoms after dental treatment and antimicrobial therapy. The results of this systematic review suggested for an association between periodontal disease and the incidence of thromboembolic disease. As most of the included/available studies are case series and case reports, the strength of evidence is weak. Evidence generated from well-designed longitudinal controlled clinical trials may be helpful to further assess the strength of the association.

Hemolytic uremic syndrome following COVID-19; a case report

High incidence of thromboembolic diseases in patients with coronavirus disease 2019 (COVID-19) have been reported that can affect several organs ranging from cutaneous thrombosis to pulmonary embolism, stroke, coronary thrombosis or kidney infarction. There are two proposed mechanisms for these phenomena, disseminated intravascular coagulation (DIC) and endotheliopathy. We report a case of 11-year-old girl presented to the emergency department with generalized tonic colonic seizure with upward gaze which was repeated in emergency room. Respiratory distress and loss of consciousness happened which led to her intubation. Due to increased serum creatinine levels and impaired consciousness which was associated with thrombocytopenia and hemolysis, she underwent plasmapheresis three times by the diagnosis of hemolytic uremic syndrome. Additionally, antihypertensive therapy was conducted. The patient’s condition improved and was discharged with good circumstances. Two weeks later the patient returned with thromboembolism that happened in the distal part of her left hand which underwent fasciotomy and thrombectomy.

The prevalence and safety of direct oral anticoagulants in patients with non-atrial fibrillation associated intra-cardiac thrombus

Abstract Background The standard of care in management of intra-cardiac thrombus has been the use of vitamin K antagonists (VKAs). The emergence and use of direct oral anticoagulants (DOACs) in other conditions has led to the consideration of their use in patients with intra-cardiac thrombus. Thus far, case-reports have provided the majority of data regarding the efficacy of DOACs in this population. Purpose The aim of this observational study was to investigate the safety and efficacy of DOACs in intracardiac thrombus not associated with atrial fibrillation, compared to the current standard of care, VKAs. Methods An observational study was conducted between 10 hospitals in our region. The study was conducted between 2013 and 2019 in patients with a diagnosis of intracardiac thrombus. All left and right, atrial and ventricular thrombi were included. Patients with atrial fibrillation were excluded. Patient information was collected from the hospital electronic record. The primary endpoints were clinically significant bleeding requiring transfusion and thromboembolic events, excluding myocardial infarction. Results 1153 patients had a diagnosis of intracardiac thrombus. 878 out of 1153 patients were discharged on warfarin and 275 were discharged on a DOAC. In the warfarin population 73 of 878 patients (8.3%) had clinically significant bleeding events compared to 21 of 275 patients (7.6%) in the DOAC population (p=0.801). The median ages were 60.5 and 58 respectively. The median time period to a bleeding event was 151 and 198 days respectively. In the warfarin population, 116 of 878 patients (13.2%) had thromboembolic disease versus 34 of 275 patients (12.4%) in the DOAC arm (p=0.759). The median ages were 62 and 62.5 respectively. The median time period to a thromboembolic event was 114 and 184 days respectively. In the warfarin arm, 3 patients had systemic thromboembolism and 113 patients had embolic strokes. In the DOAC arm, 2 patients had systemic thromboembolism, 32 patients had embolic strokes. Conclusion The data from this study suggests that DOACs may be a feasible alternative to warfarin in patients with intracardiac thrombus. There was no statistically significant difference in the rates of clinically significant bleeding or in incidence of thromboembolic disease. To our knowledge, this is the largest observational study to date on this topic. Randomized controlled trials are needed to fully establish the efficacy of DOACs in this patient population. Funding Acknowledgement Type of funding sources: None. Table 1

English

The incidence of thromboembolic diseases is high. It is one of the leading causes of death and disability. Anticoagulants are used for preventing or reducing blood clot formation and treatment of other related thrombotic disorders. Vitamin K antagonists (VKA) were developed more than 60 years ago. Warfarin is the most commonly used VKA. The drawbacks of vitamin K antagonists were that it requires frequent monitoring and dose adjustments, food and drug interactions, narrow therapeutic range, diet restrictions. For the past 15 years, various new drugs have been introduced to overcome the disadvantages of vitamin K antagonists. In 2008, a new group of anticoagulants were introduced. They are known as novel anticoagulants (NOAC) or direct oral anticoagulants. They include dabigatran, apixaban, rivaroxaban and edoxaban. The major issue with NOAC is difficulty in monitoring the dose. A literature search was done on this topic. It is very important for the dentists to know the bleeding complications in patients under anticoagulant therapy. The dental treatment of patients who tend to have an increased risk of bleeding due to the use of anticoagulants and / or antiplatelet drugs raises a challenge in the daily practice of dental professionals. According to current evidence, there is no significant difference in postoperative bleeding between novel anticoagulants and vitamin K antagonists. The risk of thromboembolic events on stopping the anticoagulants should be assessed. Local haemostatic measures are shown to suffice to control possible bleeding secondary to dental treatments. KEY WORDS Anticoagulants; Apixaban; Dabigatran; Dentistry; Edoxaban; Rivaroxaban.

Tek testise sahip genç hastada akut testiküler ven trombozu: nadir bir ürolojik acil

Acute scrotal pain due to testicular vein thrombosis is a rare condition. Thrombosis is defined as clot formation within the blood vessels and as a result, it interrupts the blood supply of the peripheral organs. In routine urology practice, the incidence of thromboembolic diseases is &lt;1%, and it is mostly encountered in patients at the postoperative period. Nevertheless, testicular vein thrombosis should also be remembered in the differential diagnosis of patients admitted to the emergency department due to acute scrotum. In general, conservative treatment is the first choice in treatment management, but surgical intervention may also be required in some cases. Since the available data on this subject are based on the information obtained from case reports, a standard treatment approach should be developed by examining the current treatment methods. We aim to present the case report of testicular vein thrombosis in the light of the literature, which is one of the rarely seen emergencies of urology. Keywords: acute pain; color doppler ultrasonography; venous thrombosis; testicular diseases

Percutaneous Mechanical Pulmonary Thrombectomy in a Patient With Pulmonary Embolism as a First Presentation of COVID-19

There has been a high incidence of thromboembolic diseases in patients with coronavirus disease 2019 (COVID-19) pneumonia. We present a case of a healthy 32-year-old male with no past medical history who presented with shortness of breath, tested positive for COVID-19, and was found to have a large acute saddle pulmonary embolism.

Incidence of Thromboembolic Disease in Hereditary Hemorrhagic Telangiectasia (Osler Weber Rendu Syndrome)

▪The Hereditary Hemorrhagic Telangiectasia (HHT) is a rare autosomal dominant vascular dysplasia that affects 1-5000 individuals worldwide. Is characterized by fragile mucocutaneous telangiectasia and vascular malformations in organs such as brain, lungs, liver and the gastrointestinal tract. Nose and gastrointestinal bleeding are remarkable, leading to frequent iron deficiency anemia (IDA) or life threatening bleeding episodes. Venous thromboembolic events (VTE) in HHT are probably more frequent than general population due to high plasmatic levels of FVIII specially in clinical conditions like long time immobilization due to brain abscesses or severe anemia. Additionally, in those patients with pulmonary fistula, the thromboembolic events can produce paradoxal strokes. On the other hand, almost all HHT medical treatments usually used to treat HHT related bleeding could produce thromboembolic disease. Anticoagulation (ACO) in this bleeding condition is a challenge, nevertheless, almost 50% can tolerate it well.Objective: To report the incidence of VTE in the HHT population.Methods: Ambispective cohort of adult based on the Institutional Registry of HHT. VTE was defined as the first episode of pulmonary embolism (PE), deep venous thrombosis (VTE) or thrombosis in the fistula sac or the progression of a prior event after its first 48 hs despite anticoagulation.Result: Over 524 patients 394 adults with HHT confirmed by Curazao criteria or positive genetic test and complete data were included. There were 18 VTE events 4.6% (CI95% 2.7-6.8%), 9 DVT (2.3% IC95% 1.2-4.4%) and 3 PE (0.7% IC95% 0.13-2%). The female gender represents 72%. The median age at the event was 67 years (IIQ 25-75% 56-73).Five patients (27%) were on ACO prior to the event, mainly for atrial fibrillation, and 3(18%) suffered a previous VTE.The most frequent risk factors were recent hospitalization (44%) and iron deficiency anemia (44%), immobility (33%), recent surgery (18%), as well as cancer (5%) and recent travel (5%) patient each.Fifteen (83%) patients received ACO, 10(55%) received LMH followed by acenocumarol, 3(30%) of which had to be stopped due to nose or gastrointestinal bleeding.In 5 (27%) a cava vein filter were inserted, of which 3 are under anticoagulation therapy.Conclusion: VTE incidence in our study was significantly higher than reported in general population at similar age. However, the inclusion of more symptomatic and serious HHT patients could be selection bias. The low number of patients, may influence the results. IDA and hospitalization were the most important associated conditions. Most patients tolerated well the anticoagulation therapy. DisclosuresNo relevant conflicts of interest to declare.

Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation therapy.

To investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT), while accounting for known TED risk factors. We assessed TED risk for 42 263 men with PCa who were receiving ADT compared with a matched cohort of 190 930 without PCa. The associations between ADT and deep vein thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models, while accounting for previous PCa-related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy. Between 1997 and 2013, 11 242 men with PCa received anti-androgen monotherapy, 26 959 men received gonadotropin-releasing hormone (GnRH) agonists, 1 091 men received combined androgen blockade and 3 789 men underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men had a higher risk of TED than the comparison cohort: hazard ratios (HRs) 1.67 (95% confidence interval [CI] 1.40-1.98) and 1.61 (95% CI 1.15-2.28), respectively. Men on anti-androgen monotherapy had a lower risk: HR for DVT 0.49 (95% CI 0.33-0.74). TED risk was highest among those who switched from anti-androgen to GnRH agonists: HR for PE 2.55 (95% CI 1.76-3.70). This increased from 2.52 (95% CI 1.54-4.12) in year 1, to 4.05 (95% CI 2.51-6.55) in year 2. The incidence of TED among men on ADT increased with the duration of therapy and the risk was highest for those who switched regimen, suggesting that disease progression as well as ADT contribute to the propagation of TED risk. Nonetheless, these findings support the hypothesis that only men with a relevant indication should receive systemic ADT.

Urological surgery in elderly patients: results and complications.

PurposeOwing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.MethodsThe authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.ResultsThe median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22%) complications were recorded. The most serious were as follows: one patient (<0.5%) died; and four (<2%) patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.ConclusionSurgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease.

A Reproducible Venous Thrombosis Model in Horses Induced by the Combination of an Endothelial Lesion and Blood Flow Stasis

Because of the high incidence of thromboembolic diseases in humans, experimental models of thrombosis have been widely developed in different animal species. The pathogenesis of thrombosis is associated with three components, first outlined by Virchow in 1856: vessel injury, stasis, and hypercoagulability. Based on this concept, the purpose of the present investigation was to create an innovative model of jugular thrombophlebitis in horses that included components of Virchow's triad and excluded surgical procedures. Eighteen horses were subjected to blood vessel injury through the coadministration of sclerosing agents (glucose and ethanolamine oleate) and transitory occlusion of the jugular flow by manual compression. Thrombus formation was followed by ultrasonography imaging, and all horses developed jugular thrombophlebitis, showing that the proposed model was effective. Once occlusive thrombophlebitis was induced, jugular venous pressure cranial to the lesion was evaluated and yielded increased values, suggesting cephalic hypertension. Biochemical tests were performed to verify hepatotoxicity and nephrotoxicity after the ethanolamine injection, but no abnormalities were observed. Five horses were then euthanized to evaluate the vascular, hepatic, and renal tissues. The jugular vein wall had increased thickness, inflammatory cell influx, endothelial destruction, and thrombus firmly adhered to the vessel intima. Histological evaluation of the hepatic and renal tissues was normal. The present thrombophlebitis model in the jugular vein of the horse is simple and reproducible, providing a useful tool for investigating acute and chronic venous thrombosis because the model allows evaluation of different aspects of the prevention, pathogenesis, and treatment of this disease.

Tranexamic Acid Leads to Low Incidence of Thromboembolic Disease After Primary Total Hip and Knee Arthroplasty

Tranexamic Acid Leads to Low Incidence of Thromboembolic Disease After Primary Total Hip and Knee Arthroplasty

Deep Venous Thrombosis and Pulmonary Embolism as Rare Complications After Hallux Valgus Surgery

The incidence and life-threatening complications of thromboembolic disease after major orthopedic surgical procedures have been extensively defined in the medical literature. However, there are few studies concerning the incidence of thromboembolic disease after foot and ankle surgery. We describe a 57-year-old female patient who underwent surgery for bilateral hallux valgus deformities and was diagnosed as having deep venous thrombosis and pulmonary embolism after the surgery despite early mobilization and mechanical prohylaxis. Her preoperative physical examination revealed varicose veins in both cruris. She was treated for pulmonary embolism with low-molecular-weight heparin and an oral anticoagulant in the postoperative period. Although venous thromboembolism is more commonly described after proximal lower-extremity procedures, it can occur after foot and ankle surgery, particularly if the patient has certain risk factors. Therefore, in addition to mechanical prophylaxis, pharmacologic prophylaxis should be kept in mind in such patients.

Antithrombotic effect of repeated doses of the ethanolic extract of local olive (Olea europaea L.) leaves in rabbits

The incidence of thromboembolic diseases is increasing, and they are a major cause of mortality and morbidity worldwide. Mediterranean diet is known for its high content of olive products, especially olive oil, which has known cardiovascular health benefits, including those on blood pressure, cholesterol level, and thrombogenesis. All previous animal and clinical studies investigating the beneficial antithrombotic effects of olives have focused on olive oil and a few on olive leaves (OLEs). In this study, the ethanolic extract of OLE was evaluated for its antithrombotic activity in the rabbit model of thrombosis induced by ligature of the vena cava and intravenous administration of tissue thromboplastin. Pre-treatment with 100 or 200 mg/kg per day of the ethanolic extract for 8 weeks significantly prolonged the prothrombin time (PT) in comparison to the control group (12.10±0.35 sec and 14.38±0.29 sec vs. 10.8±0.32 sec, p<0.05 and 0.001, respectively). In comparison to the control group, the same doses had no statistically significant effect on thrombus weight (16.85±0.67 mg, 16.32±0.35 mg, and 17.81±0.75 mg; p=0.18 and 0.06) or on activated partial thromboplastin time (APTT) (19.17±0.33 sec, 19.12±0.73 sec, and 18.97±0.41 sec; p=0.36 and 0.43, respectively). One important finding in this study concerns thrombus morphology. In the extract treatment groups, the thrombus was filament-like and did not adhere to blood vessel walls, whereas in the control group the thrombus was thick and almost completely occluded the vein. Therefore, these results suggest that OLE ethanolic extract can modify the extrinsic coagulation pathway as evidenced by the prolongation of PT and changes in thrombus morphology, enough to justify further research to evaluate its possible antithrombotic effects.

Anticoagulant and Fibrinolytic Drugs Possible Agents in Treatment of Lung Cancer?

The effect of anticoagulant adjuvant anti-tumor therapy depends on the cancer type and stage and on the type of the used anticoagulant drug. A striking response rate was described in experiments involving human patients with lung cancer. The aim of this study is to review anticoagulant and fibrinolytic drugs as antitumor agents with focus on their clinical use. The first part of the review evaluates the results of clinical studies. The results of early clinical research are promising and observations suggest novel approaches to the experimental therapy of lung cancer. The second part of the review shortly describes the problem of thrombosis in patients with lung cancer (incidence of thromboembolic disease and its pathogenesis). The third part briefly describes the antimetastatic and antitumor attributes of anticoagulants and fibrinolytics.

Thromboprophylaxis in spinal surgery: a survey.

BackgroundVenous Thromboembolism (VTE) is the most common complication following major joint surgery. While attention has been focused upon the incidence of thromboembolic disease following total hip or knee arthroplasty or emergency surgery for hip fracture, there exists a gap in the medical literature examining the incidence of VTE in spinal surgery. Evidence suggests that the prevalence of DVT after spinal surgery is higher than generally recognized but with a shortage of epidemiological data, guidelines for optimal prophylaxis are limited. This survey, of individuals attending the 2009 British Association of Spinal Surgeons Annual Meeting, sought to examine prevailing trends in VTE thromboprophylaxis in spinal surgery, adherence to guideline outlined by the National Institute for Health and Clinical Excellence (NICE) and to compare selections made by orthopaedic and neurosurgeons.MethodsWe developed a questionnaire with eight clinical scenarios. Participants were asked to supply details on their specialty and to select which method(s) of thromboprophylaxis they would employ for each scenario. Chi squared analysis was used for statistical comparison of the questionnaire responses.Results73% of neurosurgical respondents' and 31% of orthopaedic surgeons employed low molecular weight heparin (p < 0.001). Neurosurgeons also selected anti-embolism stockings more frequently (79% v 50%) while orthopaedic surgeons preferred mechanical prophylaxis (26% v 9%). There was no significant difference between trauma and non-trauma scenarios (p = 0.05).ConclusionThere is no clear consensus in thromboprophylaxis in spinal surgery. There was a significant difference in selections across surgical disciplines with neurosurgeons more closely adhering to national guidelines. Further research examining the epidemiology of venous thromboembolism in spinal surgery and the risks-benefit relationship of thromboprophylaxis is warranted.

FondaKIDS: A prospective pharmacokinetic and safety study of fondaparinux in children between 1 and 18 years of age

The incidence of thromboembolic disease is increasing in children. New anticoagulants have been licensed in adults and need to be studied in children. This report describes the first prospective study of fondaparinux in children. The purpose of the study was to determine the dosing, pharmacokinetics, and safety of fondaparinux in children with deep vein thrombosis (DVT) or heparin-induced thrombocytopenia (HIT). Hospitalized children between 1 and 18 years of age with DVT or HIT received fondaparinux 0.1 mg/kg once daily. Fondaparinux-based anti-factor Xa levels were assessed at 2, 4, 12, and 24 hr following the first dose, and peak levels were measured twice weekly thereafter. Detailed pharmacokinetic analyses were performed. Twenty four subjects in 3 age cohorts were enrolled and completed the study. Pharmacokinetic modeling demonstrated that a once-daily dose of fondaparinux at 0.1 mg/kg resulted in similar concentrations known to be efficacious in adults. Safety was demonstrated with only two bleeding events: one which may have pre-dated study drug administration and one which led only to temporary discontinuation of study drug. Dosing of fondaparinux at 0.1 mg/kg once daily in children resulted in PK profiles comparable to those in adults receiving standard dosing. Fondaparinux can be considered an attractive alternative to LMWH given its once-daily dosing, acceptable safety data, and other favorable properties.

Prolonged use of thromboprophylaxis may not be necessary in laparoscopic colorectal surgery

Patients undergoing colorectal resections are considered high risk for developing thromboembolic disease. We postulate, however, that the rapid recovery and swift mobilization after laparoscopic resections reduce this risk and that these patients therefore do not need prolonged thromboprophylaxis. This hypothesis was tested in this paper. All patients who underwent laparoscopic colorectal surgery in our Colorectal Surgical Unit in the period from June 1991 until January 2010 were entered into a prospective database. The entire database was reviewed, and incidence of thromboembolic disease and significant bleeding complications were noted. Three thousand, three hundred sixty-four patients were laparoscopically operated on for colorectal disease and were entered in the database. Two thousand, one hundred twenty-seven patients were operated on for benign disease; 1,230, for colorectal cancer, and four, for other malignancies. Two deep venous thromboses were encountered (0.059%), and ten patients had pulmonary embolism (0.30%). The combined venous thromboembolism (VTE) risk for the overall group of patients undergoing laparoscopic colorectal operations is 0.36%. The combined VTE risk was 0.57% (7/1,230) in patients with colorectal cancer and 0.24% (5/2,127) in patients with benign disease (p = 0.118). Bleeding complications occurred in 44 patients (1.3%). In our group, the combined VTE risk for the overall group of patients undergoing laparoscopic colorectal operations is 0.36%. Therefore, we postulate that the prolonged use of thromboprophylaxis is not indicated in the vast majority of patients undergoing laparoscopic colorectal surgery. In particular, patients undergoing laparoscopic resections for benign disease and without other risk factors have such a low VTE risk that prolonged prophylaxis is probably not warranted.

103 A SUCCESSFUL MANAGEMENT OF A PATIENT WITH SUBCLAVIAN VEIN THROMBOSIS AFTER IVF

The incidence of thromboembolic disease associated with the assisted reproductive techniques is considered to be rare. The aim of the report is to present a case of successful management of woman with subclavian vein thrombosis after IVF and embryo transfer. A 29-year-old smoking woman was refered to our programme for IVF and ICSI because of infertility associated with the male factor. Her past medical history didn’t report any serious disease. The treatment procedure consisted of a long protocol included administration of Diferelinum and Gonal F 75U/day. After 10 days of stimulation she received 6000 IU of hCG. At that point there were 16 follicles between 18 20mm in diameter. Oocyte recovery took place 36 hours later. 14 oocytes were collected and 9 were mature and underwent ICSI resulting in 6 embryos. Three embryos were transferred to the uterus 3 days later and three embryos were frozen. A dose of 40mg Dufaston per os, 600mg Utrozestan per vaginum and 1500U Pregnil in a day were given for luteal phase support. One day before embryo transfer the patent complained of slight shortness of breath, flatulence. Haematocrit was normal, ovaries were moderately enlarged at 85× 54 and 77x53mm. A diagnosis of moderate ovarian hyperstimulation syndrome was made and intravenous hydratation with HAES-sterile was administered. In two weeks triplets pregnancy was diagnosed. At 5th week of gestation (w.g.) the patient experienced pain and swelling of left arm and neck. Ultrasonography revealed thrombus in left internal jugular, subclavian and brachiocephalic veins. The patient started low molecular weight heparin (LMWH) and remained on therapeutic doses of LMWH until postpartum. Thrombophilia work-up (antiphospholipid antibody, lupus anticoagulant, total homocysteine, proteins C, S, antithrombin III, plasminogen, prothrombin G20210A, factor V Leiden and methyleneteterahydrofolatreductase (MTHFR) C677T) revealed high titer of antib2-GPI IgM (twice 14 weeks apart) and homozygosity for MTHFR C677T. At 11w.g. the patient passed prenatal ultrasound screening for Dawn syndrome and reduction of one fetus of triplets was made by method of Berkovich at 11 weeks of gestation. The procedure of reduction was simple. Patient’s pregnancy course was otherwise uncomplicated. Patient delivered female twins with Apgar 6 7 weighing 2200 and 1900 g via caesarian section at 37w.g. The pregnancy was ended via caesarian section at 37w.g. Female twins were born with Apgar 6 7 weighing 2200 and 1900. This case illustrates serious complication of assisted reproductive treatment. Early recognition and treatment of OHSS and thrombophilia is critical for prevention and effective therapy of thromboembolic complications in patients undergoing ovarian stimulation. 104 CLINICAL SIGNIFICANCE OF HIDDEN THROMBOPHILIA BEFORE IN VITRO FERTILIZATION AND EMBRYO TRANSFER A.M. Harutyunyan, Zh.K. Isentayeva. Moscow Centre of Urology, Andrology and Reproductive Gynecology, Moscow, Russia

A comparison of regional and general anaesthesia for total replacement of the hip or knee

We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included. We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) -0.19; 95% confidence interval (CI) -0.33 to -0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80). Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement.