Incidence Of Thromboembolism Research Articles

The Incidence of Venous Thromboembolism (VTE) Using the Caprini Risk Assessment Model in Breast Reconstruction: An Analysis of the NSQIP Database

The Incidence of Venous Thromboembolism (VTE) Using the Caprini Risk Assessment Model in Breast Reconstruction: An Analysis of the NSQIP Database

Safety and efficacy of apixaban vs. enoxaparin in thromboprophylaxis after spinal stenosis and degenerative spine surgery

IntroductionDegenerative spine surgeries often require postoperative immobilization or reduced mobility, predisposing patients to the formation of thrombosis and higher risk of thromboembolic complications. Despite the significance of this issue, there remains a lack of consensus on the optimal anticoagulant agent for postoperative thromboprophylaxis in spinal stenosis and degenerative spine surgeries. Low molecular weight heparins and direct Xa inhibitors represent two anticoagulant groups with high chemoprophylactic potential. MethodsThis study included a prospective cohort of patients undergoing posterior decompressive surgery with or without instrumentation for degenerative spine disease and/or spinal stenosis. Patients receiving postoperative prophylactic Enoxaparin and Apixaban were selected to evaluate the rate of complications, as assessed by Clavien-Dindo classification, thromboembolic events, and 30-day mortality, readmission, and reoperation rate between the two anticoagulants. Results130 patients were included in the analysis. 65 patients received Apixaban and Enoxaparin in each group. Mean age of the participants was 57.6±11.0. 83.1% underwent laminectomy and posterior spinal fusion, while 22 patients underwent decompressive surgery only. The incidence of venous thromboembolism (P-value=0.403), deep vein thrombosis (p-value=0.999), hematoma formation (p-value=0.403), surgical site infection (p-value=0.901), readmission (p-value=0.545), reoperation (p=0.510), mortality (p=0.648), and complications rate (p-value=0.232) were not statistically different between Enoxaparin and Apixaban. DiscussionBoth Apixaban and Enoxaparin may be viable options for postoperative thromboprophylaxis in spine surgeries with comparable efficacy and safety profile. Future research endeavors should investigate the efficacy of these agents in comparison to placebo in a randomized setting.

Incidence and influence factors of venous thromboembolism in traumatic rib fracture patient: a multicenter study

BackgroundThis study aimed to determine the incidence and influencing factors of venous thromboembolism (VTE) in patients with traumatic rib fractures.MethodsThe retrospective study analyzed medical records of patients with traumatic rib fractures from 33 hospitals.ResultsThe overall incidence of VTE in hospitalized patients with traumatic rib fractures was 8.1%. Patients with isolated traumatic rib fractures had a significantly lower incidence of VTE (4.4%) compared to patients with rib fractures combined with other injuries (12.0%). Multivariate analysis identified the number of rib fractures as an independent risk factor for thrombosis. Surgical stabilization of isolated rib fractures involving three or more ribs was associated with a lower VTE incidence compared to conservative treatment.ConclusionsPatients with rib fractures have a higher incidence of VTE, positively correlated with the number of rib fractures. However, the occurrence of thrombosis is relatively low in isolated rib fractures. Targeted thromboprophylaxis strategies should be implemented for these patients, and surgical stabilization of rib fractures may be beneficial in reducing the risk of VTE.

Incidence and risk factors of venous thromboembolism in neurosurgical patients after implementing a screening protocol; a retrospective cohort study of a tertiary center

Introduction: Venous thromboembolism (VTE) is a common complication in neurosurgical procedures both before and after surgery. Objective: To examine the incidence of venous thromboembolism (VTE) in neurosurgical patients before surgery and in the postoperative period after implementing a VTE prophylaxis protocol. We also aimed to determine VTE risk factors. Methods: We conducted a retrospective cohort study examining 200 patients admitted to the hospital for cranial and spine neurosurgical procedures between January 2020 and October 2021. All patients were screened for VTE using a protocol combining measurement of D-dimer level and venous duplex ultrasonography. Patients who screened negative for VTE were evaluated for VTE risk using the Caprini risk assessment model; those with Caprini score ≥3 (indicating moderate-to-high risk) received VTE prophylaxis using intermittent pneumatic compression devices. Results: Preoperative screening demonstrated DVT in seven of 200 patients (3.5%). All DVTs were asymptomatic and proximal in location. Univariate logistic regression showed that stroke, neurodegenerative disease, and confinement to bed for more than 72 hours were significant predictors of preoperative DVT. Among the patients without DVT on preoperative screening, 179 (93%) had a Caprini score ≥3; intermittent pneumatic compression was used for prophylaxis in 173 of these (96.6%). Incidence of postoperative VTE was 2.6% (5/193). Extended length of hospital stay, postoperative hydrocephalus, and infection were significant risk factors for VTE. Conclusion: Preoperative VTE screening using D-dimer level and V-DUS and implementation of VTE prophylaxis using IPC can reduce the incidence of VTE and VTE-related mortality in neurosurgical patients.

(389) Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin

Abstract Introduction Patients undergoing inflatable penile prosthetic (IPP) surgery are generally at a higher risk for cardiovascular (CV) complications such as venous thromboembolism (VTE) following surgery, due to pre-existing comorbidities, such as age, obesity, smoking status, and vascular disease, which are associated with erectile dysfunction (ED). The use of perioperative subcutaneous heparin (SqH) along with a surgical drain was shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively and this is an unaddressed area of perioperative IPP surgical management. The American Urologic Association (AUA) and European Association of Urology (EAU) perioperative VTE guidelines do not address VTE risk with IPP surgery. Objective In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain. Methods This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or revision and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, hematoma incidence, and 90-day post-operative complications were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not. Results We reviewed data for 240 patients. Of the 240, 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, no VTE was recorded in the group receiving heparin. There was no statistical difference in hematoma formation between groups (SqH 5.5% vs. non-SqH 6.2% p=.898). Hypertension prevalence was found to be higher in the SqH group (p=.045). There was no statistical significance between other comorbidities including diabetes (p=.343), average BMI (p=.078), vascular disease (p=.155), immunosuppressed status (p=.604), smoker status (p=.530), history of malignancy (p=.513), COPD (p=.084), MI (p=.820), CVA/TIA (p=.158), hyperlipidemia (p=.157), and heart failure (p=.244). Average operative time was found to be slightly higher in the non-SqH group (SqH 78.1 minutes vs. non-SqH 85.9 minutes p=.032). Caprini risk factor scores were similar (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups. 94% of the patients in this study were considered high risk for VTE (≥5 Caprini Risk factor score). Conclusions Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery. Disclosure No.

Milvexian: A Focus on a New Oral Anticoagulant that Targets Factor XIa for Thromboembolism Prophylaxis.

Drugs that target factor XI and/or XIa have been evaluated as alternatives to existing anticoagulants, in light of studies that indicate that a decrease in Factor XI/XIa levels or activity may result in a lower risk of thrombosis without a significant increase in bleeding risk. Milvexian is an investigational small-molecule factor XIa inhibitor that has recently completed phase 2 clinical trials. Preclinical studies were suggestive of its potential to prevent arterial and venous thrombosis. It was well-tolerated in healthy participants, as well as in participants with mild or moderate hepatic impairment and moderate or severe renal impairment. Notably, patients who received milvexian after knee arthroplasty had a dose-proportional lower incidence of venous thromboembolism compared to patients who received postoperative enoxaparin, and they had a lower incidence of clinically relevant bleeding. A separate phase 2 trial was conducted that assessed the use of milvexian for secondary stroke prevention in patients who had ischemic stroke or transient ischemic attack. It failed its primary objective of establishing a dose-response relationship between milvexian and a composite endpoint of symptomatic ischemic stroke or covert brain infarction. The trial did, however, show a reduction in the relative risk of symptomatic ischemic stroke across most of the treatment groups receiving various dosages of milvexian compared to placebo. The efficacy of milvexian in secondary stroke prevention will be further assessed in an upcoming phase 3 trial. Additional upcoming phase 3 trials will also assess its efficacy in stroke prevention in patients with atrial fibrillation as well as in event reduction in patients with acute coronary syndrome.

Abstract WP237: Anticoagulant Utilization and Risk of Thromboembolic Events Following Ischemic Stroke Among Adults With Cancer

Rationale: Ischemic stroke and cancer frequently coexist, but there are limited data from population-based cohorts regarding prevalence, risk of subsequent thromboembolic events, and treatments. Methods: We leveraged large-scale healthcare data to assess recurrent thromboembolic events in the 6 months following discharge for ischemic stroke among a nationally representative U.S. population with active cancer. Landmark analyses were undertaken with anticoagulant exposure status based on dispensations in the week following hospital discharge. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazard models with robust variance estimators to account for clustering within propensity score-matched pairs. Results: Among 86,365 adults discharged after an ischemic stroke between 10/2020-09/2021, 10.2% had active cancer. Based on eligibility criteria (including removal of those with known atrial fibrillation), 4,819 were assessed [median age 74 years; 48.7% female; common cancer types: 25.3% gastrointestinal, 20.3% prostate, 18.4% lung]. Anticoagulants were dispensed to 14.7% of the cohort in the week following discharge. Incidence of thromboembolic event recurrence was 37.5 per 100 person-years (66.7% ischemic stroke). Initial anticoagulation was associated with an increased risk of thromboembolism recurrence (aHR=1.42, 95% CI: 1.06-1.90). Conclusions: This large-scale real-world study demonstrates an estimated 10% of patients with ischemic stroke had active cancer, and they faced a very high 6-month incidence of recurrent thromboembolism. Anticoagulants were not commonly prescribed after discharge, suggesting that clinicians use them less commonly for stroke than for venous thromboembolism in cancer patients. The higher risk of recurrent events on anticoagulants likely reflects residual confounding by indication. Clinical trials are needed to further assess optimal antithrombotic strategies in this population.

Effect of combination of molnupiravir with clarithromycin on blood biomarkers in patients with mild-to-moderate COVID-19

Background: Molnupiravir is a type of medication used to treat coronavirus disease 2019 (COVID-19). However, no evidence regarding the therapeutic effect of molnupiravir combined with clarithromycin (CAM) on blood biomarkers is available. Methods: Of the 156 rehabilitation patients, 124 patients with mild-to-moderate COVID-19 were treated with molnupiravir. Among these 124 patients, 54 were treated with CAM. The remaining 28 rehabilitation patients were negative for COVID-19. Blood biomarkers were assessed after administration of molnupiravir in patients receiving molnupiravir plus CAM or molnupiravir alone. Results: Among the measured blood biomarkers, lactate dehydrogenase, potassium, white blood cells, C-reacted protein, neutron–lymphocyte ratio, fibrin degradation product, and prothrombin time–international normalized ratio values were significantly higher (P < 0.05) in the molnupiravir alone group than in the molnupiravir plus CAM group, and lymphocytes were significantly lower (P < 0.05) on day 5 after admission. In the molnupiravir plus CAM group, immunoglobulin (Ig) A levels increased and soluble interleukin 2-receptor levels (sIL2R) decreased (P < 0.05) on day 14 after admission. In addition, COVID-19-negative patients had higher IgA levels and lower sIL2R levels compared to infected patients (P < 0.05). The concomitant administration of molnupiravir plus CAM resulted in fewer sequelae after 12 months, and the incidence of venous thromboembolism was significantly reduced (P < 0.05). Conclusion: In patients with mild-to-moderate COVID-19, concomitant administration of molnupiravir plus CAM showed several non-worsening blood biomarkers, elevated immune activity, and reduced post-infection sequelae. Relevance for Patients: After administration of molnupiravir to patients with mild-to-moderate COVID-19, administration of CAM to patients suffering from secondary macrolide-sensitive bacterial infection was compared with administration of molnupiravir alone. D-dimer, IgA, and sIL2R are potential predictive factors of disease severity in critically ill patients with COVID-19.

Effectiveness and cost effectiveness of pharmacological thromboprophylaxis for medical inpatients: decision analysis modelling study

ObjectiveTo determine the balance of costs, risks, and benefits for different thromboprophylaxis strategies for medical patients during hospital admission.DesignDecision analysis modelling study.SettingNHS hospitals in England.PopulationEligible adult medical inpatients, excluding patients...

Cardiovascular disease in transgender people: a systematic review and meta-analysis.

Hormone therapy in transgender people might be associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate whether the risk of CVD is increased in transgender people compared with people of the same birth sex. PubMed, Cochrane, Embase, and Google Scholar were searched until July 2022. Studies evaluating cardiovascular events in transgender women or men were included. Primary outcomes were stroke, myocardial infarction (MI), and venous thromboembolism (VTE). The risk for transgender women versus cisgender men and for transgender men versus cisgender women was analysed through random-effects meta-analysis. Twenty-two studies involving 19 893 transgender women, 14 840 transgender men, 371 547 cisgender men, and 434 700 cisgender women were included. The meta-analysis included 10 studies (79% of transgender women and 76% of transgender men). In transgender women, incidence of stroke was 1.8%, which is 1.3 (95% confidence interval [CI], 1.0-1.8) times higher than in cisgender men. Incidence of MI was 1.2%, with a pooled relative risk of 1.0 (95% CI, 0.8-1.2). Venous thromboembolism incidence was 1.6%, which is 2.2 (95% CI, 1.1-4.5) times higher. Stroke occurred in 0.8% of transgender men, which is 1.3 (95% CI, 1.0-1.6) times higher compared with cisgender women. Incidence of MI was 0.6%, with a pooled relative risk of 1.7 (95% CI, 0.8-3.6). For VTE, this was 0.7%, being 1.4 (95% CI, 1.0-2.0) times higher. Transgender people have a 40% higher risk of CVD compared with cisgender people of the same birth sex. This emphasizes the importance of cardiovascular risk management. Future studies should assess the potential influence of socio-economic and lifestyle factors.

Validating the safety of low-dose CTPA in pregnancy: results from the OPTICA (Optimised CT Pulmonary Angiography in Pregnancy) Study.

Pulmonary embolism (PE) is a leading cause of pregnancy-related mortality. CT pulmonary angiogram (CTPA) is the first-line advanced imaging modality for suspected PE in pregnancy at institutes offering low-dose techniques; however, a protocol balancing safety with low dose remains undefined. The wide range of CTPA doses reported in pregnancy suggests a lack of confidence in implementing low-dose techniques in this group. To define and validate the safety, radiation dose and image quality of a low-dose CTPA protocol optimised for pregnancy. The OPTICA study is a prospective observational study. Pregnant study participants with suspected PE underwent the same CTPA protocol between May 2018 and February 2022. The primary outcome, CTPA safety, was judged by the reference standard; the 3-month incidence of venous thromboembolism (VTE) in study participants with a negative index CTPA. Secondary outcomes defined radiation dose and image quality. Absorbed breast, maternal effective and fetal doses were estimated by Monte-Carlo simulation on gestation-matched phantoms. Image quality was assessed by signal-to-noise and contrast-to-noise ratios and a Likert score for pulmonary arterial enhancement. A total of 116 CTPAs were performed in 113 pregnant women of which 16 CTPAs were excluded. PE was diagnosed on 1 CTPA and out-ruled in 99. The incidence of recurrent symptomatic VTE was 0.0% (one-sided 95% CI, 2.66%) at follow-up. The mean absorbed breast dose was 2.9 ± 2.1mGy, uterine/fetal dose was 0.1 ± 0.2mGy and maternal effective dose was 1.4 ± 0.9mSv. Signal-to-noise ratio (SNR) was 11.9 ± 3.7. Contrast-to-noise ratio (CNR) was 10.4 ± 3.5. The OPTICA CTPA protocol safely excluded PE in pregnant women across all trimesters, with low fetal and maternal radiation. OPTICA (Optimised CT Pulmonary Angiography in Pregnancy) is the first prospective study to define the achievable radiation dose, image-quality and safety of a low-dose CT pulmonary angiogram protocol optimised for pregnancy (NCT04179487). It provides the current benchmark for safe and achievable CT pulmonary angiogram doses in the pregnant population. • Despite the increased use of CT pulmonary angiogram in pregnancy, an optimised low-dose protocol has not been defined and reported doses in pregnancy continue to vary widely. • The OPTICA (Optimised CT Pulmonary Angiography in Pregnancy) study prospectively defines the achievable dose, image quality and safety of a low-dose CT pulmonary angiogram protocol using widely available technology. • OPTICA provides a benchmark for safe and achievable CT pulmonary angiogram doses in the pregnant population.

P1137 Long-term trend of cumulative incidence of venous thromboembolism in Korean patients with inflammatory bowel disease: A nationwide population-based cohort study

Abstract Background Venous thromboembolism (VTE) is a serious extraintestinal manifestation of inflammatory bowel disease (IBD). However, limited research has been conducted on the cumulative incidence of VTE in patients with IBD. Therefore, this study aimed to observe the trend of cumulative incidence of VTE after IBD diagnosis. Methods From 2005 to 2016, a population-based cohort study was conducted using health administration claims data from South Korea. IBD and VTE were defined by ICD-10 codes. Incidence density and cumulative incidence rate were analysed. The risk of variables including age, sex, and IBD subtype was comparatively analysed. Results A total of 35,508 newly diagnosed patients with IBD between 2005 and 2015 were followed up until 2016. Among them, 634 (1.8%) experienced VTE (619 adults and 15 children). The incidence densities of VTE per 10,000 person-year were 28.90 (range, 27.75–32.54) for overall IBD, 30.07 (range, 27.75–32.54) for adult IBD, and 11.08 (range, 6.20–18.27) for PIBD, respectively. The cumulative incidences of VTE at 0, 1-, 3-, 5-, and 10 years post-diagnosis were 0.01%, 0.30%, 0.80%, 1.30%, and 3.0%, respectively (Figure 1-A). Adulthood, female sex, and ulcerative colitis were associated with an increased risk of VTE (Figure 1-B, C, D). Conclusion The study showed a steady and gradual increase in the cumulative incidence of VTE in patients with IBD over a follow-up period of up to 11 years, with a slightly more rapid increase after 8 or 9 years. This trend was even more pronounced in children. This suggests that vigilant monitoring of VTE is necessary in the management of patients with IBD.

Correlation between type of surgery and incidence of postoperative venous thromboembolism (VTE)

Venous thromboembolism (VTE) is a significant complication in patients after undergoing major surgery. The type of surgery is believed correlated with the incidence of VTE. This study aimed to evaluate the correlation between type of surgery and incidence of VTE among patients who underwent major surgery. It was a retrospective study conducted in Dr. Sardjito General Hospital, Yogyakarta using medical record data of patients who underwent major surgery and were diagnosed with VTE between 2016 and 2020. Patients were grouped by surgery type, and length of stay (LoS). All caused deaths were also analyzed. Among 29,120 patients who underwent major surgery, 76 (0.26%) experienced VTE with females patients accounting for 75%. The mean age of the patients was 55 yr. All VTE cases had the mean LoS of 25 d. The highest proportion of patients who experienced VTE were patients who underwent tumor removal (67.0%) followed by trauma patients (18.4%). A significant difference in the incidence of mortality between the surgical groups was reported (p = 0.02). Post-cardiology had the highest risk of mortality (OR=7.46; 95% CI: 0.322 - 172.61) while age had the lowest risk of mortality (OR=1.01; 95% CI: 0.953 - 1.071). In conclusion, surgery type is correlated with the incidence of VTE. Surgery due to cancer and trauma has a higher risk of VTE compared to the others.

Anticoagulation in cancer patients with atrial fibrillation and grade 3–4 thrombocytopenia

IntroductionAtrial fibrillation or flutter (AF) is prevalent in cancer patients. Many of these patients have an indication for anticoagulation (AC) but are also at risk for developing chemotherapy-induced thrombocytopenia. There are scarce data regarding management of AC and risk of bleeding and thrombosis in cancer patients with AF and thrombocytopenia. AimTo assess anticoagulation management and incidence of bleeding and arterial thromboembolism (ATE) in cancer patients with AF and grade 3–4 thrombocytopenia (platelets <50 × 109/L). MethodsA retrospective cohort study included adults with active cancer, grade 3–4 thrombocytopenia and AF with CHA2DS2-VASc score ≥ 1. Patients were stratified according to AC discontinuation (No-AC) or continuation (Continue-AC) when platelets dropped below 50 × 109/L and followed for 30 days. The study outcomes were ATE (ischemic stroke, transient ischemic attack or systemic emboli) and major bleeding. Cox proportional hazards model was used to calculate hazard ratios (HR) with death as a competing risk (Fine and Gray model). ResultsThe cohort included 131 patients; 90 in the No-AC group and 41 in the Continue-AC group. Patient characteristics were balanced between the groups. The 30-day cumulative incidence of ATE was 2 % [95 % CI 0.4 %–7 %] in the No-AC group and 2 % [0.2 %–11 %] in the Continue-AC group (HR 0.92 [95 % CI 0.09–9.88]). The 30-day cumulative incidence of major bleeding was 7.8 % [95 % CI 3.40 %–14.52 %] and 2.44 % [95 % CI 0.18 %–11.22 %] in the No-AC and Continue-AC groups, respectively (HR 3.29 [95 % CI 0.42–26.04]). ConclusionsThe high rate of bleeding and low rate of ATE in thrombocytopenic cancer patients with AF suggests that holding AC during time-limited periods may be a reasonable approach.

Association Between Venous Thromboembolism Prophylaxis and the Incidence of Thromboembolism Following Orthopedic Procedures: A Cross-Sectional Study.

Venous thromboembolism (VTE) is a significant concern following orthopedic procedures, necessitating effective prophylactic measures. The rates of VTE prophylaxis, however, vary widely between institutions and nations, falling between 13% and 70% on average. In the absence of adequate thromboprophylaxis, pulmonary embolism, which accounts for 5% to 10% of mortality in hospitalized patients, is one of the leading causes of death. This study investigates the relationship between VTE prophylaxis and thromboembolism incidence, considering patient characteristics, risk assessment completion, anticoagulant prescription, and weight-bearing status. To evaluate the knowledge gap by examining the relationship between VTE prevention and the prevalence of thromboembolism also to examine the anticoagulant prescription trends for patients being discharged from orthopedic operations and to investigate the connection between post-procedure weight-bearing status and the development of VTE problems. A retrospective, cross-sectional design was employed, analyzing 200 orthopedic procedure patients from January to June of 2023 performed at Rehman Medical Institute.After getting ethical approval from the institutional ethical approval board, data were collected on the basis of variables encompassing patient attributes, surgery details, VTE risk factors, prophylaxis type, and VTE complications. Data wasentered and analyzed via IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), and the data were run through various tests including descriptive statistics, cross-tabulations, and chi-square. Results were then presented in the form of a table. Among 200 individuals 24 individuals experienced VTE, while 176 did not. Significant gender-based VTE differences were observed (p = 0.01). Hypertension (HTN) showed a significant association (p = 0.04) with VTE. Major surgeries were correlated with higher VTE incidence (p = 0.03). Pharmacological prophylaxis reduced the occurrence of VTE (p = 0.01). Early mobilization and Ted stockings were correlated with lower VTE incidence (p = 0.04, p = 0.12). This study reveals gender-specific VTE differences, emphasizes the role of HTN, surgical nature, and prophylaxis in VTE incidence, and supports tailored prophylactic strategies. Our findings align with previous research and emphasize the significance of tailored prophylaxis strategies. By examining multiple factors, including gender, co-morbidities, surgical characteristics, and prophylactic methods, our study contributes to the evidence base that supports clinical decision-making and enhances patient safety in orthopedic surgery.

Von Willebrand Factor Antigen Levels Predict Poor Outcomes in Patients With Stroke and Cancer: Findings From the Multicenter, Prospective, Observational SCAN Study.

Patients with acute ischemic stroke and active cancer have more severe neurological symptoms, elevated risks of stroke recurrence, and death compared with the general population. We examined whether von Willebrand factor (vWF) antigen levels at stroke onset were associated with the poor outcomes of patients with stroke and cancer. Using data from 90 patients with acute ischemic stroke and active cancer who were registered in the SCAN (Ischemic Stroke in Patients With Cancer and Neoplasia) study, a prospective multicenter, observational study in Japan, we divided patients into 2 groups according to their median vWF antigen levels (high, n=46; or low, n=44). The high-vWF group had a significantly higher initial National Institutes of Health Stroke Scale score (median, 7 [interquartile range, 3-11.25] versus 3 [interquartile range, 1-8.5]; P<0.05) and a significantly higher incidence of cryptogenic stroke (32 [70%] versus 16 [36%]; P<0.01) and venous thromboembolism (7 [15%] versus 0 [0%]; P<0.01), as well as multiple lesions (28 [62%] versus 12 [27%]; P<0.001), than the low-vWF group. We observed no significant difference in the rate of stroke recurrence within 1 year between the groups. However, increased vWF levels were an independent predictor of death within 1 year of stroke onset, after adjusting for potential confounders (odds ratio, 6.77 [95% CI, 1.49-30.78]; P<0.05). Elevated vWF antigen levels were associated with adverse outcomes in patients with cancer-associated stroke and may represent a useful biomarker to guide future therapeutic interventions.

Incidence and Time Course of Symptomatic Thromboembolic Outcomes After Lower Extremity Arthroscopic Surgery, Ankle Fracture Surgery, and Achilles Tendon Repair.

The incidence and time course of acute venous thromboembolism (VTE) after ambulatory surgery for lower extremity orthopaedic conditions is not well-defined. The purpose of this study was to analyze the incidence, the time course, and risk factors associated with clinically diagnosed acute deep vein thrombosis or pulmonary embolism within 3 months of surgery in patients undergoing specific operations for lower extremity injuries. Patients undergoing arthroscopic procedures of the knee, ankle fracture surgery, Achilles tendon repair, and ankle arthroscopy from January 1, 2005, to December 31, 2010, were identified in the California Ambulatory Surgery database with linkage to hospital discharge data, emergency department data, and a death registry. Outcomes were acute VTE and death within 90 days. Time courses were compared using Kaplan-Meier analysis, and risk factors were analyzed using proportional hazard modeling. Analysis of data from 468,699 surgeries showed that the cumulative incidence of acute VTE was significantly higher after Achilles tendon repair (0.72%, P < 0.001) than ankle fracture surgery (0.33%), knee arthroscopy procedures (range, 0.29% to 0.41%), or ankle arthroscopy (0.24%). The time course of diagnosis of VTE was similar for all arthroscopic procedures (median postoperative day for diagnosis = 9 to 10; 80% by 22 to 36 days), whereas for Achilles tendon surgery, the time course was protracted (median postoperative day for diagnosis = 29 days; 80% by 51 days). Ninety-day mortality was low (<0.06%) after all procedures except ankle fracture (0.12%). Predictors of pulmonary embolism included age older than 60 years (HR, 3.1; 95% CI; 2.0 to 4.8, versus younger than 30 years), Achilles tendon repair (HR, 3.8; 95% CI; 2.8 to 5.3), and ankle fracture surgery (Hazard Ratio [HR], 2.1; 95% Confidence Interval [CI]; 1.5 to 2.8); Asian/Pacific Islander (HR, 0.3; 95% CI; 0.1 to 0.6) and Hispanic patients (HR, 0.5; 95% CI; 0.4 to 0.7) had significantly lower risk. The incidence and time course of onset of acute VTE after lower extremity orthopaedic surgeries varies significantly depending on the surgical procedure. These findings have implications regarding the use and duration of pharmacologic thromboprophylaxis.

Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin

Background/Objective: Patients undergoing inflatable penile prosthetic (IPP) surgery are at an increased risk for cardiovascular complications such as venous thromboembolism (VTE) following surgery due to pre-existing comorbidities associated with erectile dysfunction. The use of perioperative subcutaneous heparin (SqH) along with a surgical drain has been shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively. In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain.&#x0D; Methods: This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or explant and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, and 90-day postoperative complications, including hematoma formation, were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not.&#x0D; Results: We reviewed data for 240 patients; 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, and no VTE was recorded in the group receiving SqH. There was no statistical significance in hematoma formation betweengroups (SqH 5.5% vs. non-SqH 6.2% p=.898). Beyond hypertension prevalence (SqH 74.8% vs. non-SqH 62.8% p=.045), there was no difference between comorbidities or Caprini risk factor scores (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups (Table 1). 94% of thepatients in this study were considered high risk for VTE.&#x0D; Conclusions: Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.

COVID-19 and Antipsychotic Therapy: Unraveling the Thrombosis Risk.

In the context of the COVID-19 pandemic, this study investigates the potential correlation between the increased use of antipsychotic medications and the rising incidence of venous thromboembolism (VTE). As psychiatric disorders surged, the consequential escalation in antipsychotic drug use raised concerns about thrombotic risks. We conducted a comprehensive literature review using PubMed, focusing on articles that intersected COVID-19, antipsychotic medication, and thrombosis. This approach allowed for a nuanced examination of the historical and recent data on antipsychotic drugs and their association with thrombotic events. Our findings reveal a notable link between the use of antipsychotic medications, particularly second-generation antipsychotics, and an increased risk of VTE, including pulmonary embolism and deep vein thrombosis. This association was evident, despite variations in study designs and populations. The study underscores the need for cautious medication management in psychiatric care, especially during pandemic conditions like COVID-19, to mitigate thrombotic risks. It advocates a personalized approach to prescribing antipsychotics, considering individual patient factors and comorbidities, to balance the benefits against potential thrombotic complications.

Low Dietary Manganese and the Incidence of Venous Thromboembolism: Evidence for Minerals and Vitamins and the Other Comorbidities Linked to Venous Thromboembolism.

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