Increased Risk Of PE Research Articles

Below the knee, let it be: Management of calf DVT in hospitalized trauma patients

IntroductionManagement of below-knee DVT (BKDVT) in trauma patients is uncertain. We hypothesized that BKDVT can be managed with observation only. MethodsSecondary analysis on trauma inpatients March 2017–September 2019 with risk assessment profile ≥5. Management of BKDVT included observation with ultrasound. BKDVT was compared to above-knee DVT (AKDVT), and BKDVT with progression to AKDVT/PE compared to no progression. ResultsOf 1988 patients, 136 (6.8%) BKDVT and 23 (1.2%) AKDVT. 7 (6.9%) BKDVT progressed to AKDVT/PE. 6.9% had BKDVT progression, associated with higher ISS (36.7 vs 21.6, p ​= ​0.005), longer prophylaxis delay (121 vs 45 ​h, p ​= ​0.02) and longer hospital LOS (25.6 vs 7.8, p ​= ​0.01). None experienced post-thrombotic syndrome. ConclusionMajority of BKDVT in hospitalized trauma patients did not progress to AKDVT. Observation for progression, rather than treatment, was not associated with increased PE risk or thrombotic sequelae. Observation with serial ultrasound may serve as a practical alternative to anticoagulation in trauma patients with BKDVT.

Use of Low Dos Aspirin in Women with Increased Risk of Preeclampsia

Introduction: The role of aspirin in the primary or secondary prevention of preeclampsia has beenthe subject of numerous studies and great controversy. Our aim reports on LDA usage rates bywomen with an increased PE risk, as well as on determinants and reasons given for use and non‐use. Material and Method: In this multicenter, double-blind, placebo-controlled trial, the currentstudy randomly assigned 2100 women with singleton pregnancies who were at high risk for pretermpreeclampsia to receive aspirin, at a dose of 150 mg per day, or placebo from 11 to 14 weeks ofgestation until 36 weeks of gestation. The primary outcome was delivery with preeclampsia before37 weeks of gestation. The analysis was performed according to the intention-to-treat principle.Results: Preterm preeclampsia occurred in 13 participants (1.6%) in the aspirin group, as comparedwith 35 (4.3%) in the placebo group (odds ratio in the aspirin group, 0.38; 95% confidence interval,0.20 to 0.74; P=0.004). Results were materially unchanged in a sensitivity analysis that took intoaccount participants who had withdrawn or were lost to follow-up. Conclusion: This randomizedtrial showed that among women with singleton pregnancies who were identified using first-trimesterscreening as being at high risk for preterm preeclampsia, the administration of aspirin at a dose of150 mg per day from 11 to 14 weeks of gestation until 36 weeks of gestation resulted in asignificantly lower incidence of preterm preeclampsia than that with placebo.

Three polymorphisms of renin-angiotensin system and preeclampsia risk

PurposeSome data suggest an association between the single nucleotide polymorphisms AGT T704C, ACE I/D, and AT1R A1166C and preeclampsia, but overall, the data are conflicting; the aim of our study was to discover a more stable and reliable association between these polymorphisms and PE risk.MethodsA comprehensive literature search for this meta-analysis was conducted. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated to evaluate the strength, and heterogeneity test was conducted. Trial sequential analysis was also performed.ResultsA total of forty studies were finally included in our meta-analysis. The AGT T704C polymorphism was associated with PE risk in three genetic models (dominant OR = 1.33, 95%CI = 1.12–1.59; heterozygote OR = 1.26, 95%CI = 1.05–1.52; homozygote OR = 1.44, 95%CI = 1.14–1.83). No heterogeneity was observed in the three genetic models for the ACE I/D polymorphism. For subgroup analysis by geography, no significant association was detected. Significant associations were observed in mixed race, early-onset, late-onset, and more than 200 subgroups for the AT1R A1166C polymorphism; however, only one study was analyzed in these subgroups.ConclusionsOur results indicated the AGT T704C and ACE I/D polymorphisms were associated with an increased risk of PE. Increased risks were also observed for the two polymorphisms in subgroups including Asians, Europeans, Caucasoid, and Mongoloid. Moreover, an increased PE risk with the ACE I/D polymorphism in the severe PE population was also detected. Regarding the AT1R A1166C polymorphism, weak associations were observed, but further studies are required.

Association between the soluble epoxide hydrolase gene and preeclampsia

ABSTRACTObjective: In this study the association between K55R polymorphism, methylation level of the EPHX2 promoter region, and PE was investigated in 520 individuals including 260 PE patients and 260 healthy pregnant women.Methods: K55R polymorphism and methylation level of the EPHX2 promoter were determined by the real-time PCR using double-dye hydrolysis probes and methylation-sensitive high-resolution melting analysis, respectively.Results: The presence of the K55R polymorphism was significantly higher in cases (28.1%) than controls (17.3%), and was associated with increased risk of PE (OR: 1.86; 95% CI: 1.09–2.63). Methylation levels of the EPHX2 promoter region in cases were significantly lower than controls. A 2.83 times increased PE risk was observed in pregnant women with EPHX2 promoter methylation levels of <25% (OR: 2.83; 95% CI: 1.15–6.91).Conclusion: In conclusion, hypomethylation of the promoter region of EPHX2 and K55R polymorphism were associated with significant increased risk of PE. sEH enzyme may play a role in the pathogenesis of PE by contributing to reduction of the vasodilatator, anti-hypertensive, and anti-inflammatory effects of EETs by rapid degradation of these molecules.