Deep Venous Thrombosis Of Leg Research Articles

Deep venous thrombosis in the nonoperated leg after primary major lower extremity arthroplasty: a retrospective study based on diagnosis using venography.

Venous thromboembolism (VTE) is a common complication after major orthopedic surgery. However, the reported rates of deep venous thrombosis (DVT) vary widely. Our aim was to study the incidence of DVT in the nonoperated leg after primary major lower extremity arthroplasty using bilateral venography. The records of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) at our institution between August 2013 and August 2014 were reviewed. We examined the records for a total of 380 patients, of which 244 had undergone bilateral venography 3-5 days after THA or TKA. A total of 244 patients undergoing TKA (n = 119) or THA (n = 125) were recruited for this study. DVT was diagnosed in 42 (17.2%) of the 244 patients; nine patients developed DVT in both legs, and four developed DVT only in the nonoperated leg. All of the DVTs were located in calf veins. DVT occurred more frequently after TKA than THA, especially in muscular veins. Female sex and older age were found to be positive risk factors for DVT after THA. The incidence of DVT after major lower arthroplasty is high. DVT in nonoperated legs should be carefully considered because of its potential risks, especially in left. Distal DVT also has a high risk to develop pulmonary embolism (PE). The combination of anticoagulant and pneumatic compression is a good measure to avoid proximal DVT, and it is well tolerated to stop anticoagulant if the patients were diagnosed as having no DVT.

A Cross-Sectional Analysis of Cardiovascular Disease in the Hemophilia Population

A Cross-Sectional Analysis of Cardiovascular Disease in the Hemophilia Population

陈旧性跟腱止点断裂骨隧道钛缆固定治疗1例

陈旧性跟腱断裂是常见运动损伤疾病，多采用手术治疗。作者报道了一例43岁的男性患者，因“摔伤致左侧足跟部疼痛，乏力9月余”入院。入院时患者生命体征平稳，左侧足跟部轻度肿胀，压痛(+)，Thompson试验(±)，提踵试验(±)，足背动脉搏动可，充分的术前准备后行左侧陈旧性跟腱止点断裂钛缆Krackow法缝合，经跟骨骨隧道固定术，手术顺利，术后长腿石膏管形固定，定期换药，指导功能康复，早期出现缝线反应，随访半年，Arner-lindholm评定为良，未发生再断裂、下肢深静脉血栓及深部感染的并发症。 Old rupture of Achilles tendon is a kind of common athletic injuries and usually prefers surgical treatment. The author reported a 43-year-old male patient with fall-induced left heel pain for more than 9 months. At the admission to hospital, the patient was evaluated with stable vital signs, mild swelling at left heel, pressing pain (+), Thompson test (±), heel raising (±) and good arteriopalmus of foot. After the well surgical preparation, the left old rapture of Achilles tendon was sutured by titanium Krachow method, supported by Calcaneal bone tunnel fixation. The operation was finished successfully. After the operation, the patient was offered with long-leg tubular plaster, regular dressing change and mentoring functional rehabilitation. Suture reaction was observed during the early stage. The half-year follow-up visit reported good Arner-lindholm assessment without complications like palindromic rapture, deep venous thrombosis of legs and deep infection.

Effectiveness of Early Mobilization in Hospitalized Patients with Deep Venous Thrombosis

D eep venous thrombosis (DVT) is a common problem among hospitalized patients. It places the patient at risk for pulmonary embolism (PE), recurrent thrombosis, and post-thrombotic syndrome (PTS). In particular, up to 50% of patients with proximal DVT of the lower extremity develop PE. Because of the high mortality rate, there is a great concern from physiotherapists and physicians regarding patient’s treatment in the hospital setting. Thus, the purpose of the present review is to examine the effectiveness of early mobilization on acute leg DVT of lower extremity in hospitalized patients . Current evidence showed that early mobilization, i.e., walking and/or exercising, with anticoagulation and leg compression may be encouraged in patients with acute DVT. R ecent studies reported the benefits of reduction in pain and edema, with improvement in quality of life when using the therapeutic strategy of early mobilization in patients with DVT. Early mobilization does not appear to increase the risk of developing PE, progression of an existing DVT, or developing a new DVT. Further research with larger hospitalized patient samples is required to determine the appropriate time in which ambulation should initiate after DVT, and whether exercise (regular or vigorous) or not exercise is more effective for DVT, PE, and PTS.

Extensive deep vein thrombosis following prolonged gaming (‘gamer’s thrombosis’): a case report

IntroductionThe average time spent playing video games is increasing. Prolonged immobility associated with gaming may therefore be an important risk factor for venous thromboembolism. We report a case of deep vein thrombosis associated with prolonged playing of PlayStation® games.Case presentationA 31-year-old Caucasian man, an exterior painter, presented with a three-day history of left leg pain and swelling after playing PlayStation® games for almost eight hours a day for four consecutive days. Doppler ultrasound of the left leg confirmed extensive left leg deep venous thrombosis requiring thrombolysis and anticoagulation.ConclusionsVideo gaming should be considered a risk factor for venous thromboembolism. Further studies are needed to estimate the degree of risk associated with prolonged periods of playing video games, and education for preventing venous thrombosis should be provided to gamers.

Postural abnormality as a risk marker for leg deep venous thrombosis (DVT) in Parkinson's disease

Postural abnormality as a risk marker for leg deep venous thrombosis (DVT) in Parkinson's disease

PUMA: A Puzzle Piece in Chloroquine’s Antimelanoma Activity

Chloroquine can induce cell death in a subset of cancer cell lines, and some melanoma cell lines are quite susceptible. While it is well known that chloroquine impairs lysosomal function and can serve as an autophagy inhibitor, the molecular target of chloroquine and the subsequent cascade of events that leads to cell death are not fully understood. Recent evidence indicates that in melanoma cell lines, chloroquine induces apoptosis by preventing degradation of the pro-apoptotic BH3-only protein PUMA. This finding adds to the unfolding story of chloroquine’s mechanism of action as a cancer therapeutic agent.

Postural abnormality as a risk marker for leg deep venous thrombosis in Parkinson's disease.

BackgroundPulmonary thromboembolism is a common cause of death in patients with autopsy-confirmed Parkinsonism. This study investigated the incidence of leg deep vein thrombosis in Parkinson’s disease and relationships between deep vein thrombosis and clinical/laboratory findings, including postural abnormalities as assessed by photographic measurements.MethodsThis cross-sectional study assessed the presence of deep vein thrombosis using bilateral leg Doppler ultrasonography in 114 asymptomatic outpatients with Parkinson’s disease.ResultsDeep vein thrombosis was detected in 23 patients (20%) with Parkinson’s disease. Deep vein thrombosis was located in the distal portion in 18 patients and in the proximal portion in 5 patients. No significant differences in age, sex, body mass index, disease duration, Hoehn-Yahr stage, anti-Parkinson’s drugs, or daily levodopa-equivalent dose were seen between deep vein thrombosis-positive and -negative groups. Univariate analysis for developing deep vein thrombosis in patients with Parkinson’s disease identified the following markers: long-term wheelchair use, bent knee, bent spine, and D-dimer elevation. Bending angles were significantly greater in the deep vein thrombosis-positive group at the knee and spine than in the deep vein thrombosis-negative group. Half of Parkinson’s disease patients with camptocormia had deep vein thrombosis. Among diabetes mellitus cases, long-term wheelchair use, bent knee over 15°, camptocormia, D-dimer elevation, the more risk markers were associated with a higher incidence of DVT. The presence of risk markers contributed to the development of deep vein thrombosis. On multivariate logistic regression analysis, a bent knee posture was strongly associated with an increased risk of deep vein thrombosis.ConclusionPresence of leg deep vein thrombosis correlated with postural abnormalities in Parkinson’s disease. We recommend non-invasive ultrasonographic screening for leg deep vein thrombosis in these high-risk patients with Parkinson’s disease.

Dose Adjustment and Use of Alternative Eltrombopag Dosing Regimens for the Treatment of Patients with Chronic Immune (Idiopathic) Thrombocytopenic Purpura (ITP)

Abstract 4657 Introduction:Recently, the therapeutic approach of patients with chronic refractory thrombocytopenic purpura has dramatically improved since the adoption, as second-line treatment, of two new thrombopoietin receptor agonists, Eltrombopag and Romiplostim.Purpose: Reporting the experience of our Center on the efficacy, dosing regimens and safety of the administration of Eltrombopag in refractory ITP patients.Material and Methods: We studied retrospectively 300 patients in our Center with a diagnosis of ITP. One hundred eighty five patients were classified as refractory ITP after multiple cycles of treatment. Fourteen patients with refractory ITP were treated with Eltrombopag during the last two years. We studied dose adjustment, the time to response and duration of response as well adverse events. A partial response (PR) was defined as achieving a platelet count of ≥ 50×103/ml, while a complete response (CR) as achieving a platelet count of ≥ 150 × 103/mL.Results: The patients were six men and eight women with a median age of 68.5 years (39.0 to 84.0 years). These patients had tried and failed numerous previous treatment regimens (2 to 8), including 6 patients who had received the thrombopoietin receptor agonist Romiplostim, 2 patients with splenectomy, as well as 2 patients in PR, who needed a higher platelet count due to concomitant disease. The median time from ITP diagnosis to Eltrombopag administration was 20.5 months (0.3 to 235.9 months) and the initial median platelet count was 34×103/mL. Twelve out of 14 patients (12/14 ) responded (85.71%), 10 CR (71.42%) and 2 PR (14.29%) with a mean platelet count of 294 × 103/mL (an increase of 260.5 x103/mL). The median time to response was 17 days (5–64 days) and the response was durable in 9/ 10 patients (90%). Forty per cent of patients required a dose increase at the Day 22 visit. The starting dose was 25mg once daily of Eltrombopag and administered over 6 cycles. If the patientxs platelet number was >200 x103/mL the treatment was interrupted. The next cycle started when the patient’s platelet count was <20 x103/mL. The dose of Eltrombopag was increased to 75mg daily when a patient’s platelet count remained < 50 x103/mL. The number of patients who had Eltrombopag dose increases to 75mg were 3 (21%), 2(14%) and 2 (14%) in cycles 1, 2 and 3, respectively. One patient (7%) experienced a serious side effect such as thromboembolic disease (right leg deep venous thrombosis and pulmonary embolism).Conclusions: Despite the small number of patients in this study, our results agree with those of similar large studies from other Centers. Since Eltrombopag is an oral therapy and does not require hospitalization, is an easy, effective, alternative therapy, which improves the quality of life of patients with refractory ITP. In most cases dose adjustment and use of alternative Eltrombopag dosing regimens is needed. Disclosures:No relevant conflicts of interest to declare.

Risk factors of venous thrombosis in knee joint endoprosthesis

The high risk of thromboembolic complications after knee joint prosthetics is conditioned by the series of surgical intervention particularities. The influence of intraoperative tourniquet usage on the leg deep venous thrombosis frequency was studied.

Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report

A 60-years old patient was admitted to a community hospital with septic arthritis. He was treated with antibiotics and subcutaneous unfractionated heparin (UH) was used for venous thromboprophylaxis. After three days, he developed leg deep venous thrombosis and was treated with IV heparin. One day later, the patient developed pulmonary emboli, which was found using ventilation/perfusion scan. He was transferred to the University Hospital for further management. Upon arrival, antibiotic and intravenous UH were continued. Trans-Esophageal Echocardiogram showed a thrombus in the right atrium, a small portion of which extended to the left atrium through a patent foramen ovale. Another large thrombus was noted in the right ventricle, which extended to the pulmonary artery. Review of the patient's medical records revealed a halving of his platelet count three days following the heparin administration. Therefore, HIT seemed very likely. Intravenous UH was stopped and an emergency thrombectomy was performed. ELISA testing of HIT antibodies came negative. This made HIT diagnosis unlikely and the patient received dalteparin. A week later, as the platelet count declined again, HIT antibodies' testing using ELISA and C-14 serotonin release was repeated, and both assays were positive. Argatroban was restarted and the platelet count normalized.

Antiphospholipid antibody syndrome and vasoocclusive diseases

One hundred and thirty-four patients with vasoocclusive diseases were retrospectively tested for three kinds of antiphospholipid antibody (aPL). The mean age at onset of the disease in 58 patients with aPL was 43 years old. Seventeen, 11, and 9 patients were positive for the aCL IgA, IgM, and IgG isotypes, respectively. The rates of anti-phospholipid syndrome (APS) in patients with arterial (n=94), venous (n= 31), or both arterial and venous (n=9) occlusion were 45%, 29%, and 78%, respectively. The rates of APS in patients with autoimmune disease (n=13), thromboangiitis obliterans (TAO) (n= 36), arteriosclerosis obliterans (ASO) with lower leg involvement (n=8) or aortic arch syndrome (n=5), Raynaud's syndrome (n=15), aortitis syndrome (n= 13), ischemic heart disease (IHD) with young onset (n =12), and bilateral leg deep venous thrombosis (DVT) (n=10) were 77%, 46%, 13%, 80%, 40%, 62%, 33%, and 70%, respectively. The cumulative patency rate for reconstructive surgery in patients (n=13) with aCL was found to be considerably lower than that in those without aCL (n=13). From these results it was concluded that IgA was the most valuable aCL isotype for the diagnosis of APS and that aPL should be examined in patients with double-vessel occlusion, autoimmune disease, bilateral leg DVT, aortic arch syndrome, TAO, Raynaud's syndrome, or IHD with young onset. Furthermore, prophylaxis for graft failure is more strongly recommended for patients with aCL than for those without it.

Does dalteparin PROTECT better than heparin?

Expanded abstractCitationThe PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group: Dalteparin versus Unfractionated Heparin in Critically Ill Patients. N Engl J Med 2011, 364:1305-1314.BackgroundIt is unclear whether there is a clinically significant advantage to prophylactic low-molecular-weight heparin (LMWH) versus unfractionated heparin (UFH) in mixed medical/surgical critically ill adult patients.MethodsObjective: To compare once daily dalteparin with twice daily unfractionated heparin for primary prophylaxis of proximal deep venous thrombosis in critically ill adults.Design: A superiority randomized double-blinded controlled trial from 2006 to 2010 in both medical and surgical ICUs. (ClinicalTrials.gov registration number: NCT00182143)Setting: Multi-center, international medical and surgical intensive care units (ICUs)Subjects: Critically ill adults expected to remain in the ICU for at least 3 days.Intervention: Patients were randomized to either twice daily UFH or daily dalteparin for the duration of ICU admission.Outcomes: The primary endpoint was proximal leg deep venous thrombosis (DVT), at least three days after randomization, detected on twice weekly screening ultrasound. Secondary endpoints were: any DVT, pulmonary embolism (PE), venous thromboembolism (VTE), death, heparin-induced thrombocytopenia (HIT), major bleeding, and composite death/VTE.ResultsThree thousand seven hundred and forty-six subjects were included in the intention-to-treat analysis. Proximal leg DVT occurred in 96 of 1873 (5.1%) patients randomized to dalteparin versus 109 of 1873 (5.8%) patients randomized to UFH (hazard ratio in the dalteparin group, 0.92; 95% confidence interval [CI], 0.68 to 1.23; P = 0.57). The incidence of PE was 1.3% in the dalteparin group compared to 2.3% in the UFH group (hazard ratio, 0.51; 95% CI, 0.30 to 0.88; P = 0.01). There was no mortality difference and no difference in major bleeding between the two study arms. There was a statistically significant decrease in incidence of HIT in the dalteparin group in the per-protocol analysis, but not in the intention-to-treat analysis.LimitationsComparing the incidence of PE was a secondary endpoint and the study was not appropriately powered for this conclusion.ConclusionsAmong critically ill adult patients, dalteparin was not superior to UFH at preventing proximal lower extremity DVTs. There is a suggestion that dalteparin might be superior to UFH at preventing pulmonary embolism but a larger trial is necessary to confirm this result.

Fibrin D-Dimer Concentration, Deep Vein Thrombosis Symptom Duration, and Venous Thrombus Volume

To determine the relationship between fibrin D-dimer levels, symptom duration, and thrombus volume, consecutive patients with incident deep venous thrombosis (DVT) were evaluated. In a cross-sectional study design, patient symptom onset was determined by careful patient questioning. Venous thrombosis was confirmed by compression duplex ultrasonography. Thrombus volume was estimated based on patient's femur length using a forensic anthropology method. Fibrin D-dimer was measured by latex immunoassay. 72 consecutive patients with confirmed leg DVT agreed to participate. The median symptom duration at the time of diagnosis was 10 days. The median D-dimer concentration was 1050 ng/dL. The median thrombus volume was 12.92 cm(3). D-Dimer levels correlated with estimated thrombus volume (P < .0006 CI 0.12-0.41; R(2) (adjusted) = .15) but not symptom duration, patient's age, or gender. Despite varying symptom duration prior to diagnosis, fibrin D-dimer remains a sensitive measure of venous thrombosis and correlates with thrombus volume.

Asymptomatic Deep Venous Thrombosis after Deep Brain Stimulation for Parkinson Disease

Background/Aims: Patients with advanced Parkinson disease (PD) are at increased risk for asymptomatic leg deep venous thrombosis (DVT) because of severe motor fluctuations. Protracted immobility in the absence of antiparkinsonian therapy during stereotactic surgery may further increase the risk for venous thrombosis. Our aim was to determine the incidence of asymptomatic DVT of leg veins in PD patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS). Methods: 41 consecutive PD patients undergoing stereotactic surgery for STN-DBS were investigated by ultrasound compression sonography of leg veins and D-dimer measurement in the week preceding surgery. After surgery, D-dimer measurements were repeated and when the value exceeded the normal range, ultrasound compression sonography was repeated to confirm or exclude DVT. Results: Doppler ultrasonographic examinations demonstrated that 2 patients (4.9%) developed asymptomatic DVT shortly after surgery (8.5 days) despite the fact that none of the 41 patients submitted to STN-DBS had DVT before surgery and that a specific prophylaxis was applied during surgery. Conclusions: Our data show that advanced PD patients are at risk for developing asymptomatic leg DVT following stereotactic surgery performed for STN-DBS. A strict clinical monitoring in the perioperative period is advisable in order to ensure early detection of DVT and prevent further thrombo-embolic complications.

Long bones giant cells tumors: Treatment by curretage and cavity filling cementation

Giant cell tumors (GCT) of bone are benign tumors with local aggressiveness that most of the time occur around the metaphyseal area of long bones, often in contact with the articular cartilage. Their treatment remains controversial because of their high recurrence rate. The authors report a retrospective series of 30 cases treated using curettage followed by cementation. They suggest demonstrating the mechanical and functional benefit of this technique, its benefit controlling the risk of recurrence, and of osteoarthritis potential.Between 1992 and 2005, 30 patients with GCT were treated using curettage and cementation. Twenty-six of these tumors were present around the knee: 14 at the distal femur and 12 at the proximal tibia. Preoperative radiological evaluation with standard X-rays showed that the tumor measured a mean 71x45mm, for a mean volume of 78cm(3). Seventy-three percent of these GCT were in direct contact with the articular cartilage and 40% extended to the soft tissues as seen on the CAT scan and/or MRI. All patients were treated with curettage and cementation, 16 additional internal fixation procedures were performed. The mean follow-up of this series was 6 years and 4 months. All patients continue to be monitored, with none lost to follow-up.In all our cases, nine recurrences (30%) were observed during the first 2 years. Six patients were treated with a new curettage and cementation procedure and three underwent a total knee arthroplasty. None of these lesions had recurred at the last follow-up. The MSTS score, reflecting the function of the operated limb was a mean 93.33% (28 + or - 2/30). Standard radiological assessment showed a thin scalable border on four patients and was normal for the all-total arthroplasty cases. Two cases of minor osteoarthritis progression were noted (one less than 50% and a simple densification of subchondral bone), requiring no specific treatment. Three complications were noted: one leg deep venous thrombosis, one hematoma, and one deep infection without impacting the initial treatment outcome over the long term.The curettage and cementation technique is usual practice in GCT treatment. Simple and reproducible, this technique has a lower rate of complication than other treatment options such as cryotherapy. It produces a lower rate of recurrence with the dual benefit of excellent mechanical and functional qualities. Diagnosis of recurrence can be made earlier because of the thin scalable border at the bone-cement interface. This technique does not generally cause osteoarthritis, which was found in only two cases with no evidence of the cement having a direct effect. The 30% recurrence rate observed in this series shows that the benefit provided by the cement as an adjuvant preservative remains modest.The cement mechanical and cytotoxic properties as well as its innocuity and its ease of handling make curettage and cementation one of the top-ranking GCT treatment options. An even lower rate of recurrence may be obtained through development of additional adjuvant treatments such as calcitonin and bisphosphonates.Level IV; Therapeutic study.

Home hospitalization unit: an alternative to standard inpatient hospitalization from the emergency department

To assess the characteristics of the patients admitted to a home hospitalization unit (HHU) after a first emergency department (ED) visit. This was a descriptive, retrospective study. The setting of the study was the ED of a 500-bed teaching hospital, which treats 125 000 emergency visits per year. HHU admits patients from the ED when hospitalization is imminent. Participants were all patients attending our ED from 1 January 2005 to 31 December 2005 and finally admitted to HHU. Variables were age, sex, diagnostic, mean length of stay, and readmission rate. A cohort composed of 250 patients admitted to HHU directly from the ED was identified. Mean age was 75 years. One hundred and fifty-eight were males (63%). The most common diagnoses were acute exacerbation of chronic obstructive pulmonary disease (127 of 250 patients, 50.8%), acute exacerbation of chronic heart failure (32 of 250 patients, 12.8%), pneumonia (24 of 250 patients, 9.6%), urinary tract infection (20 of 250 patients, 8%), and leg deep venous thrombosis (14 of 250 patients, 5.6%). Mean length of stay was 8 days. Readmission rate was 9%. A HHU proved to be effective and safe for acutely ill individuals who required hospitalization.

Deep venous thrombosis in gynecological oncology: Incidence and clinical symptoms study

Objective Cancer patients have increased risks of leg deep venous thrombosis (DVT). We studied the incidence, risk factors and most predictive symptoms of leg DVT in gynecologic oncology patients. Study designs Gynecologic oncology patients with any leg DVT symptoms were recruited and screened using Doppler sonogram. All hospitalized surgery and non-ambulating patients received thigh-high sequential compression devices (SCDs) without heparin as a prophylactic method against thrombosis. Statistical analysis was done using chi-square or Fisher's exact tests. Results Out of 1974 patients, 134 complained of lower limb symptoms. Doppler studies found 38 patients with leg DVT. Incidence of leg DVT was 36/853 (4.2%) in patients with cancer and 2/1121 (0.2%) in patients without cancer (odds ratio 2.8 with a diagnosis of cancer). Leg edema, erythema, fever, and warm leg were significant symptoms in diagnosing leg DVT ( p < 0.01). The cost of finding a leg DVT was $747.54. Conclusions Clinical exam is less accurate than Doppler sonogram in diagnosing leg DVT. The incidence of leg DVT using SCD seems to be comparable with other studies. Finally, the cost of identifying leg DVT seems reasonable.

Serial Proximal Vein Ultrasonography + D-Dimer = Whole-Leg Doppler for Suspected Leg Deep Venous Thrombosis

There is inadequate power to perform a valid clinical trial in pediatric heart transplantation (HT) using a conventional end-point, because the disease is rare and hard end-points, such as death or graft loss, are infrequent. We sought to develop and validate a surrogate end-point involving the cumulative burden of post-transplant complications to predict death/graft loss to power a randomized clinical trial of maintenance immunosuppression in pediatric HT.Pediatric Heart Transplant Study (PHTS) data were used to identify all children who underwent an isolated orthotopic HT between 2005 and 2014 who survived to 6 months post-HT. A time-varying Cox model was used to develop and evaluate a surrogate end-point comprised of 6 major adverse transplant events (MATEs) (acute cellular rejection [ACR], antibody-mediated rejection [AMR], infection, cardiac allograft vasculopathy [CAV], post-transplant lymphoproliferative disease [PTLD] and chronic kidney disease [CKD]) occurring between 6 and 36 months, where individual events were defined according to international guidelines. Two thirds of the study cohort was used for score development, and one third of the cohort was used to test the score.Among 2,118 children, 6.4% underwent graft loss between 6 and 36 months post-HT, whereas 39% developed CKD, 34% ACR, 34% infection, 9% AMR, 4% CAV and 2% PTLD. The best predictive score involved a simple MATE score sum, yielding a concordance probability estimate (CPE) statistic of 0.74. Whereas the power to detect non-inferiority (NI), assuming the NI hazard ratio of 1.45 in graft survival was 10% (assuming 200 subjects and 6% graft loss rate), the power to detect NI assuming a 2-point non-inferiority margin was >85% using the MATE score.The MATE score reflects the cumulative burden of MATEs and has acceptable prediction characteristics for death/graft loss post-HT. The MATE score may be useful as a surrogate end-point to power a clinical trial in pediatric HT.

Emergency Clinician–Performed Compression Ultrasonography for Deep Venous Thrombosis of the Lower Extremity

Emergency clinician-performed ultrasonography holds promise as a rapid and accurate method to diagnose and exclude deep venous thrombosis. However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined. Prospective, single-center study conducted at an urban, academic emergency department (ED). Clinician participants included ED faculty, supervised residents, and midlevel providers who completed a training course for above-calf, 3-point-compression, venous ultrasonography. Patient participants had suspected leg deep venous thrombosis and greater than or equal to 1 predefined sign or symptom. Before any imaging, clinicians classified patients as low (<15%), moderate (15% to 40%), or high (>40%) pretest probability of deep venous thrombosis, followed by emergency clinician-performed ultrasonography. A whole-leg reference venous ultrasonography was then performed and interpreted separately in the radiology department. Patients were followed for 30 days. The criterion standard for deep venous thrombosis(+), required thrombosis of any leg vein on a reference ultrasonograph and clinical plan to treat. We enrolled 183 patients, and 27 (15%) had deep venous thrombosis(+). The sensitivity and specificity emergency clinician-performed ultrasonography was 70% (95% confidence interval [CI] 60% to 80%) and 89% (95% CI 83% to 94%), respectively, with overall diagnostic accuracy of 85% (95% CI 79% to 90%). The posterior probability of deep venous thrombosis(+) among the 88 low-risk patients with a negative emergency clinician-performed ultrasonographic result was 1 of 88, or 1.1% (95% CI 0% to 6%), and the posterior probability of deep venous thrombosis(+) among 14 high-risk patients with a positive emergency clinician-performed ultrasonographic result was 11 of 14, or 79% (95% CI 49% to 95%). The overall diagnostic accuracy of single-visit emergency clinician-performed ultrasonography performed by a heterogeneous group of ED clinicians is intermediate but may be improved by pretest probability assessment.