Management Of VTE Research Articles

Gene expression profiling in Venous thromboembolism: Insights from publicly available datasets

BackgroundVenous thromboembolism (VTE) is the third most common cardiovascular disease and is a major cause of mobility and mortality worldwide. VTE is a complex multifactorial disease and genetic mechanisms underlying its pathogenesis is yet to be completely elucidated. The aim of the present study was to identify hub genes and pathways involved in development and progression of blood clot during VTE using gene expression data from public repositories. MethodologyDifferential gene expression (DEG) data from two datasets, GSE48000 and GSE19151 were analysed using GEO2R tool. Gene expression data of VTE patients were compared to that of healthy controls using various bioinformatics tools. ResultsWhen the differentially expressed genes of the two datasets were compared, it was found that 19 genes were up-regulated while 134 genes were down-regulated. Gene ontology (GO) and pathway analysis revealed that pathways such as complement and coagulation cascade and B-cell receptor signalling along with DNA methylation, DNA alkylation and inflammatory genes were significantly up-regulated in VTE patients. On the other hand, differentially down-regulated genes included mitochondrial translation elongation, termination and biosysthesis along with heme biosynthesis, erythrocyte differentiation and homeostasis. The top 5 up-regulated hub genes obtained by protein-protein interaction (PPI) network analysis included MYC, FOS, SGK1, CR2 and CXCR4, whereas the top 5 down-regulated hub genes included MRPL13, MRPL3, MRPL11, RPS29 and RPL9. The up-regulated hub genes are functionally involved in maintain vascular integrity and complementation cascade while the down-regulated hub genes were mostly mitochondrial ribosomal proteins. ConclusionPresent study highlights significantly enriched pathways and genes associated with VTE development and prognosis. The data hereby obtained could be used for designing newer diagnostic and therapeutic tools for VTE management.

Analysis of the Current Status and Influencing Factors of Deep Vein Thrombosis Knowledge and Prevention Practices among Orthopedic Nurses in Western Guangxi

Objective: To investigate the current status of deep vein thrombosis knowledge and prevention practice of orthopedic nurses in western Guangxi, and to analyze its influencing factors, so as to provide reference strategies and empirical evidence for the training and VTE management of nurses in the future. Methods: From July to August 2023, a questionnaire survey was conducted on 250 orthopedic nurses in western Guangxi using the Chinese version of the deep vein thrombosis risk knowledge and prevention practice evaluation questionnaire. Results: A total of 250 nurses were surveyed, and the total score of DVT knowledge and prevention practice was (92.31±6.33), which was at a medium level overall. The score of deep vein thrombosis knowledge was (28.96±2.17), which was at a good level, and the score of prevention practice was (63.35±4.76), which was at a medium level. Multiple linear regression analysis showed that nursing years, years of work in the current department, nurse professional title and grade, and whether or not they had received VTE specialist training were influencing factors for the knowledge dimension of deep vein thrombosis; nurse professional title, nurse grade, and whether or not they had received VTE specialist training were influencing factors for the practice dimension of deep vein thrombosis prevention. Conclusion: The total scores of DVT knowledge and prevention practice of orthopedic nurses in western Guangxi were at a medium level overall, with a good grasp of the DVT knowledge dimension score, and the prevention practice part needed to be improved. It is recommended that nursing managers pay attention to the nurses' knowledge of DVT, attach importance to the knowledge training of nurses with low seniority and low professional titles, provide more opportunities for learning and communication, and combine the training content with clinical work to ensure that nurses can apply theoretical knowledge to actual nursing work.

Successful management of VTE with essential thrombocythemia and cavernous transformation of the portal vein in early pregnancy: a case report

Due to the thrombohemorrhagic potential of essential thrombocythemia, pregnancy complicated by essential thrombocythemia should be recognized as a risk factor for obstetric complications. Here, we report the case of a patient with essential thrombocythemia with two significantly different pregnancy outcomes. Her first pregnancy (at 30 years of age) ended with an uneventful term delivery. However, the patient progressed to cavernous transformation of the portal vein in the period between her two pregnancies and subsequently experienced deep venous thrombosis during the first trimester of her second pregnancy (at 36 years of age). The patient’s platelet count during pregnancy was within the normal range, so she ignored previous instances of essential thrombocytosis (at 26 years of age). The patient’s main symptom was unrelieved pain in her leg. After that, she was successfully treated with anticoagulant throughout her entire pregnancy, resulting in a term vaginal delivery. This case highlights the importance of assessing pregnant patients with essential thrombocythemia according to their risk stratification. Specifically, risk assessments for potential pregnancy complications should take into account advanced maternal age and a previous history of thrombosis. Patients with essential thrombocythemia should be encouraged to participate in preconception counseling for risk assessment and to initiate prophylactic anticoagulation as soon as possible.

Unmet needs and barriers in venous thromboembolism education and awareness among people living with cancer: a global survey

BackgroundVenous thromboembolism (VTE) is a major preventable cause of morbidity, disability, and mortality in subjects with cancer. A global appraisal of cancer-associated VTE education and awareness is not available. ObjectivesTo evaluate VTE-related education, awareness, and unmet needs from the perspective of people living with cancer using a quantitative and qualitative approach. MethodsThis cross-sectional study used data from an online-based survey covering multidimensional domains of cancer-associated VTE. Data are presented descriptively. Potential differences across participant subgroups were explored. ResultsAmong 2262 patients with cancer from 42 countries worldwide, 55.3% received no VTE education throughout their cancer journey, and an additional 8.2% received education at the time of VTE diagnosis only, leading to 63.5% receiving no or inappropriately delayed education. When education was delivered, only 67.8% received instructions to seek medical attention in case of VTE suspicion, and 36.9% reported scarce understanding. One-third of participants (32.4%) felt psychologically distressed when becoming aware of the potential risks and implications connected with cancer-associated VTE. Most responders (78.8%) deemed VTE awareness highly relevant, but almost half expressed concerns about the quality of education received. While overall consistent, findings in selected survey domains appeared to numerically differ across age group, ethnicity, continent of residence, educational level, metastatic status, and VTE history. ConclusionThis study involving a large and diverse population of individuals living with cancer identifies important unmet needs in VTE-related education, awareness, and support across healthcare systems globally. These findings unveil multilevel opportunities to expedite patient-centered care in cancer-associated VTE prevention and management.

Improving Venous Thromboembolism Prophylaxis Through Service Integration, Policy Enhancement, and Health Informatics.

Venous thromboembolism (VTE) prevention and management are susceptible issues that require specific rules to sustain and oversee their functioning, as preventing VTE is a vital patient safety priority. This paper aims to investigate and provide recommendations for VTE assessment and reassessment through policy enhancement and development. We reviewed different papers and policies to propose recommendations and theme analysis for policy modifications and enhancements to improve VTE prophylaxis and management. Recommendations were set to enhance the overall work of VTE prophylaxis, where the current VTE protocols and policies must ensure high levels of patient safety and satisfaction. The recommendations included working through a well-organized multidisciplinary team and staff engagement to support and enhance VTE's work. Nurses', pharmacists', and physical therapists' involvement in setting up the plan and prevention is the way to share the knowledge and paradigm of experience to standardize the management. Promoting policies regarding VTE prophylaxis assessment and reassessment using electronic modules as a part of the digital health process was proposed. A deep understanding of the underlying issues and the incorporation of generic policy recommendations were set. This article presents recommendations for stakeholders, social media platforms, and healthcare practitioners to enhance VTE prophylaxis and management.

Effect of Enoxaparin on D-dimer levels in hospitalized Corona Virus patients with a comparison of its level in patients with comorbid conditions.

Aim: The main goal is to assess the levels of comorbid diseases and examine the changes in D-dimer in hospitalized patients before and following SC enoxaparin medication. Material and Methods: At the Al-Yarmouk Teaching Hospital in Baghdad, Iraq, from October 2022 to May 2023, 86 patients who were hospitalized and had severe to critical COVID-19 infections provided data for a retrospective analysis. Results: The medical records of all COVID-19 patients who were hospitalized and whose D-dimer level was greater than 0.5 mg/l and who were given enoxaparin (40 mg subcutaneously) were reviewed with the requisite authorization from the relevant authorities. The D-dimer level was assessed following therapy on the day of admission and day five after commencing enoxaparin. An examination of 86 case records revealed that persons with COVID-19 had significantly decreased D-dimer levels after taking subcutaneous enoxaparin (p-value<0.0001). The comorbidities (diabetes mellitus, hypertension) of patients who received the drug were compared. Conclusions: Enoxaparin and other anticoagulants were utilized to treat the coagulopathy brought on by COVID-19. Low molecular weight heparin enoxaparin has demonstrated positive outcomes in the management of VTE. A decrease in D-dimer level is anticipated when COVID-19 patients are treated with subcutaneous enoxaparin, partly because decreased coagulation results in lower fibrin formation.

Assessment of bleeding risk in cancer patients treated with anticoagulants for venous thromboembolic events.

Anticoagulant is the cornerstone of the management of VTE at the cost of a non-negligible risk of bleeding. Reliable and validated clinical tools to predict thromboembolic and hemorrhagic events are crucial for individualized decision-making for the type and duration of anticoagulant treatment. We evaluate the available risk models in real life cancer patients with VTE. The objectives of the study were to describe the bleeding of cancer patients with VTE and to evaluate the performance of the different bleeding models to predict the risk of bleeding during a 6-month follow-up. VTE-diagnosed patient's demographic and clinical characteristics, treatment regimens and outcomes for up to 6 months were collected. The primary endpoint was the occurrence of a major bleeding (MB) or a clinically relevant non major bleeding (CRNMB) event, categorized according to the ISTH criteria. During the 6-months follow-up period, 26 out of 110 included patients (26.7%) experienced a bleeding event, with 3 recurrences of bleeding. Out of the 29 bleeding events, 19 events were CRNMB and 10 MB. One patient died because of a MB. Bleeding occurred in 27 % of the patients treated with DOACs and 22% of the patients treated with LMWH. Most of the bleedings were gastrointestinal (9 events, 31%); 26.9% of the bleedings occurred in patient with colorectal cancer and 19.6% in patients with lung cancer. In our cohort, none of the 10 RAMs used in our study were able to distinguish cancer patients with a low risk of bleeding, from all bleeding or non-bleeding patients. The Nieto et al. RAM had the best overall performance (C-statistic = 0.730, 95% CI (0.619-0.840)). However, it classified 1 out of 5 patients with major bleeding in the low risk of bleeding group. The rest of the RAMs showed a suboptimal result, with a range of C-statistic between 0.489, 95%CI (0.360-0.617)) and 0.532, 95%CI (0.406-0.658)). The management of CAT patients is challenging due to a higher risk of both recurrent VTE and bleeding events, as compared with non-cancer patients with VTE. None of the existing RAMs was able to consistently identify patients with risk of anticoagulant associated bleeding events.

Secondary polycythemia and venous thromboembolism: a systematic review

Background Secondary polycythemia is an acquired condition characterized by an elevation in red blood cell (RBC) mass either in response to tissue hypoxia or inappropriate erythropoietin (EPO) secretion. It is proposed that the elevation of RBC mass in secondary polycythemia can lead to hyperviscosity and VTE. This systematic review aims to assess the relationship between secondary polycythemia and venous thromboembolism and discuss diagnostic strategies and management of secondary polycythemia and VTE. Methods This systematic review was conducted on September 2, 2022, and followed PRISMA guidelines to select and analyze relevant articles using the following databases: PubMed, ScienceDirect, and CINAHL. The queries used were “secondary polycythemia AND venous thromboembolism,” “secondary polycythemia AND deep vein thrombosis,” “secondary polycythemia AND pulmonary embolism,” “chronic obstructive pulmonary disease AND venous thromboembolism,” “chronic obstructive pulmonary disease AND deep vein thrombosis,” “chronic obstructive pulmonary disease AND pulmonary embolism,” “high altitude AND venous thromboembolism,” “high altitude AND deep vein thrombosis,” “high altitude AND pulmonary embolism,” “smoking AND venous thromboembolism,” “smoking AND deep vein thrombosis”, “smoking AND pulmonary embolism”, “hypoventilation AND venous thromboembolism”, “hypoventilation AND deep vein thrombosis”, “hypoventilation AND pulmonary embolism”, “testosterone AND venous thromboembolism”, “testosterone AND deep vein thrombosis”, and “testosterone AND pulmonary embolism.” The search duration was set from 2012–2022. Relevant publications were selected based on the inclusion and exclusion criteria. Results The initial search generated 5,946 articles. After narrowing the search based on inclusion and exclusion criteria, 30 articles were selected for this systematic review. Conclusion We found evidence to support the relationship between secondary polycythemia and VTE. Therapies targeting the factors that lead to secondary polycythemia can correct it and prevent VTE progression. If VTE occurs as a result of secondary polycythemia, anticoagulation therapy is recommended or inferior vena cava filters if contraindicated.

Serum C-reactive protein-to-albumin ratio may be a potential risk indicator for venous thromboembolism: Findings from a prospective cohort study

Background and aimsCirculating C-reactive protein (CRP) and albumin are commonly used inflammatory biomarkers. C-reactive protein-to-albumin ratio (CAR), a novel inflammatory biomarker, has been suggested to be a more reliable risk indicator compared to CRP or albumin alone. An inflammatory hypothesis has been postulated in VTE aetiology, but the association between CAR and VTE has not been investigated. We aimed to assess the prospective association of CAR with VTE risk. Methods and resultsC-reactive protein and albumin were measured in serum samples at baseline from 2479 men aged 42–61 years. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. During a median follow-up of 27.0 years, 168 VTE cases were recorded. In analysis adjusted for potential confounders, the HR (95% CI) for VTE comparing extreme tertiles of CAR was 1.49 (1.01–2.21), which was minimally attenuated on further adjustment for prevalent cancer, a potential mediator 1.48 (1.00–2.19). Serum CRP and albumin were each modestly associated with VTE risk in the same set of participants. ConclusionIn middle-aged and older men, elevated serum CAR may be associated with an increased risk of VTE. Further research is needed to replicate or refute these findings in other populations and assess if CAR may be of potential value in VTE management.

Management of venous thromboembolism in far-advanced cancer: current practice

ObjectivesVenous thromboembolism (VTE) is common in advanced cancer. Guidelines suggest that indefinite anticoagulation be considered for patients with ongoing active cancer. There are no data on the management of cancer-associated...

Consolidate the foundation, steadily promote and comprehensively improve the quality control in prevention and management of venous thromboembolism in China

Hospital-associated venous thromboembolism (HA-VTE) has become a public health problem that seriously affects the quality of medical care and patient safety. Many countries regarded VTE prevention as a key element of medical quality management, carried out quality improvement work in VTE prevention and achieved remarkable results. In China, there is also unremitting efforts and explorations in the field of VTE prevention and management. The national program for prevention and management of pulmonary embolism and deep vein thrombosis was officially launched. Through a series of measures such as excellent center construction, regional alliance, and strengthening of quality control and informatization, the national program has greatly promoted the construction of VTE prevention and management system in hospitals across the country. Strengthening the prevention and treatment of VTE has become the common will of the government, hospital administrators, clinical medical staff and the public. In the future, we need to continue to steadily promote the prevention and management of VTE, and comprehensively improve the quality control management level of VTE prevention and management in hospitals.

Developing a Cancer-Associated Thrombosis Clinic: Two-Year Experience

Background: Cancer-associated thrombosis (CAT) is a common comorbidity in patients with cancer. Prior trials have demonstrated that direct oral anticoagulants (DOACs) and low-molecular weight heparins (LMWHs) are safe and effective for CAT management. Despite these data, treatment of CAT is complicated by consequences of both cancers and cancer-directed therapies that can impact anticoagulation options. Methods: We developed the Northwestern Medicine CAT clinic in April 2020 to improve care by streamlining referrals for evaluation and management of CAT by a non-malignant hematologist. Patients were referred for either acute management of new VTE or for ongoing management of previously known VTE. Goal time-to-appointment for acute referrals was within 24 hours and for ongoing management within two weeks. Initial evaluations were completed by advanced practice providers with review by an attending classical hematologist and clinical pharmacist. We manually reviewed electronic health records of patients seen in the CAT clinic since its inception. Data collected included demographic, cancer diagnosis and cancer-directed therapy, CAT clinic recommendations, and recurrent VTE, bleeding and death within 6 months of initial CAT clinic appointment. We used descriptive statistics to assess referral and treatment patterns. Results: One hundred twenty-two patients (N=122) were seen by CAT clinic clinicians between April 2020 - April 2022, including 63 (51%) in the first year. Patients had a median age of 63 years and 56.4% were female. Appointments occurred in nearly equal proportion via telehealth (50.8%) and in-office visits (49.2%) during these two years; however, 78% of visits were telehealth during the first year, and only 25.4% during the second. Forty-three (35.2%) referred for acute management were seen at a median time of two days, and the remainder for ongoing management were seen at a median time of 10 days. Referrals were predominantly for PE (25.4%), concurrent PE/DVT (23.0%), and proximal lower extremity DVT (18.9%); however, consults included thrombi of the cerebral, pulmonary, and splanchnic veins, as well as tumor thrombi, arterial thrombi, and need for primary prophylaxis. Tumor types were categorized into nine groups, with the largest proportion consisting of gastrointestinal (25.4%), gynecologic (17.2%), and hematologic (17.2%) malignancies (Figure 1). DOACs were recommended in 47.5%, and LMWHs in 41% (Figure 2), with a similar proportion of DOACs prescribed between year one (47.5%) and year two (47.6%). Primary reasons for choosing LMWHs over DOACs were perceived bleeding risk (40%), tumor type (22%), and prior DOAC failure (20%). Twelve (9.8%) patients were advised to stop anticoagulation, due to lack of indication for 11 (91.7%) and perceived bleeding risk for one (8.3%). Four were referred for inferior vena cava (IVC) filter retrieval. At the time of evaluation, 16 (13.1%) patients were noted to have platelet counts <150,000/µL, but none had platelet counts <50,000/µL. Within 6 months of initial evaluation, 11 (9.0%) patients developed progressive or recurrent VTE. Fourteen (11.5%) patients experienced bleeding: eight (57.1%) had major bleeding episodes as defined by the International Society on Thrombosis and Hemostasis, and six (42.9%) had clinically-relevant non-major bleeding. Among major bleeding events, six (75%) were gastrointestinal and two (25%) intraabdominal in origin, with no identified intracranial hemorrhages. Twenty (16.4%) died during the follow up period. Seventy-six (61.8%) patients were seen for a follow up visit after initial consultation. Conclusion: Building the CAT clinic led to improved access to classical hematologists with thrombosis expertise to manage CAT. Historical wait times for this specialty have exceeded 90 days, while those referred to the CAT clinic had a median time-to-appointment of only nine days. Highlighting the complexity of CAT management, more than 40% of patients were not treated with DOAC, primarily related to perceived bleeding risk. Four patients were identified for IVC filter removal, suggesting there may be additional benefits to non-malignant hematologists beyond anticoagulant management. Decisions regarding treatment of individual patients with CAT remain complex, and access to thrombosis specialists provides additional expertise to optimize care. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

THROMBOEMBOLIC DISEASE DURING TUBERCULOSIS: A SERIES OF 47 CASES

Tuberculosis (TB) is considered a risk factor for thromboembolic venous disease (VTE). The prevalence of this association ranges from 0.6% to 10%. This work aims to analyze the epidemiological and clinical aspects and the therapeutic management of VTE during tuberculosis and discuss the diagnostic and especially therapeutic particularities of this association.

Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review

BackgroundVenous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens’ underlying preferences. The objective of this review is to systematically assess women’s values and preferences research evidence on this topic.MethodsWe searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display.ResultsWe screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process.ConclusionsWe are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient’s values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy.

Discordance in management of adverse events associated with oral therapies in hormone receptor–positive breast cancer among health care providers and experts: Findings from an online decision support tool.

382 Background: Oral targeted therapies (OTTs) inhibiting CDK4/6, PI3K, and mTOR have established roles across multiple lines of therapy in patients with advanced hormone receptor–positive, HER2-negative breast cancer (HR+ BC). Abemaciclib, a CDK4/6 inhibitor (i), now also is approved in the adjuvant setting for eligible patients with early-stage HR+ BC. These OTTs are associated with various adverse events (AEs), such as cytopenias, diarrhea, hepatotoxicity, and rash. Optimal AE management is critical to promote patient adherence and achieve the best possible outcomes. Here we report an analysis of healthcare professional (HCP) management of AEs associated with OTTs in HR+ BC using an online decision support tool. Methods: The online tool was developed with 5 BC experts providing recommendations on the management of AEs associated with OTTs. Within the online tool, HCPs were prompted to input relevant patient case details through a series of predefined questions, including which OTT and type of AE the patient is experiencing, along with their management approach. Participants were then shown an expert recommendation based on the specific characteristics of that case and were asked if their management plan changed based on that recommendation. Results: Between September 2021 and April 2022, 557 cases were entered by 390 participants. Among 291 cases of patients currently receiving oral therapy, CDK4/6i therapy was most commonly selected (82%), followed by PI3Ki (11%) and mTORi (8%) therapy. The most common AE reported for CDK4/6i, PI3Ki, and mTORi therapy were cytopenias (56%), hyperglycemia (64%), and stomatitis (57%), respectively. With CDK4/6i, HCPs were discordant with expert recommendations for management of AEs reported in 44%, 39%, and 35% of entered cases with ribociclib, abemaciclib, and palbociclib, respectively. The greatest variance between HCP and expert recommendations were with management of VTE, hepatotoxicity, QT prolongation, and rash (Table). Among HCPs with discordant results from the experts, 50% changed their AE management plan after viewing the expert recommendation. Conclusions: These data suggest that HCPs may be challenged to optimally manage AEs related to OTTs in patients with HR+ BC. Use of an online tool may enhance HCP management of these AEs for patients with HR+ BC. A detailed analysis of the tool, including HCP planned management vs expert recommendations, will be presented.[Table: see text]

Factors and Outcomes Associated With Venous Thromboembolism Following Bariatric Surgery.

The present national study characterized the incidence and factors associated with VTE following bariatric operations and its association with postoperative outcomes and resource use. Adults (≥18years) undergoing elective sleeve gastrectomy or gastric bypass (laparoscopic and open) were identified in the 2016-2018 Nationwide Readmissions Database. International Classification of Diseases 10th Revision codes for deep venous thrombosis and/or pulmonary embolism were used to ascertain the presence of VTE. Multivariable linear and logistic models were developed to evaluate the independent association of VTE with outcomes of interest. Of an estimated 537,522 patients meeting inclusion criteria, .55% developed VTE during index hospitalization (.14%) or within 90 days of index discharge (.41%). Compared to others, VTE patients were older (51.8 vs 44.9 years, P<.001), more commonly male (20.0% vs 31.5%, P<.001), and had gastric bypass (56.3% vs 31.9%, P<.001) or an open procedure (21.9% vs 2.6%, P<.001). After risk adjustment, several factors including increasing age, male gender, gastric bypass and open approach remained associated with increased odds of VTE. Patients with VTE during index hospitalization had greater odds of mortality (AOR 11.6, 95% CI: 6.12-22.19) and increased index LOS (β:+14.1 days, 95% CI: 11.7-16.5) and hospitalization costs (β: +$53,100, 95% CI: 43,100-63,500). Additionally, VTE patients had greater odds of readmission within 90 days (AOR 1.86, 95% CI: 1.40-2.47). Although VTE is uncommon following bariatric operations, it is significantly associated with increased mortality, readmission, and resource use. Further research is necessary to ascertain optimal management of VTE for bariatric surgery patients.

Prophylaxis of Venous Thromboembolic Disease: Knowledge, Attitudes and Practices of Health Care Personnel in a Hospital Setting in Parakou in 2017

Aims: To describe the knowledge, attitudes and practices of health care personnel regarding venous thromboembolic disease prophylaxis (VTE) in the hospital setting to Parakou in 2017.&#x0D; Study Design: A descriptive cross-sectional study with prospective data collection.&#x0D; Place and Duration of Study: Departments of medicine and medical specialties, Departments of surgery and surgical specialties, Departments of gyneco-obstetrics and intensive care at the Hospital University of Parakou (CHUD-B), in northern Benin, between February 2017 and May 2017.&#x0D; Methodology: We included all health professionals working in these services who consented to participate. The American College of Chest Physicians (ACCP) guidelines for the management of VTE were used as the reference for the assessment of knowledge, attitudes and practices. The evaluation form consisted of two parts, one addressed to physicians and the other to paramedics. The data were analyzed with SPSS 21 software with a significance level of 5% for comparisons.&#x0D; Results: A total of 223 health workers participated in the study. The knowledge level of the health workers was good in 52.47%, attitudes were correct in 37.67% and practices were adequate in 4.32%. Overall, health professionals had a good knowledge-attitude-practice (KAP) score in 5.83% of the cases. Factors significantly associated with a good overall KAP score were practice on medical departments, continuing education of staff, status of doctors, knowledge of VTE guidelines and existence of VTE prevention protocols.&#x0D; Conclusion: Venous thromboembolic disease prophylaxis is moderately known by the health care personnel in Parakou, but attitudes and practices are not satisfactory. This highlights the need for continuous training.

No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study

No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study

Assessment of Risk Factors and Cognitive Level Associated with Venous Thrombosis Patients in a Coexistence of Multiple Diseases Study in Shanghai.

BackgroundVenous thrombosis (VTE) is a high-incidence disease that affects different systems of the body, but no comparative studies have been conducted to explore its incidence in different systems in patients with the coexistence of multiple diseases. Primary care is a medical institution that has the first contact with patients’ conditions. The majority of outpatients suffer from multiple diseases, and they are more prone to VTE, which is of significance and requires investigation. At the same time, we observed that the primary care patients’ cognition level of VTE is insufficiency at present, and the prevention and management of VTE in China is still in its infancy. Most studies focus on whether doctors and nurses are clear about the diagnosis and manifestations of VTE, however, few studies on patients’ cognitive level and influencing factors of symptoms and prevention of VTE. Therefore, it is necessary to study the causes of cognitive deficiency of VTE from the perspective of patients, conduct targeted cognitive and behavioral interventions, and finally achieve the purpose of improving the effect of VTE prevention and management.AimThis study aimed to explore the risk factors, cognitive level and cognitive potential influence factors of VTE in outpatients of primary care in Shanghai, as well as which diseases, are more likely to promote occurrence of VTE among patients with multiple diseases.MethodsA total of 710 patients were included in the analysis. Shanghai in China is divided into urban and suburban areas by their geographical location, and a random sample of 10 primary care areas was investigated, including 5 urban areas and 5 suburban areas. The Padua scale and the VTE cognitive level-related knowledge test scale were used for the investigation. Statistical software was used to conduct univariate Pearson correlation analysis and multivariate logistic regression analysis for VTE high-risk factors among outpatients of primary care. Furthermore, the high-risk factors for VTE and the types of chronic disease in patients with multiple diseases were subjected to subgroup analyses. t-test was used to statistically analyze cognitive level of VTE and the potential influence factors related to the patients’ VTE cognitive level.ResultsUnivariate analysis of risk factors for VTE in 710 outpatients showed that age (χ2=83.895, P<0.001), education (χ2=8.324, P=0.004), region (χ2=63.936, P<0.001), chronic disease (χ2=18.198, P<0.001) and the coexistence of multiple diseases (χ2=61.347, P<0.001) were the main risk factors for VTE risk in patients. Logistic multivariate regression analysis showed that age, region, chronic diseases and the coexistence of multiple diseases were independent risk factors for VTE risk in patients. The correlation between high risk of VTE in patients with multiple diseases and various types of chronic diseases was further analyzed by logistic multivariate regression. The results showed that diabetes mellitus (OR=1.636 [95% CI, 1.030–2.599], P=0.037), cerebral infarction (OR=8.484 [95% CI, 4.615–15.597], P<0.001), coronary heart disease (OR=2.987 [95% CI, 1.699–5.252], P<0.001), intracerebral hemorrhage (OR=15.130 [95% CI, 4.707–48.630], P<0.001), respiratory diseases (OR=3.470, [95% CI, 1.428–8.43], P=0.006) and malignant tumors (OR=4.576, [95% CI, 1.85–11.315], P=0.001) were independent risk factors for VTE among patients with co-existing diseases, and the risks from high to low were cerebral hemorrhage>cerebral infarction>malignant tumor>respiratory system disease>coronary heart disease> diabetes. In addition, patients’ age (t=6.869, P<0.001), region (t=3.420, P<0.001), education level (t=−7.341, P<0.001), chronic disease (t=5.875, P<0.001), BMI (t=6.404, P=0.012), smoking (t=4.152, P=0.042) were related to the VTE cognitive level.ConclusionGeneral practitioners should pay close attention to independent risk factors for VTE among patients in routine outpatient care, especially patients with co-existing diseases with independent risk for VTE, placing them high risk of VTE. At the same time, health education and other measures should be strengthened to improve the patients’ awareness and cognitive level of VTE to prevent the occurrence of VTE and its related complications.

Effects and safety of intraoperative intermittent pneumatic compression for preventing postoperative venous thromboembolism: a meta-analysis

IntroductionIntermittent pneumatic compression (IPC) has been used for venous thrombosis (VTE) prevention. It’s necessary to evaluate the effects and safety of intraoperative use of IPC devices in the prevention of VTE in surgical patients.Material and methodsTwo authors independently searched the PubMed, Cochrane Library, MedLine, EMbase, China national knowledge infrastructure (CNKI), Wanfang databases for randomized controlled trials (RCTs) and cohort studies on the use of IPC in surgical patients up to June 10, 2021. The Cochrane Collaborations risk of bias tool and Newcastle-Ottawa Scale (NOS) were used for quality assessment. RevMan 5.3 software were used for statistical analyses.ResultsA total of 13 studies including seven RCTs and six retrospective cohort studies involving 6673 surgical patients were included, 1883 patients underwent IPC intervention. The synthesized RCT results indicated that IPC was beneficial to the reduce the incidence of DVT (RR0.30, 95%CI0.22~0.40, P&lt;0.001) and VTE (RR0.51, 95%CI0.27~0.95, P=0.03). The synthesized results from retrospective cohort studies indicated that IPC is beneficial to the reduce the incidence of DVT (RR0.63, 95%CI0.42~0.96, P=0.03) and PE (RR0.34, 95%CI0.16~0.72, P=0.005). No significant publication biases were found for all synthesized outcomes (all p&gt;0.05).ConclusionsIPC seems to be safe and effective in the prevention and management of intraoperative VTE. Limited by sample size, this conclusion still needs to be further confirmed by large-sample, multi-center, high-quality clinical studies.