Occurrence Of Venous Thrombosis Research Articles

Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury

Venous thrombus embolism (VTE) is common after polytrauma, both of which are considered significant contributors to poor outcomes and mortality. Traumatic brain injury (TBI) is recognized as an independent risk factor for VTE and one of the most common components of polytraumatic injuries. Few studies have assessed the impact of TBI on the development of VTE in polytrauma patients. This study sought to determine whether TBI further increases the risk for VTE in polytrauma patients. A retrospective, multi-center trial was performed from May 2020 to December 2021. The occurrence of venous thrombosis and pulmonary embolism from injury to 28 days after injury was observed. Of 847 enrolled patients, 220 (26%) developed DVT. The incidence of DVT was 31.9% (122/383) in patients with polytrauma with TBI (PT + TBI group), 22.0% (54/246) in patients with polytrauma without TBI (PT group), and 20.2% (44/218) in patients with isolated TBI (TBI group). Despite similar Glasgow Coma Scale scores, the incidence of DVT in the PT + TBI group was significantly higher than in the TBI group (31.9% vs. 20.2%, p < 0.01). Similarly, despite no difference in Injury Severity Scores between the PT + TBI and PT groups, the DVT rate was significantly higher in the PT + TBI group than in the PT group (31.9% vs. 22.0%, p < 0.01). Delayed anticoagulant therapy, delayed mechanical prophylaxis, older age, and higher D-dimer levels were independent predictive risk factors for DVT occurrence in the PT + TBI group. The incidence of PE within the whole population was 6.9% (59/847). Most patients with PE were in the PT + TBI group (64.4%, 38/59), and the PE rate was significantly higher in the PT + TBI group compared to the PT (p < 0.01) or TBI (p < 0.05) group. In conclusion, this study characterizes polytrauma patients at high risk for VTE occurrence and emphasizes that TBI markedly increases the incidence of DVT and PE in polytrauma patients. Delayed anticoagulant therapy and delayed mechanical prophylaxis were identified as the major risk factors for a higher incidence of VTE in polytrauma patients with TBI.

Quality Improvement Initiative for Neonates: Use of In-line Endotoxin Filters in Central Venous Catheters: A Prospective Interventional Study

Introduction: Sick newborns often require central venous catheters for prolonged periods of time when admitted to the Neonatal Intensive Care Unit (NICU). These central lines, hence, raise the problems of sepsis, thrombus and other potential linerelated complications. In-line endotoxin filters are found to be an effective intervention to remove potential sepsis causing bacteria, endotoxins and other particulates there by reducing the mortality and morbidity of these newborns. Aim: To determine the effect of in-line endotoxin filters on mortality and occurrence of venous thrombosis, sepsis and Necrotising Enterocolitis (NEC) in sick newborns with central venous catheters. Materials and Methods: This single-centre, prospective interventional study was conducted over a period of 12 months, where, all sick babies admitted to the NICU for more than 24 hours with a central venous catheter were eligible for the study. They were grouped into those which received the in-line filters (study group) and those with standard care without filters (control group). The primary outcome variables studied were sepsis, thrombus formation, NEC, ventilator days and death. Secondary outcomes were days of hospital stay, line days, and length of ICU stay. Results: Out of 137 eligible neonates, 127 were finally included in the study; 66 were in the control group while 61 in the study group, seven were excluded and a total of 54 in the study group were included. A total of 20 cases developed NEC in the control group while only six in the study group (p-value=0.03). Thrombus formation was lesser in the study group 3 (5.6%) compared to the control group 14 (21.2%). Thrombus formation was also found to be less likely to occur when an in-line filter is attached as compared to not using one (OR 0.232; 95% CI 0.628-0.858; p-value=0.02). The odds of occurrence of NEC (OR: 0.307 95 % CI: 0.113 - 0.834) also were found to be significantly less in the study group. Conclusion: A simple intervention like addition of in-line endotoxin filters to the central venous catheters in sick newborns in NICU decreases the risk of thrombosis, risk of NEC and overall complications in critically ill NICU patients.

The Impact of Hydroxyurea on Survival and Risk of Thrombosis Among Older Patients with Essential Thrombocythemia

Introduction: Patients with essential thrombocythemia (ET) are at greater than 20% risk for thrombotic complications. They are categorized into high- and low-risk groups based on the presence of advanced age (> 60 years) and / or thrombosis history. One of the main goals of ET treatment is thrombosis prevention. Use of hydroxyurea (HU) among high-risk ET patients improves rate of thrombosis and is the frontline guideline-recommended therapy for older patients. Little is known about HU impact on the survival and thrombosis in the real-world setting.Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified patients diagnosed with ET (International Classification of Diseases for Oncology, 3rd edition, code 9962) from 2007-2011. Patients were required to: 1) be aged 66-99 years; 2) have continuous enrollment in Medicare Parts A and B from one year before diagnosis to death or the end of study (12/31/2012); and 3) have continuous Part D six months before diagnosis to the end of follow-up to capture HU use. HU users were restricted to those who had more than two HU prescription claims. HU coverage was calculated as the percentage of days from diagnosis to the end of follow-up covered by HU prescriptions. Thrombotic events were defined as first occurrence of venous thrombosis, arterial thrombosis, or sudden death after diagnosis. Predictors of receiving HU were evaluated using multivariate logistic regression models. Multivariable Cox proportional hazard regression models were utilized to assess the impact of HU on survival and thrombotic events, controlling for patient age at diagnosis, sex, race, Part D low income subsidy (a proxy marker for lower socioeconomic status), influenza vaccination 12 months prior to diagnosis (an indicator for health care access), disability status (a claims-based proxy for poor performance status), modified Elixhauser comorbidity score (the original comorbidity score excluding cardiovascular conditions), and pre-existing cardiovascular conditions. HU was treated as a time-dependent variable in the Cox model.Results: A total of 654 high-risk ET patients with a mean age of 79.0 (standard deviation =7.4) years were included in the study, of which 67.9% were women and 85.5% were white. The median duration of follow-up was 2.5 years. In this large sample of older patients, only 59.2% of the patients received HU after ET diagnosis. Results of multivariate logistic regression models showed that patients with comorbidities (p<.01), with pre-existing cardiovascular conditions (p=.05), or disabled (p<.01) were less likely to receive HU. At the end of follow-up, 26.6% (n=103) HU users and 58.8% (n=157) non-users died. The median survival for HU non-users was 2.53 years, while it was not reached for HU users (log-rank test, p<.01, Figure 1). In the multivariate Cox model, HU usage after diagnosis was associated with a significantly lower risk of death (hazard ratio [HR]=0.42, 95% confidence interval [CI]: 0.32-0.54, p<.01). Every 10% increase of HU coverage was associated with a 16% decreased risk of death (HR=0.84, 95% CI: 0.81-0.88, p<.01). A total of 235 (35.9%) patients had thrombotic events after diagnosis, including 180 arterial thromboses, 54 venous thromboses and 1 sudden death. Thrombotic events occurred in 25.3% (n=85) HU users and nearly half of the HU non-users (47.2%, n=150). The median time to develop thrombosis was not reached for HU users and was significantly longer than for HU non-users (2.12 years, log-rank test, p<.01, Figure 2). In the multivariate model, compared with non-users, HU users had a significantly lower risk of thrombotic events (HR=0.51, 95% CI: 0.38-0.68, p<.01). Every 10% increase of HU coverage was associated with a 13% lower risk of thrombotic events (HR=0.87, 95% CI: 0.84-0.91, p<.01). Sensitivity analyses, which only included patients who survived more than 6 months, showed similar association between use of HU, improved survival and decreased incidence of thrombotic events.Conclusions: To our knowledge, this is the first study to evaluate association between HU and survival among high risk ET patients. Use of HU was associated not only with improved overall survival but also with reduced incidence of thrombotic events in older ET patients. HU was underutilized in the studied high risk ET population, including patients with pre-existing cardiovascular conditions who need the drug the most. [Display omitted] DisclosuresPodoltsev:Incyte: Consultancy; CTI biopharma/Baxalta: Consultancy; Alexion: Consultancy; Ariad: Consultancy. Zeidan:Otsuka: Consultancy; AbbVie, Otsuka, Pfizer, Gilead, Celgene, Ariad, Incyte: Consultancy, Honoraria; Takeda: Speakers Bureau. Huntington:Celgene: Consultancy, Other: Travel; Janssen: Consultancy; Pharmacyclics: Honoraria. Ma:Incyte Corp.: Consultancy.

The Impact of Phlebotomy and Hydroxyurea on Survival and Risk of Thrombosis Among Older Patients with Polycythemia Vera

Introduction: Polycythemia vera (PV) is a classical myeloproliferative neoplasm characterized by the overproduction of mature red blood cells leading to an increased risk of thrombosis. Maintenance of hematocrit below 45% using phlebotomy improves rate of cardiovascular death and major thrombosis and is recommended for all PV patients. For high risk patients (> 60 years and/or with thrombosis history) cytoreductive therapy is recommended, with hydroxyurea (HU) being most commonly used among older PV patients. Little is known about the patterns of care and the impact of phlebotomy and HU on the outcomes of PV patients in the real-world setting.Methods: We conducted a retrospective cohort study of older adults (aged 66-99 years) diagnosed with PV (International Classification of Diseases for Oncology, 3rd edition, code 9950) in 2007-2011 and included in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Patients were required to have: 1) continuous enrollment in Medicare Parts A and B from one year before PV diagnosis through death or end of study (12/31/2012), whichever came first; and 2) continuous Part D coverage from diagnosis to end of follow-up to capture HU use. HU users were restricted to those who had more than two HU prescription claims. Predictors of receiving phlebotomy or HU were evaluated using multivariate logistic regression models. Thrombotic events were defined as the first occurrence of venous thrombosis, or arterial thrombosis, or sudden death after diagnosis. Multivariate Cox models were used to assess the impact of phlebotomy and HU on two outcomes measured from the time of diagnosis, including overall survival and time to the above mentioned thrombotic events, adjusting for patient age at diagnosis, sex, race, Part D low income subsidy (LIS, a proxy marker for reduced out-of-pocket cost sharing, and lower socioeconomic status), influenza vaccination 12 months prior to diagnosis (an indicator for health care access), disability status (a claims-based proxy for poor performance status), modified Elixhauser comorbidity score (the original comorbidity score excluding cardiovascular conditions), and pre-existing cardiovascular conditions. Phlebotomy and HU were treated as time-dependent variables.Results: A total of 482 PV patients with a mean age of 77.7 years were identified. The majority of patients were female (55.6%) and white (90.0%). During the study period, 376 (78.0%) received phlebotomy and/or HU. Among them, 136 (36.2%) patients underwent therapeutic phlebotomy only, 95 (25.2%) received HU only, and 145 (38.6%) received both phlebotomy and HU. On multivariable regression, patients with increasing age (p=.01) and non-white (p=.01) were less likely to get phlebotomy; whereas patients who were male (p<.01), lacked influenza vaccination 12 months before diagnosis (p<.01), and who were without LIS (p=.01) were less likely to receive HU. After a median follow-up of 2.75 years, 28.8% (n=81) phlebotomy users and 46.8% (n=94) phlebotomy non-users died. The median survival for phlebotomy non-users was 3.81 years, while for phlebotomy users it was not reached (log-rank test, p<.01, Figure 1). In the multivariate Cox model, receipt of phlebotomy was significantly associated with a lower risk of death (hazard ratio [HR]=0.71, 95% confidence interval [CI]: 0.52-0.96, p=.03). While HU use was not associated with overall survival (users vs. non-users: HR=0.85, 95% CI:0.62-1.16, p=.30), HU users were less likely to experience a thrombotic event after PV diagnosis (21.4% vs. 46.5%, p<.01). Median time to develop thrombosis for HU non-users was 2.64 years while for HU users it was significantly longer (not reached, log-rank test, p<.01, Figure 2). HU use remained associated with a lower risk of thrombosis after PV diagnosis on multivariable Cox regression (HR=0.47, 95% CI: 0.33-0.68, p<.01). On similar models, phlebotomy use was not strongly associated with the development of thrombosis.Conclusions: In this population-based study reflecting general clinical practice, phlebotomy use was associated with improved overall survival among older adults with PV while HU-treated patients had decreased risk of thrombosis. Both treatment modalities were underused in this high-risk PV population. [Display omitted] DisclosuresPodoltsev:Incyte: Consultancy; CTI biopharma/Baxalta: Consultancy; Ariad: Consultancy; Alexion: Consultancy. Zeidan:Takeda: Speakers Bureau; Otsuka: Consultancy; AbbVie, Otsuka, Pfizer, Gilead, Celgene, Ariad, Incyte: Consultancy, Honoraria. Huntington:Celgene: Consultancy, Other: Travel; Janssen: Consultancy; Pharmacyclics: Honoraria. Ma:Incyte Corp.: Consultancy.

A 22-year-old COVID-19 positive male with no prior medical history presented to the emergency department with pulmonary infarction

ABSTRACT Rapidly growing evidence has now shown a high incidence of venous thrombosis in patients with severe acute respiratory syndrome secondary to novel coronavirus 2, a disease now named COVID-19. Accumulating case reports and series have also shown a higher prevalence of arterial thrombosis in these patients as well. Although the pathophysiology remains unknown but likely multifactorial – including endotheliitis from direct viral damage and an underlying hyper-inflammatory state, arterial and venous thrombosis occurrence does not appear to be linked with underlying classic risk factors for venous thromboembolism and may present in healthy patients without significant comorbidities. We present a case of a 22-year-old healthy patient with COVID-19 who developed a pulmonary embolism with a pulmonary infarction, a complication that results from arterial and venous thrombosis of the pulmonary vascular supply resulting in tissue necrosis.

Venous thrombosis in patients after intracardial catheter interventions: incidence, risk factors, special aspects of the diagnosis

Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.Materials and methods: This prospective study included 408 patients (194 men and 214 women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269 patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3 months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p&lt;0.001). No association between elevated baseline D-dimer values (&gt;500 ng/mL) and subsequent VT development was found (p&gt;0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434 ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65 years (p&lt;0.001), female gender (p=0.001), arterial hypertension (p=0.003), chronic coronary heart disease (p=0.044).Conclusion: In this study, all VTs (11.7%) detected after catheter transvenous interventions by USDS were asymptomatic. VTs were most frequent in patients with diabetes mellitus and obesity. D-dimer had no predictive value in the development of VT; however, its increased baseline values were more common in women, patients over 65 years, and in patients with arterial hypertension and chronic coronary heart disease.

Research on efficacy of thromoela-stogram in predicting PICC-associated thrombosis

Objective To explore the efficacy of thromoela-stogram (TEG) to predict the occurrence of venous thrombosis related to peripherally inserted central catheter (PICC). Methods A retrospective analysis was performed on 302 patients who underwent PICC catheterization in the hospital from June 1, 2015 to June 1, 2017.According to whether there was thrombosis, they were divided into the thrombosis group with 35 cases and the non-thrombosis group with 267 cases.TEG index changes before and after PICC catheterization were detected by T or U test to screen meaningful indicators for predicting thrombosis, and TEG index was further evaluated by receiver operating characteristic curve (ROC) to predict the efficacy of thrombosis. Results The results of χ2test showed that thrombosis was associated with hyperlipidemia and diabetes mellitus, and the differences were statistically significant(P 0.05). The r value (reaction time), K value (coagulation time), ma value (maximum thrombus size) of the thrombus group before and after treatment were statistically significant(P 0.05). In the non-thrombotic group, there was no significant difference in r value, K value, ma value and α Angle(P>0.05). Further Logistic binary regression analysis showed that r value and K value were significant in predicting thrombosis(P 0.242. Conclusion The efficacy of thrombus elastograms combined with indicators in predicting thrombosis is obvious, which is worthy of further clinical application. Key words: Thromoela-stogram; PICC; Thrombus

Analysis of survival and risk factors of DVT in patients with cervical cancer

Objective To investigate the relationship between vWF levels and ADAMTS13 levels of DVT (venous thrombosis) in patients with cervical cancer, and then to evaluate the predictive value of vWF levels and ADAMTS13 levels of cervical cancer patients with DVT. Methods A total of sixty-six patients diagnosed as cervical cancer and treated from June 2015 to June 2016 in Weinan Maternal and Child Health Hospital were enrolled, and their baseline data, pathological type, tumor classification, TNM staging, vWF, ADAMTS13 levels and Autar score were recorded.All patients were followed up for 1 year and the patients with adverse outcomes were defined as poor prognosis group during the follow-up period while the patients whose disease progression free were defined as good prognosis group.Univariate analysis showed that the incidence of venous thrombosis in patients with cervical cancer was affected; Cox proportional hazard model further assessed the impact of all statistically significant factors on the occurrence of venous thrombosis in patients; t test showed the distribution of influential factors between the two groups; ROC curve was used to analyze the sensitivity and specificity of vWF and ADAMTS13 levels in predicting the occurrence of venous thrombosis in cervical cancer patients. Results At the end of the follow-up, among the 66 patients, Six were not followed and 40 had good prognosis without venous thrombosis, which was a good prognosis group; Twenty had poor prognosis, i.e.venous thrombosis, which was a poor prognosis group, including 5 deaths.The poor prognosis rate was 30.30%.Univariate Cox proportional hazard model results showed that vWF (P=0.023, (95%CI: 1.743-1.215)) and ADAMTS13 (P=0.037, (95%CI: 1.158-1.566)) had a significant effect on the patients with venous thrombosis.The levels of vWF ((0.535±0.075) μg/L) and ADAMTS13 ((69.453±10.284) %) in good prognosis group were significantly lower than those in poor prognosis group((0.592±0.082)μg/L, (79.245±11.477) %), and the differences between the two groups were statistically significant (t=2.690, 3.345, P<0.05). Under ROC curve, the AUC of vWF level was 0.841, the sensitivity and specificity were 55% and 97.5% respectively, and that of ADAMTS13 level was 0.906, the sensitivity and specificity were 85% and 80%, respectively. Conclusion The levels of vWF and ADAMTS13 have a good predictive effect on the occurrence of venous thrombosis in patients with cervical cancer.It is expected to be used as a routine evaluation index to predict the occurrence of venous thrombosis in patients with cervical cancer after treatment. Key words: Cervical cancer; Venous thrombosis; Von Willebrand factor vWF; A distintegrin-like and metalloproteinase with thrombospond in type-1 domain 13

The cause analysis and nursing care of patients with venous thrombosis induced by PICC

Objective To explore the causes of venous thrombosis after peripherally inserted central catheter(PICC) in tumor patients and corresponding nursing precautions. Methods A total of 105 patients with tumors undergoing long-term infusion and chemotherapy in this hospital were selected as the research subjects.All patients were treated with PICC catheterization.Nursing measures were observed and administered at the beginning of catheterization. Results A total of 6 patients developed venous thrombosis, and the patients' condition gradually recovered after anticoagulation therapy.It was found that venous thrombosis was not only directly related to catheterization, but also related to drug use in the course of disease treatment and activity of patients. Conclusion Skilled puncture techniques and related nursing measures can effectively reduce the occurrence of venous thrombosis in patients with PICC. Key words: Venous thrombosis; PICC; Nursing measures

VENOUS THROMBOSIS IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS WITH LYMPHOMAS: INCIDENCE, CHARACTERISTICS, RISK FACTORS AND PROGNOSTIC VALUE

Objective . To define the epidemiology of venous thrombosis (VT) in children, adolescents and young adults with lymphomas, to identify the thrombotic risk factors and VT’s prognostic value. Materials and methods. We reviewed the medical records of 513 lymphoma patients (284 with Hodgkin's lymphoma (HL) and 229 with non-Hodgkin lymphoma (NHL)) aged from 0,6 to 26 years (median – 14 years), diagnosed with lymphomas in 2005–2017. Risk thrombotic factors were assessed using binary Cox regression in univariate and multivariate models with calculation of the odds ratio (OR) with 95 % CIs. Results . Twenty-eight of 513 patients (5.5 %, 95 % CI, 4.5–6.5 %) were diagnosed as having VT with a total of 32 thrombotic events. The incidence of VT in NHL patients (23/229, 10.5 %, 95 % CI, 8.5–12.5 %) was higher than in HL patients (5/284, 1.8 %, 95 % CI, 1.0–2.6 %, p &lt;0.0001). VT was associated with venous catheterization (VC) in 53.6 % and with local compressive effect in 32.1 % cases. VT occurred during the first 6 weeks after lymphoma diagnosis in 57.1 % patients. Genetic predisposition to thrombosis (FV Leiden и FII G20210A mutations) was revealed in 3 (10.7 %) patients. The recurrence rate of VT was 14.3 %. Age older than 13 years (ОR 2.5, 95 % CI, 1.1–6.0, p &lt;0.05) and lymphoblastic lymphoma (LL) subtype (ОR 5.5, 95 % CI; 2.3–13.6, p &lt;0.01) independently associated with the occurrence of VT in NHL patients. In HL group all cases of VT were detected in patients older than 15 years. The only risk factor predisposing patients with HL to VT was significant mediastinal lymphadenopathy (bulky disease) (ОR 7.0, 95 %; 1.2–42.3, p&lt;0.05). The presence of VT did not influence OS of NHL patients (73.7 %, SE 9.2 % (n = 23) versus 83.4 %, SE 9.2 % (n = 206), p &gt;0.05), but had a negative impact on the OS of HL patients (60.0 %, SE 21.9 % (n = 5) versus 94.8 %, SE 1.5 % (n = 279), p &lt;0.001). HL patients older than 15 years with bulky disease (38/284, 13.4 %), had a high thrombotic risk with lower OS of 78.8 ± 8.3 %, p &lt;0.001. Conclusion. Cumulative incidence of VT in NHL patients was higher than in HL patients. Age older than 13 years and LL were independent thrombotic risk factors for NHL patients. Age older than 15 years and bulky disease increased risk of VT in HL patients. VT occurrence decreased OS of young HL patients. It may be necessary to delay the central VC of vena cava superior in children with massive mediastinal tumor. Prophylactic anticoagulation for high thrombotic risk patients might be warranted.

Effect of anticoagulant therapy on prevention of thrombosis in PICC patients with lung cancer with hypercoagulability

Objective To explorethe efficacy of anticoagulation therapy with peripherally inserted central venous catheter (PICC) for prevention of venous thrombosis in patients with lung cancer with hypercoagulability. Methods During the period from August 2015 to December 2016, 30 patients in our hospital were enrolled as the observation group, and 30 patients from May 2014 to July 2015, with lung cancer treated with PICC catheter in our hospital were selected as the control group. In the control group, PICC during intubation by conventional methods to prevent the occurrence of venous thrombosis; while in the observation group with the additional treatment before and after anticoagulant therapy catheter based on routine prevention. Venous thrombosis incidence and the indwelling time of PICC were compared between two groups. Results The incidence of thrombosis in observation and control groups was 0 and 20% respectively, with significant difference between the two groups (P= 0.024). The PICC retention time in observation group and control group was 95.5 (21.00, 117.25) days and 108 (97.00,130.25) days, the difference between the two groups was statistically significant (Z=-2.249, P= 0.025). Conclusions Anticoagulation treatment with PICC catheter before and after in hypercoagulability lung cancer patients can significantly improve the hypercoagulable state of patients, effectively prevent venous thrombosis, and prolong the PICC retention time. Key words: Catheterization, central venous; Hypercoagulability; Lung cancer; Anticoagulant treatment; Thrombosis

La maladie veineuse thromboembolique : quels autres facteurs de risque dans une population nord-africaine ? Une étude de 276 cas

IntroductionVenous thromboembolism is a multicausal disease. Understanding interactions between risk factors is the key to advance knowledge about the etiology of venous thrombosis. These interactions are still unclear. In addition to traditional risk factors, there is data about many other risk factors, recorded with few populations based prospective epidemiologic studies or punctually reported. Interactions between these risk factors remain unclear. The aim of our work is to identify and analyze combinations of risk factors. MethodsThis is a retrospective, single-center study, which investigates the etiology of venous thromboembolism, on the records of patients hospitalized in internal medicine for venous thrombosis, over a period of 12 years. ResultsWe selected 276 cases. The average age was 51 years. At least, we found one traditional risk factors in 87 % of cases, 34 patients had no traditional risk factors. Suspected risk factors were found in 81 % of cases and there was at least one punctually reported factor in 34 % of cases. The combination of risk factors mostly found was association of traditional and suspected risk factors. In more than 50 % of patients, we noted at least, more than one traditional or one suspected risk factors. Among 18 patients presenting only suspected risk factors, there was at least combination of 3 risk factors per patient. ConclusionThe role of suspected risk factors in the occurrence of venous thrombosis was not negligible in this work. Our data suggest a hypothesis that it's through their association that suspected risk factors might be able becoming comparable to traditional risk factors.

Impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly

Objective To study the impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly. Methods 86 elderly patients with hip fracture surgery were divided into the control group(43 cases) and observation group(43 cases) according to random number table method.The control group was given low molecular heparin calcium, and the observation group was given rehabilitation training combined with low molecular heparin calcium.After four weeks, the hip functional recovery and venous thrombosis occurrence were observed in the two groups.The levels of blood rheology indicators such as blood high shear viscosity, shear viscosity, low shear viscosity, erythrocyte aggregation index and coagulant function index of thrombin time and D-dimer were detected. Results The scores of hip joint pain, joint function, joint mobility, deformity and Harris score in the observation group were higher than those in the control group, the differences were statistically significant(t=3.713, 3.224, 3.345, 1.861 and 8.087, all P<0.05). The incidence rate of venous thrombosis in the observation group was 6.89%, which was lower than 23.26% in the control group, the difference was statistically significant (χ2=4.440, P=0.035). After 4 weeks treatment, the levels of the whole blood high shear viscosity, shear viscosity, low shear viscosity and erythrocyte aggregation index in the observation group were lower than those in the control group, the differences were statistically significant (t=2.092, 2.590, 1.716 and 2.590, all P<0.05). After treatment, the level of D-dimer in the observation group was lower than that in the control group, and the prothrombin time in the observation group was higher than that in the control group, the differences were statistical significance(t=7.510 and 2.151, all P<0.05). Conclusion The rehabilitation training combined with low molecular heparin calcium can promote hip joint function recovery of postoperative period of hip fracture in the elderly, reduce the incidence of venous thrombosis, improve blood rheology and blood coagulation function indicators. Key words: Rehabilitation training; Low molecular heparin calcium; Hip fracture; Venous thrombosis; Blood rheology; Blood coagulation function

Risk of venous thrombosis in persons with increased body mass index and interactions with other genetic and acquired risk factors

Essentials Obesity, factor V Leiden (FVL) and blood group non-O are common. We studied the combined effect of these factors on the risk of venous thrombosis (VT). The combination of obesity, non-O blood group and FVL increased VT risk up to ten-fold. Identifying high VT may be beneficial in thrombosis prevention. Background Overweight/obesity has a substantial effect on the occurrence of venous thrombosis (VT). Blood group non-O has a high prevalence in Western populations, and the factor V Leiden mutation could be present in 5% of Caucasians. These frequent prothrombotic risk factors will have a considerable impact on the incidence of VT, especially when combined. Objectives We investigated whether FV Leiden with blood group non-O modifies VT risk in individuals with different body mass index (BMI) strata in a case-control study (n = 11253). Results We observed a progressively increasing risk of VT with higher BMI, with an odds ratio of 1.9 (95% confidence interval [CI] 1.6-2.3) for those in the upper BMI tertile (BMI > 26.7 kg m(-2) ), as compared with the first BMI tertile (BMI < 23.5 kg m(-2) , blood group O, and no FV Leiden) (reference group). The addition of FV Leiden and blood group non-O to the model increased the risk in all BMI tertiles; the odds ratios were 3.8 (95% CI 3.2-4.6) in the third BMI tertile of individuals with blood group non-O, and 5.4 (95% CI 3.5-8.5) in the third BMI tertile of individuals with FV Leiden. When both FV Leiden and blood group non-O were present, the odds ratios were 9.1 (95% CI 5.9-14.0) in the first BMI tertile, 9.4 (95% CI 6.6-13.5) in the second BMI tertile, and 12.5 (95% CI 8.9-17.6) in the third BMI tertile. Conclusion Individuals with a high BMI, blood group non-O and/or FV Leiden have a high VT risk. The high VT risks in some subgroups may justify targeted screening and thromboprophylaxis decisions in these patients.

Venous thrombosis in patients with giant cell arteritis: Features and outcomes in a cohort study

ObjectivesTo describe the features and outcomes of patients with giant cell arteritis who developed venous thrombosis. MethodsInception cohort study including 428 newly diagnosed patients of giant cell arteritis from 1976 to 2014. Clinical and biological data and outcomes were analysed by comparing patients with and without venous thrombosis. ResultsTwenty-six patients (6%) developed venous thrombosis, 12 of whom presented with pulmonary embolism. The mean time between the onset of giant cell arteritis symptoms and venous thrombosis occurrence was 248.8±215.0 days. No difference was observed between the two groups in clinical or laboratory data collected at diagnosis. The mean time from the start of prednisone to venous thrombosis diagnosis was 187.7±217.0 days. The average dose of prednisone at venous thrombosis onset was 21.5mg/day. The venous thrombosis group had a higher number of glucocorticoid-related adverse effects (mean, 3.1 vs 1.1; P<0.0001), a higher mortality rate (58% vs 33%, P=0.01) and a higher proportion of deaths occurring during glucocorticoid treatment (31% vs 14%, P=0.03). Death was related to venous thrombosis in four patients. DiscussionThe occurrence of overt venous thrombosis is more than anecdotal among patients treated for giant cell arteritis. Venous thrombosis does not rely on the active phase of giant cell arteritis, but could be associated with long-term use of glucocorticoids. Because venous thrombosis may be associated with an increased mortality risk in patients with giant cell arteritis, a high index of suspicion should be applied in appropriate settings, especially in patients experiencing multiple glucocorticoid-related adverse effects.

Role of thromboxane-dependent platelet activation in venous thrombosis: Aspirin effects in mouse model

Recent trials suggest that Aspirin (ASA) reduces the incidence of venous thromboembolism in human. However, the molecular mechanisms underlying this effect are still unclear. In this study we assessed the effects of ASA in venous thrombosis mouse model induced by inferior vena cava (IVC) ligation and we investigated the mechanisms responsible for this effect.ASA (3mg/kg daily for 2 days) treatment decreased the thrombus size, the amounts of tissue factor activity in plasma microvesicles (TF-MP) and the levels of 2,3-dinor Thromboxane B2 (TXB-M) in urine compared to control mice. Interestingly, the thrombus size positively correlated with both TF-MP activity and TXB-M. In addition, positive correlation was observed between TF-MP activity and TXB-M. A reduced number of neutrophils and monocytes, and of TF-positive cells accompanied to a lower amount of fibrin and neutrophil extracellular traps (NETs) were also found in thrombi of ASA-treated mice. Similar results were obtained when mice were treated 24h before IVC ligation with SQ29548 (1mg/kg), a selective thromboxane receptor antagonist. In addition, transfusion of platelets in SQ29548 treated-mice excluded the likelihood of a redundant role of platelet-TP receptor in this context.Finally, incubation of macrophages and neutrophils with SQ29548 prevented TF activity and/or NETs formation induced by supernatant of activated platelets or by IBOP, a selective thromboxane analogue.In conclusion, ASA, suppressing TXA2, prevents macrophages and neutrophils activation and markedly reduces thrombus size with a mechanism most likely dependent of the inhibition of TF activity and NETs formation. These results provide a new link between platelet-produced thromboxane and the occurrence of venous thrombosis.

Update of thrombosis in multiple myeloma

With the introduction of thalidomide and multi-agent chemotherapy in the treatment of multiple myeloma around 15years ago a strongly increased risk of venous thrombosis was observed. The occurrence of venous thrombosis in multiple myeloma is not only determined by the kind of treatment, but also by several other factors, including disease specific factors, patient-specific factors, changes in pro-and anticoagulant factors and fibrinolysis. Studies showed a prevalence of up to 25% in patients with newly diagnosed multiple myeloma. Therefore these patients nowadays receive prophylaxis with aspirin, low molecular weight heparin or warfarin in order to reduce the risk of venous thrombosis. It is however still debatable which patients should receive prophylaxis and what the best kind of prophylaxis is, considering both the risk of thrombosis and the risk of bleeding. In recent years several new anti-myeloma agents have been developed and investigated in large clinical studies. The risk of thrombosis using these new drugs seems less than with thalidomide and lenalidomide-based regimens. In this article an update on prevention and management of thrombotic events in patients with multiple myeloma is given.

Review of efficacy and safety of the new oral anticoagulants (NOACS) in the treatment of venous thromboembolism in gastrointestinal (GI) oncology patients.

761 Background: The occurrence of venous thrombosis (VTE) has been reported to increase the likelihood of death for cancer patients by 2- to 6-fold. Additionally, cancer patients have both a higher rate of VTE recurrence during oral anticoagulant therapy with warfarin and a higher anticoagulation-associated hemorrhagic risk as compared with non-cancer patients. New oral anticoagulants (NOACs) have administration and monitoring advantages treatment options for patients, however, there is limited data on the use of NOACs for cancer patients. Methods: We performed a single-institution retrospective review of electronic medical records of patients with GI cancer who received rivaroxaban with an active VTE diagnosis. Data collected included patient demographics, diagnosis, previous and active chemotherapy, previous history of VTE, and clinical outcomes. Results: Thirty-two patients were identified, with 28 patients concurrently treated with chemotherapy. Rivaroxaban was given to treat DVT = 23 patient and PE = 9 patients with average length of therapy 181 days. Forty-one percent of patients started on rivaroxaban, while 25% received enoxaparin, and 22% received warfarin prior to rivaroxaban. Overall, 13/32 (41%) patients experienced a bleeding episode; 7 patients had their dose held and 6 patients were noted to have minor bleeding. Conclusions: In our retrospective study, rivaroxaban did show efficacy in secondary prophylaxis for VTE in patients with active cancer. However our results revealed a rather high rate of bleeds in patients being treated with chemotherapy and rivaroxaban as compared to previous studies. [Table: see text]

The risk of venous thrombosis after air travel: contribution of clinical risk factors

The risk of venous thrombosis after air travel: contribution of clinical risk factors

Three polymorphisms in promoter of protein c gene with endothelial protein c receptor gene and risk of venous thrombosis

The primary abnormalities that are associated with a risk of venous thrombosis are the deficiencies of protein C. Protein C (PROC), encoded by the PROC gene, acts through its affinity for binding to its transmembrane endothelial cell protein C receptor (EPCR) encoded by the EPCR gene. The objective of the study was to analyze the link between three polymorphisms in the promoter of PROC gene, the polymorphism in the EPCR gene and the occurrence of venous thrombosis. We genotyped 135 individuals - 51 cases with documented venous thrombosis and 84 healthy volunteers without a history of venous thrombosis. The occurrence of the TAA haplotype of PROC gene was significantly more frequent in the controls (N = 48; 57.1%), compared with the patients (N = 18; 35.3%), (P = 0.0206). The healthy individuals were also significantly often carriers of the TAA haplotype and the standard genotype AA of EPCR gene (50 vs. 25.5%) than the patients (P = 0.0066). The frequency of haplotypes CAA and CGT of PROC gene was insignificantly higher in the patients (15.7 and 21.6%, respectively) than in the control group (9.5 and 13.1%). The combination of haplotype CAA/CAA of PROC gene and variant genotype AG of EPCR gene was confirmed with a higher frequency in the group of patients (3.9 vs. 1.2%).This analysis showed that the PROC haplotype associated with a high protein C level (TAA) and the EPCR AA genotype was significantly more frequent in the healthy volunteers (P = 0.0066). Haplotypes associated with a low production of protein C (CAA or CGT) were more frequent in patients with venous thrombosis.