Prevention Of Pulmonary Embolism Research Articles

Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis

During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements. To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population. In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022. Start of dialysis. The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015). In total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6). In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.

Development of a Fluorescent Microfluidic Device Based on Antibody Microarray Read-Out for Therapeutic Drug Monitoring of Acenocoumarol.

The development of a proof-of-concept point-of-care (PoC) device for the determination of oral anticoagulants determination is presented. Acenocoumarol (ACL) is prescribed to prevent certain cardiovascular diseases related to the prevention of deep vein thrombosis, pulmonary embolism, myocardial infarction, and stroke. Oral anticoagualant treatment (OAT) represents a population of 2% under treatment which has expenditures about $ 144 million in 2011. The main drawback for OAT is the associated narrow therapeutic window and the unpredictable dose-response relationship, which is one of the main causes for visiting the emergency room at the hospitals. In a previous work, family antibodies were produced for the simultaneous detection of ACL and warfarin (W) depending on the area of application. It was developed in different formats, indirect and direct, either with similar detectabilities and both assays quantifying the oral anticoagulants with high accuracy and reproducibility. We present the implementation of the already developed immunochemical method to a point-of-care (PoC) device to assist on the patient compliance assessment programs. In order to achieve this goal, a first development was performed implementing ACL ELISA assay into a microarray format with fluorescent read-out. The assay was successfully implemented achieving a LOD of 1.23 nM of ACL directly measured in human plasma. Then, a fully integrated microfluidic system is developed which incorporates the specific immunoreagents for the detection of ACL. The immunoreagents were attached onto the glass slide in a microarray format. The system is automatic, rapid, sensitive, and disposable that could help clinicians monitor patients under OAT. According to the fluorescent label of the ACL binding, the chip can be easily read with a scanner. The microfluidic system performed good according to the robust and reproducible signals, and subsequently yielded an accurate result.

Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol

IntroductionMore than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%–0.5% fatal PE, and over 1000...

Low incidence of clinically relevant bleeding complications after fast-track arthroplasty: a register study of 8,511 arthroplasties.

Background and purposeFast-track total joint replacement (TJR) has become increasingly common. Routine thromboprophylaxis for pulmonary embolism and deep venous thrombosis prevention lasts from 2 to 5 weeks. This retrospective registry study focused on clinically relevant bleeding complications 90 days after fast-track primary TJR.Patients and methodsAll primary fast-track total hip (THA) and knee arthroplasties (TKA) performed between 2015 and 2016 were extracted from the Finnish Arthroplasty Register and Finnish Hospital Discharge Register. Type of arthroplasty and indication for the operation were combined with diagnoses of clinically relevant bleeding complications within 90 days of surgery. The incidence of these bleedings was the primary outcome measure.ResultsOf the total of 8,511 patients (mean age 67 years (SD 10); 60% female), 45% underwent unilateral THA, 52% unilateral TKA, and 3% bilateral TKA. The incidence of clinically relevant bleeding complications within 90 days was 1% (95% CI 0.8–1.3). No difference was observed in bleeding incidence between the groups. The 87 bleedings comprised 57 operative site bleedings, 17 gastrointestinal bleedings, 6 intracranial non-traumatic bleedings, 5 bleedings from the nose or another undetermined site, and 2 intraocular bleedings. 1 death due to intracranial bleeding was recorded, and hence clinically relevant bleeding-specific 90-day mortality was 0.01%.InterpretationThe incidence of clinically relevant bleeding complications was low. However, they cause patient discomfort, increase the use of healthcare services, and can be life-threatening and even fatal.

POSB124 Costs of Inferior Vena Cava Filter Placement for Medicare Beneficiaries with Acute Venous Thromboembolism

Inferior vena cava filters (IVCFs) are placed in patients with acute venous thromboembolism (VTE) to prevent pulmonary embolism (PE) when there is a contraindication to or failure of anticoagulation. Studies examining the costs of IVCF placement among VTE beneficiaries are lacking. This study quantified the costs incurred to Medicare for the index IVCF placement in VTE beneficiaries.

O USO DA QUIMIOPROFILAXIA OU NÃO PARA TVP EM CIRURGIA DE COLUNA: REVISÃO SISTEMÁTICA

ABSTRACT Objective: To compare pharmacological and non-pharmacological prophylaxis in elective spine surgery to determine the risks of DVT, PTE, and epidural hematoma (EH) in both groups, as well as their respective treatment effectiveness. Methods: Systematic review and meta-analysis based on systematically searched articles, using combinations of MeSH terms related to chemoprophylaxis and non-chemoprophylaxis for prevention of deep vein thrombosis and pulmonary embolism in elective spine surgery. Adult patients were eligible for inclusion in the study, except for those with trauma, spinal cord injury, neoplasms, or those using vena cava filters. Results: Five studies were selected for this systematic review and meta-analysis: 3 retrospective studies, 1 prospective study, and 1 case series. Data analysis showed that 4.64% of patients treated with chemoprophylaxis had an unfavorable outcome regarding DVT, while this outcome occurred in 1.14% of patients not treated with chemoprophylaxis (p=0.001). Among patients using chemoprophylaxis, only 0.1% developed epidural hematoma and 0.38% developed PTE. Among those on non-pharmaceutical prophylaxis, 0.04% had EH (p=0.11) and 0.42% had PTE (p=0.45). Conclusions: No benefits were found for chemoprophylaxis as compared to non-chemoprophylaxis in preventing DVT in elective spine surgery, nor was there an increased risk of epidural hematoma or fatal thromboembolic events. Level of evidence III; Therapeutic studies; Investigation of treatment results.

Appearance and Frequency of Deep Venous Thrombosis After Total Hip Arthroplasty.

Postoperative venous thromboembolism is an important peri-operative complication associated with total hip arthroplasty (THA). In particular, early detection of deep venous thrombosis (DVT) is important for the prevention of pulmonary embolism (PE). However, the methods and timing of examinations for DVT detection differ among the facilities. This study aimed to clarify the time, site, and frequency of DVT after THA. Background characteristics including age, sex, body mass index, diagnosis, operation type, operation time, and anesthesia type were investigated in 348 patients who underwent THA at our hospital between April 2017 and April 2019. Blood tests were performed preoperatively and on postoperative days (POD) 0, 1, 3, 7, 14, and 21. Simultaneously, vascular ultrasonography was performed to investigate the time and site of thrombus occurrence before and after the surgery. DVT was observed in 27.2% of the patients on POD 21. The DVT-positive ratio was 9.4% (6/64) in males and 31.3% (89/284) in females. There was a significant difference between the groups (p = 0.0002). Patients in the DVT-positive group were significantly older than those in the DVT-negative group (73.0 ± 7.9 years vs. 63.3 ± 11.2 years, p = 0.0041). DVT mainly occurred in the soleal vein (74.7%). However, there was no significant difference between the operated and non-operated sides. In the DVT-positive group, thrombus occurred in 13.3% of preoperative cases, 20.0% on POD 0, 46.7% on POD 1, 13.3% on POD 3, 6.7% on POD 7, and 0% on POD 14 and 21. Vascular ultrasonography showed that thrombus occurred most frequently in the soleal vein. Thrombus occurred in 66.6% of DVT-positive patients by POD 1, indicating that thrombus appeared very early after surgery. All thrombus cases were formed by POD 7.

Life-threatening thrombotic complications in a pediatric in the intensive care unit

Introduction. This article highlights the problem of thrombus formation in pediatric patients staying in ICU, namely, the problem of prevention and management of pulmonary embolism in children. Currently, there is a tendency to increasing pulmonary embolism occurrence in children, though there are no clear guidelines on the medicine dosage for the systemic thrombolytic therapy of pulmonary embolism in children and for the acute coronary syndrome in children with Kawasaki disease.Clinical observations. The authors present two clinical cases from their practice when a successful management was obtained in children with life threatening thrombotic complications due to the applied systemic thrombolytic therapy.Conclusion. The obtained success in the described clinical cases have resulted from a thorough analysis of ratios “risk-benefit” and “efficiency-safety”. But the authors conclude that further research work in this direction is still needed.

Pulmonary embolism: Age specific temporal trends in incidence and mortality in Denmark 1999–2018

BackgroundThrough the last two decades the prevention, diagnosis and treatment of pulmonary embolism (PE) has evolved along with demographic changes. The influence of these current transformations is important in the assessment of the future burden of PE. We aimed to describe age specific temporal trends in incidence of first-time PE and subsequent mortality. MethodsWe identified patients ≥18 years of age with a first-time in-hospital diagnosis of PE in Danish national registers. By dividing patients into seven age groups (18–34, 35–44, 45–54, 55–65, 65–74, 75–84, >85 years), age specific incidence and 1-year mortality rates were calculated for four different calendar periods between 1999 and 2018. ResultsFrom 1999 to 2018 65,478 patients with a first-time PE were identified. PE incidence per 100,000 person years increased during the study period in all age-groups (18–34 years: 10 to 18, 35–44 years: 18 to 35, 45–54: 26 to 63, 55–64 years: 42 to 123, 65–74 years: 92 to 229, 75–84 years: 166 to 383 and >85 years: 155 to 417), ptrend <0.0001 for all. During the study period 1-year mortality rate decreased from 4 to 2 per 10 person years in patients aged 65–74 years and this trend was found in all age groups (ptrend = 0.0001 for all). ConclusionDespite a decreasing mortality rate, incidence rate of PE increased in Denmark across all age groups from 1999 to 2018, reflecting improved sensitivity of diagnostic methods and changes in the burden of comorbid conditions, all together warranting a continuing need for early prevention of PE.

РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПАЦИЕНТОВ С КАВОАТРИАЛЬНЫМ ОПУХОЛЕВЫМ ТРОМБОЗОМ ПРИ ПОЧЕЧНО-КЛЕТОЧНОЙ КАРЦИНОМЕ

Objective. Improvement the surgical management for cavoatrial tumor thrombosis due to renal cell carcinoma. Methods. The results of complex clinical, laboratory, instrumental examination, intraoperative observations and morphological studies were analyzed in 62 patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis, hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period 1993-2019. Surgical treatment included radical nephrectomy, thrombectomy from inferior vena cava and right atrium. Kaplan-Meier method was used to evaluate the long-term survival of patients. Results. The postoperative complications included: posthemorrhagic anemia - 22 (38,6%), acute renal failure - 15 (26,3%), pulmonary embolism - 4 (7,0%), acute liver failure - 3 (5,3%), phlebothrombosis - 3 (5,3%), pneumonia - 3 (5,3%), stroke - 2 (3,5%), wound сomplications - 5 (8,8%) cases. Perioperative mortality was 11,3%. The causes of death included: hemorrhagic shock - 4 (6,5%), pulmonary embolism - 3 (4,8%), stroke - 1 (1,6%) cases. Long-term survival indicators were evaluated among 53 patients. The median follow-up was 36,9±13,3 months. The cumulative 2-, 5-, and 10-year survival rates were 53,5%; 38,2% and 17,2%, in 32 patients without metastases - 58,7%; 43,1% and 18,5% respectively. There was no significant difference іin survival among patients with atrial and retrohepatic venous tumor thrombosis versus infrahepatic and cavarenal venous tumor thrombosis (p&gt;0,05). Conclusion. The accurate preoperative assessment of the level of neoprocess involvement, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications make it possible to provide acceptable survival rates for patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis. What this paper adds The role of intraoperative blood reinfusion in the aspect of oncological safety in patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, was first determined. Based on the results of cytological examination of tumor contamination of blood sediment material from the operating field during the cavatomy and washed autoerythrocytes it has been established that intraoperative reinfusion can provide necessary ablastics and doesn’t pose an additional risk of tumor dissemination during radical nephrectomy and inferior vena cava thrombectomy. The use of combined mini-invasive approaches in the surgical treatment of supradiaphragmatic level of intracaval invasion due to renal cell carcinoma is proposed, which will reduce the volume, trauma and duration of surgery, as well as provide reliable pulmonary embolism prevention. For the first time in Ukraine the immediate and long-term results of surgical treatment of patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, during the last three decades were analyzed.

Nursing Intervention Countermeasures of Robot-Assisted Laparoscopic Urological Surgery Complications.

The objective is to explore the application effect of comprehensive nursing intervention in prevention of lower extremity deep vein thrombosis and pulmonary embolism in urological patients undergoing laparoscopic and robot-assisted laparoscopic surgery. From April 2019 to April 2020, 200 patients who received urological laparoscopic surgery and robot-assisted laparoscopic surgery were selected. According to the random number table method, they were divided into control group and observation group, 100 cases in control group and 100 cases in observation group. Patients in control group received routine nursing, while patients in observation group received comprehensive nursing intervention. The skin condition, swelling, pain, and occurrence of deep venous thrombosis and pulmonary embolism of lower extremities in 2 groups were observed. The experimental results showed that the lower limb swelling, lower limb pain, and lower limb deep vein thrombosis in the control group were significantly higher than those in the observation group, but all patients were cured and discharged after taking effective symptomatic treatment and nursing measures in time. In the control group, pulmonary embolism occurred in 3 patients, all of whom died. There was no significant difference in skin changes of lower limbs (P > 0.05), and there were significant differences in other skin changes (P < 0.05). It proved that comprehensive nursing intervention can effectively prevent the formation of lower extremity deep vein thrombosis and pulmonary embolism in urological patients undergoing laparoscopic and robot-assisted laparoscopic surgery with high-risk factors.

47 DOSING OF DIRECT ORAL ANTICOAGULANTS IN OLDER ADULTS

Abstract Background Direct oral anticoagulants (DOACs) are approved for a variety of uses including prevention of stroke in non-valvular atrial fibrillation and treatment and prevention of deep vein thrombosis and pulmonary embolism. Adjustment to DOAC dosing may be required for age, weight and renal impairment. Incorrect lower dosing puts patients at risk of thromboembolic events whereas inappropriate higher dosing increases the risk of bleeding. We compared current DOAC dosing for patients admitted to our hospital and compare this against HSE best practice to determine if patients were receiving the correct dose [1]. Methods A prospective single-centre study. Patients admitted to our hospital following a fracture and reviewed by the Orthogeriatric team between August–October 2020 were eligible for inclusion. We recorded admission DOAC dose, age, weight and renal function. We also obtained data including sex and Clinical Frailty Scale (CFS). Results Thirty-one patients were included. Mean age was 86 years [range 66–99] and 21(68%) were female. Apixaban was the most commonly used DOAC; 25(81%). Stroke prevention in non-valvular atrial fibrillation was the most common DOAC indication; 29(93%). Twelve patients (39%) had an inappropriate DOAC dose prescribed. Eight patients (67%) had an inappropriately low dose and 4 patients (33%) had an inappropriately high dose. The mean CFS was 5 [Range 2–7] classifying our cohort as mildly frail. Conclusion Our study has shown that over one-third of our patients were on an inappropriate DOAC dose on admission with the majority (67%) due to under-dosing. Many factors may have influenced dosing choices by clinicians but our findings highlight the challenges in dosing, monitoring and the overall management of DOAC therapy in older people. Further studies and research are required to establish the most accurate and effective dosing strategies for DOACs in older adults. Reference 1. Health Service Executive [Internet]. Ireland ‘Anticoagulation Prescribing Tips’ https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/noac-prescribing-tips-for-noacs.pdf.

Prevention of Thromboembolic Complications in Patients with Postphlebitic Lower Extremities Syndrome

Prevention of venous thromboembolic complications (pulmonary embolism, stroke, deep vein thrombosis) remains the most important clinical medicine problem and affects all doctors’ professional expertise areas without exeption due to an extremely high potential risk to the health and life of patients that might cause thromboembolic complications. A worldwide trend is to use conservative methods of treatment and prevention of pulmonary embolism, stroke, deep vein thrombosis, which are most often limited to the use of compression treatment, periodic appointment of phlebotropic medications courses. At the same time, effective and safe methods of using non-drug technologies for the prevention of thromboembolic complications in patients, in particular, with postphlebitic lower extremities syndrome, are in progress. They can prevent and/or significantly reduce the number of life-threatening complications and mortality with minimal risk of bleeding. The article presents a review of the literature data using the Russian and foreign sources on the use of medicinal and non-medicinal,mechanical methods of medical rehabilitation and sanatorium-resort treatment of patients with preventive effect on the dangerous thromboembolic complications occurrence.

Effect and complications of proximal femoral anti-rotation intramedullary nail in the treatment of femoral intertrochanteric fracture in the elderly

To study the prognosis and complications of proximal femoral nail antirotation(PFNA) in the treatment of elderly intertrochanteric fracture. From January 2016 to November 2019, 127 cases of femoral intertrochanteric fracture were treated with PFNA, including 51 males and 76 females. The average age was 81.39±8.16 (range from 60 to 98). According to Evans classification, the numbers of cases of typeⅠa, typeⅠb, typeⅠc, typeⅠd and typeⅡwere 10, 46, 48, 16 and 7, respectively. Based on the AO /OTA classification, there were 10 cases of type 31-A1.2, 84 of type 31- A1.3, 17 of type 31-A2.2, 9 of type 31-A2.3, and 7 of type 31-A3. Preoperative and the final follow up, function of hip joint of patients treatedwith the PFNA were evaluated by harris hip score, and the postoperative complications were observed. No incision infection occurred in all patients after PFNA. In this research, 4 cases failed in internal fixation, three of them underwent artificial femoral head replacement;5 cases died within one year after operation;2 cases had multiple embolizations of pulmonary artery branches, which recovered after anticoagulation treatment. There were 48 cases complicated with pneumonia, among which 9 cases had pulmonary inflammation before operation;27 cases with pleural effusion, 3 cases with acute heart failure, 3 cases with acute renal insufficiency, except one case died of pneumonia, pleural effusion, hypoproteinemia and respiratory failure during hospitalization, the other patients recovered after treatment. All 119 patients were followed up for 6 to 36 months, with an average of (17.01±6.03) months, Harris hip score increased from 8.96±5.40 preoperation to 83.57±8.92 at the final follow-up (t=75.86, P<0.01). PFNA is a recommended option for the treatment of senile patients with intertrochanteric fracture. However, there were a lot of complications when femoral intertrochanteric fractures happened in aged patients, especially prevention and treatment of pulmonary embolism, promptly corrected low hemoglobin and low albumin, and reduce complications.

HF02-14 JOHN KELSO ORMOND: MORE THAN A SYNDROME

You have accessJournal of UrologyHistory of Urology Forum II (HF02)1 Sep 2021HF02-14 JOHN KELSO ORMOND: MORE THAN A SYNDROME Naveen Kachroo, Craig Rogers, and James Peabody Naveen KachrooNaveen Kachroo More articles by this author , Craig RogersCraig Rogers More articles by this author , and James PeabodyJames Peabody More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001993.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: John Kelso Ormond is remembered for his seminal paper providing the first description in English medical literature of Idiopathic Retroperitoneal Fibrosis (IRF) or Ormond’s Syndrome. We examine the many contributions this progressive Urologist provided in advancing the field of urology. METHODS: A comprehensive literature review concerning the life and works of Dr John Kelso Ormond was performed via online search, review of published historical texts and published material on PubMed. Contemporary records held by The Conrad R. Lam medical archives at Henry Ford Hospital were also reviewed. RESULTS: John Kelso Ormond (1886-1978) received his MD degree from Johns Hopkins University in 1914 and was the first surgical resident at the newly established Henry Ford Hospital in Detroit in 1916. During his training, he also provided medical services in Europe during World War I. On his return, he founded the Division of Urology as the inaugural Chief of Urology from 1920-1952. During his accomplished tenure, in addition to training a future generation of urologists, he published on eclectic areas such as intra-abdominal testis torsion, female stress incontinence treatment, genito-urinary trauma management and even recognition of deep vein thrombosis and targeted prevention of pulmonary embolism in urologic patients in 1952 where “early ambulation was pioneered at Henry Ford Hospital”. His surgical outcome observations following radical perineal prostatectomy were exemplary for that era. His 1947 publication revealed “in as much as at least half of the patients were still sexually active”, testament to his surgical prowess being 35 years prior to Patrick Walsh’s nerve sparing radical prostatectomy and over 50 years prior to Viagra. Regarding urinary incontinence, “I no longer fear it greatly. Some patients have satisfactory control from the start…of 27 patients…none has had incontinence at night”. His indelible mark on medicine was made in 1948 with his seminal description of the clinical and pathologic features of IRF based upon 2 cases he had treated. Seventeen years later, he correctly postulated the systemic nature of the disease related to IgG4 diseases. Today, there are 3457 PubMed results related to Ormond’s syndrome alone. Urology was his life’s passion, practicing until 88 and still writing about his syndrome until his death aged 91. CONCLUSIONS: Dr Ormond’s contribution to urology stretches beyond his eponymous syndrome. His pioneering establishment of the Henry Ford Urology Department and the work he accomplished with his enduring academic passion even to his death, is something to be emulated. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e241-e241 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naveen Kachroo More articles by this author Craig Rogers More articles by this author James Peabody More articles by this author Expand All Advertisement Loading ...

Efficacy and Safety of Oral Anticoagulants in the Treatment of COVID-19

Coagulopathy and associated thrombotic complications are common conditions seen in COVID-19. Therefore, anticoagulants are an integral part of the treatment of patients with COVID-19.The aim of the study was to compare the efficacy of oral anticoagulants and low molecular weight heparins in the prevention of pulmonary embolism and their safety in terms of major bleeding incidence, as well as to evaluate the cost-effectiveness of using oral anticoagulants in the treatment of COVID-19.Materials and methods. Two stages of patient management were compared: before and after the start of a widespread use of oral anticoagulants (OAC). The incidence of pulmonary embolism and gastrointestinal bleeding during the compared time periods was analyzed to assess the efficacy and safety of anticoagulants. To assess the cost-effectiveness, we compared the cost of anticoagulants per day of treatment and per patient.Results. The incidence of pulmonary embolism and gastrointestinal bleeding did not differ during the compared time periods. Despite the increased frequency of anticoagulant use, the costs per day of treatment and per patient decreased after the start of a widespread use of OACs.Conclusion. According to the results of the study, inclusion of OACs in COVID-19 management protocols allows to reduce treatment costs without compromising its efficacy and safety. However, the short period of comparison does not allow drawing any firm conclusions. Additional large-scale comparative studies are needed.

ТРОМБОЭМБОЛИЯ ЛЕГОЧНОЙ АРТЕРИИ ПРИ ПОЛИТРАВМЕ: ОСОБЕННОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ

Treatment of patients with polytrauma is a difficult problem for surgeons and physicians of intensive care units due to the fact that a multiple and complex lesion often serves as a trigger for the development of a number of life-threatening complications, such as pulmonary embolism (PE). Despite the existing methods of prevention and treatment of pulmonary embolism, the development of this complication in patients with polytrauma accompanied by massive hemorrhageisstill remains an unsolved problem. This article presents a clinical case of the development of isolated PE during performing osteosynthesis of the patient with polytrauma and in stable condition achieved after the intensive therapy within the week. The analize of studies considering the problem of thrombus formation in various parts of the vascular bed and considering of pathophysioliogycal mechanisms of the systemicinflammatory response has been performed. Riskfactors forpulmonary embolism and methods of prophylaxis are studied. Taking into consideration the currently available research data dedicated to this issue, the idea about the generalized nature of the pathological process which can be manifested as deep vein thrombosis such as PE or their combination has been expressed. In respect the insufficient effectiveness of thromboprophylaxis, the need to work out the other or additional laboratory and diagnostic methods of blood coagulation system assessment and responsively therapeutic methods is being considered.

Retrievable inferior vena cava filter to prevent pulmonary embolism in patients with fractures and deep venous thrombosis of lower extremities: a single-center experience.

ObjectiveTo evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery.MethodsClinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups.ResultsAn IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups.ConclusionsRetrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a <1-cm thrombus than does AKDVT.

Bleeding events in COVID-19: the other side of the coin?

We present three cases of patients affected by severe SARS-CoV-2-related pneumonia treated with a low molecular weight heparin for prevention or treatment of pulmonary embolism, who presented a major bleed, in particular an ileopsoas haematoma that caused severe anaemia; in one case it was fatal. In the recent outbreak of novel coronavirus infection, significantly abnormal coagulation parameters in SARS-CoV-2 infection occur very often, but complications in the opposite direction such as bleeding diathesis are very rare. In these cases, there are different levels of gravity: for one patient the major bleed required the anticoagulant therapy to be stopped until bleeding stabilized, one patient needed interventional radiology and one patient died.

Phosphinanes and Azaphosphinanes as Potent and Selective Inhibitors of Activated Thrombin-Activatable Fibrinolysis Inhibitor (TAFIa).

Selective and potent inhibitors of activated thrombin activatable fibrinolysis inhibitor (TAFIa) have the potential to increase endogenous and therapeutic fibrinolysis and to behave like profibrinolytic agents without the risk of major hemorrhage, since they do not interfere either with platelet activation or with coagulation during blood hemostasis. Therefore, TAFIa inhibitors could be used in at-risk patients for the treatment, prevention, and secondary prevention of stroke, venous thrombosis, and pulmonary embolisms. In this paper, we describe the design, the structure-activity relationship (SAR), and the synthesis of novel, potent, and selective phosphinanes and azaphosphinanes as TAFIa inhibitors. Several highly active azaphosphinanes display attractive properties suitable for further in vivo efficacy studies in thrombosis models.