Prevention Of Thromboembolic Disease Research Articles

Etiology, Treatment and Prevention Thromboembolic Diseases

The relevance of solving the issues of prevention and treatment of thromboembolic diseases is characterized not only by high mortality, but also by the lack of reliable methods for the early diagnosis of DVT and PATE. The problems of early diagnosis are associated with the polymorphism of clinical manifestations and the frequent asymptomatic course of the disease. In most cases, this is due to the non-specificity of the clinical manifestations of PE. The purpose of the article is to analyze the etiology, methods of treatment and prevention of thromboembolic diseases in surgical departments and non-surgical patients. The methodological basis of the research is a complex application of complementary approaches. The main approaches in this case were a retrospective statistical analysis of case histories with thromboembolic diseases. The article considers the results of foreign clinics, the National Surgical Center. MM. Mamakeev and clinics of the Department of Propaedeutic Surgery of the Kyrgyz State Medical Academy named after I.K. Akhunbaev. The article outlines the factors of occurrence, development of deep vein thrombosis and thromboembolic complications in surgical and non-surgical patients, as well as the use of fast-acting anticoagulating and thrombolytic agents. Particular emphasis in the article is given to the underestimation of individual predisposing genetically determined and acquired risk factors for the occurrence and development of DVT and PATE.

Features of Prevention of Thromboembolic Complications in Intensive Care

Venous thromboembolism is characterized by high mortality and lack of methods for early diagnosis of PATE. In most cases, PATE is not detected in vivo and is an often-unrecognized cause of death in patients. The problems of early diagnosis are associated with the polymorphism of clinical manifestations and the frequent asymptomatic course of the disease. The aim of the article is to analyze the etiology, methods of treatment and prevention of thromboembolic diseases in intensive care units, to identify the features of intensive care in the perioperative period, as well as to analyze approaches to the hospital treatment of pulmonary embolism. The article outlines the features of emergency medical care for thromboembolism, intensive care in obstetrics in the prevention of thromboembolic complications, as well as features of intensive care for cancer patients. Material and research methods. The work is based on the results of examination, treatment and study of case histories with thromboembolic diseases of the National Surgical Center. MM. Mamakeev and clinics of the Department of Propaedeutic Surgery of the Kyrgyz State Medical Academy named after I.K. Akhunbaev.

On the Capabilities of Some High-tech Instrumental and Laboratory Methods for the Diagnosis of Thromboembolic Complications

Due to the lack of reliable methods for the early diagnosis of DVT and PE, the problem of high mortality in the treatment and prevention of thromboembolic diseases has not yet been solved. Most researchers recognize the fact that unsatisfactory results of intensive care in feasibility study are due to the delayed diagnosis of thromboembolic complications. That is why early diagnosis of TEC is a major clinical and scientific challenge. The analysis shows that annually thromboembolic complications are registered in 40 people per 100 thousand of the population. The specificity of the pathogenesis of PE is characterized by the development of complications. In view of the polymorphism of symptoms and the transience of the process, problems of diagnostic resolution arise. According to summary data, certain clinical signs of PE appear only when pulmonary artery (PA) occlusion covers more than 40-50% of the lumen. The article presents an analysis of the opinions of specialists and scientists on the issue of the possibilities of a number of selective and combined high-tech instrumental and laboratory methods for optimizing the diagnosis of pulmonary embolism. The paper summarizes the statements of specialists and scientists about certain advantages and disadvantages of methods for detecting thromboembolic diseases. The main research methods were an analytical review and comparison of approaches and methods of scientific research by domestic and foreign authors, in the period 2010-2015. These studies summarize the results of an analytical review of the proposals of specialists and scientists on selective combination when using certain methods of diagnosing PE with the designation of the prospects for their modernization.

The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement

The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement

The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement

Orthopedic and trauma surgery carries a high risk of deep vein thrombosis (DVT) in the lower limbs and acute pulmonary embolism (APE). In traumatology, the greatest risk is in hip fractures of the proximal extremity of the femur, especially those of the neck, and intertrochanteric fractures. In orthopedics the risk of thromboembolic complications (TEC) is particularly high in hip and knee surgery, especially in prosthetic replacement, as general factors are associated with local factors such as trauma to vessels and / or blood stasis which further aggravate the perioperative imbalance of the coagulation system. In particular, hip replacement surgery is the one that shows a higher frequency of DVT (especially affecting the proximal large vessels), and of TEC, so much so that pulmonary embolism is one of the main causes of death after this intervention. In this paper, we review the different instruments used for the diagnosis of DVT such as phlebography, radiolabeled fibrinogen collection test, impedance, plethysmography, ultrasound, nuclear magnetic resonance and computed tomography. We also discuss the different prophylaxis methods for DVT and subsequent PE prevention. Then, we performed an experimental study on 420 patient’s operated on for total hip replacement at the 1st Orthopedic Clinic of the University of Florence and other private clinics in the period between 1994-1996. These are 286 first cemented implants, 36 first hybrid implants, 38 first cementless implants and 60 hip replacement reviews. This study showed the importance of color doppler ultrasonography in the prevention of DVT in hip replacement patients and subsequent APE prophylaxis. Significant relationship was found between APE and the protocole used to follow up with the patients (Pvalue 0.0007). Patients in group 2 in which only clinical control (no preoperative color doppler ultrasonography assessment) was performed have higher risk for APE To Occur Than patients in group 1 to whom pre and post-operative color doppler ultrasonography was routinely applied.

A systematic review of adherence to anticoagulation regimens in pediatric patients.

Thromboembolic disease rates are increasing in pediatric patients. Anticoagulation is prescribed for treatment and prevention of thromboembolic disease. While nonadherence to anticoagulation regimens predicts poor health outcomes in adults, data in anticoagulated pediatric patients are limited. We systematically reviewed the rates, outcomes, and predictors of anticoagulation nonadherence in the pediatric population. Out of a total of 3581 unique articles identified for review, 17 studies met inclusion criteria. These studies primarily evaluated patients with cardiac disease treated with vitamin K antagonists. Overall nonadherence rates varied from 3% to 42%, based upon population, definition of adherence, and measurement strategy. Patient age, goal international normalized ratio (INR), and number of concurrent potentially interacting medications correlated with nonadherence. Data examining the relationship between nonadherence and health outcomes were included in only two studies. Limitations of current literature, as well as critical knowledge gaps that require future study, are discussed.

Design and fabrication of r-hirudin loaded dissolving microneedle patch for minimally invasive and long-term treatment of thromboembolic disease

Cardiovascular disease is the leading cause of global mortality, with anticoagulant therapy being the main prevention and treatment strategy. Recombinant hirudin (r-hirudin) is a direct thrombin inhibitor that can potentially prevent thrombosis via subcutaneous (SC) and intravenous (IV) administration, but there is a risk of haemorrhage via SC and IV. Thus, microneedle (MN) provides painless and sanitary alternatives to syringes and oral administration. However, the current technological process for the micro mould is complicated and expensive. The micro mould obtained via three-dimensional (3D) printing is expected to save time and cost, as well as provide a diverse range of MNs. Therefore, we explored a method for MNs array model production based on 3D printing and translate it to micro mould that can be used for fabrication of dissolving MNs patch. The results show that r-hirudin-loaded and hyaluronic acid (HA)-based MNs can achieve transdermal drug delivery and exhibit significant potential in the prevention of thromboembolic disease without bleeding in animal models. These results indicate that based on 3D printing technology, MNs combined with r-hirudin are expected to achieve diverse customizable MNs and thus realize personalized transdermal anticoagulant delivery for minimally invasive and long-term treatment of thrombotic disease.

From basic science to life-saving therapy: the rationale, and drug discovery efforts that led to the direct factor Xa inhibitor eliquis.

Over the past few decades, drug discovery directed at the treatment and prevention of thromboembolic diseases has been challenged by the need to balance robust efficacy with improved safety relative to the standard of care. To this end, the most impactful advance to date has been the discovery and development of oral factor Xa inhibitors. In this essay, a brief account of the program that culminated in the discovery of Eliquis (apixaban) and the commitment to identify a compound with an optimal profile are described.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis.

Seven Years of Ventricular Assist Device Support on Dabigatran

Introduction Currently, left ventricular assist device (LVAD) support mandates anticoagulation with coumarin derivatives such as warfarin and acenocoumarol as well as antiplatelet therapy with low-dose aspirin, for the prevention of thromboembolic events. Bleeding remains a major concern in LVAD recipients and is mainly attributed to the acquired von Willebrand factor deficiency exhibited in such patients. In addition, proper anticoagulation with vitamin K antagonists depend on targeted levels of international normalized ratio (INR) which can be influenced by several factors such as diet and liver function. Case Report A 64-year-old male patient underwent LVAD implantation as destination therapy 13 years ago due to end-stage heart failure caused by ischemic cardiomyopathy. The device used was the HeartMate II ventricular assist device. As per recommended guidelines, the patient was started on anticoagulation treatment using acenocoumarol and low-dose aspirin. The patient reports difficulty reaching therapeutic INR levels, necessitating very frequent coagulation blood tests. After six years on LVAD support, the patient presented to the emergency department with major intramuscular bleeding leading to compartment syndrome after a bicycle accident, necessitating transfusion of more than 2 units of packed red blood cells. His INR levels was within therapeutic range at the incident. The LVAD team then decided to change acenocoumarol to dabigatran exetilate, at the standard dose of 150mg bid as used in the prevention of thromboembolic disease in atrial fibrillation patients. Since then, after seven years of ventricular assist device support with dabigatran exetilate used for anticoagulation, the patient is still alive and has not had any bleeding or thromboembolic events. Summary The use of dabigatran exetilate as a second-line therapy in patients who have exhibited at least one major bleeding event on vitamin K antagonists seems intriguing.

Prevention of Thromboembolic Disease and Thrombophilias in Pregnancy

Prevention of Thromboembolic Disease and Thrombophilias in Pregnancy

Covid-19 : aspects cliniques et principaux éléments de prise en charge

Asymptomatic infections are not rare and most patients complain with fever and respiratory signs. Clinical signs are polymorphic and aspecific. Chest CT scan is commonly used as a diagnostic and triage tool in patients admitted to hospitalization. The 2 main complications are respiratory distress related to worsening pneumonia with an associated cytokine storm occurring mostly 7 to 10 days after disease onset, and thromboembolic disease. The fatality rate is around 2%. In-hospital management includes oxygen supply when needed and prevention of thromboembolic disease. Associated bacterial infections seem to be rare. Remdesivir might reduce the time to recovery in hospitalized patients needing an oxygen supply. Dexamethasone might reduce the fatality rate in patients requiring mechanical ventilation. The development of many candidate vaccines gives hope to fight the pandemic.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer.

Thrombocytopenia due to rivaroxaban: A rare adverse effect

IntroductionRivaroxaban is a novel, oral direct acting anticoagulant (DOAC) that is used for both treatment and prevention of thromboembolic diseases. Due to mechanism of action; most common side effect may be seen with hemorrhage. Here in we reported that a patient with chronic atrial fibrillation presented with thrombocytopenia while taking rivaroxaban. Case reportA 76-year-old female patient with atrial fibrillation was given rivaroxaban, after lack of dose administration of warfarin and gastrointestinal bleeding. In 12th dayweek of treatment, the patient was admitted to emergency department (ED) with oral mucosal bleeding and petechial spots.The patient diagnosed as Drug-induced Thrombocytopenia (DITP)due to rivaroxaban use, after ruled out most possibilities ofITP (immune thrombocytopenic purpura). After rivaroxaban is discontinued, the patient's bleeding complaints regressed,symptoms were completely resolved, and platelet count rapidly increased towards physiological level in days. The patient is currently in the 6th month of follow-up and is has no bleeding. ConclusionTo the best of our knowledge there are only two cases about rivaroxaban induced thrombocytopenia (RIT). In addition to the well-known side effects ofrivaroxaban treatment, it should be kept in mind that thrombocytopenia may also develop.Naranjo adverse drug reaction probability scale calculated as 7 points.(probable cause for the patient's thrombocytopenia)

Switching from vitamin K antagonists to direct oral anticoagulants: Treatment satisfaction and patient concerns

BackgroundSince direct oral anticoagulants (DOACs) have been introduced for treatment and prevention of thromboembolic diseases, patients on vitamin K antagonists (VKA) have to decide whether to remain on VKA or switch to DOAC. The goal of this study was to evaluate treatment satisfaction, preferences, and concerns among those who already have switched from VKA to DOAC. MethodsA questionnaire was sent to 2920 former patients of three anticoagulation clinics in the Netherlands, who switched from VKA to DOAC (2016‐2017). Questions concerned demographics, treatment satisfaction, concerns, perspectives on antidotes, and monitoring. To identify predictors for being concerned about adverse events, logistic regression was used to estimate crude‐ and adjusted (age and sex) odds ratios (OR) and 95% confidence intervals (95% CI). ResultsOne thousand, three hundred ninety‐nine questionnaires (response rate 48%) were used for analysis. DOAC treatment satisfaction was high (mean 8.8 of a maximum 10‐point score). A quarter of patients expressed concerns about adverse events. Predictors for being concerned were age < 60 years (vs age > 75 years, OR 4.1, 95% CI 2.6‐6.4), female sex (OR 1.3, 95% CI 1.0‐1.6), and high education (OR 1.6, 95% CI 1.2‐2.2). Fifty‐nine percent of all patients indicated antidote availability as important, 73% would be willing to participate in DOAC monitoring. ConclusionsDOAC treatment satisfaction was high. A substantial number of patients expressed concerns about adverse events, especially women, patients aged < 60 years, or highly educated patients. Our findings among patients who already had switched to DOAC may assist in the process of shared decision‐making when switching a patient from VKA to DOAC is considered.

Mechanisms of the Antitumor Activity of Low Molecular Weight Heparins in Pancreatic Adenocarcinomas.

Immune checkpoint inhibitors have revolutionized cancer treatment in the last decade. Despite the progress in immunotherapy, most pancreatic cancer patients still do not derive benefit when receiving immune-based therapies. Recently, resistance mechanisms to immune therapies have been mainly focused on tumor microenvironment properties. Pancreatic cancer is considered one of the most lethal and difficult to treat tumors due to its highly immunosuppressive and desmoplastic microenvironment. Low molecular weight heparins (LMWHs) have been used for the treatment and prevention of thromboembolic disease in these patients. However, many nonanticoagulant properties attributed to LMWHs have been described. Exploiting LMWH properties in a combined treatment modality with immune checkpoint inhibition and chemotherapy could provide a new approach in the management of pancreatic adenocarcinoma patients. The ability of LMWH to interfere with various aspects of the tumor microenvironment could result in both the alleviation of immunosuppression and improvement in drug delivery within the tumor, leading to higher cancer cell destruction rates and more potent immune system activity that would, ultimately, lead to better patient outcomes.

Evaluation of a program of pharmaceutical counseling for French patients on oral anticoagulant therapy.

Background Oral anticoagulants are widely used for treatment and prevention of thromboembolic diseases. We set up a pharmaceutical counseling program for both direct oral anticoagulant and vitamin K antagonist drugs in our hospital in 2015. Objective Evaluate patient satisfaction and the evolution of their knowledge throughout the pharmaceutical counseling program on anticoagulants and identify knowledge variability factors. Setting Cardiology Inpatient Unit from the University Antoine Béclère Hospital, France. Methods Evaluation was based on data collection of patients surveyed between 2015 and 2018. Inpatients in the cardiology department on oral anticoagulants were eligible.The learning process was designed to enhance patient knowledge and understanding based on 10 cognitive or self-management skills, relating to the optimization of oral anticoagulant therapy management. It consisted in 2 face-to-face interviews during hospitalization and 2 additional phone interviews one and six months after discharge.The median patient score was evaluated at each step of the process as well as the mean score for each item from the global population. A sub-analysis was run on the less well-acquired skills in order to identify risk factors for limited knowledge. The association between those factors and the level of knowledge (score ≥ 7 or < 7) was assessed using Chi square test followed by multivariate analysis. Main outcome measure Patient knowledge of anticoagulation therapy depending on specific factors. Results Of the 880 patients eligible for pharmaceutical counseling, 319 entered the process and 102 completed it.Median knowledge scores were 8/10 and 9/10 after the first and the final interviews respectively with a significant improvement (p = 0.0003).The least well-acquired items at each step were surveillance and under-dosing management. The sub-analysis showed the use of vitamin K antagonist to be linked to an enhanced understanding related to treatment surveillance (p = 0.029). Patients suffering from atrial fibrillation were found to have a worse understanding of under-dosing management (p = 0.013). Finally, patients evaluated the process as helpful and suitable for their conditions. Conclusion Pharmaceutical counseling is appropriate for patients, improving and maintaining knowledge of oral anticoagulants. Our evaluation highlights the need to focus on patient-specific profiles to reach a satisfactory level of knowledge.

Utilization profile of enoxaparin in hospitalized patients with Chronic Kidney Disease in southern Brazil

Chronic Kidney Disease (CKD) patients usually require the use of anticoagulants for treatment or prevention of thromboembolic diseases. One such commonly used anticoagulant is enoxaparin. However, special attention is advised when using this drug for CKD patients because dosage adjustments may be needed. This prospective observational study was conducted in adult patients (> 18 years) with CKD stages 3 to 5 who were followed-up daily via prescriptions, medical records and laboratory tests. Enoxaparin doses, renal function and adverse drug events (ADEs) were thus monitored. Of the 87 ADEs identified in this study, 56 (64.3%) occurred in patients requiring enoxaparin prescription adjustment. Out of the 9 patients who had severe ADEs, 8 (88.9%) needed enoxaparin prescription adjustment. The results of this study suggest an overall increased risk of major bleeding and ADEs in patients requiring enoxaparin prescription adjustment. Further investigation of alternative dosing regimens in patients with CKD to maintain efficacy while reducing risks is imperative, as are studies on the utility of monitoring anti-factor Xa activity to guide dosing of enoxaparin. In addition, the role of clinical pharmacists in the management of CKD patients is crucial, as dose adjustments are often necessary.

Photobinding of Triflusal to Human Serum Albumin Investigated by Fluorescence, Proteomic Analysis, and Computational Studies.

Triflusal is a platelet antiaggregant employed for the treatment and prevention of thromboembolic diseases. After administration, it is biotransformed into its active metabolite, the 2-hydroxy-4-trifluoromethylbenzoic acid (HTB). We present here an investigation on HTB photobinding to human serum albumin (HSA), the most abundant protein in plasma, using an approach that combines fluorescence, MS/MS, and peptide fingerprint analysis as well as theoretical calculations (docking and molecular dynamics simulation studies). The proteomic analysis of HTB/HSA photolysates shows that HTB addition takes place at the ε-amino groups of the Lys137, Lys199, Lys205, Lys351, Lys432, Lys525, Lys541 and Lys545 residues and involves replacement of the trifluoromethyl moiety of HTB with a new amide function. Only Lys199 is located in an internal pocket of the protein, and the remaining modified residues are placed in the external part. Docking and molecular dynamic simulation studies reveal that HTB supramolecular binding to HSA occurs in the “V-cleft” region and that the process is assisted by the presence of Glu/Asp residues in the neighborhood of the external Lys, in agreement with the experimentally observed modifications. In principle, photobinding can occur with other trifluoroaromatic compounds and may be responsible for the appearance of undesired photoallergic side effects.

A Review of the Currently Available Retrievable and Next Generation Inferior Vena Cava Filters

A review and comparison of the currently available removal and novel Inferior Vena Cava Filters; including design characteristics, composition, delivery methods, and limitations. This article is aimed at aiding interventionists in filter selection by providing easily accessible data. The Inferior Vena Cava filters has and will continue to play a primary role in the prevention of thromboembolic disease, especially in the acute care setting. There are a plethora of publications regarding the safety and efficacy of the traditional removable filter in addition to multiple comparative analyses discussing their intervariability and design characteristics. Over the last three years, the FDA has approved novel filter designs for widespread use. While the research on these “next-generation” filters is relatively limited compared to the traditional designs, the results are promising. Nine of the most commonly used filters in the United States were included in the final review. Manufacture specifications are listed for each filter. The available literature, including clinical trials on the newer generation filter designs, is summarized. Understanding of the variability between filter options, short- and long-term complications, optimal removal time, delivery methods, and retrieval methods will hopefully aid current and future practitioners in optimizing their filter selection to improve patient care.