Prophylaxis Of Thromboembolic Disease Research Articles

Determination of the Percentage of Patients Using Warfarin to Reach Target INR

Warfarin is the most commonly used oral anticoagulant in the treatment and prophylaxis of thromboembolic diseases. In order to prevent thrombosis and to avoid hemorrhagic complications, the patient's INR is kept within a certain range according to the indication and monitored at certain intervals. Our aim in our study is to determine the percentage of patients using warfarin for various indications reaching target INR values.
 Patients who used warfarin for various indications at our hospital's Internal Medicine outpatient clinic between May 2023 and November 2023 were included in our study, and their INR results were recorded by retrospectively scanning them.
 A study group was formed with a total of 130 patients. Patients using warfarin due to metallic heart valve replacement, AF, PTE and CVD were evaluated separately according to the target INR value. The percentage of patients with metallic heart valve replacement reaching the target INR value of 2.5-3.5 was calculated as 38.5% (n: 27). The percentages of patients with AF, PTE and CVD reaching their target INR values of 2-3 were calculated as 40% (n:16), 54% (n:7), 70% (n:5), respectively. Considering the entire study group, the percentage of reaching the target INR was calculated as 42% (n: 55).
 As a result, warfarin not being within the therapeutic range causes serious morbidity and mortality. In our study, the percentage of patients reaching the target INR was found to be 42%. This percentage is very low, and in order to increase this rate, it is necessary to increase patient awareness, increase the frequency of follow-up of patients and develop more effective follow-up strategies.

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

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

Evaluation of an education program of patients undergoing oral anticoagulation treatment

Anticoagulants are used in the treatment and prophylaxis of thromboembolic diseases. Acenocoumarol is a widely prescribed oral anticoagulant in the World. However, because of the narrow therapeutic index and life-threatening complications, patients must be regularly and continuously followed-up. The acenocoumarol dose is set according to the International Normalized Ratio (INR) level in the blood. To evaluate the therapeutic impact of an education program on patients undergoing acenocoumarol treatment. A group of 28 patients how are using acenocoumarol for at least two months, were invited to participate in an educational program in the Department of Internal Medicine. We compared the population before and after education in terms of treatment knowledge. All patients knew the trade name for acenocoumarol, were aware that it should be taken always at the same time and were able to describe its action in simple words. Before the education, 22 patients (78.5%) were aware of the reason for a regular INR test, only 11 patients (39.2%) knew the target range of INR, 8 patients (28.5%) were aware that the over-on-counter medication can interact with the acenocoumarol and that they should inform their doctor before starting any medication, and 7 patients (25%) were aware of the importance of maintaining a steady dietary intake of vitamin K which is commonly found in green leafy vegetables. Eighteen patients (64.2%) were able to identify bleeding and bruising as signs to watch for. After the education, a significantly greater number of patients were able to identify the target range of INR ( P < 0.001), and the possibility of interaction with diet ( P < 0.001) and medications ( P < 0.001). The results of this study suggest that patients who participate in a structured educational program about acenocoumarol use understand more about certain factors essential to safe therapy.

Rigorous Assessment of Guidelines on COVID-19-Related Thrombotic or Thromboembolic Disease: Implications for Clinical Practice of Prevention, Diagnosis, and Treatment.

Purpose Severe COVID-19 patients were prone to develop venous thromboembolism. Unfortunately, to date, there is no evidence of any effective medications for thromboembolism in COVID-19. The management of the disease relies on symptomatic and supportive treatments, giving rise to a variety of guidelines. However, the quality of methodology and clinical recommendations remains unknown. Materials and Methods We searched Medline, Cochrane Library, Web of Science, websites of international organizations and medical societies, and gray literature databases. Four well-trained appraisers independently evaluated the quality of eligible guidelines and extracted recommendations using well-recognized guideline appraisal tools. Furthermore, recommendations were extracted and reclassified according to a composite grading system. Results The search identified 23 guidelines that offered 108 recommendations. Guidelines scored average on AGREE II criteria, with Scope and Purpose and Clarity of Presentation highest. Only five (22%) guidelines provided high-quality recommendations. The existed clinical recommendations were inconsistent in terms of prophylaxis, diagnosis, and treatment of thromboembolic disease to some extent. Conclusion Current guidelines for COVID-19 thromboembolism are generally of low quality, and clinical recommendations on thromboembolism are principally supported by insufficient evidence. There is still an urgent need for more well-designed clinical trials as evidence to prevent adverse events and improve prognosis during COVID-19 treatment.

Antithrombotic Drugs in Cirrhosis

Abstract In patients with liver cirrhosis treated for portal vein thrombosis, there was no increase in the risk of bleeding, but there was a decrease in the incidence of liver decompensation and an increase in the survival of treated patients when compared to the untreated ones(1). Current guidelines(2) do not provide specific recommendations for the prophylaxis or treatment of thromboembolic diseases in patients with liver cirrhosis(3). In order to determine the influence of anti-thrombotic treatment on the prognosis of liver cirrhosis, 85 patients with liver cirrhosis were followed clinically, by laboratory and ultrasound parameters, for 6 months. Microsoft Excel and IBM SPSS Statistics 20 were used to analyse the data of patients, divided into two groups according to the presence or absence of anti-thrombotic treatment initiated for cardiovascular pathology. The obtained results showed that the mortality rate between the two groups was similar: 11.54% untreated, 12.12% treated, the decompensation rate of untreated patients was higher than that of the treated ones (36.54% vs. 24.24%) with antithrombotic drugs and that no patient among those treated with antithrombotic drugs showed upper digestive haemorrhage (p =0.038). The conclusions drawn from this study were that patients with liver cirrhosis in antithrombotic treatment have a better prognosis than untreated ones, in the absence of major bleeding complications, but for a change in guidelines and current practice, studies are needed on a larger number of patients in order to validate these observations.

Pre-clinical pharmacodynamic study of a novel oral factor Xa inhibitor zifaxaban

Zifaxaban is an orally active, direct Factor Xa (FXa) inhibitor that is in development for the prevention and treatment of arterial and venous thrombosis. This study was conducted to investigate the biochemical and pharmacological activity of zifaxaban. In vitro activity was evaluated by enzyme, platelet aggregation, and clotting assays. In vivo effects were examined in venous thrombosis, arteriovenous-shunt thrombosis, carotid thrombosis, and bleeding models in rats. Zifaxaban competitively inhibits human FXa (IC50 = 11.1 nM) with > 10,000-fold greater selectivity than other serine proteases. It did not impair platelet aggregation induced by collagen, adenosine diphosphate (ADP) or arachidonic acid. It significantly prolonged clotting time, prothrombin time (PT), and activated partial thromboplastin time (APTT) in the plasma of humans, rabbits, and rats, with a relatively weak effect on thrombin time (TT). In venous thrombosis models in rats, zifaxaban strongly suppressed thrombus formation with ED50 values of 3.09 mg/kg, and its best efficacy time occurred at 2 h after administration. In arteriovenous-shunt thrombosis and carotid thrombosis models in rats, it inhibited thrombus formation in a dose-dependent manner. And in the rat tail bleeding assay, it showed a trend of less bleeding than rivaroxaban at doses that achieved the same antithrombotic effect. In conclusion, zifaxaban is a selective and direct FXa inhibitor and a promising oral anticoagulant for the prophylaxis and treatment of thromboembolic diseases.

Fine structural characterization of sulodexide

Sulodexide is a heparinoid which combines the properties of its components heparin and dermatan sulfate and is used not only for the prophylaxis and treatment of thromboembolic diseases but also for the treatment of diabetic nephropathy. Despite many clinical studies have been conducted to investigate its activity and safety, no data are available on the fine chemical characterization of its components. In this work, the in-depth investigation on the structural features of both the whole mixture and the isolated components was accomplished, involving the analysis of molecular weight distribution and of their mono, di and oligosaccharide composition by HP-SEC/TDA, 2D-NMR and HPLC–MS techniques. Moreover, also the separation of fractions endowed of graded affinity to antithrombin was achieved followed again by detailed structural analysis. The combination of different techniques permits to profile in depth the structural features of such a drug and offers a useful tool for possible analysis of batch production.

Arterial Thrombosis in Patients with Cancer.

Cancer is a common cause of morbidity and mortality in the USA. While the association between venous thrombosis and malignancy is well established, arterial thrombosis has more recently been recognized as a serious complication of cancer and certain chemotherapeutic agents. This review aims to summarize the most recent literature regarding the incidence and risk factors for cancer-related arterial thrombosis, understand the pathophysiologic mechanisms of thrombosis, and highlight the specific diagnostic and treatment considerations relevant to cancer patients. Based on a recent study looking at the Surveillance, Epidemiology, and End Results (SEER) database, the incidence of arterial thromboembolic events (ATEs) in patients with cancer at 6months is 4.7%; the presence of an ATE is predictive of worse outcomes. Certain drugs such as platinum-based agents, vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, and taxanes have been associated with high rates of ATEs. Increased platelet reactivity appears crucial to development of arterial thrombosis in cancer patients. Cancer patients have an increased risk of arterial thrombosis that is likely due to both a cancer-associated procoagulant state as well as the adverse effects of certain chemotherapeutic agents. Treatment of arterial thromboembolism in cancer patients typically requires a multidisciplinary approach in part due to high rates of thrombocytopenia and stent thrombosis in the setting of percutaneous interventions. More studies are needed to investigate optimal prophylaxis, surveillance strategies, and treatments of cancer-related arterial thromboembolic disease.

Compliance with the 2009 Royal College of Obstetricians and Gynaecologists guidelines for venous thromboembolic disease prophylaxis in pregnancy and postpartum period in Uruguay.

: Venous thromboembolism remains as one of the leading causes of maternal death. Prevention of venous thromboembolism in the obstetric population is challenging as recommendations for prophylaxis have low grade of evidence. Risk factors and prophylaxis guidelines have been highlighted by Royal College of Obstetricians and Gynaecologists. In 2014, we developed a written alert following this guidelines to guide thromboprophylaxis. The aim of this study is to assess recommendations compliance. This study was conducted at University-Hospital in Uruguay from January 2014 to December 2016. A total of 1035 women were enrolled and stratified in high, intermediate or low risk based on Royal College of Obstetricians and Gynaecologists guidelines. Thromboprophylaxis was recommended for women at intermediate and high risk. Women were followed up to assess symptomatic thromboembolism or haemorrhagic complications. A total of 309 were pregnant and 731 puerperal. Median age was 24 (19-29) years old. Of them, 3.0% (n = 31) were at high risk and 35.4% (n = 366) at intermediate risk. All high-risk women received prophylaxis with low-molecular-weight heparin. Of the 366 intermediate-risk women, 52.7% received prophylaxis. Venous thromboembolism was developed in only one woman of the intermediate group, who had received prophylaxis. Bleeding complications were not observed. Awareness of the thrombotic risk, as conferred by an easy and suitable risk assessment, has the potential to improve venous thromboembolism prophylaxis in pregnant and puerperal women. We have a good guidelines compliance with the written alert in the high-risk women group. However, we have to improve low-molecular-weight heparin indication in intermediate-risk group, especially in postcaesarean women.

Heparin-induced Thrombocytopenia

Abstract Heparin products are commonly used in the hospitalized patient for prophylaxis or treatment of thromboembolic disease. One adverse effect of using heparin products with potential devastating consequences is heparin-induced thrombocytopenia (HIT). It is crucial the health care providers, including nurse practitioners (NPs), consider HIT in the differential diagnosis for this patient population when they present with thrombocytopenia. This article provides NPs with the latest evidence-based guidelines for diagnosing and managing the patient with HIT.

Novel venous thromboembolic disease (VTED) prophylaxis for total knee arthroplasty-aspirin and fish oil.

Despite the demonstrated success of multiple anticoagulation therapies for post-operative prophylaxis of thromboembolic disease in lower extremity arthroplasties, each modality comes with a unique set of limitations. Thus, the ideal anticoagulation medication which provides adequate therapy with minimal cost, complications, or added patient work is yet to be defined. One promising novel thrombophylactic supplement is fish oil, as many preliminary clinical trials have demonstrated a protective effect of fish oil against thrombosis in multiple clinical settings. In addition, others have demonstrated synergistic effect when combined with aspirin. However, there are paucity of studies that compared combined aspirin and fish oil therapy for venous thromboembolism prophylaxis with other pharmacological agents, especially in the field of orthopaedics. Therefore, this study evaluated: (I) risk of post-operative deep vein thrombosis (DVT) and pulmonary embolism (PE), and (II) bleeding complications; among patients who had primary total knee arthroplasty (TKA) and received one of the following regimens: (i) 325 mg aspirin and mechanical pulsatile stocking; (ii) rivaroxaban; or (iii) 325 mg aspirin and 1,000 mg fish oil. This was a 6-year prospective study analyzing the postoperative thromboembolic prophylaxis received by patients who underwent primary TKA. Patients who had a previous history of thromboembolic disease were excluded from the study due to an increased risk of recurrent clot formation. A total of 850 patients were enrolled. A total of 300 patients enrolled between October 2011 and June 2013 received 325 mg aspirin and mechanical pulsatile stocking, while 250 patients enrolled between June 2013 and December 2014 received rivaroxaban. A total of 300 patients enrolled between January 2015 and July 2017 received 325 mg aspirin and 1,000 mg fish oil. Major venous thromboembolic events (VTEs) and bleeding complications within the first 90 days post-operatively were recorded in each cohort. The odds ratios (ORs) and 95% confidence intervals (CIs), for thromboembolic and bleeding events were calculated and compared between the aspirin and fish oil cohort vs. aspirin and pulsatile stocking cohort, and aspirin and fish oil cohort vs. rivaroxaban cohort. A P value of <0.05 was used to determine statistical significance. A total of 25 DVT events were recorded including 1 of 300 (0.33%) in the aspirin and fish oil cohort, 22 of 300 (7.33%) in the aspirin and pulsatile stocking cohort and 2 of 250 (0.8%) in the rivaroxaban cohort. When comparing ORs, patients who received aspirin and fish oil demonstrated significantly lower risk for thromboembolic events when compared to the aspirin and pulsatile stocking group (OR: 0.045; 95% CI: 0.0061-0.3394; P<0.05). When compared to the rivaroxaban cohort the ORs did not differ significantly (OR: 0.416; 95% CI: 0.0376-4.6223; P>0.05). In addition, no PE events were recorded in any of the cohorts. When compared to rivaroxaban, the fish oil and aspirin cohort demonstrated significantly lower incidence of bleeding episodes (1 of 300, 0.33% vs. 30 of 250 patients, 12%; OR: 0.0278; 95% CI: 0.0038-0.2051; P<0.05). No bleeding events were recorded in the aspirin and pulsatile stocking cohort. This study demonstrated the potentially synergistic anti-thromboembolic effect of aspirin and fish oil in the prevention of post-operative venous thromboembolism in primary TKA patients. Based on the results from this study, the authors conclude that the combination of aspirin and fish oil maybe an excellent thromboprophylactic modality for patients to use after TKA. These results warrant further, larger prospective studies analyzing the use of fish oil supplements in VTE prophylaxis.

Wound Discharge After Pharmacological Thromboprophylaxis in Lower Limb Arthroplasty

BackgroundThe benefits vs risk of pharmacological prophylaxis for thromboembolic disease in orthopedic patients remain controversial. Pharmacological thromboprophylaxis regimes are commonly used in this patient group. Few studies specifically examine wound complications attributable to this therapy. In this prospective trial, we investigated the effect of various regimens on postoperative wounds. MethodsA prospective, observational, multicenter study involving patients undergoing elective hip or knee arthroplasty was undertaken. Patients were divided into 3 groups depending on thromboprophylaxis: no anticoagulation, aspirin, or low molecular weight heparin (LMWH) (enoxaparin). Surgical wounds were evaluated for each regime using the Southampton Wound Assessment Score. ResultsOver a 12-month period, 327 patients were enrolled with a mean age of 68.1 years (±11.2 years). There were 105 patients in the no anticoagulation group (32.1%), 97 patients in the aspirin group (29.7%), and 125 patients in the LMWH group (38.2%). Wound scores were evaluated for evidence and amount of discharge. The use of LMWH conferred a 4.92 times greater risk and aspirin a 3.64 times greater risk of wound discharge than no pharmacological thromboprophylaxis (P < .0001). There were no significant differences in the incidence of deep vein thrombosis or pulmonary embolus between groups either as an inpatient or postdischarge. ConclusionThere is a significant increase in the risk of wound discharge when aspirin or LMWH is used in arthroplasty patients. As potential complications of wound problems are significant, a more balanced view of risk vs benefit needs to be taken when prescribing thromboprophylaxis for this patient group.

The 5 Clinical Pillars of Value for Total Joint Arthroplasty in a Bundled Payment Paradigm

BackgroundOur large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms. MethodsWe summarize a number of experiences and lessons learned since the implementation of Bundled Payments for Care Improvement at our institution. ResultsOur experience has led to the development of more refined clinical pathways and coordination of care through evidence-based approaches. We have established that the success of the bundled payment program rests on the following 5 main clinical pillars: (1) optimizing patient selection and comorbidities; (2) optimizing care coordination, patient education, shared decision making, and patient expectations; (3) using a multimodal pain management protocol and minimizing narcotic use to facilitate rapid rehabilitation; (4) optimizing blood management, and standardizing venous thromboembolic disease prophylaxis treatment by risk standardizing patients and minimizing the use of aggressive anticoagulation; and (5) minimizing post-acute facility and resource utilization, and maximizing home resources for patient recovery. ConclusionFrom our extensive experience with bundled payment models, we have established 5 clinical pillars of value for bundled payments. Our hope is that these principles will help ease the transition to value-based care for less-experienced healthcare systems.

Direct oral anticoagulant drugs in the prophylaxis and therapy of thromboembolic diseases

More than 50 years ago, vitamin K antagonists were the only available oral anticoagulants. Since their application involves a number of limitations, it was necessary to develop new oral anticoagulant drugs and introduce them into clinical practice. These drugs have many advantages over vitamin K antagonists, including rapid onset/offset, a small number of interactions with other drugs and food, simplified dosing and predictable pharmacokinetics, eliminating the need for daily laboratory monitoring. In addition, new oral anticoagulant drugs act selectively on a single coagulation factor. Currently, the following drugs are approved for use: direct thrombin inhibitor, dabigatran etexilate, direct factor Xa inhibitor, rivaroxaban, apixaban and edoxaban. Dabigatran etexilate and apixaban are approved for the primary prevention of venous thromboembolism in adult patients undergoing elective surgery of total hip or knee replacement, while in addition to these anticoagulants edoxaban is approved for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation. For the treatment and prevention of recurrent deep vein thrombosis dabigatran etexilate, rivaroxaban and edoxaban are approved. In addition, rivaroxaban is approved for the secondary prevention of atherothrombotic events in patients with acute coronary syndrome.

Arthroscopic hip preservation surgery practice patterns: an international survey.

To design and conduct a survey analyzing pre-, intra- and post- hip arthroscopy practice patterns among hip arthroscopists worldwide. A 21-question, IRB-exempt, HIPAA-compliant, cross-sectional survey was conducted via email using SurveyMonkey to examine pre-operative evaluation, intra-operative techniques and post-operative management. The survey was administered internationally to 151 hip arthroscopists identified from publicly available sources. Seventy-five respondents completed the survey (151 ± 116 hip arthroscopy procedures per year; 8.6 ± 7.1 years hip arthroscopy experience). Standing AP pelvis, false profile and Dunn 45 were the most common radiographs utilized. CT scans were utilized by 54% of surgeons at least some of the time. Only 56% of participants recommended an arthrogram with MRI. Nearly all surgeons either never (40%) or infrequently (58%) performed arthroscopy in Tönnis grade-2 or grade-3 osteoarthritis. Surgeons rarely performed hip arthroscopy on patients with dysplasia (51% never; 44% infrequently). Only 25% of participants perform a routine ‘T’ capsulotomy and 41% close the capsule if the patient is at risk for post-operative instability. Post-operatively, 52% never use a brace, 39% never use a continuous passive motion, 11% never recommended heterotopic ossification prophylaxis and 30% never recommended formal thromboembolic disease prophylaxis. Among a large number of high-volume experienced hip arthroscopists worldwide, pre-, intra- and post- hip arthroscopy practice patterns have been established and reported. Within this cohort of respondents, several areas of patient evaluation and management remain discordant and controversial without universal agreement. Future research should move beyond expert opinion level V evidence towards high-quality appropriately designed and conducted investigations.

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

A Modular Synthetic Approach to Isosteric Sulfonic Acid Analogues of the Anticoagulant Pentasaccharide Idraparinux.

Heparin-based anticoagulants are drugs of choice in the therapy and prophylaxis of thromboembolic diseases. Idraparinux is a synthetic anticoagulant pentasaccharide based on the heparin antithrombin-binding domain. In the frame of our ongoing research aimed at the synthesis of sulfonic acid-containing heparinoid anticoagulants, we elaborated a modular pathway to obtain a series of idraparinux-analogue pentasaccharides bearing one or two primary sulfonic acid moieties. Five protected pentasaccharides with different C-sulfonation patterns were prepared by two subsequent glycosylation reactions, respectively, using two monosaccharide and four disaccharide building blocks. Transformation of the protected derivatives into the fully O-sulfated, O-methylated sulfonic acid end-products was also studied.

Indwelling and Retrieval Complications of Denali and Celect Infrarenal Vena Cava Filters

PurposeTo compare indwelling and retrieval complications of Denali and Celect filters placed in the infrarenal inferior vena cava (IVC). Materials and MethodsA retrospective study was conducted over 2 years at a single institution in which 171 Denali and 162 Celect filters were placed in 333 patients with a mean age of 62.3 years ± 15.7 (161 men; 48.3%). Filter indications included venous thromboembolic disease (n = 320; 96.1%) and surgical prophylaxis (n = 13; 3.9%). A jugular approach was used to place 303 filters (91.0%). Computed tomography (CT) follow-up, complications, and retrieval data were obtained. ResultsFollow-up CT imaging was performed on 58 filters from each group with lower incidences of caval strut penetration (one vs 12) and filter tilt (one vs 15) in the Denali filter group (P = .002 and P < .001, respectively). There was no difference in incidences of breakthrough pulmonary embolism (P = .68). Retrieval attempts were performed on 43 Denali and 53 Celect filters with mean indwelling times at retrieval of 128.2 and 144.1 days, respectively (P = .40). Mean fluoroscopy time at retrieval was lower in the Denali group (3.1 min vs 6.0 min; P = .01). There were fewer cases of complex retrieval in the Denali group (n = 2 vs 10; P = .06). Tilt, fluoroscopy time, and air kerma were associated with complex retrieval (P = .04, P < .001, and P < .001, respectively). There was one Denali filter deployment complication that led to retrieval failure. ConclusionsThis study suggests that Denali filters are associated with lower incidences of strut penetration and filter tilt as well as shorter fluoroscopy time at retrieval compared with Celect filters when placed in the infrarenal IVC.

Kontrolsüz warfarin kullanımına bağlı ciltte kanama: Olgu sunumu

Anticoagulant therapy is a vital method of treatment and prophylaxis of thromboembolic diseases which clinically have a wide spectrum. Sometimes the most important complication of anticoagulant therapy is bleeding that may threaten life. Therefore, it is vital that anticoagulant therapy be planned so that it does not lead to thrombosis or bleeding and clinical and laboratory follow-up should be performed carefully. Skin bleeding caused by oral anticoagulants rarely occurs. It is advised that the reversal of anticoagulation should be done with the treatment of vitamin K, prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) as soon as possible. In this article, a case, who developed skin bleeding caused by receiving warfarin as prophylaxis because of atrial fibrillation and aortic valve replacement (AVR), was presented.

Prophylaxis of thromboembolic disease: patient safety protocoL

Critically ill patients have a high risk of deep venous thrombosis and pulmonary embolism, which comprise venous thromboembolic disease (VTED). Prevention during critical illness is a widely used quality metric and safety initiative for these patients.