Prevention Of Pulmonary Embolism Research Articles

Lower Limb Doppler Ultrasound Prior to Pneumatic Compression for the Prevention of Pulmonary Embolism in Gynecological Cancer Patients: A Retrospective Cohort Study.

Venous thromboembolism, which includes deep-vein thrombosis and pulmonary embolism, is the third most common cardiovascular disease after myocardial infarction and stroke. This study aimed to determine the effect of Doppler ultrasound on the prophylaxis and prevention of postoperative venous thromboembolism in gynecological oncology. This is a retrospective cohort study of procedures performed at King Abdulaziz Medical City in Jeddah, Saudi Arabia, between 2016 and 2021. The study included all patients diagnosed with gynecological cancers who underwent major cancer resection. A total of 295 eligible patients were enrolled and divided into two groups: the first group consisted of 104 patients who were screened for deep vein thrombosis using lower limb Doppler ultrasound prior to their gynecologic oncology surgery, while the second group included 190 patients who were not screened. The prevalence of pulmonary embolism and/or deep vein thrombosis was found to be eight out of 104 patients (7.7%) in the group screened for deep-vein thrombosis using lower limb Doppler ultrasound prior to their gynecologic oncology surgery. In the group that was not screened, one out of 190 patients (0.5%) developed deep vein thrombosis. The prevalence of postoperative pulmonary embolism and/or deep-vein thrombosis was reported in four out of 104 screened patients (3.8%) and in three out of 190 patients (1.6%) in the unscreened group. This study concluded that Doppler screening did not change the incidence of pulmonary embolism and/or deep-vein thrombosis postoperatively, but it may be helpful in detecting these conditions preoperatively. Therefore, Doppler screening for deep-vein thrombosis before surgical procedures in gynecological oncology could be considered after clinical assessment of the patient. To improve the study and address its limitations, a larger sample size would help to further investigate and identify relevant factors and determine their significance.

The prevention, diagnosis and management of pregnancy-associated pulmonary embolism

Pregnancy-associated pulmonary embolism (PE) is a type of venous thromboembolism (VTE) that seriously threatens the lives of pregnant women and has gained more attention in clinical practice. Due to physiological and anatomical characteristics, the incidence of VTE during pregnancy and postpartum is significantly higher than that during non-pregnancy periods. Currently, guidelines widely acknowledge the exploration of appropriate risk assessment models to evaluate the risk of pregnancy-associated VTE and to take corresponding preventive measures from mechanical to medication methods according to different risk levels. For patients suspected of PE, initial assessments can be made based on whether they exhibit clinical manifestations of deep vein thrombosis, with options including vascular compression ultrasonography or chest X-ray examination. Confirmation relies on CT pulmonary angiography or V/Q imaging. For patients with shock, echocardiography can be quickly used for the diagnosis and differential diagnosis of PE. The management of pregnancy-associated pulmonary embolism PE depends on the patient's hemodynamic status, with options including reperfusion therapy or anticoagulation therapy. Extracorporeal membrane oxygenation may also be beneficial in high risk patients. The overall evidence level for the prevention and management of pregnancy-associated PE is low, and further exploration in clinical practice is still needed to promote the safety of pregnant women.

Hypercoagulable state and risk of venous thromboembolism in Cushing syndrome.

Cushing syndrome (CS) is an endocrine-metabolic disorder characterized by hypercortisolism. Elevated cortisol levels can induce a hypercoagulable state, increasing the risk of venous thromboembolism (VTE). Both pituitary-origin Cushing disease (CD) and adrenal-origin non-adrenocorticotropic hormone (ACTH)-dependent CS are primarily treated with surgery. The dual impact of surgery and the underlying disease further elevates the risk of VTE, potentially leading to pulmonary embolism, which poses a severe threat to patient survival. Additionally, CS patients in a hypercoagulable state have a higher incidence of cardiovascular diseases and VTE, and even mortality compared with the general population. Untreated active CS patients have a 17.8-fold increased risk of VTE compared to the general population. In recent years, the relationship between the hypercoagulable state in CS and VTE has garnered increasing attention from clinicians. A better understanding of the clinical epidemiological characteristics, pathophysiological mechanisms, and clinical prevention and treatment of VTE and pulmonary embolism in CS can provide valuable references for the standardized use of prophylactic anticoagulant therapy in CS patients.

Guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (2024 edition)

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 pulmonary hypertension, characterized by pulmonary arterial thrombotic occlusion leading to vascular stenosis or obstruction, progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and even death. Recent years have seen rapid progress in the diagnostic and therapeutic in CTEPH field. More and more patients with CTEPH have been accurately diagnosed and assessed in time. Nevertheless, there is still a lot of work to do in the popularization of CTEPH diagnostic and therapeutic technique and the building of CTEPH expert center. To better guide clinical practice in our country, Pulmonary Embolism & Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism & Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians, National Cooperation Group on Prevention & Treatment of Pulmonary Embolism & Pulmonary Vascular Disease, National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension, convened multidisciplinary experts for deliberation and Delphi expert consensus to develop the "Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension (2024 edition) ". These guidelines systematically evaluate domestic and international evidence-based medical research on CTEPH and propose recommendations tailored to clinical practice in our country. The key areas covered include definitions, epidemiology, pathogenesis, diagnosis and assessment, treatment, and management, with the aim of further standardizing the clinical diagnosis and treatment of CTEPH in our country.

Meta-analysis of new intervention measures for preventing side effects of artificial joint replacement.

Intertrochanteric fracture of the femur occurs mostly among older people, and seriously affects daily life and quality of life. At present, physical intervention, drug treatment, routine intervention and rehabilitation training are widely used for prevention of side effects, but it is still inconclusive which intervention has the best effect. To compare the effects of new intervention measures for preventing side effects of artificial joint replacement. We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet, PubMed, Wanfang, Weipu and other databases. Study quality was evaluated by improved Jadad scoring standard, and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software. Ten articles, including 869 cases, were finally included. The preventive effects of different interventions on the side effects of artificial joint replacement were studied, and valid data were extracted. There were two articles on the preventive effects of drug intervention, four on comparison of the preventive effects of combined and single interventions, and three on the preventive effects of physical intervention, rehabilitation training and routine intervention. Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium [mean difference (MD) = -0.16, 95%CI: -0.28 to -0.04, P < 0.05]. The effect of combined intervention was significantly better than that of single intervention (MD = -0.08, 95%CI: -0.16 to -0.01, P < 0.001). Physical intervention was significantly better than routine intervention and rehabilitation training (MD = 0.26, 95%CI: 0.16-0.36, P < 0.001). Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement. In the prevention of pulmonary embolism, rivaroxaban drug intervention is given priority. The effect of combined intervention is better than that of single intervention.

Pharmacological and Nonpharmacological Interventions for Prevention and Management of Pulmonary Embolism in Patients with Cardiac Comorbidities: A Literature Review

Pulmonary embolism (PE) presents significant healthcare challenges and potentially life-threatening consequences, demanding a nuanced approach to management. This systematic review aimed to critically evaluate available pharmacological and nonpharmacological interventions for PE, analyzing their efficacy and safety in patients with cardiac comorbiditie, ranging from traditional anticoagulants like warfarin to novel direct oral anticoagulants (DOACs) or thrombolytic therapies is commercially available options with varying benefits and limitations. Nonpharmacological interventions, including catheter-directed therapies and embolectomy, provide alternative avenues, especially when thrombolysis is contraindicated despite advancements, and gaps persist, particularly in reconciling efficacy with safety profiles and optimizing resource allocation. Addressing these challenges necessitates a multidisciplinary approach, integrating clinical expertise with evidence-based practices. By exploring these interventions' intricacies and implications, this review aims to inform clinicians, researchers, and policymakers, fostering improved care pathways and better outcomes for patients facing the complex landscape of PE management.

Long-term anticoagulant therapy in the aspect of secondary prevention of recurrent pulmonary embolism

Aim. To determine differences in laboratory coagulation parameters using routine and integral monitoring methods in patients depending on anticoagulant therapy &gt;12 months after pulmonary embolism (PE) with a high recurrence risk.Material and methods. The study included 72 patients who, according to indications, received long-term anticoagulant therapy &gt;12 months due to a high risk of recurrent thromboembolism. During the follow-up period (15-20 months from the first pulmonary embolism episode), the plasma coagulation parameters were studied using a conventional panel and D-dimer assessment, as well as a thrombin generation test and thrombodynamics. Patients adherent to prolonged anticoagulation were included in group 1. During the collection period, 8 patients independently stopped taking anticoagulants, despite the high risk of recurrent pulmonary embolism (group 2).Results. There were no significant differences in coagulation parameters and D-dimer levels between the studied groups of patients. In the group of patients continuing to take anticoagulants, there was an increase in clot growth delay parameters in comparison with patients of group 2 according to the thrombodynamics results (p=0,046) and the thrombin generation test in platelet-poor plasma in comparison with reference values (p=0,001).Conclusion. Long-term anticoagulant therapy effectively prevents recurrent venous thromboembolism. In patients after primary pulmonary embolism who refuse anticoagulation, the clot growth delay values are shortened, which indicates an increased risk of recurrent venous thromboembolism. The most stable plasma coagulation parameters are observed in patients taking direct oral anticoagulants.

Acute caval thrombosis leading to obstructive shock in the early post insertion period of an inferior vena cava filter: a case report and literature review

BackgroundObstructive shock is extremely rare in clinical practice and is caused by acute blood flow obstruction in the central vessels of either the systemic or pulmonary circulation. Utilizing inferior vena cava filters (IVCFs) to prevent pulmonary embolism (PE) is associated with some potential complications, such as inferior vena cava thrombosis (IVCT). Shock as a direct result of IVCT is rare. We present a case of obstructive shock secondary to extensive IVCT caused by inadequate anticoagulant therapy after the placement of an IVCF.Case presentationA 63-year-old male patient with a traffic accident injury presented orthopaedic trauma and lower limb deep vein thrombosis (DVT). He experienced sudden and severe abdominal pain with hypotension, tachycardia, tachypnea, oliguria and peripheral oedema 5 days after IVCF placement and 3 days after cessation of anticoagulant therapy. Considering that empirical anti-shock treatment lasted for a while and the curative effect was poor, we finally recognized the affected vessels and focused on the reason for obstructive shock through imaging findings—inferior vena cava thrombosis and occlusion. The shock state immediately resolved after thrombus aspiration. The same type of shock occurred again 6 days later during transfer from the ICU to general wards and the same treatment was administered. The patient recovered smoothly in the later stage, and the postoperative follow-up at 1, 3, and 12 months showed good results.ConclusionThis case alerts clinicians that it is crucial to ensure adequate anticoagulation therapy after IVCF placement, and when a patient presents with symptoms such as hypotension, tachycardia, and lower limb and scrotal oedema postoperatively, immediate consideration should be given to the possibility of obstructive shock, and prompt intervention should be based on the underlying cause.

All-cause mortality of hospitalized inflammatory bowel disease patients: a multicenter study from Iran.

In this multicenter study, we investigated all causes of mortality in hospitalized inflammatory bowel disease (IBD) patients. The widespread use of biologics and immune suppressive treatments, along with the longer lifespan of patients with IBD, may have changed the cause of death in this population. Knowing this may lead to better preventive and therapeutic strategies for IBD patients. This cross-sectional study reviewed records of 1926 IBD patients hospitalized in referral hospitals in Isfahan and Shiraz during 2013-2021. In nine years, 84 patients, 39 from Isfahan and 45 from Shiraz, died. We retrospectively gathered data on demographic, clinical, and laboratory information, as well as the cause of death. We extracted the cause of death from the death sheets and classified it using the International Classification of Diseases (ICD-10). Using the Kaplan-Meier model, we estimated the median survival time from disease diagnosis to death. Males accounted for 47 (55%) of the deceased patients. The mean age of the patients was 48.63 ± 18.7 years. The mortality rates among hospitalized UC and CD patients were 7.2% and 7.8%, respectively. The median duration of admission to death was 8 days, with 19 (22.6%) of IBD patients dying on the first day of their hospital admission. Half of the cohort of deceased IBD patients had survived for 8 years following their disease diagnosis. 32.7% of all recorded causes of death were due to certain infectious diseases. The second and third most common causes of death were diseases of the digestive system and diseases of the circulatory system, including pulmonary embolism, accounting for 30.1% and 14.2%, respectively. According to this study from Iran, infectious diseases are the leading cause of death among hospitalized IBD patients. Prevention and clinical management of pulmonary embolism in IBD patients require more careful consideration. We strongly encourage population-based cohort studies to enhance the findings.

Prevention of symptomatic pulmonary embolism for gynecologic malignancies with preoperative asymptomatic venous thromboembolism: GOTIC-VTE trial.

In Japan, perioperative prophylaxis of pulmonary embolism (PE) in gynecologic cancer patients with preoperative asymptomatic venous thromboembolism (VTE) has not been well established yet. The GOTIC-VTE trial was a prospective, multi-center, single-arm clinical trial to investigate the prevention of postoperative symptomatic PE onset by seamless anticoagulant therapy from the preoperative period to 4 weeks after surgery instead of using intermittent pneumatic compression. Anticoagulant therapy was started immediately after asymptomatic VTE diagnosis and stopped preoperatively according to the rules of each institution. Unfractionated heparin administration was resumed within 12 hours postoperatively, and this was followed by the switch to low-molecular-weight heparin and subsequently, edoxaban; this cycle was continued for 28 days. Primary outcome was the occurrence of symptomatic PE in 28 days postoperatively. Secondary outcomes were the incidence of VTE-related events in 28 days and 6 months postoperatively and protocol-related adverse events. Between February 2018 and September 2020, 99 patients were enrolled; of these, 82 patients were assessed as the full analysis set, including 58 for ovarian cancer, fallopian tube, or peritoneal cancer; 21 for endometrial cancer; and 3 for cervical cancer. No symptomatic PE was observed within 28 days postoperatively; two patients had bleeding events (major bleeding and clinically relevant nonmajor bleeding) and three had grade 3 adverse events (increased alanine transaminase, aspartate aminotransferase, or gamma-glutamyl transferase). The multifaceted perioperative management for gynecologic malignancies with asymptomatic VTE effectively prevented postoperative symptomatic PE. JRCT Identifier: jRCTs031180124.

Prevention and treatment of venous thromboembolic complications in orthopedic patients

To analyze the comprehensive program for prevention of thromboembolic complications in orthopedic patients. We have analyzed thromboembolic complications in orthopedic patients after surgeries on large joints over the past 5 years (2018-2022). A comprehensive approach to prevention and treatment of thromboembolic complications including ultrasound, early surgical prevention of pulmonary embolism can significantly improve postoperative outcomes after joint replacement surgery. Vacuum aspiration retrograde thrombectomy is effective, feasible and safe for acute ilio-femoral venous thrombosis reducing hospital-stay (p=0.0124) and restoring vein patency. Widespread thromboembolic complications, especially for pulmonary embolism in 2022, are likely due to a new coronavirus infection and require careful screening of patients with risk factors with appropriate preventive antithrombotic therapy.

The Role of Saveliev V.S. and his School in Development of Endovascular Prevention of Pulmonary Embolism

The Role of Saveliev V.S. and his School in Development of Endovascular Prevention of Pulmonary Embolism

Indications and Outcomes of Inferior Vena Cava Filter Insertion in a Tertiary Hospital in Metro Manila, Philippines: A Retrospective Cohort Study

INTRODUCTION: Inferior vena cava (IVC) filters entrap emboli from the periphery going to the pulmonary circulation, preventing pulmonary embolism (PE). Studies show that many IVC filter insertions are done for weak or non–guideline-directed indications. This study examined the indications for IVC filter insertion in a tertiary care hospital in Metro Manila, adherence to society guidelines, and clinical outcomes after filter insertion. METHODS: This study is a retrospective cohort involving patients who received an IVC filter from January 2015 to February 2021. The main outcome was the indication for IVC filter. Other outcomes were strength of recommendation for filter placement and postfilter clinical outcomes: all-cause death, venous thromboembolism–related mortality, PE, and filter-related complications. RESULTS: Eighty-three patients received IVC filters from January 2015 to February 2021, and 77 were included in the analysis. Sixty-one percent had moderate to strong indications for the procedure, 49% were due to contraindication to anticoagulation. Thirty-nine percent had unclear indications: 16% concomitantly received therapeutic anticoagulation, whereas 11% had isolated distal deep vein thrombosis. Mean follow-up was 170 days. Postfilter clinical outcomes included all-cause death in 12%, venous thromboembolism–related mortality in 1%, and PE in 3%. Filter complications occurred in 4%. Retrievable IVC filters were used in 51% with attempted removal in 4%, 3% of which were successful. CONCLUSION: The majority of patients receiving IVC filters in our center had strong to moderate indications for the procedure. The use of retrievable filters and consequent retrieval is low and should be encouraged. Venous thromboembolism–related mortality and filter complications were low, comparable to international data. KEYWORDS: echocardiography, laboratory, reader, resources, sonographer, survey

Analysis of Inferior Vena Cava Filter Indications and Retrieval Rates at an Academic Medical Center in Appalachia

Introduction: Inferior vena cava (IVC) filters are placed for prevention of pulmonary embolism in patients with venous thromboembolism (VTE) and a contraindication to anticoagulation. Additional clinical indications for IVC filters, such as pre-operative prophylaxis for VTE and extensive VTE, are controversial and vary across clinical guidelines. Current guidelines recommend that IVC filters be retrieved after resolution of their clinical indication. A common problem is failure to retrieve IVC filters when indicated, resulting in prolonged or indefinite placement of these devices. Failure to remove IVC filters contributes to an increased risk of filter-associated complications such as device migration, embolization to the cardiopulmonary circulation, perforation and increased risk of deep vein thrombosis (DVT). The goal of this study is to identify IVC filter indications and retrieval statistics at our academic medical center in Appalachia. We seek to compare our performance to national averages, identify the reasons for failure of retrieval in our patient population and develop quality improvement initiatives to improve our performance. Methods: An IRB-approved, single-institution, retrospective chart review was conducted for all patients who had an IVC filter placed between January 2020 and December 2022 at West Virginia University Hospital. Patient demographics, comorbidities, placement indications, retrieval statistics and filter-associated complications were obtained from the electronic medical record (EMR). Patients who had a permanent IVC filter placed were excluded from the final analysis. Statistical analysis was performed using Mann-Whitney U and Chi squared tests where appropriate to compare the retrieval and failure of retrieval groups. Results: The study sample (n=450) had a mean age of 65.3±15.4 years and was comprised of 54.2% males and 45.8% females. West Virginia residents comprised 82.4% of the study sample. The most common reported clinical indications for placement included VTE with a contraindication to anticoagulation (62.4%), preoperative prophylaxis for VTE (15.8%), extensive VTE (15.3%), pharmacomechanical thrombectomy (15.0%) or other (3.1%). The rate of IVC filter retrieval was 25.4% (n=114). The most common reasons for failure of retrieval were loss to follow-up (31.8%), other reasons including provider or patient preference (31.5%), patient death (28.3%), clinical indication remains present (5.7%) and unsuccessful retrieval (2.7%). Patients in the failure of retrieval group (n=114) were significantly older (69 vs 61 years, p&amp;lt;0.001) and had a higher frequency of clinical indications for history of VTE with a contraindication to anticoagulation (231 vs 50 patients, p&amp;lt;0.0001) and extensive VTE (49 vs 20 patients, p&amp;lt;0.0001) compared to retrieval group (n=336). There was a nonsignificant trend toward greater frequency of chronic conditions in the failure of retrieval group including cancer history (101 vs 26 patients, p=0.15), heart failure (44 vs 11, p=0.41) and hypercoagulable disease (16 vs 2 patients, p=0.26). Conclusions: Our institution had a lower IVC filter retrieval rate than the estimated average of 34% reported in a systematic review by Angel et al. Patients with comorbid conditions tended to not undergo retrieval, predisposing them to a higher risk of filter-associated complications. A history of VTE with a contraindication to anticoagulation was the most common clinical indication for placement, but the other most common indications are not universally guideline recommended which identified an area of opportunity for multidisciplinary provider education. Patient loss to follow-up is the predominant reason for failure of retrieval at our institution, which is consistent with the healthcare disparity faced by our predominantly rural, Appalachian patient population of travelling long distances to our tertiary center to obtain specialty care. Quality improvement strategies to mitigate this limitation in the context of IVC filter placement through close local follow-up for timely reassessment, retrieval evaluation and removal will be developed.

Substantial Improvement in Self-Reported Mental Health Following Total Hip Arthroplasty Occurs Independent of Anesthetic Technique

BackgroundThe influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia (GA) on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia (NA) would provide favorable mental health profiles compared with GA after THA. MethodsProspectively collected Patient-Reported Outcomes Measurement Information System-10 (PROMIS) Global Mental Health (GMH) scores at preoperative baseline, and 1, 3, and 6 months after THA were accessed on 4,353 patients in the Pulmonary Embolism Prevention After HiP and KneE Replacement (PEPPER) Trial (ClinicalTrials.gov: NCT02810704). Anesthesia was categorized as: general (GA), neuraxial (NA), and neuraxial with peripheral block (NAP). The GMH was assessed longitudinally and compared between groups. ResultsPostoperative GMH improved (P < .05) over preoperative in every anesthetic group. Groups receiving NA had higher baseline GMH scores. Improvement in GMH was diminished after GA alone and plateaued after 1 month. Adding NA or peripheral nerve block to GA conferred additional benefit to GMH improvement. ConclusionsPatient-perceived mental health improves significantly after THA regardless of anesthetic type. Patients who have higher baseline GMH scores more commonly received NA, likely due to nonsurgical care determinants; these differences in mental wellness persisted at follow-up. Adjunctive NA or peripheral nerve block favored GMH improvement, whereas solitary GA diminished GMH improvement, which plateaued after 1 month. Substantial mental health benefits of THA may overshadow subtle differences in GMH attributable to anesthetic type.

Development and Validation of RP-HPLC Method for the Determination of Enoxaparin Sodium in Dry Injection Formulation.

Enoxaparin sodium is an anticoagulant medication that is used as a blood thinning agent. It is mostly used for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). It is also used in certain surgeries and during pregnancy. For the treatment of acute coronary syndrome (ACS) and heart attacks, it may be used. Enoxaparin sodium was validated by the RP-HPLC method. A simple RP-HPLC method was developed in a single HPLC run in a dry powder injection formulation. All injections of HPLC sample were 20 μL volume. The chromatographic separation was completed in the isocratic mode. The used column was USP-L8 (250 mm × 4.6 mm) of BDS type of 10 μm meters in the same mobile phase throughout the analysis by using methanol and ultrapure water with a ratio of 7:93, respectively. The flow rate was 1.0 mL/min. The mobile phase was filtered through 0.45 μm filter paper, and isocratic elution was performed. The refractive index (RI) detector was used to analyze this sample. The specific peak of enoxaparin sodium was observed at 5:56 min. The calculated detection limit (LOD) was 0.351 ppm, and the calculated quantitation limit was 1.063 ppm. In repeatability of precision, the average calculated assay (%) was 100.85%, and the calculated RSD (%) was 0.01. In the accuracy test, the RSD (%) was 0.50, and the mean recovery (%) was 100.35. The system's suitability was within the limit. This newly developed method is proposed according to ICH guidelines, and rules and can be applied effectively for the exact estimation of enoxaparin sodium in injection formulation. This newly developed methodology is affordable in cost as long as less time is taken and the consumption of samples is in smaller quantities for every investigation. In medicinal chemistry, the USP (United States Pharmacopeia) and BP (British Pharmacopeia) are directly involved in production as well as in quality testing.

POSSIBILITIES OF CORRECTING CELLULAR-HUMORAL IMMUNE DISORDERS AND CYTOKINE STATUS IN HIGH-RISK PREGNANT WOMEN FOR THE DEVELOPMENT OF PREECLAMPSIA

POSSIBILITIES OF CORRECTING CELLULAR-HUMORAL IMMUNE DISORDERS AND CYTOKINE STATUS IN HIGH-RISK PREGNANT WOMEN FOR THE DEVELOPMENT OF PREECLAMPSIA

A DIFFERENTIATED APPROACH IN THE TREATMENT OF ACUTE FLOATING VENOUS THROMBOSIS OF THE INFERIOR VENA CAVA SYSTEM

We analyzed the results of surgical treatment floating DVT. Unfortunately, there are no randomized studies in the world regarding the determination of clear tactical approaches to the treatment of floating venous thrombosis, in many cases doctors make decisions about the choice of surgical tactics based on their own experience. In our research, we tried to systematize our own experience and form the basic principles of determining surgical tactics in the treatment of floating venous thrombosis. To date, anticoagulants, surgical interventions in the form of thrombectomy, and thrombolytic therapy are used in the treatment of DVT. Unfortunately, at the moment, no consensuses clearly define the issues of surgical treatment of floating venous thrombosis, venous thrombosis in pregnant women, venous thrombosis complicated by pulmonary embolism, venous thromboembolism.&#x0D; The goal. The aim of the research was to develop a surgical tactics in the treatment of floating DVT of the inferior vena cava.&#x0D; Materials and methods. The treatment of 76 patients with floating DVT from 2008 to 2020 were analyzed.&#x0D; In a research among patients with floating DVT in 15(20%) patients experienced thrombosis of the inferior vena cava, 19(25%) patients had ilio-femoral thrombosis in 17(22%) patients with femoral - popliteal thrombosis in 9(12%) patients with popliteal - tibial.&#x0D; Deep vein thrombosis complicated by pulmonary embolism with medium and high risk of death was observed in 10 (13%) patients. Among them, floating thrombosis of the iliac-femoral segment was observed in 4 patients.&#x0D; Floating thrombosis of deep veins in pregnant women was observed in 6 (8%) patients.&#x0D; Among patients, 20 (296%) patients were admitted within 1 day of the onset of the disease, 30 (39%) patients on 2-3 days, 11 (14%) patients on 4-7 days, 8 on 8-14 days (11%) patients, from the 15th day - 7 (10%) patients).&#x0D; The results. Patients with long of floating part of the more than 4 cm, we used an active surgical tactics. In the presence of the floating thrombus a total iliac vein thrombectomy we performed in 12 patients with the removal of the floating thrombus with femoral access. For the prevention of pulmonary embolism in these cases we implanted a temporary cava-filter. When flotation thrombus in the external iliac vein, we used the technique of thrombectomy using Fogarty two catheters in 12 patients. When flotation clots in common femoral vein and distally using a vein thrombectomy with clamping head above floating thrombus. When treating patients with floating DVT, pulmonary embolism complicated with medium and high risk of death, we used systemic thrombolysis with pre- implantation temporary coffee filter in patients with floating DVT, pulmonary embolism complicated with medium and high risk of death, we used systemic thrombolysis with pre- implantation temporary coffee filter. In the presence of pregnancy and floating thrombosis thrombectomy was performed with the removal of the thrombus floating. In our research, when performing the surgical treatment of DVT no cases of pulmonary embolism during or after treatment were observed. In 100 % of patients after treatment has been a clinical improvement in all cases floating DVT was eliminated floating nature of the danger of thrombosis and pulmonary embolism.&#x0D; Conclusions. In the presence of a floating DVT of the inferior vena cava system with a length of the floating part of the thrombus greater than 4 cm, it is necessary to use an active strategy of thrombus removal. When performing thrombectomy, it is necessary to use methods of surgical prevention of PE, taking into account the localization of the floating part.

Prevalence and risk factors for pulmonary embolism in children with sickle cell disease: an institutional retrospective cohort study.

The study was conducted to examine prevalence of pulmonary embolism in children with sickle cell disease (SCD) and identify potential risk factors associated with pulmonary embolism in a single tertiary paediatric centre. Children with SCD between 0 and 21 years of age from January 2010 to January 2021 were included. Pulmonary embolism was initially identified using International Classification of Diseases (ICD)-9 or 10 codes and confirmed with manual chart review of identified cases. Logistic regression analysis was performed to assess association between SCD specific and general thrombotic risk factors and pulmonary embolism. We identified 492 unique patients with SCD with a median age of 11 years (interquartile range: 4-18). A total of eight (1.6%) patients developed a pulmonary embolism. Patients with pulmonary embolism were significantly older (median, interquartile range: 20.5, 14-21 years) than patients without pulmonary embolism (median, interquartile range: 10, 4-17 years). Central nervous system (CNS) vasculopathy and erythrocytapheresis were significantly associated with pulmonary embolism on univariable logistic regression analysis. A previous diagnosis of deep vein thrombosis (DVT) was significantly more common among patients with pulmonary embolism than among those without pulmonary embolism (50 vs. 5.2%; P < 0.0001). Prevalence of pulmonary embolism in children with SCD was high. Risk factors associated with pulmonary embolism in this study such as CNS vasculopathy or erythrocytapheresis could suggest that the risk for pulmonary embolism in SCD may be related to the severity of disease state. Future studies are needed on pulmonary embolism prevention strategies.

Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of deep vein thrombosis.

Deep vein thrombosis (DVT) is a condition in which a clot forms in the deep veins, most commonly of the leg. It occurs in approximately one in 1000 people. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Previously, a DVT was treated with the anticoagulants heparin and vitamin K antagonists. However, two forms of direct oral anticoagulants (DOACs) have been developed: oral direct thrombin inhibitors (DTIs) and oral factor Xa inhibitors, which have characteristics that may be favourable compared to conventional treatment, including oral administration, a predictable effect, lack of frequent monitoring or dose adjustment and few known drug interactions. DOACs are now commonly being used for treating DVT: recent guidelines recommended DOACs over conventional anticoagulants for both DVT and PE treatment. This Cochrane Review was first published in 2015. It was the first systematic review to measure the effectiveness and safety of these drugs in the treatment of DVT. This is an update of the 2015 review. OBJECTIVES: To assess the effectiveness and safety of oral DTIs and oral factor Xa inhibitors versus conventional anticoagulants for the long-term treatment of DVT. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.govtrials registers to 1 March 2022. We included randomised controlled trials (RCTs) in which people with a DVT, confirmed by standard imaging techniques, were allocated to receive an oral DTI or an oral factor Xa inhibitor compared with conventional anticoagulation or compared with each other for the treatment of DVT. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were recurrent venous thromboembolism (VTE), recurrent DVT and PE. Secondary outcomes included all-cause mortality, major bleeding, post-thrombotic syndrome (PTS) and quality of life (QoL). We used GRADE to assess the certainty of evidence for each outcome. We identified 10 new studies with 2950 participants for this update. In total, we included 21 RCTs involving 30,895 participants. Three studies investigated oral DTIs (two dabigatran and one ximelagatran), 17 investigated oral factor Xa inhibitors (eight rivaroxaban, five apixaban and four edoxaban) and one three-arm trial investigated both a DTI (dabigatran) and factor Xa inhibitor (rivaroxaban). Overall, the studies were of good methodological quality. Meta-analysis comparing DTIs to conventional anticoagulation showed no clear difference in the rate of recurrent VTE (odds ratio (OR) 1.17, 95% confidence interval (CI) 0.83 to 1.65; 3 studies, 5994 participants; moderate-certainty evidence), recurrent DVT (OR 1.11, 95% CI 0.74 to 1.66; 3 studies, 5994 participants; moderate-certainty evidence), fatal PE (OR 1.32, 95% CI 0.29 to 6.02; 3 studies, 5994 participants; moderate-certainty evidence), non-fatal PE (OR 1.29, 95% CI 0.64 to 2.59; 3 studies, 5994 participants; moderate-certainty evidence) or all-cause mortality (OR 0.66, 95% CI 0.41 to 1.08; 1 study, 2489 participants; moderate-certainty evidence). DTIs reduced the rate of major bleeding (OR 0.58, 95% CI 0.38 to 0.89; 3 studies, 5994 participants; high-certainty evidence). For oral factor Xa inhibitors compared with conventional anticoagulation, meta-analysis demonstrated no clear difference in recurrent VTE (OR 0.85, 95% CI 0.71 to 1.01; 13 studies, 17,505 participants; moderate-certainty evidence), recurrent DVT (OR 0.70, 95% CI 0.49 to 1.01; 9 studies, 16,439 participants; moderate-certainty evidence), fatal PE (OR 1.18, 95% CI 0.69 to 2.02; 6 studies, 15,082 participants; moderate-certainty evidence), non-fatal PE (OR 0.93, 95% CI 0.68 to 1.27; 7 studies, 15,166 participants; moderate-certainty evidence) or all-cause mortality (OR 0.87, 95% CI 0.67 to 1.14; 9 studies, 10,770 participants; moderate-certainty evidence). Meta-analysis showed a reduced rate of major bleeding with oral factor Xa inhibitors compared with conventional anticoagulation (OR 0.63, 95% CI 0.45 to 0.89; 17 studies, 18,066 participants; high-certainty evidence). AUTHORS' CONCLUSIONS: The current review suggests that DOACs may be superior to conventional therapy in terms of safety (major bleeding), and are probably equivalent in terms of efficacy. There is probably little or no difference between DOACs and conventional anticoagulation in the prevention of recurrent VTE, recurrent DVT, pulmonary embolism and all-cause mortality. DOACs reduced the rate of major bleeding compared to conventional anticoagulation. The certainty of evidence was moderate or high.