Related Thrombosis Research Articles

CLINICAL EVALUATION OF THE INDIGENOUSLY MANUFACTURED REJUVENATE® BARE METAL STENT SYSTEM IN PAKISTANI PATIENTS WITH CORONARY ARTERY DISEASE

Objectives: The aim of this pilot study was the first-in-man evaluation of the safety, feasibility, deliverability, and efficiency of the newly developed REJUVENATE® bare metal stent system in coronary artery disease. Methodology: Current study was a pilot non-randomized, multi-centric and prospective study which was intended to study the safety of the REJUVENATE® bare metal stent in Pakistani population over 10 months. Study endpoints included target vessel related myocardial infarction, stent thrombosis, in-stent restenosis, stroke and death. The diameter of the target lesions selected was between 3-4mm with length no more than 22mm. Only one BMS was implanted per patient. These patients had well defined regular clinical follow-ups and CT scan coronary angiography at the end of 10 months. Results: 20 patients suffering from coronary artery disease (CAD) including15 male subjects and 5 female subjects were enrolled in this study and were treated with REJUVENATE® BMS. 65% patients were hypertensive, 25% diabetics and 25% were active smokers. Out of the 20 stents implanted, 14 stents were implanted in the right coronary artery and 6 were implanted in the left circumflex artery. During this 10-month study period there was 10.65% of cases in which late lumen loss (lumen stenosis <70%) was observed, however no cases of in stent restenosis and stent thrombosis were observed. There was no target vessel related myocardial infarction or stroke as well. One patient died of pneumonia during the follow up period. Conclusion: The current study demonstrated the deliverability and clinical safety of REJUVENATE® bare metal stent over a period of 10 months.

Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis

Objective: To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis. Methods: Six patients with AF and end-stage renal disease(ESRD)on long term hemodialysis who underwent LAAO from March 2017 to March 2021 in Beijing Anzhen Hospital were enrolled. Baseline characteristics such as age, sex, types of arrhythmia, stroke and bleeding score, and continuous dialysis time were collected. Four patients underwent LAAO, two patients underwent the combined procedure of catheter ablation and LAAO. Perioperative treatment and serious complications were recorded. Transesophageal echocardiography was repeated at 45 days and 60 days after the procedure. Telephone follow-up was conducted at 3, 6 and 12 months after the procedure, and every 6 months thereafter. Thromboembolism and major bleeding events and survival were evaluated. Results: The average age was (66.7±17.0) years old, and 5 were male (5/6). There were 4 patients with paroxysmal AF (4/6), and 2 patients with persistent AF (2/6). The mean CHA2DS2-VASc score was (4.8±1.5), and the HAS-BLED score was (3.5±1.4). The duration of hemodialysis was 2.6 (1.1, 8.3) years. Successfully Watchman implantation was achieved in all patients. There were no severe perioperative complications, and no device related thrombosis or leaks were observed by transesophageal echocardiography. During a mean of 22.0 (12.0, 32.0) months follow-up, there was no thromboembolism or major bleeding events. A total of 2 patients died, one from sudden cardiac death, and another one from heart failure. Conclusions: LAAO may be a safe and effective therapeutic option for prevention of thromboembolism in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis, further studies with larger patient cohort are needed to confirm our results.

P12.04 Body Mass Index: a possible PICC-related complications risk factor in neuro oncological patients

Abstract BACKGROUND The use of central venous catheter with peripheral insertion (PICC) has increased rapidly in recent years particularly in cancer patients because they represent a stable and safe vascular access to administer irritants or vesicants therapies. However, the benefit provided may occasionally be affected by severe complications. An observational study conducted at our Institute, showed a significant increase of thromboembolic risk in neuro-oncological patients compared to general cancer population (16.3% vs 6.7% respectively). For this reason, it is essential to identify independent risk factors in order to avoid preventable harm. MATERIAL AND METHODS Neuro-oncological patients with PICC that developed a thromboembolic event were retrospectively analyzed. We evaluated clinical data, BMI, KPS, steroid therapies and anticoagulants at the time of positioning of the PICC and at the onset of the thrombotic event. RESULTS A total of 90 neuro-oncological patients have been analyzed. The most common histology was represented by glioblastoma, followed by anaplastic astrocytoma, primary central nervous system lymphoma, grade II glioma. 17.6% of patients were at first diagnoses, 41.6% were at the first recurrence, and the remaining patients were at the second or third recurrence. The median KPS was 90 (range 80–100), and the median ECOG was 0 (range 0–2). Overall, 14% patients developed thromboembolic events within a median time of 34.5 days (range 5–146) after PICC implantation. Among these, 64% of patients was considered overweight. No patients were on anticoagulant therapy but all were treated with a median dose of 5.5 mg of steroids (range 3,5-12), stable between PICC insertion and onset of adverse event. CONCLUSION 64% of patients who developed a thromboembolic event had BMI >28 at the time of PICC insertion, suggesting a possible trend towards a risk of developing PICC related thrombosis in overweight/obese patients. Other independent risk factors for PICC associated complications seems to be amount of previous chemotherapies administered: 82% of patients who developed thrombotic complications had already undergone at least one line of chemotherapy before PICC placement, suggesting this condition as a possible risk factor for the onset of the event. Also failed positioning attempts could damage vascular endothelium, contributing to the onset of thrombotic complications. An accurate anamnesis and a physical evaluation with particular attention to the presence of malnutrition could help in the in the early identification of independent risk factors that could farther negatively influence the outcome of neuro-oncological patients.

Treatment of ChAdOx1 nCoV-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia Related Acute Ischemic Stroke

Recently cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) and thrombosis following the adenoviral vector vaccine against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported. A mechanism similar to heparin-induced thrombocytopenia was proposed with antibodies to platelet factor 4 (PF4). Vaccine related arterial thrombosis in the brain is rare but life-threatening and optimal treatment is not established. We report clinical, laboratory, imaging findings and treatment in a 51-year-old female presenting with acute left middle cerebral artery (MCA) occlusion 7 days after the first dose of ChAdOx1 nCoV-19 vaccine. Due to low platelet count and suspicion of VITT she was not eligible for intravenous thrombolysis (IVT) and proceeded to mechanical thrombectomy (MER) with successful recanalization four hours after onset of symptoms. Treatment with intravenous immunoglobulin (IVIG) and heparin pentasaccharide fondaparinux was initiated. Presence of anti-PF4 antibodies was confirmed. The patient improved clinically with normalization of platelet count. Clinicians should be alert of VITT in patients with acute ischemic stroke after ChAdOx1 nCov-19 vaccination and low platelet counts. MER showed to be feasible and effective. We propose considering MER in patients with VITT and large vessel occlusion despite thrombocytopenia. High-dose IVIG should be started immediately. Alternative anticoagulation to heparin should be started 24 hours after stroke onset unless significant hemorrhagic transformation occurred. Platelet transfusion is contraindicated and should be considered only in severe hemorrhagic complications. Restenosis or reocclusion of the revascularized artery is possible due to the hypercoagulable state in VITT and angiographic surveillance after the procedure is reasonable.

Line Thrombosis in Patient on Maintenance Hemodialysis with use of Trisodium Citrate 4% V/S Heparin at Sheikh Zayed Hospital Rahim Yar Khan

Background: Conventional Heparin and Tri-sodium citrate 4% are used for locking double lumen catheter after dialysis to prevent line thrombosis. Objectives: To compare the line thrombosis after use of heparin and tri-sodium citrate 4%. Methodology: Randomized controlled trial study involving patient who develop line thrombosis after use of heparin and tri-sodium citrate 4% from February 2020 to August 2020. The study was done on a group of 200 patients who had poor blood flow in double lumen catheter during dialysis. After informed consent first detailed clinical history was taken from patient. Inclusion criteria waspatient of age 14 year of above either gender who presented with renal failure, whom dialysis was performed via temporary catheter or permanent catheter. Conventional heparin and tri-sodium citrate are used as line blocking agents and line thrombosis was observed in patients. The data was entered and analyzed SPSS 20. Results: During this research work 200 double lumen were paced in patients. Out of these, in 100 patients heparin was used as locking solution and locking period was 45-60 days. In remaining 100 patients tri-sodium citrate was used as locking solution in the locking period was 45-60 days. There was no difference in patient’s comorbid conditions in both groups of the patients (Figure1). The catheter change rate was greater in patients whose catheter were locked with heparin (52 patients) as compared to tri-sodium citrate (42 patients). The proportion of the patient who needs replacement of the double lumen were 81% in conventional heparin sulphate and 65% with 4% tri-sodium citrate groups. There was longer insertion time for requiring double lumen for line thrombosis related poor blood flow in patients in which 4% tri-sodium citrate were used for catheter locked with comparison to the group in which heparin sulphate were used for locking (Figure2). The average hospitalization for line related thrombosis was longer in heparin group (10.5 days) as compared to citrate group 3.2 days. (P=0.02) The hospitalization rate was 6% in heparin group as compared to 2.5% in tri-sodium citrate group (P=045%). Conclusion: Tri-sodium citrate 4% is equally effective cheap and beneficial with comparison to heparin sulphate. It showed good outcome as far as change of double lumen or double lumen related infection or hospital admission when compared with heparin sulphate. Randomized trials while using tri-sodium citrate with other anti-coagulant would definitely will decide the better double lumen catheter locking agent. Key Words: End stage kidney failure, Advanced renal disease, Dialysis, double lumen blood flow.

Venous thromboembolism is not a risk factor for the development of bloodstream infections in critically ill COVID-19 patients

Venous thromboembolism is not a risk factor for the development of bloodstream infections in critically ill COVID-19 patients

Incidence, timing and risk factors of venous thromboembolic events in patients with pancreatic cancer

IntroductionPancreatic cancer is associated with a high risk of venous thromboembolism (VTE). However, comprehensive data on incidence, timing and relevant determinants of VTE in this particular population are scarce. Current study assesses incidence, timing and predictors of VTE in pancreatic cancer through different phases of disease. MethodsAll pancreatic cancer patients treated in our tertiary referral center between 2013 through 2017 were studied. Occurrence of VTE was evaluated from diagnosis through end of follow-up or death. Relevant determinants of VTE were identified in logistic regression models. Hazard ratios were calculated to evaluate impact of VTE on overall survival. ResultsIn total, 361 patients were followed for a median period of 43 months; 64 were diagnosed with VTE (18%). Most were tumor related thrombosis (59%), incidental (75%) and occurred after anti-cancer treatment had been stopped (80%), only 1.6% occurred during remission phase. Stage IV pancreatic cancer was a predictor for VTE (hazard ratio (HR) 2.46, 95% confidence interval (CI) 0.9–6.8). Biliary drainage (HR 0.52, 95%CI 0.28–0.98) and tumor resection (HR 0.45, 95%CI 0.45–1.83) were protective factors. VTE was not associated with worse survival (HR 1.3; 95% CI 0.97–1.74). ConclusionsVTE in pancreatic cancer is disease-stage dependent, with 80% occurring in advanced phases of disease when patients no longer receive active treatment. We speculate that this is the main reason for the absence of a survival effect of VTE in our cohort. These practice-based findings should be taken into account when considering wide-spread introduction of primary thromboprophylaxis in patients with pancreatic cancer.

Tailored approach to the choice of long-term vascular access in breast cancer patients

This study compared the possible options for vascular access in breast cancer patients by analyzing the complications of each method. We retrospectively evaluated the vascular access procedures for intravenous chemotherapy in breast cancer patients from 2016 to 2018. A total of 300 consecutive patients were included, 100 each who received peripherally inserted central catheters (PICCs), arm ports, and chest ports. When selecting a catheter, a PICC was considered when four cycles of chemotherapy were expected. Otherwise, patient preference was considered. All but one patient with an arm port were women, with mean age of 51.7 ± 9.1 years. The total mean complication-free catheter indwelling time was 1357.6 days for chest ports, 997.8 days for arm ports, and 366.8 days for PICCs (p = 0.004). There were 11 catheter-related complications (3.7%), one in a chest port patient, five in arm port patients, and eight in PICC patients. There was no patient with catheter related blood stream infection or deep vein thrombosis. All three types of catheters could be used in breast cancer patients without causing serious complications. The selection of catheter considering the clinical situation was effective for providing a safe and secure chemotherapy delivery route.

Risk Factors of Tumor Patients with Peripherally Inserted Central Catheter Related Thrombosis and Nursing Intervention Analysis Mediated by Algorithm-Based Ultrasound Images

This paper aimed to explore the risk factors of peripherally inserted central catheter (PICC) related thrombosis (PICC-RT) in tumor patients mediated by ultrasound images under minimum variance (MV) algorithm and put forward the corresponding nursing intervention methods based on the risk factors. The smoothing algorithm, diagonal loading algorithm, and coherence factor algorithm were optimized via MV algorithm. The optimized algorithm was compared with other algorithms to analyze its image quality and image processing speed. Literature retrieval was conducted to analyze the risk factors of PICC-RT in tumor patients. Tumor patients who received PICC for chemotherapy in the hospital from June 2018 to December 2019 were selected. Patients who were accepted before the experiment were taken as the controls, and there were control group (89 cases) and observation group (91 cases). Exercise, average flow rate of axillary vein per unit time, and PICC-RT were compared between the two groups. The results showed that the optimized algorithm (MV-N) had better image resolution, image contrast, and calculation speed than other algorithms. Gender, body mass index (BMI), pathological type, clinical stage, disease history, fibrinogen (FIB), and use of anticoagulant drugs were risk factors for PICC-RT in tumor patients. The number of PICC-RT and complications in the observation group was notably lower in contrast to the control group ( P < 0.05 ). It indicated that a novel algorithm was successfully established, which could increase the ultrasonic image quality and computing speed, and upper limb exercise could reduce the incidence of PICC-RT and its complications in tumor patients.

Implementation of Electronic Health Record Tools for Prevention of Venous Thromboembolism in Hospitalized Children with Cancer and Blood Disorders

▪IntroductionVenous thromboembolism (VTE) is the 2nd most common hospital acquired condition at our pediatric hospital. Children with cancer and blood disorders have acquired prothrombotic risk factors. As part of a quality improvement (QI) initiative to decrease VTE in hospitalized children with cancer and blood disorders, we implemented VTE risk assessment, prevention, and documentation tools within the Electronic Health Record (EHR). The baseline documented screening prior to the tool was 0% and sequential compression device (SCD) and prophylactic anticoagulation were rarely prescribed. The primary outcome was percentage of patients with documented screening.MethodsA VTE risk assessment tool, including the Braden Q activity score (score <3 is defined as chair or bedridden) and clinical risk factors, was developed based on published literature, clinical practice guidelines, local experience, and recommendations from the Children's Hospitals' Solutions for Patient Safety. Patients were categorized as LOW, MODERATE, or HIGH risk for VTE and risk-based recommendations for VTE prevention were provided. MODERATE risk was defined as Braden Q activity score <3 plus 0-1 other risk factors; SCD were recommended if not contraindicated. HIGH risk was defined as central venous catheter (CVC) in place and/or Braden Q activity score <3 plus 2 or more other risk factors; SCD and prophylactic anticoagulation were recommended if no contraindications. Patients are eligible for risk assessment if they are 10-17.99 years and admitted to the hematology/oncology unit at Rady Children's Hospital San Diego for >24 hours.ResultsBetween March 1 to May 31, 2017, 57 unique patients had a total of 107 admissions, and VTE risk assessment was completed for 102 admissions (95.3%), see Table 1. Members of the VTE Prevention Taskforce reviewed the accuracy of the risk assessments. Four LOW risk patients were reclassified as HIGH risk and 1 MODERATE risk patient was reclassified as HIGH risk. One HIGH risk patients with new diagnosis of VTE had therapeutic anticoagulation ordered and SCD placed on the unaffected lower extremity. Three MODERATE risk patients had SCD placed. Two patients who were initially classified as LOW risk during hospitalization were subsequently diagnosed with CVC related upper extremity deep vein thrombosis (DVT) after hospital discharge. New risk factors at the time of DVT diagnosis were obesity in one patient and recent asparaginase treatment in the other.Tools which positively impacted adherence with the risk assessment are a Best Practice Advisory (BPA) which fired for medical providers when an eligible patient was admitted, a BPA which fired once the risk category was assigned, a VTE Registry which included all eligible patients, and a VTE Quality Measure Screen which the VTE Prevention Champion used to identify patients who had not been screened and those who were identified at HIGH and MODERATE risk. Medical decision making was documented with a VTE risk assessment note located in the Admission Navigator.ConclusionsWe effectively implemented VTE risk assessment, prevention, and documentation tools in the EHR. Additional QI cycles are required to determine the optimal VTE risk assessment, to improve accuracy of screening, and to increase adherence with recommended interventions to decrease VTE. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Incidence of Venous Thromboembolism in Acute Leukemia: A Systematic Review and Meta-Analysis

Background:Venous thromboembolism (VTE) incidence in hematological cancer patients greatly influences their morbidity and mortality. However, VTE complications in acute leukemia (AL) received little attention in comparison to other more frequently occurring complications, such as thrombocytopenia-associated bleeding and granulocytopenia related severe infection.Methods:We conducted a systematic review to systematically assess the incidence rate of VTE in the setting of AL, including acute myeloid leukemia (AML), acute promyelocytic leukemia (APL), and acute lymphoid leukemia (ALL), using the information from available observational studies and randomized trials. A meta-analysis of proportions using fixed and random effects models was performed. Herein, we report all the outcomes in random model estimates.Results:Thirty studies were included (29 observational and 1 case control) with a total of 15,491 AL participants in (age range: 15-91). Of the total participants, the number of evaluable patients was 10,788 in AML, 3,242 in ALL, and 1,031 in APL. The VTE rate was found to be 8.8% (95%CI: 8.78-8.81) in all AL patients, 8.2% (95%CI: 8.21-8.23) in AML, 9.7% (95%CI: 9.68-9.75) in ALL, and 10.8% (95%CI: 10.79-10.85) in APL. The recurrence rate was 12% (95%CI: 9.03-15.08) in AL patients (n=435); 17% (95%CI: 11.02-24.26) with AML (n=135); 12% (95%CI: 7.61-18.33) with ALL (n=142) (AML vs. ALL: p=0.233). A subgroup analysis of catheter related thrombosis (CRT) demonstrated a rate of 4.95% in all AL participants (95%CI: 4.94-4.96), 4.7% (95%CI: 4.68-4.77) in AML, 4.3% (95%CI: 4.27-4.32) in ALL, and 7% (95%CI: 6.99-7.10) in APL. The rate of cerebral vein thrombosis in ALL patients treated with l-asparaginase was 2.8% (95%CI: 2.78-2.90).Conclusion:Our data demonstrates a significant incidence of venous thrombosis in AL patients, with a high recurrence rate among those patients. L-asparaginase seems to be particularly associated with a considerably high rate of cerebral thrombosis in ALL. However, there was a lack in randomized trials addressing thrombosis incidence in AL as a primary outcome. Given these significant incidence rates of thromboembolism, future studies are warranted to address the efficacy and safety of thromboprophylaxis in AL patients. [Display omitted] DisclosuresLazo-Langner:Bayer: Honoraria; Daiichi Sankyo: Research Funding; Alexion: Research Funding; Pfizer: Honoraria.

Catheter-Related Thrombosis Incidence and Risk Factors in Adult Cancer Patients with Central Venous Access Devices

▪Central venous access devices (CVADs) are commonly employed in the management of cancer patients, facilitating administration of chemotherapy, parenteral nutrition, blood products and antibiotics, and stem cell collection/reinfusion. Previous studies have demonstrated certain cancer subtypes to have a higher risk of thrombosis, when incorporated into a risk scoring system. We sought to review the incidence and risk factors for catheter related thrombosis (CRT) in a large cohort of hematology and oncology patients using a retrospective study in an Australian tertiary hospital, including the influence of cancer subtype.We reviewed data from a prospectively gathered CVAD database. The presence of CRT was defined as a positive duplex ultrasound scan either while line was in situ or within one week of line removal. Only patients symptomatic for CRT underwent USS imaging. We performed univariate and multivariate cox regression, and competing risk analysis to assess which parameters were associated with an increased risk of CRT.5043 central lines were inserted into 3218 patients between Jan 2003 and Dec 2016 with the majority (72%) of lines being peripherally inserted central catheters (PICCs). Overall incidence of CRT was 3.55%, at a rate of 0.45 per 1000 line days. CRT developed at a median of 12 days following line insertion. In univariate analysis, PICCs were associated with the highest rates of CRT (HR 7.48, 95%CI 1.03-54.1, p=0.046) when compared to non-tunnelled lines, while implantable ports (HR 0.47 95%CI 0.03-7.90 p=0.597) and tunnelled catheters (HR 0.00) were not associated with increased thrombosis risk. Patient age <50 (HR 1.46, 95% CI 1.06-2.00, p=0.019) and number of prior CRT (HR 1.95, 95% CI 1.30-2.92, p=0.01) were associated with higher thrombosis rates in univariate analysis. In multivariate analysis, PICC lines (HR 8.63, 95% CI: 1.17-63.5 p=0.034) and number of prior CRT (HR 1.84, 95% CI 1.18-2.86, P=0.007) increased CRT risk. Age groups 50-61 (HR 0.56 95% CI 0.37-0.83 p=0.004) and > 61 (HR 0.65 95% CI 0.46-0.91 p=0.012) were associated with reduced risk compared to age group <50. We used the tumor score from the previously validated Khorana score and found mixed results, with intermediate, but not high-risk tumours associated with higher thrombosis risk (HR1.42 95%CI 1.03-1.95 p=0.031 and HR 0.65 95% CI 0.26-1.60 p=0,346 respectively). When individual cancer subtypes were analysed in univariate analysis, Hodgkin lymphoma (HR 2.43 95% CI 1.01-5.82 p=0.046) and germ cell tumours (HR 2.63 95% CI 1.05-6.55 p=0.038) were found to be associated with increased CRT rates. However, once controlling for age and line type in multivariate analysis, no subgroup of cancer was associated with higher CRT rates. Side of insertion was not associated with higher thrombosis risk (left vs right HR 0.79 95% CI 0.58-1.07 P=0.13). When the analysis was restricted to PICC lines (n=3642), we found no difference in significant predictors of CRT.In conclusion, this is the largest published series reviewing CRT from a single centre. In patients with cancer, age <50, presence of a PICC line and prior CRT were associated with higher risk of CRT. Cancer subtype and insertion side were not significant predictors of thrombosis in this series. DisclosuresNo relevant conflicts of interest to declare.

The effect of systemic and local risk factors on triggering peripherally inserted central catheter–related thrombosis in cancer patients: A prospective cohort study based on ultrasound examination and structural equation modeling

BackgroundThe negative synergistic effect of cancer and a peripherally inserted central catheter could significantly increase the incidence of thrombosis. Rather than identifying risk factors for peripherally inserted central catheter–related thrombosis, exploring the effect of these risk factors might be a promising method to improve the outcomes of thrombosis. ObjectivesTo analyze the effect of systemic and local risk factors on triggering peripherally inserted central catheter–related thrombosis in the first two weeks post–insertion in cancer patients. DesignA prospective cohort study. SettingThe study was conducted at a 4500-bed university-affiliated medical center in China. ParticipantsOne hundred seventy-three cancer patients with peripherally inserted central catheters were included. MethodsPeripherally inserted central catheter–related thrombosis was assessed using ultrasound at a series of timepoints, once every two days post–insertion. Data on age, body mass index, blood hypercoagulation, insertion attempts, catheter-to-vein ratio, and blood flow velocity were collected as risk factors. Descriptive statistics and structural equation modeling were used to describe the study samples and analyze the effects of systemic and local risk factors. ResultsAmong the 173 cancer patients included, 126 (72.8%) patients were diagnosed with peripherally inserted central catheter–related thrombosis. Most thromboses (n = 118, 93.7%) were detected within five days, and 100% were detected within nine days post–insertion. Structural equation modeling analysis showed that local risk factors [catheter-to-vein ratio (standardized path coefficient = 0.32, p < 0.05) and blood flow velocity (standardized path coefficient = −0.35, p < 0.05)] had a greater effect than systemic factors [age (standardized path coefficient = 0.13, p < 0.05) and blood hypercoagulation (standardized path coefficient = 0.17, p < 0.05)] on triggering peripherally inserted central catheter–related thrombosis. ConclusionPeripherally inserted central catheter–related thrombosis is quite common and can occur very early post–insertion in cancer patients. Among the common risk factors, local risk factors reflecting peripherally inserted central catheter technology itself had a greater effect than systemic risk factors reflecting predisposition to thrombosis.Clinical Registration: Clinical Trials ChiCTR1900024890.

Feasibility and safety of left atrial appendage occlusion guided by procedural fluoroscopy only: A pilot study.

Left atrial appendage occlusion (LAAO) is usually performed via the guidance of procedural transesophageal echocardiography (TEE) companied by general anesthesia (GA). To investigate the feasibility and safety of LAAO guided by procedural fluoroscopy only. The patients eligible for LAAO were enrolled into the current study and received implantation of either Watchman device or LAmbre device. The procedure was carried out with procedural fluoroscopy only and no companied GA; the position, shape, and leakage of the device were assessed by contrast angiography. TEE was performed after 3-month follow-up to evaluate the thrombosis, and leakage of device. Ninety-seven patients with atrial fibrillation (AF) with either Watchman device (n=49) or LAmbre device (n=48) were consecutively enrolled. Watchman device group was of lower CHA2 DS2 -VASc and HAS-BLED scores compared with LAmbre device groups (p<.05); the two groups had similar distributions of other baseline characteristics (p>.05), including procedural success rate (98.0%vs. 97.9%), mean procedure time, mean fluoroscopy time, total radiation dose, contrast medium dose, percentage of peri-device leakage. Pericardial effusions requiring intervention occurred in two of the Watchman group. TEE follow-up found no patient with residual leakage≥5mm at 3 months and no device related thrombosis (DRT). During the 22.0 ± 11.1 months follow-up, two patients experienced ischemic stroke. LAAO with the procedural imaging of fluoroscopy only exhibited the promising results of efficacy and safety. A prospective randomized multicenter study would be required to verify the observations in this study.

Peripheral Vascular Disease in 2021.

Peripheral Vascular Disease in 2021.

Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study.

Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

Concepts and preconceptions on the use of direct oral anticoagulants in Italy: a Delphi consensus panel of the Atherosclerosis Thrombosis, Vascular Biology Study Group (ATBV)

In the last decade, direct oral anticoagulants (DOACs) have entered the clinical practice of different specialists for the prevention of cardioembolic stroke in patients with non-valvular atrial fibrillation (NVAF) and the prevention and treatment of venous thromboembolism (VTE). Owing to the persistent uncertainties about the use of DOACs in daily clinical scenarios not fully explored in the clinical trials, we conducted a national Delphi consensus regarding issues deemed interesting by the Italian Atherosclerosis, Thrombosis and Vascular Biology (ATBV) Study Group in relation to: (i) elderly and/or frail patients; (ii) chronic kidney disease; (iii) drug-drug interactions; (iv) lower doses and safety; (v) criteria for choosing individual drugs and compliance; (vi) VTE in the cancer patient. Eighty-four Italian clinicians (cardiologists, internists, geriatricians, neurologists and hematologists) expressed their level of agreement on each statement using a 5-point Likert scale (1: very much in disagreement, 2: disagreement, 3: partial agreement, 4: agreement, 5: very much in agreement). In particular, 1-2 selections were considered as disagreement, while 3-5 selections were considered as agreement. A ≥66% agreement between the participants for each statement was considered consensus. In general, a broad and general awareness and sharing of the methods of use of DOACs emerged from our initiative, and in particular their preferential indication in the elderly population and in frail patients or with renal insufficiency or oncological, always following the prescription indications and dose reduction criteria. The importance of being aware of drug-drug interactions has also been underlined in a concordant way, as well as simplicity of treatment in the multi-treated patient. In view of the persistent, albeit limited (12%), absence of consensus on some issues, with regard to the frail patient, drug-food interactions and availability of antidote, the acquisition of further evidence and a persistent educational effort are nonetheless indicated.

Enoxaparin Reduces Catheter-associated Venous Thrombosis After Infant Cardiac Surgery

BackgroundCentral venous catheter (CVC) related venous thrombosis (VT) after pediatric cardiac surgery increases morbidity and mortality. Although VT prevention using low-dose anticoagulation therapy has proven ineffective, anticoagulation therapy using high-dose enoxaparin to achieve a therapeutic anti-Xa level has not been studied. We hypothesized that high-dose enoxaparin would reduce VT after pediatric cardiac surgery. MethodsEnoxaparin was administered to infants aged less than 150 days when postoperative CVC duration was anticipated to extend beyond 5 days. The primary outcome was the rate of VT, reexploration for bleeding, and postoperative red blood cell transfusions per 1000 CVC days. ResultsFrom 2012 to 2019, 157 infants were treated with enoxaparin. Infants were divided into two groups: (1) subtherapeutic (n = 51), in which therapeutic anti-Xa level (0.5 to 1.0 IU/mL) was not achieved; and (2) therapeutic (n = 106), in which therapeutic anti-Xa level was achieved. Baseline demographics demonstrated a lower age at operation in the therapeutic group. The subtherapeutic group had a higher VT rate per 1000 CVC days (8.2) compared with the therapeutic group (2.6; P = .005). Reexploration for bleeding was similar between groups. The number of postoperative red blood cell transfusions per 1000 CVC days was significantly greater in the subtherapeutic group (109.4 vs 81.6; P = .008). Multivariate analysis demonstrated that higher median anti-Xa levels reduced the risk of VT (odds ratio 0.02; 95% confidence interval, 0.001 to 0.63; P = .02). ConclusionsThese data suggest that enoxaparin treatment resulting in a therapeutic anti-Xa level reduces postoperative CVC-associated VT without increasing bleeding complications.

MO786HEPARIN VERSUS SODIUM BICARBONATE CATHETER LOCK SOLUTION: AN ALTERNATIVE LOCK HEMODIALYSIS CATHETER?

Abstract Background and Aims Infections and thrombosis of central venous catheter (CVC) in hemodialysis patients are the major causes of catheter loss resulting in hospitalization and increased costs. Interdyalitic catheter lock solutions, usually heparin, avoid these complications. Among the many, sodium bicarbonate has been proved as effective and safe catheter lock solution due to its antimicrobial and antithrombotic properties. The aim of this study was to compare the efficacy of two different CVC lock solution: sodium heparin versus sodium bicarbonate, to prevent catheter–related thrombosis and infection in hemodialysis patients Method They were enrolled, in a 12 months case-control study, 17 hemodialysis patients with tunneled hig-flux CVC (femoral or internal jugular). Each patient was evaluated in its common treatment for CVC dysfunction (Qb, CVC that works in reverse branches during the hemodialysis session, use of urokinase or extra lock with sodium heparin or 4% citrate) and infection (WBC count, C reactive protein -CRP, bloodstream culture, exit-site infection -ESI) during standard sodium heparin CVC lock solution (hep-lock), for the first 6 months, and then, during sodium bicarbonate lock solution (10 mEq/10 ml, bic-lock) for following 6 months. aPTT, PLT, Hct and albumin are also montly evaluated. Type and anticoagulant dose during hemodialysis sessions were unchanged over the study as well as any antiplatelet/anticogulant home therapy. Results Fifteen patients on 17 completed the study and the main results are reported in table 1. There were no significant differences between patients on demographics and number of catheter days treatments for both study periods. The blood flow was similar in either study phases and stable during the hemodialysis sessions (Qb 225±13 ml/m’ at 2-hours vs 225±15 ml/min at start of dialysis), even the use of reverse branches was similar. Hep-lock showed a lower usage of extra lock drug in comparison with Bic-lock (0,4% vs 3,1%, p&amp;lt;0,05), data confirmed also for Urokinase (1,9% vs 3,4%, p=0,274). None bloodstream are registred while ESI and WBC count show no significant differences between two study periods. No HD catheter was loss during the study due to thrombosis or infection. Finally, Hct, CRP and Albumin was found slightly lower on Bic-lock phase. Conclusion There is no CVC ideal lock solution and although sodium bicarbonate is inexpensive and readily avalaible our data shows better CVC performances with sodium heparin.

Abstract No. 527 High incidence of large-bore temporary hemodialysis catheter thrombosis in patient with COVID-19–related kidney injury

Purpose: To evaluate the incidence of large-bore hemodialysis catheter thrombosis in the setting of COVID-19. Materials and Methods: A retrospective review was performed of all patients who underwent placement of a temporary hemodialysis catheter after developing kidney injury after COVID 19 infection at our institution. Data collected included demographic information, procedure related information, and incidence of replacement due to lumen thrombosis. Groups were compared using students t-test for continuous variables and Fisher’s exact test for nominal variables. Results: 64 patients (43M, mean age 63.2 ± 13.3) underwent placement of temporary hemodialysis catheter placement for kidney injury related to COVID 19 infection. 31 (48.4%) of catheters were placed via an internal jugular vein (IJV) access and 33 (52.6%) of catheters were placed via a common femoral vein (CFV) access. Overall, 15 (23.4%) catheters required replacement due to lumen thrombosis despite heplock. There were no difference in age or sex in patients who required replacement to those who did not (P.0.05) [sic]. Of the replacements, 5/31 (16%) were placed via an IJV access and 10/33 (30.3%) were placed via a CVF access, although this difference was not statistically significant (P = 0.18). The average time to malfunction/replacement was 7.8 ± 4.8 days for catheters placed via an IJ access versus 3.4 ± 3.3 days for catheters placed via a CFV access (P = 0.055), trending toward significance. Conclusions: A high incidence of temporary dialysis catheter lumen thrombosis was present in patients with COVID-19 infection. This may be due to COVID related thrombosis versus decreased level of catheter care. Catheters placed via a femoral vein access had more frequent malfunction and with shorter indwelling time, although not significant, which may be due to small sample size.