Risk Factors For Embolism Research Articles

Risk factors for pulmonary embolism in ICU patients

Abstract Background: Pulmonary embolism (PE) is a clinical disease of pulmonary hypertension, right heart failure and pulmonary oxygen uptake dysfunction caused by obstruction of pulmonary artery blood flow caused by embolic substances. The incidence rate of acute PE (ATPE) has been increasing year by year in recent years. And ATPE has become a hot topic of common concern in the departments of severe, emergency, respiratory and heart diseases. Research and clinical practice have proved that early thrombolysis and other specific treatment can greatly improve its prognosis. However, the early diagnosis and treatment rate of ATPE is only 7%, for the lack of simple and objective diagnosis and quantitative evaluation of the degree of ATPE. Therefore, the screening of risk factors for PE in intensive care unit (ICU) patients by systematic review and meta-analysis is an important preliminary work to carry out the early diagnosis model of PE. Methods: We will retrieve eight electronic databases from their inception to May 31, 2021, which include PubMed, Cochrane Library, Excerpt Medical Database (Embase), Web of science, China Biology Medicine disc, VIP database (VIP), Wan Fang database, China National Knowledge Infrastructure. Methodological quality of all studies was assessed using the Newcastle-Ottawa scale. We will use STATA V.13.0 software and RevMan5.3 for data analysis, and risk factor effect sizes will be expressed as an odds ratio and their 95% Cl. Results: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. With this study, we can get the significant risk factors and risk ratio of PE in ICU patients. Conclusion: This study systematically reviewed the existing evidence and determined the risk factors for PE in ICU patients. This study provides a basis for the establishment of early warning and prediction model of PE in ICU patients.

Risk factors for postoperative proximal deep vein thrombosis and pulmonary embolism after laparoscopic colorectal cancer surgery: analysis of a multicenter randomized controlled trial.

Postoperative venous thromboembolism (VTE) is a major and potentially fatal postoperative complication of colorectal cancer surgery. However, there is uncertainty about the necessity for anticoagulant prophylaxis to prevent VTE after laparoscopic colorectal cancer surgery because of its associated relatively lower incidence. Currently, anticoagulant therapy is considered mainly for patients at high risk of the development of VTE. Focusing on proximal deep vein thrombosis (DVT)/ pulmonary embolism (PE), we aimed to identify those cases at high risk of the development of fatal VTE. We performed an exploratory retrospective analysis to identify the risk factors for postoperative proximal DVT and PE after laparoscopic colorectal cancer surgery in patients included in our prospective trial. A logistic regression analysis revealed factors that could predict the onset of proximal DVT/PE in patients with colorectal cancer. Blood loss and tumor location were identified as the predictors of proximal DVT/PE. Patients with rectal cancer and those with excessive blood loss during colon cancer surgery must be monitored carefully for signs of VTE and especially proximal DVT/PE, after laparoscopic surgery.

Risk Factors for Pulmonary Embolism in Patients with Paralysis and Deep Venous Thrombosis.

Background. Venous thromboembolism is a frequent complication and an important cause of death in patients with paralysis. We aimed to investigate predictors of pulmonary embolism (PE) and the impact of PE on the survival of patients with paralysis in comparison to those with deep venous thrombosis or thrombophlebitis (DVT). Methods: Patients were selected by screening the German nationwide inpatient sample (2005–2017) for paralysis, and were stratified for venous thromboembolism (VTE) and the VTE-sub-entity PE (ICD-code I26). Impact of PE on mortality and predictors for PE were analyzed. Results: Overall, 7,873,769 hospitalizations of patients with paralysis were recorded in Germany 2005–2017, of whom 1.6% had VTE and 7.0% died. While annual hospitalizations increased (2005: 520,357 to 2017: 663,998) (β 12,421 (95% CI 10,807 to 14,034), p < 0.001), in-hospital mortality decreased from 7.5% to 6.7% (β −0.08% (95% CI −0.10% to −0.06%), p < 0.001). When focusing on 82,558 patients with paralysis hospitalized due to VTE (51.8% females; 58.3% aged ≥ 70 years) in 2005–2017, in-hospital mortality was significantly higher in patients with paralysis and PE than in those with DVT only (23.8% vs. 6.3%, p < 0.001). Cancer (OR 2.18 (95% CI 2.09–2.27), p < 0.001), heart failure (OR 1.83 (95% CI 1.76–1.91), p < 0.001), COPD (OR 1.63 (95% CI 1.53–1.72), p < 0.001) and obesity (OR 1.42 (95% CI 1.35–1.50), p < 0.001) were associated with PE. PE (OR 4.28 (95% CI 4.07–4.50), p < 0.001) was a strong predictor of in-hospital mortality. Conclusions: In Germany, annual hospitalizations of patients with paralysis increased in 2005–2017, in whom VTE and especially PE substantially affected in-hospital mortality. Cancer, heart failure, COPD, obesity and acute paraplegia were risk factors of PE.

Clip-Assisted Endoscopic Cyanoacrylate Injection: A Novel Technique for Acute Gastroesophageal Variceal Bleeding.

Background and Aim: Endoscopic injection sclerotherapy is effective for the treatment of gastric variceal bleeding, but may cause fatal ectopic embolism. Spontaneous portosystemic shunts are one of the risk factors for ectopic embolism. This present study aims to evaluate the efficacy and safety of clip-assisted endoscopic cyanoacrylate injection for the treatment of acute gastroesophageal variceal bleeding. Methods: The medical records of patients with gastroesophageal varices (GOVs) who underwent clip-assisted cyanoacrylate injection at the Ningbo First Hospital from March 2017 to August 2020 were reviewed. The outcomes were immediate hemostasis rate, early rebleeding rate, late rebleeding rate, and procedure-related complications. The gastrorenal and splenorenal shunts were evaluated by the computed tomography angiography. Results: A total of 9 patients with GOVs (GOV1 and GOV2) were analyzed, and 4 of the patients had spontaneous portosystemic shunts. The average number of clips used in each patient was 2.11 ± 1.96, and an average of 5.11 ± 1.76 mL of cyanoacrylate was injected into each patient. All patients completed immediate hemostasis. Two patients experienced rebleeding, including 1 case of early rebleeding and 1 case of late rebleeding (both due to cyanoacrylate extrusion) during a median follow-up of 367 days (interquartile range 270-855 days). Five patients underwent follow-up endoscopy; eradicated gastric varices (GVs) were revealed in 1 patient, and shrunken GVs were found in 4 patients. No serious complications, including ectopic embolism, were observed. Conclusion: The present study showed the efficacy and safety of clip-assisted endoscopic cyanoacrylate injection in acute GOV bleeding, but these results require verification by randomized controlled studies with larger sample numbers.

Malignant tumor is the greatest risk factor for pulmonary embolism in hospitalized patients: a single-center study

BackgroundThis study aimed to investigate the background of patients who presented with pulmonary embolism (PE) on contrast-enhanced chest computed tomography (CT) and to explore the risk factors for PE.MethodsThis study included a review of the medical records of all 50,621 patients who were admitted to one community hospital between January 1, 2013 and December 31, 2017. Data on sex, age, risk factors related to blood flow stagnation (obesity, long-term bed rest, cardiopulmonary disease, cast fixation, long-term sitting), risk factors related to vascular endothelial disorder (surgery, trauma/fracture, central venous catheterization, catheter tests/treatments, vasculitis, antiphospholipid antibody syndrome, history of venous thromboembolism (VTE)), and risk factors related to hypercoagulability (malignant tumor, use of oral contraceptives/low-dose estrogen progestin/steroids, infection, inflammatory enteric disease, polycythemia, protein C or protein S deficiency, dehydration) were evaluated.ResultsOf all inpatients, 179(0.35%) out of 50,621 were diagnosed with PE after contrast-enhanced chest CT examination, in which 74 patients were symptomatic and 105 patients had no symptom. Among asymptomatic 105 patients, 71 patients got CT scans for other reasons including cancer screening and searching infection focus, and 34 patients got CT scans for searching PE due to either apparent or suspicious DVT. The rate of discovering PE was significantly greater in women (0.46%, 90/19,409) than men (0.29%, 89/31,212) (P = 0.008). Of the 179 patients with PE, 164 (92%) had some type of risk factor. For both men and women, the most frequent risk factor was a malignant tumor, followed by obesity, long-term bed rest and infection for men and long-term bed rest, obesity and infection for women. The most common malignant tumor was lung cancer. Although taking antipsychotic agent is not advocated as a risk factor, there is a possibility of involvement.ConclusionsThe risk factors for PE were identified in this single-center, retrospective study.

An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate.

An observational study on 22 patients presenting with acute limb ischemia and SARS-CoV-2 infection, and without any other embolic risk factors, was performed. All patients were classified according to Rutherford classification for acute limb ischemia. The primary goal of this study was to assess the risk of amputation in these patients after revascularization procedures. The secondary goal was to find the correlation between acute limb ischemia (ALI) severity, patient comorbidities, risk of death, and the association of SARS-CoV-2 infection. The patients were treated by open surgery (18 patients—81.81%) or by the means of endovascular techniques (four patients—18.18%). The amputation-free survival rate was 81.81% in hospital and 86.36% at 1-month follow-up. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event. The application of the standard treatment—open surgery or endovascular revascularization—in patients with acute limb ischemia and SARS-CoV-2 infection represents the key to success for lower limb salvage.

Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background:The prevalence of pulmonary embolism (PE) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) varies over a wide range. Early detection and treatment of PE in AECOPD is a key to improve patient outcome. The purpose of the study was to investigate the prevalence and predictors of PE in patients of AECOPD in a high burden region of North India.Materials and Methods:This prospective study included patients of AECOPD with no obvious cause of exacerbation on initial evaluation. Apart from routine workup, the participants underwent assessment of D-dimer, compression ultrasound and venous Doppler ultrasound of the lower limbs and pelvic veins, and a multidetector computed tomography pulmonary angiography.Results:A total of 100 patients of AECOPD with unknown etiology were included. PE as a possible cause of AE-COPD was observed in 14% of patients. Among the participants with PE, 63% (n = 9) had a concomitant presence of lower extremity deep venous thrombosis. Hemoptysis and chest pain were significantly higher in patients of AECOPD with PE ([35.7% vs. 7%, P = 0.002] and [92.9% vs. 38.4%, P = 0.001]). Likelihood of PE was significantly higher in patients who presented with tachycardia, tachypnea, respiratory alkalosis (PaCO2 <45 mmHg and pH >7.45), and hypotension. No difference was observed between the two groups in terms of in-hospital mortality, age, sex distribution, and risk factors for embolism except for the previous history of venous thromboembolism (35.7% vs. 12.8% P = 0.03).Conclusion:PE was probably responsible for AECOPD in 14% of patients with no obvious cause on initial assessment. Patients who present with chest pain, hemoptysis, tachypnea, tachycardia, and respiratory alkalosis should be particularly screened for PE.

Direct Oral Anticoagulants: Overcoming the Challenges of Managing Venous Thromboembolism in Children

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism, is relatively common among adults, with estimated incidence rates ranging from approximately 10 to 1200 per 100 000 adults aged ≥30 years. 1 Raskob G.E. Angchaisuksiri P. Blanco A.N. Büller H. Gallus A. Hunt B.J. et al. Thrombosis: a major contributor to global disease burden. Semin Thromb Hemost. 2014; 40: 724-735 Crossref PubMed Scopus (73) Google Scholar VTE is less common in children than in adults, with estimated incidence rates ranging from 0.7 to 4.9 per 100 000 children. 2 Andrew M. David M. Adams M. Ali K. Anderson R. Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994; 83: 1251-1257 Crossref PubMed Google Scholar , 3 van Ommen C.H. Heijboer H. Büller H.R. Hirasing R.A. Heijmans H.S. Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001; 139: 676-681 Abstract Full Text Full Text PDF PubMed Scopus (517) Google Scholar , 4 Stein P.D. Kayali F. Olson R.E. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004; 145: 563-565 Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar , 5 Tuckuviene R. Christensen A.L. Helgestad J. Johnsen S.P. Kristensen S.R. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011; 159: 663-669 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar However, it can have serious consequences, such as death, recurrence of thrombosis, loss of vessel patency required for future intravascular cannulation or organ transplantation, chronic pulmonary hypertension, or post-thrombotic syndrome. 2 Andrew M. David M. Adams M. Ali K. Anderson R. Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994; 83: 1251-1257 Crossref PubMed Google Scholar ,6 Goldenberg N.A. Donadini M.P. Kahn S.R. Crowther M. Kenet G. Nowak-Göttl U. et al. Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors. Haematologica. 2010; 95: 1952-1959 Crossref PubMed Scopus (137) Google Scholar , 7 Greene L.A. Goldenberg N.A. Deep vein thrombosis: thrombolysis in the pediatric population. Semin Intervent Radiol. 2012; 29: 36-43 Crossref PubMed Scopus (18) Google Scholar , 8 Pelland-Marcotte M.C. Tucker C. Klaassen A. Avila M.L. Amid A. Amiri N. et al. Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study. Lancet Haematol. 2019; 6: e144-e153 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Despite its relative rarity, the incidence of pediatric VTE has increased in recent years. 5 Tuckuviene R. Christensen A.L. Helgestad J. Johnsen S.P. Kristensen S.R. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011; 159: 663-669 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar ,9 Sandoval J.A. Sheehan M.P. Stonerock C.E. Shafique S. Rescorla F.J. Dalsing M.C. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg. 2008; 47: 837-843 Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar ,10 Carpenter S.L. Richardson T. Hall M. Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014. Blood Adv. 2018; 2: 1403-1408 Crossref PubMed Scopus (38) Google Scholar This increase is considered related to a number of factors, including the increased use of central venous catheters (CVCs), improved survival rates for children with chronic or critical conditions, and more frequent VTE diagnoses through improved pediatrician awareness and imaging techniques. 11 Raffini L. Huang Y.S. Witmer C. Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009; 124: 1001-1008 Crossref PubMed Scopus (569) Google Scholar ,12 Malec L. Young G. Treatment of venous thromboembolism in pediatric patients. Front Pediatr. 2017; 5: 26 Crossref PubMed Scopus (18) Google Scholar First to the public, next to youThe Journal of PediatricsVol. 240PreviewThanks to direct-to-consumer marketing, snappy jingles, familiar spokespeople, and ubiquitous slogans, you are probably familiar with some direct oral anticoagulants (as well as any number of other classes of medications), such as rivaroxaban (Xarelto) and apixaban (Eliquis). You might not have focused on their use, however, since they were initially developed for use in adults. This volume of The Journal includes a Medical Progress report on direct anticoagulants (DOACs) for use in children with venous thromboembolism, including data from the latest trials and projected approval by the US Food and Drug Administration. Full-Text PDF

Incidence, risk factors and clinical course of pyogenic spondylodiscitis patients with pulmonary embolism

PurposeIn patients with pyogenic spondylodiscitis, surgery is considered the treatment of choice to conduct proper debridement, stabilise the spine and avoid extended bed rest, which in turn is a risk factor for complications such as deep vein thrombosis and pulmonary embolism.MethodsWe conducted a retrospective clinical study with analysis of a group of 99 patients who had undergone treatment for pyogenic discitis at our institution between June 2012 and August 2017. Included parameters were age, sex, disease pattern, the presence of deep vein thrombosis, resuscitation, in-hospital mortality, present anticoagulation, preexisting comorbidities, tobacco abuse, body mass index, microbiological germ detection and laboratory results.ResultsAmong the analysed cohort, 12% of the treated patients for pyogenic spondylodiscitis suffered from a radiologically confirmed pulmonary embolism. Coronary heart disease (p < 0.01), female sex (p < 0.01), anticoagulation at admission (p < 0.01) and non-O blood type (p < 0.001) were associated with development of pulmonary embolism. Pulmonary embolism was significantly associated with resuscitation (p < 0.005) and deep vein thrombosis (p < 0.001). Neurosurgery was not associated with increased risk for pulmonary embolism compared to conservative-treated patients (p > 0.05).ConclusionSurgery for pyogenic spondylodiscitis was not associated with an elevated risk of pulmonary embolism in our analysis. However, we describe several risk factors for pulmonary embolism in this vulnerable cohort. Prospective studies are necessary to improve prevention and postoperative management in patients with pyogenic spondylodiscitis.

P35 - Topic: AS04-MDS Biology and Pathogenesis/AS04i-Microenvironment and stem cell niche: PATIENTS DIAGNOSED WITH MYELODYSPLASTIC SYNDROMES HAVE LOWER BONE MASS

Research using large administrative databases has substantially increased in recent years. Accuracy with which comorbidities are represented in these databases has been questioned. The purpose of this study was to evaluate the extent of errors in obesity coding and its impact on arthroplasty research.Eighteen thousand thirty primary total knee arthroplasties (TKAs) and 10,475 total hip arthroplasties (THAs) performed at a single healthcare system from 2004-2014 were included. Patients were classified as obese or nonobese using 2 methods: (1) body mass index (BMI) ≥30 kg/m2 and (2) international classification of disease, 9th edition codes. Length of stay, operative time, and 90-day complications were collected. Effect of obesity on various outcomes was analyzed separately for both BMI- and coding-based obesity.From 2004 to 2014, the prevalence of BMI-based obesity increased from 54% to 63% and 40% to 45% in TKA and THA, respectively. The prevalence of coding-based obesity increased from 15% to 28% and 8% to 17% in TKA and THA, respectively. Coding overestimated the growth of obesity in TKA and THA by 5.6 and 8.4 times, respectively. When obesity was defined by coding, obesity was falsely shown to be a significant risk factor for deep vein thrombosis (TKA), pulmonary embolism (THA), and longer hospital stay (TKA and THA).The growth in obesity observed in administrative databases may be an artifact because of improvements in coding over the years. Obesity defined by coding can overestimate the actual effect of obesity on complications after arthroplasty. Therefore, studies using large databases should be interpreted with caution, especially when variables prone to coding errors are involved.

2021 Korean Heart Rhythm Society Guidelines for Stroke Prevention in Atrial Fibrillation

Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA2DS2-VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.

Risk Factors for Pulmonary Embolism in Patients with Lung Cancer and Effects of Pulmonary Embolism on Prognosis

Risk Factors for Pulmonary Embolism in Patients with Lung Cancer and Effects of Pulmonary Embolism on Prognosis

Relationship of D-dimer and prediction of pulmonary embolism in hospitalized COVID-19 patients: a multicenter study.

Aim: COVID-19 is a known risk factor for pulmonary embolism (PE). In this retrospective, multicenter study, we aimed to determine an optimal D-dimer cutoff to predict PE in hospitalized patients with COVID-19. Materials & methods: A total of 193 patients underwent computerized tomographic pulmonary angiography imaging and were classified into PE positive and negative groups. Physiological, radiological and biochemical parameters were compared and receiver operator curve analysis was conducted to determine a predictive D-dimer threshold. Results: An optimal D-dimer cutoff of 2494 ng/ml was selected (Youden index: 0.906), giving a sensitivity of 100% (95% CI: 100–100) and specificity of 90.62% (95% CI: 90.5–90.8) for predicting PE. Conclusion: We propose that in the absence of other clinical signs, a D-dimer threshold of 2495 ng/ml could be used with high sensitivity and specificity to predict PE in hospitalized patients with COVID-19.

Prevalence and Associated Risk Factors of Pulmonary Embolism in Children and Young Adults With Nephrotic Syndrome: A Chinese Large Cohort Study.

Nephrotic syndrome (NS) is highly associated with an increased risk of pulmonary embolism (PE) in children and young adults. However, few studies have specified the risk factors of PE in children and young adults with NS. We sought to determine the prevalence and associated factors of PE confirmed with computed tomography pulmonary angiography in Chinese children and young adults with NS. Data from 444 children and young adults with NS who had computed tomography pulmonary angiography from December 2010 to October 2018 were retrospectively analyzed. The prevalence of PE was estimated for different age, sex, and histopathologic types of NS. Multivariable logistic regression was used to identify independent risk factors of PE in children and young adults with NS. Models incorporating the independent risk factors were evaluated using receiver operation characteristic curves. Area under the curve was used to determine the best-performing prognosticators for predicting PE. There were 444 patients in the study cohort (310 male patients, 134 female patients; mean age 19±3 y; range: 6 to 25 y). PE was present in 24.8% of the participants (110 of 444, 18.2% female). Children and young adult NS patients with PE tend to be older, male, to have a previous thromboembolism history and smoking, and have a higher level of proteinuria, D-dimer, and serum albumin (P<0.05 for all). Children and young adults with membranous nephropathy are likely to have a higher incidence of PE than those with other types of nephropathy. Membranous nephropathy and proteinuria were significant predictors of PE in children and young adults with NS (P<0.05 for all). The area under the curves of each model for the presence of PE in children and young adults with NS based on biochemical parameters and clinical information (model 1), adjusted for proteinuria (model 2), and adjusted for membranous nephropathy (model 3) were 0.578, 0.657, and 0.709, respectively. Compared with model 1, model 2, and model 3 showed statistically significant differences (model 1 vs. model 2, P=0.0336; model 1 vs. model 3, P=0.0268). There was no statistically significant difference between model 2 and model 3 (P=0.2947). This study identified membranous nephropathy and proteinuria as independent associated factors of PE in children and young adults with NS, which can be noted as a risk factor to guide clinician management in this population.

Aortic Endarterectomy for Aortic Occlusive Disease: An Old Operation With a Re-emerging Role.

Descending aortic complex atheromatous plaques can cause claudication, critical lower limb ischaemia (CLI), and are an independent risk factor for systemic embolization. Current practice involves dealing with most cases using endovascular techniques. However, open repair remains superior in terms of the patency rates and may be the only valid option in a subgroup of patients who are unsuitable for endovascular treatments. Most of the current data investigating open procedures are now historic. The aim of this study is to determine whether it is a feasible option in the current day practice. Ten years data from 2010 to 2020 were collected retrospectively from the hospital records. Clinic letters, radiologic scans, operative records and discharge letters were reviewed. Death records were reviewed to identify patients who survived. Ten cases were identified. The average age was 55 and the mean BMI was 29.4. The mean hospital stay in days was 12 (range: 4 to 22). The mean follow-up period was 147 days (range: 30 to 360days). Four of the patients were TASC B, four were TASC C and two were TASC D. Two cases had to return to theatres. One patient had transient post-op AF and another had transient post-op ileus. One patient was readmitted within 30days of discharge for urosepsis. All cases are alive to date except one case which only survived three years after procedure. AE is a procedure that should be considered in selected cases where endovascular approach is not feasible. There is a trend towards lower mortality than the historic data available in literature. Larger case series or registry data may be required to accurately estimate the current day mortality and morbidity figures.

Is Hematopoietic Clonality of Indetermined Potential a Risk Factor for Pulmonary Embolism?

Background Unprovoked pulmonary embolism (uPE) is a severe and frequent condition. Identification of new risk factors is mandatory to identify patients that would benefit from a long-term treatment. Clonal hematopoiesis of indeterminate potential (CHIP) is defined by the acquisition of somatic mutations that drive clonal expansion in the absence of cytopenia. Its prevalence is estimated of 5% in the population above 65 years. Since inflammation and endothelial dysfunction may share a pathophysiological pathway(1), we hypothesized that CHIP, may be a risk factor for uPE. Methods We conducted a pilot retrospective observational study. Patients with iPE between 18 to 65 years old were included. PE was considered as unprovoked, when no transient nor persistant risk factor was present and when thrombophilia testing was negative. We excluded documented atherosclerosis, personal or familial history of VTE and presence of cytopenias. CHIP proportion in uPE patients were analyzed using next generation sequencing of the coding sequence of a custom panel composed by DNMT3A, ASXL1, SF3B1, TET2 and TP 53 . Results Upon 61 patients with uPE consecutively included, a total of 19 somatic mutations were found in 12 patients (20%) IC95% [10 - 20]. 15 mutations were found in DNMT3A gene, 3 in ASXL1 and one in TET2 . There was no diference in terms of age, PE location, DVT presence and risk stratification in CHIP carriers and non carriers. Conclusion We report for the first time, the presence of high rates of CHIP in patients presenting with uPE. Thus, CHIP may be a new risk factor for VTE. These results need to be confirmed in an ongoing prospective case-control study including more patients and using a more diverse gene panel to better determine CHIP incidence in uPE.

Game over: cocaine and video games as contemporary risk factors for pulmonary embolism

Pulmonary embolism (PE) is a life-threatening condition in which emboli, often from the legs or pelvis lodge in the pulmonary vasculature causing impairment of gas exchange and right ventricular strain. Virchow’s triad of hypercoagulable state, endothelial activation and venous stasis is a framework for understanding risk factors. Yet, some risk factors seem deceptively benign or esoteric. The case described is of a 33-year-old male who was found suddenly and unexpectedly deceased. According to family, he would play video games for extended periods of time including overnight. Autopsy examination showed the body of an obese male with the presence of bilateral pulmonary thromboemboli. Toxicological analysis showed the presence of metabolites of cocaine. There are multiple factors that contributed to PE in this individual. Obesity may have contributed to PE through its association with venous stasis. Extended periods of time engaging in video games has been associated with PE through venous stasis and a hypercoagulable state if dehydrated. Cocaine is prothrombotic by causing endothelial injury with subsequent chemokine activation. Cocaine may cause a hypercoagulable state as a result of increased haematocrit. We discuss these factors and highlight the need to consider non-traditional risk factors.

A1B and BB blood group genotypes are risk factors for pulmonary embolism.

Pulmonary embolism (PE) is apotentially life-threatening condition that mainly affects the people of advanced age. While certain blood group phenotypes (non‑O blood group) are known risk factors for the development of venous thromboembolism (VTE), there is no research which investigated the association of blood group genotypes with severity of PE. The aim of this study was to investigate the frequency of ABO blood group genotypes among the population of patients with PE and to investigate the correlation of the pulmonary embolism severity index (PESI) score to specific ABO blood group genotypes. In this cross-sectional study 74patients with PE diagnosed using CT pulmonary angiography were included and 303 blood donors without VTE or congenital thrombophilia participated as acontrol group. After isolation of genomic DNA ABO blood group genotype was determined using the polymerase chain reaction sequence-specific amplification (PCR-SSP) method. We observed asignificantly higher frequency of A1B and BB genotypes in patients with PE compared to healthy individuals (A1B 14.9% vs. 4.3%, P < 0.001; BB 5.4% vs. 0.7%, P = 0.004), while the O1O1 genotype was significantly less frequent in patients (24.3% vs. 37.3%, P = 0.036). Analyzing the severity of the clinical presentation according to the PESI score, we did not find acorrelation between the severity of the clinical presentation and acertain blood type genotype. Patients with A1B and BB blood type genotype were at increased risk for developing pulmonary embolism, while patients with O1O1 genotype had asignificantly lower risk of developing PE.

Pulmonary embolism after a long-haul flight.

The relation between long-haul flights (LHF) and venous thromboembolic disease is well established. Nonetheless, the incidence of pulmonary embolisms after these flights is probably underestimated because of the difficulties in case ascertainment. Reunion Island appears to present the ideal geographic conditions for accurately assessing this incidence. We aimed to assess the incidence of pulmonary embolisms in people who had recently taken a LHF to Reunion Island. We conducted a retrospective multi-center descriptive study and included all cases of pulmonary embolisms diagnosed between January 1, 2015, and January 30, 2017 (according to the hospitals' discharge summary database) in the island's four public hospitals within 30days after taking an LHF to Reunion. We took different delays of diagnosis to calculate the incidence. We have considered the time to diagnosis at 1month as significant according to the time applied in the Geneva score for risk factors. The study included 45 patients landing on Reunion over a 2-year period. The total number of passengers arriving by LHF during this period was 1,223,001. The incidence of pulmonary embolism after an LHF was thus calculated at 36.8 per million travelers at 1month. The incidence for PE diagnosed, after 15days was 29.4 per million travelers, and after 7days, it was 21.9 per million travelers. The male/female ratio was 0.67. The mean interval between the flight and symptom onset was 7days. In our population, the incidence of pulmonary embolisms after LHFs in our study is clearly higher than that reported in the literature (36.8 vs 4.8). Our exhaustive data collection probably explains this difference. A case-control study appears necessary to analyze the risk factors for pulmonary embolism after a LHF.

Intermediate-high and high risk acute pulmonary embolism during home confinement due to coronavirus-19 pandemic: description in a second level hospital

Funding AcknowledgementsType of funding sources: None.BackgroundTo stop Coronavirus-19 pandemic, Spanish government ordained home confinement in Basque Country from 13th March to 11th May, although some people had previously confined themselves. In this period, a decrease in cardiovascular admissions, except pulmonary embolism has been reported, speculating about viral activation of coagulation. As patients could not receive the standard care, augmented mortality of non-Covid pathologies could happen.MethodsWe, selected patients admitted with intermediate-high and high risk from 1st March to 30th June. Other risks or those occurred during a hospitalization were excluded. Several characteristics were reported.ResultsAmong 21 cases (13 women), there were 3 Covid-positive (2 women). All presented an intermediate-high risk, except 2. 16 cases happened in March and April. Mean age was 72,5 years (range 30-94). Mean total stay length was 7,24 days (range 3-12). 14 patients presented original Pulmonary Embolism Severity Index (PESI) class ≥ III and mean simplified PESI (sPESI) was 1.43 points (range 0-4). On average, patients presented 1,95 risk factors for pulmonary embolism (range 0-6), mainly weak ones. Average Troponin T was 130.15 ng/L (range 15-1099, one case unknown). Average NT-proBNP was 6690.42 pg/ml (range 267-35000, 2 cases unknown). Fibrinolytic therapy and vasopressors were only used in intensive care unit (ICU), in 2 and 1 patients respectively. 2 patients were on Unfractionated Heparin, the rest received low-molecular-weight heparin. All patients admitted in ICU were transferred later to ward, except 1 that was transfer to Intermediate respiratory care unit (IRCU). There were no mortality during hospitalization. There were 3 complications that not required intensive therapy. 8 were admitted in ICU (50% women, mean age 61,2 years (range 30-78), average sPESI 1,4 (range 0-4), 6 patients PESI class ≥ III, average troponin 109,25 ng/L (19-259) and NT-proBNP 7219.86 pg/ml (446-15787), 1,88 risk factors on average, stay length 8,25 days (6-11)). The rest were admitted in ward (4 in IRCU) (62% women, mean age 79.46 years (66-94), average sPESI 1,46 (0-4), 8 patients PESI class ≥ III, average troponin 144,08 ng/L (15-1099) and NT-proBNP 6351.58 pg/ml (439-35000), 2 risk factors on average, stay length 6,62 days (3-12)).ConclusionsProbably coronavirus-19 is not a risk factor for admission due to severe pulmonary embolism. Home confinement may be a risk factor, and if it happened again, advice against sedentary lifestyle should be given to population. Despite a possible delay in diagnosis or treatment, there were no mortality or severe complications, irrespectively of age or site of admission, although patients in intensive care tend to be younger, presented more frequently PESI class > III and stay more time in hospital. Studies are needed to determine which patients would benefit from admission in intensive care units, especially if resources are limited again. Figure. Number of cases per month