Treatment Of Deep Vein Thrombosis Research Articles

Anticoagulant therapy with direct oral anticoagulants in the context of polypragmasy: a course to safety

Cardiovascular disease is the most common cause of death in the world. For almost 60 years vitamin K antagonists (VKAs) have been the mainstay of anticoagulant therapy, but in recent years direct oral anticoagulants (DAACs) have become the anticoagulant of choice, as they have many well-known advantages: more predictable anticoagulant effect, no need for dose selection (there is a need for dose adjustment only for renal dysfunction), routine laboratory monitoring of pharmacodynamic effect (except in special clinical situations), less frequency of clinically significant drug interactions compared with warfarin, and less dependence on patient genetic characteristics. The main indications for POAC are: prevention of venous thromboembolism in patients who have undergone endoprosthesis of lower limbs, prevention of stroke and systemic embolism in patients with atrial fibrillation, treatment and prevention of recurrent deep vein thrombosis (DVT) and pulmonary embolism. The administration of direct oral anticoagulants (DOACs) has long been considered a major therapeutic advance, mainly because they do not require therapeutic monitoring. Despite this, POACs, like vitamin K antagonists, can still cause major and clinically significant minor bleeding, even when used correctly. Considering that POAC patients are often older and have multiple comorbidities, polypragmasy is widespread. Drug interactions involving POACs are important contributors to the increased risk of bleeding. Awareness of these drug interactions and how to address them is critical to optimizing treatment while reducing the risk of bleeding. This review provides an overview of POAC metabolism, the most common drugs that may interact with POACs, and ways to eliminate these interactions.

Low-dose anticoagulation for peripheral deep vein thrombosis of the lower extremities in cancer patients

Abstract Background Venous thromboembolism (VTE) is a frequent complication in cancer patients and is often detected as asymptomatic peripheral deep vein thrombosis (DVT). However, guidelines for peripheral DVT have not been established in either general cardiology or onco-cardiology. Furthermore, in cancer patients, it is generally considered difficult to administer standard doses of anticoagulants due to the high risk of bleeding caused by thrombocytopenic tendency during chemotherapy, as well as bleeding lesions such as gastrointestinal and gynecological cancers. Treatment of peripheral DVT with direct oral anticoagulants (DOACs) may minimize the worsening of bleeding and prevent the transition to proximal DVT. Objective The purpose of this study was to investigate the optimal treatment for peripheral DVT in cancer patients. Methods 242 consecutive patients with peripheral DVT of the lower extremities (excluding complications of pulmonary thromboembolism or proximal DVT) were examined by venous ultrasound from April 2019 to March 2020. 190 patients could be followed up by ultrasound examination, for up to 2 years. The course of the DVT was retrospectively examined. In cases of anticoagulant therapy, standard and low dosage of DOACs were evaluated. Results 142 patients were treated with anticoagulant (AC) therapy (group AC(+)), 48 patients were without AC therapy (group AC(−)). (4 of the 142 patients were treated with warfarin and the rest with DOACs). DVT worsened in 8 patients (5.6%) in the AC(+) group and 23 patients (47.9%) in the AC(−) group. DVT worsening was significantly less in the AC(+) group (p<0.0001). There were no cases of worsening to proximal type in the AC(+) group and 4 cases (17.4%) in the AC(−) group. Of the 138 patients who used DOACs as AC therapy, 62 used half or less than the standard dose for maintenance (low-dose DOAC group), and 76 used the standard dose as maintenance (standard-dose DOAC group). In the low-dose DOAC group, DVT worsened in 5 cases, remained unchanged in 7 cases, and improved in 50 cases. In the standard-dose DOAC group, there were 4 cases of worsening DVT, 3 cases of no change, and 69 cases of improvement. There was no significant difference in the DVT treatment effect between the two groups. There were no thrombus-related deaths. Conclusion Peripheral DVT worsens in about half of cancer patients without anticoagulation, and 17% of these worsen to proximal VTE. In addition, low-dose DOACs are found to be as effective as standard-dose DOACs in treating peripheral DVT in cancer patients. Peripheral DVT treatment with low-dose DOACs can reduce the risk of bleeding complications and thrombus-related mortality in cancer patients and should be one of the supportive treatments for the completion of cancer management. Funding Acknowledgement Type of funding sources: None.

Thrombolytic efficacy of histotripsy combined with thrombolytic-loaded echogenic liposomes

Deep vein thrombosis (DVT) is a substantial burden to the American public. Thrombolytics drugs are the front-line approach to treat the most egregious forms of DVT. Histotripsy is a bubble-based focused ultrasound therapy that enhances thrombolytic activity while simultaneously breaking down erythrocytes within the thrombus mechanically. Loading thrombolytics inside echogenic liposomes may accentuate the action of histotripsy via site-specific thrombolytic release and prompt bubble nuclei. The objective of this study was to assess clot degradation under the action of histotripsy and echogenic liposomes in an in vitro venous flow model. Histotripsy pulses were applied along the length of the clot at pulse peak negative pressures of 0 (control) or 42 MPa. Echogenic liposomes were diluted into the perfusate such that the thrombolytic concentration was 0 or 2.68 μg/ml. The combination of histotripsy and echogenic liposomes displayed increased clot mass loss, thrombolytic activity, hemolysis, and intact erythrocytes in the perfusate relative to echogenic liposomes alone (ANOVA p < 0.05, n = 6–8/group). Expect for hemolysis, markers of clot degradation were increased for histotripsy and echogenic liposome arms relative to histotripsy exposure alone. Together, these data indicate histotripsy combined with thrombolytics is a promising approach for the treatment of DVT.

Efficacy of traditional Chinese medicine combined with rivaroxaban in the treatment of lower extremity deep vein thrombosis: A meta-analysis.

Background:Despite the usefulness of traditional Chinese medicine (TCM) in the treatment of lower deep vein thrombosis (DVT), there is no consensus on safety and efficacy. We aim to systematically evaluate the safety and efficacy of TCM combined with Rivaroxaban in the treatment of lower limb DVT.Methods:An online search of databases such as Cochrane Library, Embase, Pubmed, and Web of science, as well as CBM, China Science and Technology Journal Database, China Knowledge Network (CNKI) and Wanfang Data (from inception to July, 2021) was performed. All published clinical randomized controlled trials (RCTs) were screened manually, evaluated for quality and considered for meta-analysis using RevMan 5.3.Results:Nine RCTs with a total of 730 cases were included, 368 cases in the trial group were treated with TCM combined with Rivaroxaban, and 362 cases in the control group were treated with Rivaroxaban alone after surgery. Clinical efficiency was significantly higher in the test group [OR = 3.33, 95% CI (2.01, 5.53), P < .00001], the circumference of the affected limb was significantly lower in the thigh and calf, respectively [MD = −1.48, 95% CI (−1.88, −1.09), P < .00001], [MD = −0.54, 95% CI (−0.62, −0.46), P < .00001], pain scores were significantly lower [MD = −0.97, 95% CI (−1.58, −0.36), P = .002], coagulation index plasma fibrinogen (FIB) was significantly lower [MD = −0.85, 95% CI (−1.18, −0.52), P < .00001], coagulation function index D-2 aggregates were significantly reduced [MD = −0.69, 95% CI (−1.13, −0.24), P = .002], serum hypersensitive C-reactive protein (hs-CRP) measurements were significantly reduced [MD = −5.37, 95% CI (−9.20, −1.55), P = .006], complications measurement was significantly lower [OR = 0.60, 95% CI (0.27, 1.30), P = .20], activated partial thrombin time (ATPP) measurement was significantly lower [MD = 5.70, 95% CI (4.28, 7.12), P < .00001] and prothrombin time (PT) measurement was significantly lower [MD = 1.64, 95% CI (0.70, 2.57), P = .0006].Conclusion:Based on the available evidence, TCM combined with Rivaroxaban for treating lower extremity DVT have better clinical efficacy and safety profile, reducing the risk of bleeding complications and adverse effects. Further improved studies are needed to support this inference.

Clinical Study of Deep Vein Thrombosis of Lower Limbs

Understanding the natural history of venous thrombosis is important for optimal management of this condition. Once risk factors are recognized it is possible to avoid these risk factors or to use active prophylaxis to reduce the morbidity and mortality. This study is targeted at identifying the risk factors of deep vein thrombosis in our set up, the role of Heparin in prophylaxis and to do a comparative study of low molecular weight Heparin with unfractionated Heparin in treatment of deep vein thrombosis of lower limb in Guru Gobind Singh Government hospital, Jamnagar. Material and Methods: Study population consisted of 50 consecutive patients with deep vein thrombosis, admitted to Guru Gobind Singh hospital, Jamnagar. We have studied 50 patients above 18 years of age with proven deep venous thrombosis by Doppler ultrasound. A complete clinical history was taken to assess risk factors, level of immobility if present and thorough physical examination was done. Routine investigations such as hemogram, haematocrit, blood indices, and liver and renal function tests were done. Diagnosis of deep vein thrombosis was detected by radiographic imaging like Doppler ultrasonography. Results: In our study, most of patients presented with complaints of swelling (70%) and pain (48%) of the affected lower limb. Few patients (4%) had symptoms of breathlessness (SOB), chest pain and orthopnea suggestive of pulmonary embolism. 34 patients in our study were having reasonably good level of haemoglobin while rests of all were having anaemia of different degree4 patients had haemoglobin below 8gm/dl and that needed separate treatment also. Leukocytosis was present in 16 patients. 16 patients had smoking as associated risk factor along with other acquired risk factors and 5 patients had obesity along with other risk factors. The most common complication of DVT is pulmonary embolism which occurs due to dislodgement of thrombus. Conclusion: Even though it is grievous, DVT can be prevented and treatable. Better and regular availability of drugs like LMWH and safer oral anticoagulants in the smallest possible region of the country can do wonders to save lives. Larger studies focusing more on coagulation cascade, molecular biology and genetics will be even bigger help to mankind.

Percutaneous endovenous intervention versus anticoagulation in the treatment of lower extremity deep vein thrombosis: a systematic review and meta-analysis.

BackgroundDeep vein thrombosis (DVT) of the lower extremity (LE) might lead to pulmonary embolism (PE) and post-thrombolytic syndrome (PTS). Recently, percutaneous endovenous intervention (PEVI) has been advocated for early removal of thrombus clot and restoration of venous patency. This study aims to review the safety and efficacy outcomes of PEVI versus anticoagulation in the treatment of acute LE-DVT.MethodsWe searched the databases of PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing catheter-directed thrombolysis (CDT) and/or pharmacomechanical thrombectomy (PMT) versus anticoagulation for acute proximal LE-DVT, published before August 2022. Efficacy outcomes were PTS and venous patency. Safety outcomes included recurrent thromboembolism, bleeding complications, and PE.ResultsOverall, 1,266 patients were included from 6 RCTs. The overall risk of bias was small due to enrolled high-quality RCTs. Compared to anticoagulation, PEVI moderately reduced PTS incidence [odds ratio (OR) 0.47, 95% confidence interval (CI) 0.23–0.99], obviously inhibited moderate–to–severe PTS (OR 0.60, 95% CI: 0.40–0.88), significantly decreased PE (OR 0.16, 95% CI: 0.05–0.48), and substantially increased venous patency (OR 7.95, 95% CI: 1.00–63.16). There was no significant difference in recurrent thromboembolism between PEVI and anticoagulation (OR 0.76, 95% CI: 0.34–1.73). Bleeding events did not differ statistically between PEVI and anticoagulation (OR 1.36, 95% CI: 0.87–2.11). We conducted single-arm meta-analysis of the PEVI or anticoagulation. Pooled proportion of PTS was less after PEVI (0.295, 95% CI: 0.123–0.505) than after anticoagulation (0.459, 95% CI: 0.306–0.616). Pooled proportion of moderate-to-severe PTS was lower after PEVI (0.098, 95% CI: 0.033–0.191) than after anticoagulation (0.183, 95% CI: 0.126–0.247). Pooled proportion of PE was smaller after PEVI (0.006, 95% CI: 0.00–0.020) as compared to anticoagulation (0.075, 95% CI: 0.038–0.122). Pooled proportion of recurrent thromboembolism was similar between PEVI (0.095, 95% CI: 0.054–0.146) and anticoagulation (0.124, 95% CI: 0.061–0.206). Pooled proportion of bleeding was not different statistically between PEVI (0.026, 95% CI: 0.00–0.131) and anticoagulation (0.008, 95% CI: 0.00–0.094).ConclusionsPEVI, consisting of PMT and/or CDT, is an extremely effective and feasible approach for patients with acute LE-DVT. In comparison to therapeutic anticoagulation, PEVI restores venous patency, inhibits the PTS development, reduces the PE occurrence, does not markedly increase the bleeding risk, but does not reduce recurrent thromboembolism.

Endovascular treatment for inferior deep vein thrombosis: a single center experience

Thromboembolism disorders represent the third most common cause of cardiovascular death. Deep vein thrombosis is a big part of them. Anticoagulation may not always be enough for complete treatment. Endovascular interventions in this territory are emerging as a key role player in order to prevent post-thrombotic syndrome or, when chronic, relieve symptoms.

Incidence and risk factors of preoperative deep vein thrombosis in patients with intertrochanteric fractures: a retrospective study

BackgroundThe risk of perioperative complications remains high in patients with intertrochanteric fractures. Immobilization after injury may predispose these patients to deep vein thrombosis (DVT) while waiting for surgery. The aims of this study were to determine the incidence of preoperative DVT in patients with intertrochanteric fractures and identify independent risk factors.MethodsThis retrospective study included patients with intertrochanteric fractures waiting for surgical interventions at our institution from June 2018 to December 2020. All patients received pharmacologic thromboprophylaxis after admission and ultrasound screening for DVT in both lower limbs before surgery. Demographic, clinical and laboratory data of these patients were collected to perform univariate analysis first. Subsequently, factors with a significant difference in univariate analysis were introduced into the multivariate logistic regression analysis to determine the independent risk factors for preoperative DVT.ResultsA total of 266 patients were enrolled in this study. Seventy-one patients (26.7%) developed DVTs before surgery. The majority of DVTs were distal types (91.5%). There were 40 patients with DVTs only in the affected limb, 7 patients with DVTs only in the unaffected limb, and 24 patients with DVTs in both lower limbs. Advanced age, female, prolonged period from injury to admission, combined cranial trauma, shorter thrombin time, increased level of D-dimer and lower level of albumin proved to be the independent risk factors for preoperative DVT.ConclusionsWe observed a high incidence of preoperative DVT in patients with intertrochanteric fractures. Identification of patients at high risk may improve the prevention and treatment of preoperative DVT in this population.

Successful endovascular treatment with a stent graft for chronic deep vein thrombosis with multiple arteriovenous fistulas: a case report

BackgroundDeep vein thrombosis with arteriovenous fistulas is rare, with few therapeutic options available for chronic-phase deep vein thrombosis. Moreover, the effectiveness of endovascular treatment for chronic-phase deep vein thrombosis with arteriovenous fistulas has not been established. We describe herein a case of successful endovascular treatment for chronic deep vein thrombosis with multiple arteriovenous fistulas.Case presentationWe describe the case of a 72-year-old Asian woman who had begun experiencing left leg swelling and intermittent claudication 2 years prior. Enhanced computed tomography revealed left common iliac vein occlusion with vein-to-vein collateral formation and several arteriovenous fistulas. Angiography and ultrasound showed the arteriovenous fistulas to run from the common and internal iliac arteries to the external iliac and superficial femoral veins. We opted against surgical repair for the arteriovenous fistulas due to their complex nature and complicated morphology. Since her condition was progressive, endovascular treatment with a stent graft was performed for the deep vein thrombosis, after which her symptoms gradually improved. Four months following the procedure, enhanced computed tomography confirmed remarkable reduction of the vein-to-vein collaterals and arteriovenous fistulas.ConclusionsIn the present case, enhanced computed tomography with a stent graft was effective in improving symptoms. This strategy may therefore be a treatment option for intractable chronic deep vein thrombosis with arteriovenous fistulas.

Effectiveness of a Nursing Intervention Module on Adherence, Knowledge, Quality of Life, and Complications Among Patients Receiving Anticoagulation therapy-a Randomized Controlled Trial Protocol.

BackgroundCardiovascular diseases are one of the major causes of mortality at the global level. They account for approximately 17.9 million deaths per year. Warfarin and acenocoumarol are the commonly used oral anticoagulants to treat and prevent thromboembolic disorders in patients with cardiovascular diseases. In India, approximately 2–2.5 million patients with rheumatic heart disease are receiving oral anticoagulation therapy. Additionally, this therapy is provided for stroke prevention in the case of atrial fibrillation and the treatment of valvular heart disease, stroke, and deep vein thrombosis. As the therapeutic range of these drugs is narrow and is affected by many factors, their use is challenging. This study aims to evaluate the effectiveness of a nursing intervention module in terms of adherence to therapy, knowledge, quality of life, and complications among patients receiving oral anticoagulation therapy. Furthermore, this study will address factors that affect adherence and the risk for bleeding by using a randomized controlled trial design.MethodsThis single-blind, single-center, randomized controlled trial will focus on adherence to oral anticoagulation therapy. A total of 320 patients who are on oral anticoagulation therapy will be randomized into blocks and allocated to either the intervention or standard care group. The intervention will comprise the use of a nursing intervention module that includes a booklet, log sheet, and decision aid on oral anticoagulation therapy adherence. Outcome measures, that is, knowledge regarding oral anticoagulation therapy, adherence, complications, and quality of life, will be assessed at the baseline and during follow-ups.DiscussionPatient safety can be best achieved through patients’ adherence to medication dose and monitoring of blood test values. Thromboembolic and bleeding complications are likely to occur when either the patient does not adhere to the treatment or the therapeutic range of the international normalized ratio is not maintained. This study will assess the nonadherence behavior and the effectiveness of a nursing intervention module toward adherence behavior.Trial RegistrationThis research project is registered under the Clinical Trial Registry of India (CTRI/2019/06/019610).

Warfarin versus direct oral anticoagulants for patients needing distal deep vein thrombosis treatment: Presented as an oral presentation at the Thirty-sixth Annual Meeting of the Eastern Vascular Society, Charleston, SC, September 23-26, 2021.

Objective: Great interest exists in standardizing the anticoagulant choice for patients requiring treatment of distal deep vein thrombosis (DDVT). In the present multicenter, retrospective cohort study, we evaluated the outcomes of patients with DDVT who had been treated with warfarin vs direct oral anticoagulants (DOACs; ie, rivaroxaban, apixaban, edoxaban, dabigatran).

Interim outcomes of mechanical thrombectomy for deep vein thrombosis from the All-Comer CLOUT Registry: Presented at the Thirty-fifth Annual Eastern Vascular Symposium of Twenty-second Annual New Cardiovascular Horizons, New Orleans, Louisiana, June 1-4, 2021, and the Eastern Vascular Society, Charleston, South Carolina, September 23-23, 2021.

Objectives: The multicenter, prospective, single arm CLOUT registry assesses the safety and effectiveness of the ClotTriever System (Inari Medical, Irvine, CA) for the treatment of acute and nonacute lower extremity deep vein thrombosis (DVT) in all-comer patients. Reported here are the outcomes of the first 250 patients.

HSD72 Identification of Uncomplicated DVT Patient Characteristics Treated in the Outpatient Setting

Uncomplicated deep vein thrombosis (DVT) can be treated in the outpatient setting with oral anticoagulants. However, emergency department (ED) visits for uncomplicated DVT are often managed through hospitalization initially rather than ED discharge with appropriate anticoagulation and outpatient follow-up. Providers have varying degrees of comfort with outpatient DVT treatment. This study aims to examine characteristics of patients treated as outpatients without an ED visit to better understand differentiators between patients sent to the ED and those managed by outpatient providers.

Secondary ferroptosis promotes thrombogenesis after venous injury in rats

BackgroundIron accumulation significantly accelerates thrombosis after vascular injury. The role of the ferroptosis pathway induced by iron overload in thrombosis has not been previously elucidated. In this study, we answer certain obscure questions regarding the contribution of ferroptosis to deep vein thrombosis (DVT) and explore new and potential mechanisms of thrombogenesis. MethodsAfter inducing mechanical injury to establish a DVT model with rats, liproxstatin-1 (an inhibitor of ferroptosis) was administered to inhibit ferroptosis in the injured venous rat tissue. Thrombus characteristics and ferroptosis biomarkers were evaluated. Proteomic and comprehensive bioinformatics analyses were performed to elucidate the potential mechanism by which injury affects DVT. ResultsFerroptosis is characteristic of injured venous tissues and mainly manifests in tissue as increased reactive oxygen species (ROS), malondialdehyde (MDA), and iron levels and decreased glutathione (GSH) level; mitochondrial membrane potential disruption; and abnormal expression of protein markers. In this study, administration of liproxstatin-1 before injury did not affect the rate of trauma-induced thrombogenesis but affected DVT progression, as indicated by reduced thrombus size and attenuated hypercoagulability. Differences between control, DVT and liproxstatin-1 treatment predominantly affected pathways of complement/coagulation cascades, glycolysis/gluconeogenesis, ferroptosis and so on. Transferrin receptor 1 (TFRC), lipocalin 2 (LCN2) and thrombospondin 1 (THBS1) were identified as hub proteins in ferroptosis and coagulation cascades. ConclusionFerroptosis is involved in mechanical injury-induced DVT. Inhibition of ferroptosis through liproxstatin-1 treatment can ameliorate symptoms. These findings suggest a previously unknown mechanism by which ferroptosis induced by iron accumulation contributes to thrombosis.

Resveratrol Ameliorates Deep Vein Thrombosis-Induced Inflammatory Response Through Inhibiting HIF-1α/NLRP3 Pathway.

Deep vein thrombosis (DVT) has become a prevalent and increasingly serious problem globally and resveratrol (Res) is a natural antitoxin that inhibits arterial thrombosis. To investigate the effect of Res on DVT and further explore its mechanism, thrombosis was monitored at different time points and the pathological changes occurring in the inferior vena cava (IVC) and lung tissue were observed in Sprague-Dawley rats. The protein expression of HIF-1α and NLRP3 in the IVC and lung tissue and the concentrations of D-dimer (D2D), prothrombin fragment 1 + 2 (F1 + 2), interleukin-1β (IL-1β), caspase-1, and tissue factor (TF) in the plasma were determined. After setting different doses of Res groups and using low-molecular-weight heparin (LMWH) as a positive control to determine the effective experimental dose of Res, rats were further divided into sham, DVT, HIF-1α inhibitor, Res, and HIF-1α inhibitor + Res groups. The above indicators were tested repeatedly. The DVT was formed on the 1st day of modeling. With the extension of time, DVT was gradually institutionalized and finally recanalized. Lesions in the IVC and lung tissue were effectively ameliorated, and thrombosis was significantly decreased in the LMWH or 60mg/kg Res-treated groups. The levels of D2D, F1 + 2, IL-1β, caspase-1, TF, and the expression of HIF-1α and NLRP3 were significantly reduced in the HIF-1α inhibitor, Res, and HIF-1α inhibitor + Res groups. Res can ameliorate DVT in rats by inhibiting HIF-1α/NLRP3 pathway, which provides a novel therapeutic strategy for DVT treatment.

Clinical outcomes of AngioJet rheolytic thrombectomy in the treatment of May-Thurner syndrome-related deep venous thrombosis.

ObjectiveMay–Thurner syndrome (MTS) is an anatomic stenotic variation associated with deep vein thrombosis (DVT) of the left leg. The classical DVT treatment strategy is medical treatment without thrombus removal. This study was performed to assess the clinical outcomes of the combination of AngioJet™ rheolytic thrombectomy and stenting for treatment of MTS-related DVT.MethodsWe conducted a retrospective cohort study of patients treated for MTS-related DVT from January 2017 to June 2020 at a single institution.ResultsFourteen patients (nine women) underwent AngioJet™ rheolytic thrombectomy for MTS-related DVT during the study period. The median DVT onset time was 8 days (interquartile range (IQR), 3–21 days). The median procedure time was 130 minutes (IQR, 91–189 minutes), and the median hospital stay was 7 days (IQR, 5–26 days). One patient had a residual thrombus and occluded iliac stent and underwent adjuvant catheter-directed thrombolysis for revascularization. The primary patency rate for the iliac stent was 92.9% at 12 months.ConclusionConcomitant AngioJet™ rheolytic thrombectomy and stenting of MTS-induced lesions may be beneficial for patients with MTS-related DVT.

Deep vein thrombosis and pulmonary embolism : Diagnosis and treatment

This review summarizes current evidence and guideline recommendations concerning diagnosis and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). For the diagnostic pathway, evidence-based algorithms should be employed, based on the assessment of pretest clinical probability. D‑dimer tests may reduce the need for subsequent diagnostic procedures. Clinical management of PE is guided by risk stratification according to early mortality. Lactate levels may be helpful for further risk stratification. The acute treatment of venous thromboembolism (VTE) is commenced with intensified anticoagulation (AC), either with parenteral AC or higher initial doses of apixaban or rivaroxaban. All patients with VTE should receive the anticoagulation maintenance therapy for 3-6months, while the duration of the subsequent secondary prophylaxis depends on the presumed risk of VTE recurrence and bleeding. Compression therapy is used to prevent postthrombotic syndrome. Acute revascularization procedures are limited to rare special cases. In obese patients up to 150 kg, standard doses of rivaroxaban and apixaban are appropriate. In cancer-associated thromboembolism (CAT), the previous guideline recommendation to use low molecular weight heparin (LMWH) for 3-6months is now broadened with the recommendation for factor Xa inhibitors, with the caveat for gastrointestinal and urothelial cancer or expected drug-drug interactions with the anticancer treatment. Here, and in unstable clinical situations, LMWH is preferred.

Significant role of long non-coding RNA MALAT1 in deep vein thrombosis via the regulation of vascular endothelial cell physiology through the microRNA-383-5p/BCL2L11 axis

ABSTRACT Deep vein thrombosis (DVT) is a vascular disease. The long non-coding RNA (lncRNA), metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), is positively expressed in DVT tissues, and regulates the biological behavior of endothelial progenitor cells. Here, we explored whether MALAT1 affected the physiology of human vascular endothelial cells (HUVECs) and analyzed its underlying mechanism. To overexpress/silence the expression of MALAT1 in HUVECs, MALAT1-plasmid/MALAT1-small interfering RNA (siRNA) was used. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and flow cytometry analyses were performed to observe the cell viability and apoptosis. Reverse transcription-quantitative polymerase chain reaction and western blotting were used to determine the apoptosis-related protein and gene expression levels. We used Starbase software to predict the associations among MALAT1, microRNA (miR)-383-5p, and BCL2-like 11 (BCL2L11). Luciferase reporter assay was used to validate their relationship. Compared to the control vector group, MALAT1-plasmid suppressed the viability and induced apoptosis of HUVECs, while improving Bcl-2-associated X protein (Bax) expression and decreasing Bcl-2 expression. There was an interaction between MALAT1 and miR-383-5p. Compared to the control siRNA group, MALAT1-siRNA increased the cell viability, reduced cell apoptosis, upregulated Bcl-2 expression, and suppressed Bax expression. These changes were reversed by the miR-383-5p inhibitor. Additionally, we verified that BCL2L11 is a target of miR-383-5p. miR-383-5p improved the cell proliferation, while decreasing cell apoptosis in HUVECs by targeting BCL2L11. Therefore, the lncRNA-MALAT1/miR-383-5p/BCL2L11 axis may be effective for DVT treatment.

Preventive Effect of Intensive Nursing Intervention of Deep Vein Thrombosis of Lower Extremities in Elderly Patients with Gastrointestinal Tumors after Surgery.

Tumors of the gastrointestinal system, known as gastroenteropapillary neoplasms, are very uncommon yet have a high propensity to progress to cancer. Thromboembolism of the veins (VTE) is a potentially deadly complication of surgery. In the vast majority of cases, deep vein thrombosis (DVT) in the lower extremities is the primary symptom of VTE (DVT). Deep vein thrombosis is more common in critical care units, where the prevalence ranges from 18 to 50 percent. DVT is a common complication after gastrointestinal tumor surgery, and proper nursing care is essential to lowering the risk of VTE. This research was thus done to examine if intensive nursing interventions may reduce the risk of lower limb DVT in elderly patients who had undergone surgery for gastrointestinal malignancies. The data is separated into two categories: control and treatment. As a self-care theory-based intervention strategy, we propose a hybridized KAP (knowledge, attitude, and practice) approach. Using the twin-bound decision tree algorithm (TBDTA), clinical outcomes including survival and patient satisfaction are examined. There was a considerable improvement in the treatment of DVT compared to the control group and a decrease in typical postoperative conditions. The bundles of care treatment have made a significant increase in the quality of nursing care.

Enoxaparin in the Prevention of Deep Vein Thrombosis in Patients with Acute Ischemic Stroke

Background: Deep vein thrombosis (DVT) is a severe complication in patients with acute ischemic stroke. It can cause severe pulmonary embolism, which may result in death. DVT prevalence in ischemic stroke patients ranges from 20 to 70%. Enoxaparin in prophylactic treatment can decrease the risk of developing DVT in patients with acute ischemic stroke. However, optimal enoxaparin dosing for prophylactic treatment in DVT remains elusive. Dosing between 0.3 - 0.5 IU/mL could decrease the prevalence of DVT without increased complications. Objectives: This study aims to evaluate the benefits and risks of prophylactic treatment in DVT patients with dosing of enoxaparin (Lovenox of Sanofi-Aventis Vietnam Company) 40 mg (4,000 units of anti-Xa, 0.4 mL) once daily. Methods: Following a cross-sectional design, 58 patients with acute ischemic stroke, who met the inclusion criteria, were studied. Participants received prophylactic treatment of the lower extremities DVT with enoxaparin. Results: The mean Wells score was 2.14 ± 0.35. Based on the Wells criteria for DVT, all cases had paralysis, muscle weakness, and bedridden recently &gt; 3 days. Also, 4 cases (6.9%) had leg edema; 1 case (1.7%) had superficial collateral veins; 3 cases (5.3%) had previously documented DVT. Thrombocytopenia &gt; 50% after treatment has a non-statistically significant decrease. The 2nd ultrasound showed no case of DVT. Conclusions: Enoxaparin was not the primary cause of thrombocytopenia in prophylactic treatment. Enoxaparin is a 100% effective means to prevent lower extremity DVT in average-risk patients, and it does not increase the risk of bleeding.