RESUMO
BACKGROUND: There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. METHODS: This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6-9 months) and late follow-up (9-16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. RESULTS: The overall portomesenteric thrombosis burden improved in eight (72%) TIPS patients, three (27%) anticoagulated patients, and two (10%) untreated patients at early follow-up (p = 0.001) and in seven (78%) TIPS patients, two (29%) anticoagulated patients, and three (17%) untreated patients in late follow-up (p = 0.007). No bleeding complications attributable to anticoagulation were observed. CONCLUSION: TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.
RESUMO
Musculoskeletal Disorders (MSD) often classified as sprains and strains to the low back, neck, shoulder or knee are the leading cost drivers in the workers compensation system. In 2009, soft tissue muscle injuries accounted for 40% of total injury cases requiring days away from work. The demand on U.S. employers to comply with all applicable mandates has exponentially increased as the regulatory landscape grows more complex evidenced by recent legislation from Equal Employment Opportunity Commission (EEOC), American With Disability Act 2.0 and Center for Medicare and Medicaid Services (CMS) Mandatory Reporting Act. Employers should revisit their return to work policies and engage in the interactive process to stay in compliance and avoid legal quagmire. EFA Soft Tissue Management (STM) is a comprehensive and compliant risk management program for objective diagnosis of work-related injuries that directs timely and proper allocation of resources to optimize injured worker (IW) outcomes. This bookend solution comparing pre- and post-loss data is a best practice to accurately determine between compensable acute workplace injury and exacerbation of a preexisting injury from chronic unrelated conditions. The EFA is an evidenced-based objective tool to assist in measuring functional status of the IW and make return to work determinations.