摘要
Fundamento: la trombofilia hereditaria se define como la tendencia genéticamente determinada al tromboembolismo venoso, entidad con una incidencia importante a nivel mundial. Desde el laboratorio pudieran explicarse un gran porcentaje de estos eventos de trombosis. Objetivo: caracterizar desde el punto de vista clínico humoral las trombofilias hereditarias e identificar la posible relación entre marcadores bioquímicos alterados de trombosis y su recurrencia. Método: se realizó un estudio descriptivo y transversal en el laboratorio de hemostasia del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, en el periodo de un año. Se tuvo como referencia 39 pacientes: 26 con eventos trombóticos egresados de los Servicios de Angiología, Cirugía Cardiovascular y Neurología, y 13 sin evento conocido, familiares de primera línea de aquellos pacientes que resultaron con marcadores de trombofilia positivos durante el estudio. Las variables clínicas analizadas fueron: edad, sexo, antecedentes personales y familiares de trombosis y número de eventos trombóticos en el paciente. Se calcularon media, desviación estándar y porcentajes. Resultados: el déficit de proteína S ocupó el primer lugar con 22 (56,4 %). La combinación de parámetros alterados que predominó fue el déficit de proteína C y S con 8 (20,5 %). En el 64,1 % se encontraron dos o más marcadores alterados; se muestran similares porcentajes en pacientes con 1, con 2 dos o más eventos de trombosis. Conclusión: la trombofilia se presentó como una enfermedad que afecta fundamentalmente a mujeres, en edades intermedias de la vida. En pacientes asintomáticos con antecedentes familiares de evento trombótico, sin aparente causa, los marcadores de laboratorio orientan el enfoque diagnóstico. La presencia de dos o más marcadores trombogénicos positivos inclina a la ocurrencia de eventos trombóticos en esta población.
Foundation: hereditary thrombophilia is defined as the genetically determined tendency to venous thromboembolism, an entity with a significant incidence worldwide. A large percentage of these thrombosis events could be explained from the laboratory. Objective: to characterize hereditary thrombophilias from a humoral clinical point of view and to identify the possible relationship between altered biochemical markers of thrombosis and its recurrence. Method: a descriptive and cross-sectional study was carried out in the hemostasis laboratory of the Saturnino Lora Provincial Teaching Hospital of Santiago de Cuba, over a period of one year. 39 patients were used as a reference: 26 with thrombotic events discharged from the Angiology, Cardiovascular Surgery and Neurology Services, and 13 without a known event, first-line relatives of those patients who had positive thrombophilia markers during the study. The clinical variables analyzed were: age, sex, personal and family history of thrombosis and number of thrombotic events in the patient. Mean, standard deviation and percentages were calculated. Results: protein S deficiency ranked first with 22 (56.4 %). The combination of altered parameters that predominated was protein C and S deficiency with 8 (20.5 %). Two or more altered markers were found in 64.1 %; similar percentages are shown in patients with 1, 2 or more thrombosis events. Conclusion: thrombophilia was presented as a disease that mainly affects women, at intermediate ages of life. In asymptomatic patients with a family history of thrombotic event, without apparent cause, laboratory markers guide the diagnostic approach. The presence of two or more positive thrombogenic markers suggests the occurrence of thrombotic events in this population.
摘要
Abstract Introduction As 30 to 50% of deep venous thrombosis (DVT) cases remain idiopathic, an increased focus on hematologic variables may therefore reveal novel correlates of DVT. Very few studies have investigated the association of hematological parameters with DVT and the causal relationship between them is still to be elucidated. Therefore, we aimed to investigate the association between serial values of hematologic variables and DVT. Methods Complete blood count parameters were serially measured at baseline and then at approximately 3-month intervals for 12 months in 152 adults with the first episode of DVT and 152 age- and sex-matched controls. The odds ratio (OR) with the 95% confidence interval (95%CI) was calculated as a measure of association between hematological parameters and DVT. Results The red cell distribution width (RDW) was the only hematologic variable which showed an independent and consistent association with DVT at all time points (multivariable-adjusted OR [95%CI] 3.38 [1.28 - 8.91] at baseline, 2.24 [0.85 - 5.92] at 3 months and 2.12 [0.81 - 5.55] at 12 months for RDW > 14.0%). This association was higher for provoked DVT than unprovoked DVT and for DVT plus pulmonary embolism than DVT alone. No significant correlation was found between the high RDW and classical thrombotic risk factors, except malignancy. Conclusions We demonstrated an independent and consistent association of the high RDW with the first episode of DVT in adult patients. The study was probably underpowered to evaluate the association between the high RDW and recurrent DVT. Further large studies with long follow-up are needed to confirm this association.
摘要
OBJECTIVE To systematically evaluate the efficacy and safety of novel oral anticoagulants （NOAC） in the treatment of cancer-related venous thromboembolism （VTE） patients. METHODS Retrieved from PubMed， Cochrane Library， Embase， Web of Science， CNKI， and Wanfang database from the establishment of each database to August， 2023， randomized controlled trials （RCTs） about the efficacy of low-molecular-weight heparin （LMWH， control group） versus NOAC （trial group） in the treatment of cancer-related VTE patients were collected. After extracting the data from included clinical studies， meta-analysis was performed by using RevMan 5.0 statistical software. RESULTS A total of 7 RCTs were included， with a total of 3 790 patients. Compared with the control group， the recurrence rate of VTE in the trial group was significantly reduced （RR＝0.65， 95%CI 0.51-0.82， P＝0.000 4）， while the incidence of major bleeding was slightly higher than in the control group， but the difference was not statistically significant （RR＝1.13， 95%CI 0.83-1.53， P＝0.45）. The incidence of clinically relevant non-major bleeding （RR＝1.69， 95%CI 1.34-2.13， P＜0.000 01） and gastrointestinal bleeding （RR＝1.96， 95%CI 1.15-3.34， P＝0.01） in the trial group was significantly higher than in the control group. There was no statistically significant difference in the incidence of intracranial hemorrhage， all-cause mortality， and fatal pulmonary embolism between 2 groups （P＞0.05）. CONCLUSIONS For cancer-related VTE patients， NOAC is superior to LMWH in preventing venous thrombosis recurrence， and is not inferior to LMWH in terms of major bleeding， intracranial hemorrhage， all-cause mortality， and fatal pulmonary embolism.
摘要
Resumo A embolia pulmonar (EP) é a terceira maior causa de morte cardiovascular e a principal de morte evitável intra-hospitalar no mundo. O conceito PERT® (do inglês, pulmonary embolism response team) envolve seu diagnóstico e tratamento precoce e multidisciplinar. A trombose venosa profunda (TVP) é a sua causa inicial na maioria dos casos e é responsável por complicações como a recidiva tromboembólica, a síndrome pós-trombótica e a hipertensão pulmonar tromboembólica crônica. Uma abordagem inicial semelhante ao PERT nos casos de TVP ilíaco-femoral grave pode reduzir não apenas o risco imediato de EP e morte, mas também suas sequelas tardias. Novas técnicas percutâneas e aparatos de trombectomia mecânica para o tromboembolismo venoso (TEV) vêm demonstrando resultados clínicos encorajadores. Propomos o desenvolvimento de um conceito ampliado de resposta rápida ao TEV, que envolve não apenas a EP (PERT®) mas também os casos graves de TVP: o time de resposta rápida para o TEV (TRETEV®), ou do inglês Venous Thromboembolism Response Team (VTERT®).
Abstract Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).
摘要
Resumen Se presenta el caso de un paciente con enferme dad tromboembólica venosa y contraindicación de anticoagulación en el cual se halló incidentalmente una duplicación de vena cava inferior, situación que determinó la necesidad del implante de dos filtros de protección embólica. Si bien esta anomalía vascular es de escasa presentación, es importante tener presente esta posibilidad para asegurarse de brindar una co rrecta protección a la hora del implante de filtros de vena cava inferior.
Abstract We present the case of a patient with venous throm boembolic disease and contraindication to anticoagu lation, where the incidental finding of a duplication of the inferior vena cava was made. This observation determined the need to implant two embolic protection filters. Although this vascular anomaly is rarely present, it is important to keep this possibility in mind to ensure that proper protection is provided when inferior vena cava filters are implanted.
摘要
Abstract Deep vein thrombosis in the upper extremities is uncommon, especially in the pediatric population and in the trauma setting. The diagnosis is challenging, due to its rarity, requiring a high degree of suspicion. We describe a rare case of humeral vein thrombosis after a displaced supracondylar fracture of the humerus in a 7-year-old girl. The risk factors for thromboembolism and sequelae are also discussed. The early detection and treatment are mandatory to prevent poor outcomes, such as fatal thromboembolism.
Resumo Trombose venosa profunda nas extremidades superiores é incomum, especialmente na população pediátrica e no ambiente do trauma. O diagnóstico é desafiador, devido a sua raridade, exigindo alto grau de suspeita. Descrevemos um caso raro de trombose venosa úmera após uma fratura supracondilar deslocada do úmero em uma menina de 7 anos. Os fatores de risco para tromboembolismo e sequelas também são discutidos. A detecção e o tratamento precoces são obrigatórios para evitar desfechos ruins, como tromboembolismo fatal.
Subject(s)
Humans , Female , Child , Venous Thrombosis , Venous Thromboembolism , Humeral Fractures摘要
Venous thromboembolism (VTE) in pregnancy and resulting thrombotic disorders are increasingly being recognized as an important cause of maternal morbidity and mortality. The diagnosis of VTE during pregnancy has an impact on current as well as future foeto-maternal outcomes. Whereas algorithms to manage VTEs during pregnancy in developed countries exist, these are difficult to implement in resource-constraint settings. In this narrative review, we discuss strategies that can be applied in daily clinical practice by obstetricians and haematologists dealing with these disorders in the country
摘要
Venous thromboembolism (VTE), which entails the formation of a thrombus (blood clot) in a vein, has a significant disease burden worldwide. While VTE has traditionally been considered to predominantly affect Caucasian populations, recent studies have indicated a gradual shift in the disease burden towards Asian populations, with added significance of it being a key driver of post-operative mortality. It is imperative to develop a sound understanding of the various factors that affect VTE in stratified local populations. However, there is a glaring paucity of quality data on VTE and its ramifications among Indians - both in terms of quality of life and cost of healthcare. This review aims to throw light on the disease burden, epidemiology, risk factors, environmental factors, food and nutrition that plays a key role in VTE. We also explored the association of VTE with coronavirus disease 2019 to grasp the interplay between the two most significant public health crises of our time. It is vital to place a special emphasis on future research on VTE in India to plug the gaps, which exist in our current knowledge of the disease, particularly with respect to Indian population
摘要
Abstract Introduction Cancer-associated thrombosis is a leading cause of morbidity and mortality in malignancy patients. Prophylactic anticoagulation is under-utilized and the cost of low-molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries. Material and methods A retrospective analysis was performed of all cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in North India between 2011 and 2015. Patient demographics and disease-related parameters were collected and analyzed. Results A total of 771 patients attended the thrombosis clinic during study period, of which 64 cases were malignancy-associated. Of these, 56% of the patients were female and 20% were bedridden. The median age was 48.5 years, adenocarcinoma (48%) being the most common histological subtype. Gynecological malignancies (30%) were the most common malignancies, followed by genitourinary (11%) malignancies. Most of the cases occurred during first year of diagnosis (51%), and only 14% occurred after 3 years. Most of the patients were on combined treatment. Almost 40% of the patients developed thrombosis within 30 days of surgical treatment. Lower limb thrombosis was the most commonly seen type (56%), while abdominal and pulmonary thrombosis were both seen in 5%. Patients were managed with LMWH and vitamin K antagonists (84.3%) and only 6.25% with LMWH alone. Direct oral anticoagulants were not commonly used during the study period. Discussion At the hospital studied, most of the cases occurred early in the disease course. Postoperative prophylaxis could have contributed towards reducing thrombosis in the peri-operative period. Early suspicion and prompt treatment can improve quality of life in such patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Venous Thrombosis , Neoplasms , Heparin , Epidemiology , Factor Xa Inhibitors , Anticoagulants摘要
Las hemorragias y la enfermedad tromboembólica venosa (ETEV) figuran entre las cinco causas más frecuentes de morbilidad y mortalidad materna en el mundo. Revisamos la evaluación y el manejo actualizado de las causas obstétricas de la hemorragia posparto (HPP), así como el diagnóstico y manejo de condiciones hematológicas que pueden causar o agravar la HPP, por ejemplo: coagulación intravascular diseminada, enfermedad de von Willebrand, trombocitopenia autoinmune y las microangiopatías trombóticas. Revisamos el rol del síndrome antifosfolípido y las trombofilias hereditarias como factores predisponentes a pérdidas fetales recurrentes y la ETEV en el embarazo y las recomendaciones actuales para la prevención de ambas complicaciones. Asimismo, repasamos el abordaje diagnóstico y líneas de manejo de la ETEV. Un objetivo adicional fue enfatizar la importancia del trabajo colaborativo multidisciplinario para lograr el manejo exitoso de las gestantes con las complicaciones obstétricas y hematológicas descritas.
Bleeding and venous thromboembolism (VTE) are among the five most common causes of morbidity and mortality in pregnant women worldwide. This review describes the current evaluation and management of the obstetric causes of postpartum hemorrhage (PPH), as well as the diagnosis and management of hematologic conditions which can cause or worsen PPH, such as disseminated intravascular coagulation, von Willebrand disease, autoimmune thrombocytopenia and the thrombotic microangiopathies. It also describes the role of the antiphospholipid syndrome and inherited thrombophilia as predisposing factors for recurrent pregnancy loses and VTE, and the current recommendations for the prevention of both complications. As well, the current diagnostic approach and management of ETEV are described. An additional objective of this Review is to emphasize the importance of a collaborative multidisciplinary approach for the successful management of the obstetric and hematologic complications herein described.
摘要
AIM: By assessing the impact of prolonged prophylactic anticoagulation on venous thromboembolism in patients undergoing total hip/ knee arthroplasty, we dared to hope to further clarify whetherprolonged prophylactic anticoagulation duration can benefit patients undergoing total hip/ knee arthroplasty. METHODS: The incidence of venous thromboembolism and bleeding events within 90 days of total hip/knee arthroplasty in patients who underwent total hip/knee arthroplasty in the department of orthopaedic surgery was retrospectively analyzed from January 2019 to April 2022. The Kaplan-Meier method survival curve was used to determine whether there is a relationship between the duration of prophylactic anticoagulation and the incidence of postoperative bleeding. RESULTS: A total of 115 patients undergoing primary total hip/knee surgery from January 2019 to April 2022, were enrolled in this study. Among them, there were 38 cases in the short-term prophylactic anticoagulation group and 77 cases in the extended prophylactic anticoagulation group. There were 23 cases (20%) of venous thromboembolism within 90 days after surgery, of which 12 cases (31.58%) were in the short-term anticoagulation group and 11 cases (14.29%) were in the extended anticoagulation group, and there was a statistical difference in the incidence of venous thromboembolism within 90 days after surgery between the two groups in terms of the duration of anticoagulation prevention. CONCLUSION: The results show a significant correlation between the duration of prophylactic anticoagulation and the incidence of venous thromboembolism within 90 days after total hip/knee arthroplasty, which suggests that prophylactic anticoagulation for 15-35 days after undergoing total hip arthroplasty or total knee arthroplasty reduces the incidence of postoperative VTE, and there is no significant difference in bleeding risk depending on the duration of anticoagulant prophylaxis.
摘要
Objective To evaluate the application value of perioperative interventional strategy guided by enhanced recovery after surgery (ERAS) in elderly recipients undergoing liver transplantation. Methods Clinical data of 405 liver transplant recipients were retrospectively analyzed. According to age, all recipients were divided into the elderly (≥60 years, n=122) and non-elderly groups (< 60 years, n=283). All patients received perioperative interventions under the guidance of ERAS. Intraoperative and postoperative indexes, incidence of postoperative complications and discharge were analyzed between two groups. Results There were no significant differences in the duration of anesthesia, operation time, anhepatic phase, hemorrhage volume, blood transfusion volume, lactic acid level before abdominal closure, ventilator-assisted time, the length of intensive care unit (ICU) stay, Caprini score, CHIPPS score, time of gastric tube, urinary tube and drainage tube removal, time to first drinking, time to first physical activity and time to first flatus between two groups (all P > 0.05). In the elderly group, the time to first feeding was later than that in the non-elderly group (P < 0.05). There were no significant differences in the incidence of fever, ascites, pulmonary infection, delayed gastric emptying, hemorrhage and inactive venous thrombosis between two groups (all P > 0.05). No significant differences were observed in the levels of aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine before discharge and total length of hospital stay between two groups (all P > 0.05). The alanine aminotransferase level in elderly recipients was lower than that in non-elderly counterparts, and the difference was statistically significant (P < 0.05). No unplanned reoperation was performed within postoperative 30 d in two groups. There was no significant difference in the re-hospitalization rate within 30 d after discharge (P > 0.05). Conclusions ERAS-guided interventional strategy contributes to perioperative recovery of elderly recipients undergoing liver transplantation, and yields equivalent postoperative recovery between elderly and non-elderly recipients.
摘要
Objective To investigate the clinical features, liver histological features, and diagnostic and treatment methods for patients with myeloproliferative neoplasms (MPN) with portal hypertension as the main manifestation. Methods A retrospective analysis was performed for related data of the patients who attended the hospital due to portal hypertension and were finally diagnosed with MPN in Liver Research Center, Beijing Friendship Hospital, from January 2019 to February 2022, including clinical manifestation, liver pathological features, treatment, and follow-up results. Results Nine patients were included in this study, and all the patients had splenomegaly and esophageal and gastric varices, while portal vein thrombosis was observed in eight patients. All patients had normal or slightly abnormal liver function and routine blood test results. Six patients underwent liver biopsy, without the formation of fibrous septum and pseudolobule, and hepatic extramedullary hematopoiesis was observed in two patients. All nine patients underwent bone marrow biopsy and genetic testing, among whom six had essential thrombocythemia and three had primary myelofibrosis, and genetic testing revealed JAK - 2V617F gene mutation in seven patients and CALR gene mutation in two patients. Conclusion MPN is one of the rare causes of portal hypertension and has the clinical manifestations of esophageal and gastric varices, splenomegaly, and even megalosplenia, without the manifestations of hypersplenism such as leukopenia and thrombocytopenia. Detection of the JAK - 2V617F and CALR genes can improve the diagnostic rate of MPN.
摘要
Objective To investigate the value of a risk assessment model in predicting venous thromboembolism (VTE) in patients with liver failure after artificial liver support therapy. Methods A retrospective analysis was performed for the clinical data of 124 patients with liver failure who received artificial liver support therapy in Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2019 to December 2021, among whom there were 41 patients with VTE (observation group) and 143 patients without VTE (control group). Related clinical data were compared between the two groups, and the Caprini risk assessment model was used for scoring and risk classification of the patients in both groups. The t -test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; the Mann-Whitney U rank sum test was used for comparison of ranked data between two groups. The logistic regression analysis was used to investigate the independent risk factors for VTE in patients with liver failure after artificial liver support therapy. The receiver operating characteristic (ROC) curve was used to investigate the value of Caprini score and the multivariate predictive model used alone or in combination in predicting VTE. Results The observation group had a significantly higher Caprini score than the control group (4.39±1.10 vs 3.12±1.04, t =6.805, P < 0.001). There was a significant difference between the two groups in risk classification based on Caprini scale ( P < 0.05), and the patients with high risk or extremely high risk accounted for a higher proportion among the patients with VTE. The univariate analysis showed that there were significant differences between the two groups in age ( t =6.400, P < 0.001), catheterization method ( χ 2 =14.413, P < 0.001), number of times of artificial liver support therapy ( Z =-4.720, P < 0.001), activity ( Z =-6.282, P < 0.001), infection ( χ 2 =33.071, P < 0.001), D-dimer ( t =8.746, P < 0.001), 28-day mortality rate ( χ 2 =5.524, P =0.022). The multivariate analysis showed that number of times of artificial liver support therapy (X 1 ) (odds ratio [ OR ]=0.251, 95% confidence interval [ CI ]: 0.111-0.566, P =0.001), activity (X 2 ) ( OR =0.122, 95% CI : 0.056-0.264, P < 0.001), D-dimer (X 3 ) ( OR =2.921, 95% CI : 1.114-7.662, P =0.029) were independent risk factors for VTE in patients with liver failure after artificial liver support therapy. The equation for individual predicted probability was P =1/[1+e -(7.425-1.384X 1 -2.103X 2 +1.072X 3 ) ]. The ROC curve analysis showed that Caprini score had an area under the ROC curve of 0.802 (95% CI : 0.721-0.882, P < 0.001), and the multivariate model had an area under the ROC curve of 0.768 (95% CI : 0.685-0.851, P < 0.001), while the combination of Caprini score and the multivariate model had an area under the ROC curve of 0.957 (95% CI : 0.930-0.984, P < 0.001). Conclusion The Caprini risk assessment model has a high predictive efficiency for the risk of VTE in patients with liver failure after artificial liver support therapy, and its combination with the multivariate predictive model can significantly improve the prediction of VTE.
摘要
BACKGROUND@#Venous thromboembolism (VTE) as the most common cancer-associated complication has become the second death-causing reason among cancer patients. The management of VTE in patients with lung adenocarcinoma should focus on early and timely detection of risk factors. The aim of the study is to investigate the current situation of VTE in patients with lung adenocarcinoma treated with anti-tumor therapy and then explore the risk factors associated with the occurrence of VTE during anti-tumor therapy for early detection and screening of VTE.@*METHODS@#The present study included patients diagnosed as lung adenocarcinoma undergoing anti-tumor therapy in First Affiliated Hospital of Nanjing Medical University between December 2019 and May 2021. The risk factors were identified via univariate and multivariate Cox analysis. The incidence of independent risk factors were investigated through Kaplan-Meier curves combined with Log-rank test.@*RESULTS@#The results of univariate and multivariate Cox regression showed that history of VTE, targeted therapy and radiotherapy were risk factors for VTE in patients with lung adenocarcinoma treated with anti-tumor therapy (P<0.05). Furthermore, the results of Kaplan-Meier curves and Log-rank tests indicated the incidences of VTE in patients with history of VTE, targeted therapy and radiotherapy were higher (P<0.05).@*CONCLUSIONS@#History of VTE, radiotherapy and targeted therapy are found as independent risk factors for the occurrence of VTE, which should be identified and monitored for reduction of VTE incidence. .
Subject(s)
Humans , Venous Thromboembolism , Incidence , Lung Neoplasms , Adenocarcinoma of Lung , Risk Factors摘要
@#Venous thromboembolism (VTE) is one of the significant causes of morbidity and mortality for hospital inpatients. The use of VTE prophylaxis in high-risk patients admitted under Geriatric Medicine in RIPAS Hospital, Brunei was evaluated. The electronic medical records of all patients admitted under Geriatric Medicine between 1st February 2022 and 28th February 2022 were reviewed. For these patients, the risk of developing VTE, bleeding risk and whether they were prescribed VTE prophylaxis were assessed. There were 34 patients identified, of which 20 (58.8%) were female. Median age was 81 years, ranging from 64 to 93 years. There were 13 (38.2%) COVID-positive patients, of which 9 (69.2%) were considered high VTE risk. Among these 9 patients, 4 (44.4%) were low bleed risk; of these 4 patients only two were prescribed VTE prophylaxis. Among the 21 non-COVID patients, 17 (80.9%) were high VTE risk. There were 11 (64.7%) with low bleed risk among the 17 patients in the group. Of the 11 patients only 3 (27.3%) were prescribed VTE prophylaxis. The use of VTE prophylaxis among Geriatric Medicine inpatients could be improved. Use of the VTE prophylaxis protocol should be emphasised to clinicians and re-audited to ensure compliance
摘要
@#Femoral shaft fractures are increasingly common due to various traumatic injuries. Intramedullary nail (IMN) is considered the gold standard treatment for these fractures, but comorbidities often require thorough trauma life support and intensive care. The primary goal of treatment is rigid fixation, early mobilisation, and long-term functional recovery. This article reviews current concepts in the treatment of femoral shaft fractures, including the effects of early or delayed operation, differences between antegrade or retrograde intramedullary nailing, alternative methods to using a fracture table, methods to predict nail length before operation, assessing femoral rotation during an operation, and complications.
摘要
@#Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.
摘要
Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.
Subject(s)
Humans , Child , Venous Thromboembolism/etiology , East Asian People , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Risk Factors , Thrombosis/chemically induced , China/epidemiology , Anticoagulants/adverse effects , Recurrence摘要
Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.