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1.
Medicina (B Aires) ; 84 Suppl 2: 1-32, 2024 May.
Article in Spanish | MEDLINE | ID: mdl-38823037

ABSTRACT

Venous thromboembolism disease (VTE) prevention strategy has to be constantly updated based on new evidence that is generated every year. Each institution must have a formal and active prevention policy against VTE and must develop guidelines or standards for thromboprophylaxis (TP) according to the local reality. During this process of adapting a guideline to the region and the generation of hospital recommendations, we must always consider the available local resources, the thromboembolic and hemorrhagic risk of the patients, even after discharge, and also their considerations and preferences. Adherence to local TP recommendations is one of the most important items evaluated by organizations that measure institutional quality. Individualized prophylaxis should consider personal and family history of VTE, the use of validated risk assessment models or RAMs for thrombosis and bleeding events, as well as the special characteristics of each patient. Ideally, each center's own statistics should be available for decision-making. Extrapolating guidelines from developed countries could have a negative impact, if we ignore our hospital's reality. In this document we will find practical tools for health institutions that will allow them to prepare recommendations or guidelines for adequate VTE prophylaxis.


La prevención de la enfermedad tromboembólica venosa (ETV) es motivo de continua actualización en función de nueva evidencia que se genera permanentemente. Cada institución debe contar con una estrategia activa de prevención contra la ETV y debe generar normas de tromboprofilaxis (TP) de acuerdo con la realidad local. Durante este proceso de adaptación de una guía a la región debemos siempre tener en cuenta los recursos locales disponibles, el riesgo tromboembólico y hemorrágico propio del paciente, de la enfermedad por la que se encuentra internado (ya sea clínica o quirúrgica) y las consideraciones o preferencias del paciente. La tasa de adherencia a recomendaciones locales de TP es uno de los indicadores de excelencia más importantes evaluados en organismos que califican la calidad de una institución de salud. Las medidas de profilaxis que propongamos para los centros de salud, deben ser individualizadas para cada paciente, tienen que considerar antecedentes personales y familiares del enfermo y utilizar modelos de evaluación de riesgo validados de trombosis y de sangrado. También deben incluir a la población con riesgo de trombosis persistente luego del alta. Lo ideal es tener estadísticas propias de cada nosocomio para la toma de decisiones de cómo implementar una correcta TP. Extrapolar guías de los países desarrollados a nuestro ámbito podría tener un impacto negativo, si no se conoce la propia realidad. En este documento encontraremos herramientas prácticas para las instituciones de salud de la región, que les permita orientarse al momento de confeccionar recomendaciones para una adecuada TP.


Subject(s)
Practice Guidelines as Topic , Venous Thromboembolism , Humans , Venous Thromboembolism/prevention & control , Risk Assessment , Guideline Adherence , Anticoagulants/therapeutic use , Anticoagulants/administration & dosage , Risk Factors
2.
J Vasc Nurs ; 42(2): 123-130, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38823972

ABSTRACT

BACKGROUND: The prevalence of venous thromboembolism is steadily increasing in developing nations including Ethiopia. Nurses play a vital role in the prevention of venous thromboembolism. However, the level of nurses' knowledge, practice, and associated factors in venous thromboembolism prevention is not well-known across Ethiopia. This study aimed to assess nurses' knowledge, practice, and associated factors regarding venous-thromboembolism prevention in tertiary Hospitals of Addis Ababa, Ethiopia METHODS: An institutional-based cross-sectional study was conducted among 339 randomly selected nurses working at tertiary hospitals in Addis Ababa, Ethiopia. A validated questionnaire was used to collect data. Data were analyzed with SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables. RESULTS: Out of the total 339 participants, only (51.6%) and (45.4%) had adequate knowledge and practice towards venous thromboembolism prevention respectively. Attending in-service training (AOR=1.701, p = 0.044) was significantly associated with knowledge of VTE prevention. Educational level (AOR= 3.871, P = 0.048), work experience (AOR=5.207, P<0.001), work location (AOR= 0.507, P = 0.019), working department (AOR= 2.959, P = 0.048), knowledge level (AOR= 0.477, P=0.005) were significantly associated with better preventive practice. CONCLUSION: This study suggests that nurses' level of knowledge and practice towards venous thromboembolism prevention was inadequate. Nurses' educational level, attending in-service training, work experience, work location, and working department were determinant factors associated with nurses' knowledge and practice towards venous thromboembolism prevention. Therefore, upgrading nurses' educational level and providing in-service training on venous thromboembolism prevention is crucial for positive patient outcomes.


Subject(s)
Clinical Competence , Health Knowledge, Attitudes, Practice , Tertiary Care Centers , Venous Thromboembolism , Humans , Cross-Sectional Studies , Ethiopia , Venous Thromboembolism/prevention & control , Female , Adult , Surveys and Questionnaires , Male , Clinical Competence/standards , Nursing Staff, Hospital/education , Middle Aged , Nurses/statistics & numerical data
3.
J Med Vasc ; 49(2): 72-79, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38697713

ABSTRACT

BACKGROUND: Our study aimed to describe the clinical, paraclinical, therapeutic and outcomes of patients with venous thromboembolic event (VTE) associated with cancer in the context of limited resources. MATERIALS AND METHODS: This was a descriptive cross-sectional study over a period of six years from March 1, 2016 to March 31, 2022, in the cardiology department and the oncology unit of the Sylvanus Olympio Teaching Hospital of Lome. Our study examined medical records of patients who were at least 18 years old and had venous thromboembolic disease and cancer that was histologically confirmed. This study did not include records that were incomplete or records from patients with coronavirus disease. RESULTS: Our study included 87 patients with average age of 56.36±15.26 years. The discovery of VTE occurred incidentally in 28.74%. Venous thrombosis was isolated in 68.96% and proximal in 95%. Pulmonary embolism was bilateral in 77.77%. Gynaecological and urological cancers were found in 33.33% and 32.19% respectively. Adenocarcinoma was the histological type of cancer found in 47.13%. Cancers were at a very advanced stage in 74.71%. Treatment with antivitamin K was prescribed in 12.65%. In our study, there were 58 patients who passed away with a mortality rate of 66.66%. The cause of death was a complication of VTE in 22.42% and related to the course of cancer in 63.79% of cases. CONCLUSION: VTE during cancer is particular with a fatal evolution due to the severity of VTE and the very advanced stage of cancer.


Subject(s)
Neoplasms , Venous Thromboembolism , Humans , Middle Aged , Female , Male , Togo/epidemiology , Cross-Sectional Studies , Aged , Adult , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/diagnosis , Neoplasms/epidemiology , Neoplasms/complications , Risk Factors , Pulmonary Embolism/epidemiology , Pulmonary Embolism/etiology , Anticoagulants/therapeutic use , Time Factors , Treatment Outcome , Vitamin K/antagonists & inhibitors , Venous Thrombosis/epidemiology , Venous Thrombosis/drug therapy , Neoplasm Staging , Aged, 80 and over
5.
Sci Rep ; 14(1): 10192, 2024 05 03.
Article in English | MEDLINE | ID: mdl-38702341

ABSTRACT

Inferior vena cava (IVC) filters are considered when patients with venous thromboembolism (VTE) develop a contraindication to anticoagulation. Use of IVC filters is increasing, despite associated complications and lack of data on efficacy in reducing VTE-related mortality. We characterized the pattern of IVC filter use at a large community hospital between 2018 and 2022. Specifically, we assessed the indications for IVC filter insertion, filter removal rates, and filter-associated complications. Indications for IVC filters were compared to those outlined by current clinical practice guidelines. We reviewed 120 consecutive filter placement events. The most common indications included recent VTE and active bleeding (40.0%) or need for anticoagulation interruption for surgery (25.8%). Approximately one-third (30.0%) of IVC filters were inserted for indications either not supported or addressed by guidelines. Half (50.0%) of patients had successful removal of their IVC filter. At least 13 patients (10.8%) experienced a filter-related complication. In a large community-based practice, nearly one-third of IVC filters were inserted for indications not universally supported by current practice guidelines. Moreover, most IVC filters were not removed, raising the risk of filter-associated complications, and supporting the need for development of comprehensive guidelines addressing use of IVC filters, and post-insertion monitoring practices.


Subject(s)
Hospitals, Community , Vena Cava Filters , Venous Thromboembolism , Humans , Retrospective Studies , Female , Male , Middle Aged , Venous Thromboembolism/prevention & control , Aged , Anticoagulants/therapeutic use , Adult , Device Removal/methods
6.
Bull Hosp Jt Dis (2013) ; 82(2): 124-133, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38739660

ABSTRACT

Postoperative venous thromboembolism (VTE) is a common and costly complication following total joint arthroplasty (TJA). Development of a refined thrombophilic screening panel will better equip clinicians to identify patients at high-est risk for developing VTEs. In this pilot study, 62 high-risk TJA recipients who had developed pulmonary emboli (PE) within 90-days of surgery were eligible to participate. Of these patients, 14 were enrolled and subsequently adminis-tered a pre-determined panel of 18 hematologic tests with the aim of identifying markers that are consistently elevated or deficient in patients developing PE. A separate cohort of seven high-risk TJA recipients who did not report a symp-tomatic VTE within 90-days of surgery were then enrolled and Factor VIII and lipoprotein(a) levels were assessed. The most common aberrance was noted in 10 patients (71.4%) who had elevated levels of Factor VIII followed by five patients (35.7%) who had elevated levels of lipoprotein(a). Factor VIII was significantly prevalent (p < 0.001) while lipoprotein(a) failed to achieve statistical significance (p = 0.0708). Of the patients who were within normal limits of Factor VIII, three-fourths were "high-normal" with Fac-tor VIII levels within 5% of the upper limit of normal. This study demonstrates the potential utility of this hematologic panel as part of a perioperative screening protocol aimed at identifying patients at risk for developing VTEs. However, future larger scale studies assessing the capabilities and limitations of our findings are warranted.


Subject(s)
Pulmonary Embolism , Humans , Pilot Projects , Pulmonary Embolism/blood , Pulmonary Embolism/etiology , Pulmonary Embolism/diagnosis , Female , Male , Middle Aged , Aged , Risk Factors , Risk Assessment/methods , Predictive Value of Tests , Postoperative Complications/etiology , Postoperative Complications/diagnosis , Postoperative Complications/blood , Factor VIII/analysis , Biomarkers/blood , Lipoprotein(a)/blood , Arthroplasty, Replacement/adverse effects , Venous Thromboembolism/etiology , Venous Thromboembolism/diagnosis , Venous Thromboembolism/blood , Venous Thromboembolism/epidemiology
8.
Front Immunol ; 15: 1363598, 2024.
Article in English | MEDLINE | ID: mdl-38742101

ABSTRACT

Introduction: Venous thromboembolism (VTE) is known to be intricately linked to severe COVID-19 (sCOVID-19) occurrence. Herein, we employed univariable Mendelian randomization (MR) and transcriptome analysis to predict the causal association and associated signaling networks between VTE and sCOVID-19. Methods: Potential VTE and sCOVID-19 association was assessed using MR-Egger, weighted median, simple mode, weighted mode, and inverse variance weighted (IVW) regression. We conducted independent univariable analyses involving VTE and sCOVID-19. Using heterogeneity, pleiotropy, and the Leave-One-Out examinations, we performed sensitivity analyses. Thereafter, we performed transcriptome analysis of the GSE164805 dataset to identify differentially expressed genes (DEGs) linked to single nucleotide polymorphisms (SNPs). Lastly, we conducted immune analyses. Results: Based on our univariable analysis, VTE was a strong indicator of sCOVID-19 development, and it was intricately linked to sCOVID-19. We further conducted sensitivity analysis to demonstrate the reliability of our results. Using differential analysis, we identified 15 major genes, namely, ACSS2, CEP250, CYP4V2, DDB2, EIF6, GBGT1, GSS, MADD, MAPK8IP1, MMP24, YBPC3, NT5DC3, PROCR, SURF6, and YIPF2, which were strongly connected to suppressive adaptive immune as well as augmented inflammatory cells. In addition, we uncovered strong associations with most differential immunologic gene sets, such as, the Major Histocompatibility Complex (MHC), immunoactivators, and immunosuppressors. Conclusion: Herein, we demonstrated we strong association between VTE and enhanced sCOVID-19 risk. We also identified 15 DEGs which potentially contribute to the shared immunologic pathogenesis between VTE and sCOVID-19.


Subject(s)
COVID-19 , Gene Expression Profiling , Mendelian Randomization Analysis , Polymorphism, Single Nucleotide , SARS-CoV-2 , Venous Thromboembolism , Humans , COVID-19/genetics , COVID-19/immunology , Venous Thromboembolism/genetics , Venous Thromboembolism/immunology , Transcriptome , Genetic Predisposition to Disease
9.
Tex Heart Inst J ; 51(1)2024 May 15.
Article in English | MEDLINE | ID: mdl-38748549

ABSTRACT

BACKGROUND: Current venous thromboembolism guidelines recommend using direct oral anticoagulants (DOACs) over warfarin regardless of obesity status; however, evidence remains limited for the safety and efficacy of DOAC use in patients with obesity. This retrospective analysis sought to demonstrate the safety and efficacy of DOACs compared with warfarin in a diverse population of patients with obesity in light of current prescribing practices. METHODS: A retrospective cohort study was conducted at a large academic health system between July 2014 and September 2019. Adults with an admission diagnosis of deep vein thrombosis (DVT) or pulmonary embolism, with weight greater than 120 kg or a body mass index greater than 40, and who were discharged on an oral anticoagulant were included. Outcomes included occurrence of a thromboembolic event (DVT, pulmonary embolism, or ischemic stroke), bleeding event requiring hospitalization, and all-cause mortality within 12 months following index admission. RESULTS: Out of 787 patients included, 520 were in the DOAC group and 267 were in the warfarin group. Within 12 months of index hospitalization, thromboembolic events occurred in 4.23% of patients in the DOAC group vs 7.12% of patients in the warfarin group (hazard ratio, 0.6 [95% CI, 0.32-1.1]; P = .082). Bleeding events requiring hospitalization occurred in 8.85% of DOAC patients vs 10.1% of warfarin patients (hazard ratio, 0.93 [95% CI, 0.57-1.5]; P = .82). A DVT occurred in 1.7% and 4.9% of patients in the DOAC and warfarin groups, respectively (hazard ratio, 0.35 [95% CI, 0.15-0.84]; P = .046). CONCLUSION: No significant differences could be determined between DOACs and warfarin for cumulative thromboembolic or bleeding events, pulmonary embolism, ischemic stroke, or all-cause mortality. The risk of DVT was lower with apixaban and rivaroxaban. Regardless of patient weight or body mass index, physicians prescribed DOACs more commonly than warfarin.


Subject(s)
Anticoagulants , Obesity , Venous Thromboembolism , Warfarin , Humans , Retrospective Studies , Female , Male , Warfarin/adverse effects , Warfarin/administration & dosage , Warfarin/therapeutic use , Obesity/complications , Anticoagulants/adverse effects , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Middle Aged , Venous Thromboembolism/epidemiology , Venous Thromboembolism/drug therapy , Administration, Oral , Aged , Treatment Outcome , Factor Xa Inhibitors/adverse effects , Factor Xa Inhibitors/administration & dosage , Factor Xa Inhibitors/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Follow-Up Studies
10.
Am J Nurs ; 124(6): 40-46, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38780339

ABSTRACT

BACKGROUND: Unfractionated heparin (UFH) is a high-risk medication that can cause bleeding and/or thrombotic complications if not managed appropriately. Between January and July 2019, our institution experienced a high number of patient safety events related to UFH infusion for the treatment of venous thromboembolism (VTE). PURPOSE: The aim of this quality improvement (QI) initiative was to prevent these safety events by improving compliance with our institution's nurse-driven VTE UFH infusion protocol. METHODS: Baseline data for patients on the VTE UFH protocol were collected to identify improvement opportunities. Compliance with eight standards of care related to the VTE UFH infusion protocol was measured. Time to first therapeutic activated partial thromboplastin time (aPTT) was recorded to assess the benefit of improved compliance. INTERVENTIONS: Institutional policy updates were made to clarify the management of UFH infusions and documentation in the electronic health record. A multidisciplinary workgroup implemented order set changes, nursing communication orders, UFH infusion reports, and a nursing education module to promote compliance with the protocol. RESULTS: The overall rate of compliance with the VTE UFH infusion protocol increased from 79.4% at baseline to 85.2% following implementation of the QI initiative, and the median time to first therapeutic aPTT decreased from 831.5 minutes to 808 minutes over the same period. CONCLUSIONS: A multidisciplinary initiative to address improvement opportunities in a nurse-driven UFH protocol for VTE treatment increased compliance with the protocol and decreased the time to first therapeutic aPTT.


Subject(s)
Anticoagulants , Guideline Adherence , Heparin , Quality Improvement , Venous Thromboembolism , Humans , Venous Thromboembolism/drug therapy , Venous Thromboembolism/nursing , Venous Thromboembolism/prevention & control , Heparin/administration & dosage , Heparin/therapeutic use , Heparin/adverse effects , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Anticoagulants/adverse effects , Guideline Adherence/statistics & numerical data , Infusions, Intravenous , Female , Male , Middle Aged , Patient Safety/standards
11.
Clin Podiatr Med Surg ; 41(3): 607-617, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38789173

ABSTRACT

Every surgeon may have experienced a tragic event associated with death or debilitation secondary to deep vein thrombosis (DVT) or pulmonary embolism (PE) after foot and ankle trauma and surgery. Nevertheless, the prevention of such a tragic event needs to be carefully evaluated rationally with currently available epidemiologic data. With great postoperative protocols and access to care, most PE events can be prevented. There are modifiable risk factors, such as length/type of immobilization and operative trauma/time that can lower the incidence of DVT/PE. In addition, chemical prophylaxis may be warranted in certain people within the foot and ankle trauma population.


Subject(s)
Ankle Injuries , Foot Injuries , Venous Thromboembolism , Humans , Ankle Injuries/complications , Ankle Injuries/surgery , Foot Injuries/complications , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Risk Factors , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Pulmonary Embolism/etiology , Pulmonary Embolism/prevention & control , Pulmonary Embolism/therapy , Anticoagulants/therapeutic use , Incidence
12.
BMC Surg ; 24(1): 162, 2024 May 18.
Article in English | MEDLINE | ID: mdl-38762739

ABSTRACT

OBJECTIVES: To compare the efficacy of nadroparin and fondaparinux sodium for prevention of deep vein thromboembolism (DVT) in lower extremities after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: A total of 592 patients were enrolled in the study. Clinical data of patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) in our hospital from December 2021 to September 2022 were retrospectively collected, which mainly included patients' general information, surgery-related information, and DVT-related information. The patients were categorized into the nadroparin group(n = 278) and the fondaparinux sodium group(n = 314) according to the types of anticoagulants used. Anticoagulant therapy began 12-24 h after operation and continued until discharge. DVT prevalence between two groups was compared. The Statistical Package for Social Sciences (SPSS) software version 25 (SPSS, Armonk, NY, USA) was used for statistical analysis. RESULTS: The prevalence of DVT in the nadroparin group and the fondaparinux sodium group was 8.3% (23/278) and 15.0% (47/314), respectively(p = 0.012). Statistical analysis showed that nadroparin group showed a lower prevalence of thrombosis than fondaparinux group (OR = 1.952, P = 0.012). Subgroup analyses showed that nadroparin group had a lower prevalence of DVT than fondaparinux group in some special patients groups such as female patients (OR = 2.258, P = 0.007), patients who are 65-79 years old (OR = 2.796, P = 0.004), patients with hypertension (OR = 2.237, P = 0.042), patients who underwent TKA (OR = 2.091, P = 0.011), and patients who underwent combined spinal-epidural anesthesia (OR = 2.490, P = 0.003) (P < 0.05). CONCLUSION: Nadroparin may have an advantage over fondaparinux sodium in preventing DVT in lower extremities after THA and TKA.


Subject(s)
Anticoagulants , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Fondaparinux , Nadroparin , Postoperative Complications , Venous Thromboembolism , Humans , Fondaparinux/therapeutic use , Female , Male , Retrospective Studies , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Nadroparin/therapeutic use , Nadroparin/administration & dosage , Middle Aged , Venous Thromboembolism/prevention & control , Venous Thromboembolism/etiology , Venous Thromboembolism/epidemiology , Aged , Anticoagulants/therapeutic use , Anticoagulants/administration & dosage , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Lower Extremity/blood supply , Lower Extremity/surgery , Treatment Outcome
13.
Methodist Debakey Cardiovasc J ; 20(3): 49-56, 2024.
Article in English | MEDLINE | ID: mdl-38765211

ABSTRACT

For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.


Subject(s)
Device Removal , Prosthesis Design , Prosthesis Implantation , Pulmonary Embolism , Vena Cava Filters , Venous Thrombosis , Humans , Pulmonary Embolism/prevention & control , Venous Thrombosis/prevention & control , Venous Thrombosis/therapy , Risk Factors , Prosthesis Implantation/instrumentation , Prosthesis Implantation/adverse effects , Treatment Outcome , Venous Thromboembolism/prevention & control , Venous Thromboembolism/diagnosis , Vena Cava, Inferior/diagnostic imaging , Risk Assessment , Anticoagulants/therapeutic use , Anticoagulants/adverse effects
14.
Article in English | MEDLINE | ID: mdl-38765519

ABSTRACT

•The risk of venous thromboembolism (VTE) is not increased in women using long-acting reversible contraceptive methods (LARCs) with progestogens. •Oral contraceptives with levonorgestrel or norgestimate confer half the risk of VTE compared to oral contraceptives containing desogestrel, gestodene or drospirenone. •Progestogen-only pills do not confer an increased risk of VTE. •Women using transdermal contraceptive patches and combined oral contraceptives (COCs) are at an approximately eight times greater risk of VTE than non-users of hormonal contraceptives (HCs), corresponding to 9.7 events per 10,000 women/years. •Vaginal rings increase the risk of VTE by 6.5 times compared to not using HC, corresponding to 7.8 events per 10,000 women/years. •Several studies have demonstrated an increased risk of VTE in transgender individuals receiving hormone therapy (HT). •Hormone therapy during menopause increases the risk of VTE by approximately two times, and this risk is increased by obesity, thrombophilia, age over 60 years, surgery and immobilization. •The route of estrogen administration, the dosage and type of progestogen associated with estrogen may affect the risk of VTE in the climacteric. •Combined estrogen-progesterone therapy increases the risk of VTE compared to estrogen monotherapy. •Postmenopausal HT increases the risk of thrombosis at atypical sites.


Subject(s)
Venous Thromboembolism , Female , Humans , Contraceptive Agents, Hormonal/adverse effects , Contraceptive Agents, Hormonal/administration & dosage , Risk Assessment , Risk Factors , Venous Thromboembolism/chemically induced , Venous Thromboembolism/etiology
15.
BMJ Open ; 14(5): e082951, 2024 May 20.
Article in English | MEDLINE | ID: mdl-38772580

ABSTRACT

OBJECTIVES: Venous thromboembolism (VTE) is a major cause of morbidity and mortality globally, with hospital-associated thrombosis (HAT) accounting for at least half of VTE. We set out to understand more about deaths from HAT in England, to focus improvement efforts where they are needed most. DESIGN: A retrospective cohort combining death certification and hospital activity data to identify people with an inpatient or day case hospitalisation where no VTE diagnosis was recorded, and who died from VTE in a hospital or within 90 days of discharge, between April 2017 and March 2020. SETTING: All deaths occurring in England and all National Health Service-funded hospital care in England. PARTICIPANTS: After 0.1% of cases were excluded due to duplicate but conflicting records, a cohort of 13 995 deaths remained; 54% were women, and 26% were aged under 70 years. OUTCOME MEASURES: Analysis of age, gender, primary diagnosis, type of admission, specialties and (for day cases) procedure types were preplanned. RESULTS: Only 5% of these deaths followed planned inpatient admissions. Day case admissions preceded 7% of VTE deaths. Emergency inpatient admissions, medical specialties and infection-related primary diagnoses predominated in people who died from VTE after hospitalisation where no VTE diagnosis was recorded. Most deaths occurred in a hospital or within 30 days of discharge. CONCLUSIONS: International efforts to reduce HAT historically focused on planned inpatient admissions. Further initiatives and research to prevent deaths from VTE after hospitalisation should focus on the emergency care pathway where most deaths occurred, with people undergoing day case procedures an important additional focus.


Subject(s)
Hospitalization , Venous Thromboembolism , Humans , England/epidemiology , Female , Male , Venous Thromboembolism/mortality , Venous Thromboembolism/epidemiology , Retrospective Studies , Aged , Middle Aged , Hospitalization/statistics & numerical data , Adult , Aged, 80 and over , Hospital Mortality , Young Adult , Adolescent
16.
Clin Appl Thromb Hemost ; 30: 10760296241254104, 2024.
Article in English | MEDLINE | ID: mdl-38772566

ABSTRACT

This study aims to identify risk factors for secondary venous thromboembolism (VTE) in stroke patients and establish a nomogram, an accurate predictor of probability of VTE occurrence during hospitalization in stroke patients. Medical Information Mart for Intensive Care IV (MIMIC-IV) database of critical care medicine was utilized to retrieve information of stroke patients admitted to the hospital between 2008 and 2019. Patients were randomly allocated into train set and test set at 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for secondary VTE in stroke patients. A predictive nomogram model was constructed, and the predictive ability of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). This study included 266 stroke patients, with 26 patients suffering secondary VTE after stroke. A nomogram for predicting risk of secondary VTE in stroke patients was built according to pulmonary infection, partial thromboplastin time (PTT), log-formed D-dimer, and mean corpuscular hemoglobin (MCH). Area under the curve (AUC) of the predictive model nomogram was 0.880 and 0.878 in the train and test sets, respectively. The calibration curve was near the diagonal, and DCA curve presented positive net benefit. This indicates the model's good predictive performance and clinical utility. The nomogram effectively predicts the risk probability of secondary VTE in stroke patients, aiding clinicians in early identification and personalized treatment of stroke patients at risk of developing secondary VTE.


Subject(s)
Nomograms , Stroke , Venous Thromboembolism , Humans , Venous Thromboembolism/etiology , Venous Thromboembolism/epidemiology , Female , Male , Stroke/blood , Aged , Risk Factors , Middle Aged , Databases, Factual
17.
BMC Cancer ; 24(1): 610, 2024 May 21.
Article in English | MEDLINE | ID: mdl-38773439

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is a major complication of breast cancer surgical patients. Assessing VTE awareness enables medical staff to tailor educational programs that improve patient self-management and reduce VTE risk. Therefore, this study aimed to assess VTE awareness among breast cancer surgical patients and identify factors influencing their awareness level. METHODS: A multicenter cross-sectional study was conducted on breast cancer patients scheduled for surgery from May 2023 to November 2023. Data were collected using a general information form and a validated self-assessment questionnaire on VTE awareness for breast cancer surgical patients. Univariate analysis and multiple linear regression analysis were used to analyze the data. RESULTS: Of 1969 patients included, the term awareness rates for deep vein thrombosis and pulmonary embolism were 42.5% and 26.1%, respectively. Information about VTE was primarily obtained from doctors (30.4%), nurses (24.0%), and social media (23.3%). The overall average VTE awareness score was 1.55 ± 0.53, with the dimension of VTE preventive measures scoring highest, and VTE clinical symptoms/signs scoring lowest. Multivariate analysis identified education level, personal VTE history, chemotherapy and surgical history, and the hospital's regional location as significant factors associated with VTE awareness level (p < 0.05). CONCLUSION: This study highlights a critical need for improved VTE awareness among breast cancer surgical patients, particularly regarding clinical symptoms/signs. Health education programs are recommended especially tailored for patients with lower education levels, no history of VTE, or without prior surgery or chemotherapy, to improve their understanding of VTE.


Subject(s)
Breast Neoplasms , Health Knowledge, Attitudes, Practice , Venous Thromboembolism , Humans , Female , Cross-Sectional Studies , Breast Neoplasms/surgery , Breast Neoplasms/complications , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thromboembolism/epidemiology , Middle Aged , Adult , Risk Factors , Surveys and Questionnaires , Aged , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control
19.
Clin Appl Thromb Hemost ; 30: 10760296241255958, 2024.
Article in English | MEDLINE | ID: mdl-38767088

ABSTRACT

Venous thromboembolism (VTE) is a common complication in patients with high-grade serous ovarian cancer (HGSOC) after surgery. This study aims to establish a comprehensive risk assessment model to better identify the potential risk of postoperative VTE in HGSOC. Clinical data from 587 HGSOC patients who underwent surgical treatment were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify independent factors influencing the occurrence of postoperative VTE in HGSOC. A nomogram model was constructed in the training set and further validated in the verification set. Logistic regression identified age (odds ratio [OR] = 1.063, P = .002), tumor size (OR = 3.815, P < .001), postoperative transfusion (OR = 5.646, P = .001), and postoperative D-dimer (OR = 1.246, P = .003) as independent risk factors for postoperative VTE in HGSOC patients. A nomogram was constructed using these factors. The receiver operating characteristic curve showed an area under the curve (AUC) of 0.840 (95% confidence interval [CI]: 0.782, 0.898) in the training set and 0.793 (95% CI: 0.704, 0.882) in the validation set. The calibration curve demonstrated a good consistency between model predictions and actual results. The decision curve analysis indicated the model benefits at a threshold probability of less than 70%. A nomogram predicting postoperative VTE in HGSOC was established and validated. This model will assist clinicians in the early identification of high-risk patients, enabling the implementation of appropriate preventive measures.


Subject(s)
Nomograms , Postoperative Complications , Venous Thromboembolism , Humans , Venous Thromboembolism/etiology , Venous Thromboembolism/epidemiology , Female , Middle Aged , Postoperative Complications/etiology , Risk Factors , Aged , Retrospective Studies , Ovarian Neoplasms/surgery , Risk Assessment/methods , Adult
20.
BMC Biotechnol ; 24(1): 30, 2024 May 08.
Article in English | MEDLINE | ID: mdl-38720310

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE), is a noteworthy complication in individuals with gastric cancer, but the current diagnosis and treatment methods lack accuracy. In this study, we developed a t-PAIC chemiluminescence kit and employed chemiluminescence to detect the tissue plasminogen activator inhibitor complex (t-PAIC), thrombin-antithrombin III complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC) and thrombomodulin (TM), combined with D-dimer and fibrin degradation products (FDP), to investigate their diagnostic potential for venous thrombosis in gastric cancer patients. The study assessed variations in six indicators among gastric cancer patients at different stages. RESULTS: The t-PAIC reagent showed LOD is 1.2 ng/mL and a linear factor R greater than 0.99. The reagents demonstrated accurate results, with all accuracy deviations being within 5%. The intra-batch and inter-batch CVs for the t-PAIC reagent were both within 8%. The correlation coefficient R between this method and Sysmex was 0.979. Gastric cancer patients exhibited elevated levels of TAT, PIC, TM, D-D, FDP compared to the healthy population, while no significant difference was observed in t-PAIC. In the staging of gastric cancer, patients in III-IV stages exhibit higher levels of the six markers compared to those in I-II stages. The ROC curve indicates an enhancement in sensitivity and specificity of the combined diagnosis of four or six indicators. CONCLUSION: Our chemiluminescence assay performs comparably to Sysmex's method and at a reduced cost. The use of multiple markers, including t-PAIC, TM, TAT, PIC, D-D, and FDP, is superior to the use of single markers for diagnosing VTE in patients with malignant tumors. Gastric cancer patients should be screened for the six markers to facilitate proactive prophylaxis, determine the most appropriate treatment timing, ameliorate their prognosis, decrease the occurrence of venous thrombosis and mortality, and extend their survival.


Subject(s)
Luminescent Measurements , Stomach Neoplasms , Humans , Stomach Neoplasms/diagnosis , Male , Middle Aged , Luminescent Measurements/methods , Female , Aged , Antithrombin III/metabolism , Antithrombin III/analysis , Thrombomodulin/blood , Fibrin Fibrinogen Degradation Products/analysis , Fibrin Fibrinogen Degradation Products/metabolism , alpha-2-Antiplasmin/metabolism , alpha-2-Antiplasmin/analysis , Adult , Fibrinolysin/metabolism , Fibrinolysin/analysis , Venous Thromboembolism/diagnosis , Venous Thromboembolism/blood , Peptide Hydrolases
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