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Scientific Reports Mar 2022Deep vein thrombosis (DVT) is a potentially deadly medical condition that is costly to treat and impacts thousands of Americans every year. DVT is characterized by the...
Deep vein thrombosis (DVT) is a potentially deadly medical condition that is costly to treat and impacts thousands of Americans every year. DVT is characterized by the formation of blood clots within the deep venous system of the body. If a DVT dislodges it can lead to venous thromboembolism (VTE) and pulmonary embolism (PE), both of which can lead to significant morbidity or death. Current treatment options for DVT are limited in both effectiveness and safety, in part because the treatment of the DVT cannot be confined to a defined sequestered treatment zone. We therefore developed and tested a novel thrombectomy device that enables the sequesteration of a DVT to a defined treatment zone during fragmentation and evacuation. We observed that, compared to a predicate thrombectomy device, the sequestered approach reduced distal DVT embolization during ex vivo thrombectomy. The sequestered approach also facilitated isovolumetric infusion and suction that enabled clearance of the sequestered treatment zone without significantly impacting vein wall diameter. Results suggest that our novel device using sequestered therapy holds promise for the treatment of high risk large-volume DVTs.
Topics: Acute Disease; Humans; Pulmonary Embolism; Thrombectomy; Venous Thromboembolism; Venous Thrombosis
PubMed: 35351922
DOI: 10.1038/s41598-022-09001-6 -
Journal of Orthopaedic Surgery and... Jun 2021The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence,...
BACKGROUND
The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence, the associated risk factors, and the locations of deep venous thrombosis (DVT) in patients with closed patella fracture.
METHODS
Patients who sustained closed patella fracture between January 1, 2016, and April 1, 2019, were included. Blood analyses and ultrasonography of bilateral lower extremities were routinely performed. Data of demographics, comorbidities, mechanism of injury, fracture type, total hospital stay, time from injury to DVT, and laboratory indexes were prospectively collected and compared between groups with and with non-DVT. Multivariate logistic regression analyses were performed to determine the independent risk factors of DVT.
RESULTS
Among the study cohort of 790 patients, 35 cases occurred in preoperative DVTs, indicating a prevalence of 4.4%, with 3.2% distal and 1.2% proximal DVT. Age ≥ 65 years old (OR, 3.0, 95% CI, 1.1-8.1), D-dimer > 0.5 mg/L (OR, 2.3, 95% CI, 1.1-4.8), and albumin < 35 g/L (OR, 2.5, 95% CI, 1.2-5.3) were identified to be risk factors of DVT in closed patella fracture. Among the DVTs, 30 cases (85.7%) occurred in the injured extremity, 3 cases (8.6%) in bilateral extremities, and 2 cases (5.7%) solely in the uninjured extremity.
CONCLUSION
The prevalence of preoperative DVT in closed patella fracture was 4.4%, with 3.2% for distal and 1.2% for proximal DVT. We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L).
Topics: Aged; Female; Fibrin Fibrinogen Degradation Products; Fractures, Closed; Heart Disease Risk Factors; Humans; Lower Extremity; Male; Middle Aged; Patella; Preoperative Period; Prevalence; Prospective Studies; Risk Assessment; Ultrasonography; Venous Thrombosis
PubMed: 34162417
DOI: 10.1186/s13018-021-02558-4 -
BMC Musculoskeletal Disorders Aug 2023The risks associated with deep vein thrombosis (DVT) have gained significant recognition over time. A prevalent form of distal DVT is isolated calf muscular venous...
BACKGROUND
The risks associated with deep vein thrombosis (DVT) have gained significant recognition over time. A prevalent form of distal DVT is isolated calf muscular venous thrombosis (ICMVT). Despite its common clinical occurrence, data on ICMVT subsequent to tibial plateau fracture (TPF) surgery are scarce. This study aimed to examine the epidemiological characteristics and associated risk factors (RFs) of ICMVT following TPF surgery.
METHODS
For this retrospective analysis, we included patients from our hospital, who underwent TPF surgery between March 2017 and March 2021. Patients' electronic medical records were reviewed, including admission details, fracture classification, surgical procedures, and laboratory biomarkers. The HSS (The American Hospital for Special Surgery) and Rasmussen scores were employed to evaluate the clinical effect. A Color Duplex Flow Imager (CDFI) was regularly used to detect pre- and postoperative venous thrombosis in the lower limbs. Finally, uni- and multivariate logistic regression analyses were used to identify independent RFs associated with ICMVT.
RESULTS
Overall, 481 participants were recruited for analysis. Postoperative ICMVT occurred in 47 patients. All ICMVTs occurred on the affected side. Four of the 47 ICMVT patients exhibited sudden postoperative swelling in the affected limb. The HSS and Rasmussen scores in the non-ICMVT cohort (87.6 ± 8.2, 16.0 ± 1.7) were markedly different from the ICMVT cohort (84.8 ± 8.2, 15.5 ± 1.6) (p = 0.014, p = 0.031). This study finally identified five postoperative ICMVT-related RFs, which were age (> 55 years old) (OR 3.06; 95% CI 1.47-6.37; p = 0.003), gender (female) (OR 2.67; 95% CI 1.37-5.22; p = 0.004), surgical duration (> 114 min) (OR 3.14; 95% CI 1.44-6.85; p = 0.004), elevated white blood cell content (OR 2.85; 95% CI 1.47-5.51; p = 0.002), and hyponatremia (OR 2.31; 95% CI 1.04-5.12; p = 0.040).
CONCLUSION
The epidemiological findings of this study may help predict ICMVT risk after surgery thus facilitating the development of individualized clinical assessments and targeted prevention programs.
Topics: Humans; Female; Middle Aged; Retrospective Studies; Incidence; Tibial Plateau Fractures; Leg; Venous Thrombosis; Thrombosis; Risk Factors; Tibial Fractures
PubMed: 37532980
DOI: 10.1186/s12891-023-06764-5 -
Clinical and Applied... 2023Prophylactic anticoagulation is a standard strategy for patients undergoing total hip arthroplasty (THA) to prevent deep venous thromboembolism (DVT) and pulmonary...
Prophylactic anticoagulation is a standard strategy for patients undergoing total hip arthroplasty (THA) to prevent deep venous thromboembolism (DVT) and pulmonary embolism (PE). Nevertheless, some patients still experience these complications during their hospital stay. Current risk assessment methods like the Caprini and Geneva scores are not specifically designed for THA and may not accurately predict DVT or PE postoperatively. This study used machine learning techniques to establish models for early diagnosis of DVT and PE in patients undergoing THA. Data were collected from 1481 patients who received perioperative prophylactic anticoagulation. Model establishment and parameter tuning were performed using a training set and evaluated using a test set. Among the models, extreme gradient boosting (XGBoost) performed the best, with an area under the receiver operating characteristic curve (AUC) of 0.982, sensitivity of 0.913, and specificity of 0.998. The main features used in the XGBoost model were direct and indirect bilirubin, partial activation prothrombin time, prealbumin, creatinine, D-dimer, and C-reactive protein. Shapley Additive Explanations analysis was conducted to further analyze these features. This study presents a model for early diagnosis DVT or PE after THA and demonstrates bilirubin could be a potential predictor in the assessment of DVT or PE. Compared to traditional risk assessment, XGBoost has a high sensitivity and specificity to predict DVT and PE in the clinical setting. Furthermore, the results of this study were converted into a web calculator that can be used in clinical practice.
Topics: Humans; Arthroplasty, Replacement, Hip; Venous Thrombosis; Pulmonary Embolism; Risk Factors; Anticoagulants
PubMed: 37394825
DOI: 10.1177/10760296231186145 -
Scientific Reports Aug 2021This study aimed to investigate the incidence of and risk factors for postoperative new-onset deep venous thrombosis (PNO-DVT) following intertrochanteric fracture...
This study aimed to investigate the incidence of and risk factors for postoperative new-onset deep venous thrombosis (PNO-DVT) following intertrochanteric fracture surgery. Information on 1672 patients who underwent intertrochanteric fracture surgery at our hospital between January 2016 and December 2019 was extracted from a prospective hip fracture database. Demographic information, surgical data, and preoperative laboratory indices were analysed. Receiver operating characteristic curve analysis, univariate analyses and binary logistic regression analyses were performed. The incidences of postoperative deep venous thrombosis (DVT) and PNO-DVT in inpatients after intertrochanteric fracture surgery were 11.5% (202 of 1751 patients) and 7.4% (123 of 1672 patients), respectively. PNO-DVT accounted for 60.9% of postoperative DVT. Additionally, there were 20 cases of central thrombosis (16.3%), 82 cases of peripheral thrombosis (66.7%), and 21 cases of mixed thrombosis (17.1%). In addition, 82.1% of PNO-DVTs were diagnosed within 8 days after surgery. The multivariate analysis revealed that age > 70 years, duration of surgery (> 197 min), type of anaesthesia (general), and comorbidities (≥ 3) were independent risk factors for the development of PNO-DVT after intertrochanteric fracture surgery. This study demonstrated a high incidence of PNO-DVT in inpatients after intertrochanteric fracture surgery. Therefore, postoperative examination for DVT should be routinely conducted for patients.
Topics: Age Factors; Aged; Aged, 80 and over; Female; Hip Fractures; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Risk Factors; Venous Thrombosis
PubMed: 34453081
DOI: 10.1038/s41598-021-96937-w -
Clinical and Applied... 2023Effects of warfarin and new-generation direct oral anticoagulants (DOACs) on thrombus resolution after the treatment of deep vein thrombosis (DVT) are still unknown. The...
Effects of warfarin and new-generation direct oral anticoagulants (DOACs) on thrombus resolution after the treatment of deep vein thrombosis (DVT) are still unknown. The study aimed to investigate the effects of warfarin and DOACs on thrombus resolution after DVT treatment. The study included 666 patients who were diagnosed with femoropopliteal DVT between January 2016 and January 2022 and had complete medical records without missing data. Patients with and without recanalization were added to groups 1 (n = 396) and 2 (n = 270), respectively. Ultrasonography/venous Doppler examinations of the patients during follow-up were performed by 3 radiologists. Recanalization was defined as the presence of complete flow in the femoral and popliteal veins and the absence of residual venous thrombus. Among the included patients, recanalization was observed in 59.5% patients. The mean follow-up period was 23.6 ± 17.8 (range 1-72; median 17) months. There was no difference between the 2 groups in terms of the types of drugs used in the treatment ( = .208). Cox regression models were used to investigate the factors affecting recanalization. Analysis of the variables having significant differences between both groups revealed the low rate of recanalization in patients with coronary artery disease (odds ratio [OR], 2.3%; 95% confidence intervals [CI]: 1.6-3.4; < .001) and diabetes mellitus (OR, 1.5; 95% CI: 1.1-1.9; = .009). Thrombus resolution after femoropopliteal DVT is not affected by the drugs used in the treatment.
Topics: Humans; Venous Thrombosis; Warfarin; Popliteal Vein; Thrombosis; Ultrasonography; Anticoagulants; Treatment Outcome
PubMed: 37165510
DOI: 10.1177/10760296231173409 -
Journal of Vascular Surgery. Venous and... Jul 2023Patients with severe acute low iliofemoral deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, benefit from catheter-directed thrombolysis (CDT). This... (Meta-Analysis)
Meta-Analysis Review
Effectiveness and safety of catheter-directed thrombolysis in conjunction with percutaneous mechanical thrombectomy for acute iliofemoral deep vein thrombosis: A meta-analysis.
BACKGROUND
Patients with severe acute low iliofemoral deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, benefit from catheter-directed thrombolysis (CDT). This meta-analysis investigated the effectiveness and safety of adjuvant percutaneous mechanical thrombectomy (PMT) during CDT compared with CDT alone in the treatment of acute iliofemoral DVT.
METHODS
A meta-analysis was performed in accordance with the PRISMA guidelines. Medline, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang data were searched for studies on the management of acute iliofemoral DVT by means of CDT or CDT with adjuvant PMT. Randomized, controlled trials and nonrandomized studies were included. The primary outcomes were venous patency rate, major bleeding complications, and post-thrombotic syndrome occurrence within 2 years of the procedure. The secondary outcomes were thrombolytic time and volume, as well as the rates of thigh detumescence and iliac vein stenting.
RESULTS
The meta-analysis included 20 eligible studies with a total of 1686 patients. The rates of venous patency (mean difference, 10.11; 95% confidence interval [CI], 5.59-14.62) and thigh detumescence (mean difference, 3.64; 95% CI, 1.10-6.18) of the adjuvant PMT group were higher than those of the CDT alone group. Compared with CDT alone, the adjuvant PMT group experienced fewer incidences of major bleeding complications (odds ratio, 0.45; 95% CI, 0.26-0.77) and occurrences of post-thrombotic syndrome within 2 years of the procedure (odds ratio, 0.55; 95% CI, 0.33-0.92). Furthermore, the duration of thrombolytic therapy was shorter, and the total dose of administered thrombolytics was lower with adjuvant PMT.
CONCLUSIONS
Adjuvant PMT during CDT is associated with improved clinical outcomes and a lower incidence of major bleeding complications. The studies investigated were, however, single-center cohort studies, and future randomized controlled trials are needed to substantiate these findings.
Topics: Humans; Treatment Outcome; Thrombectomy; Venous Thrombosis; Thrombolytic Therapy; Fibrinolytic Agents; Postthrombotic Syndrome; Catheters; Iliac Vein; Hemorrhage; Retrospective Studies; Mechanical Thrombolysis
PubMed: 36893883
DOI: 10.1016/j.jvsv.2023.01.010 -
Annals of Hematology May 2022
Topics: COVID-19; Humans; Pulmonary Embolism; RNA, Messenger; Vaccination; Venous Thrombosis
PubMed: 35083524
DOI: 10.1007/s00277-021-04743-1 -
BMC Musculoskeletal Disorders May 2022This study aimed to investigate the prevalence of preoperative deep venous thrombosis (DVT) following intertrochanteric fractures in the elderly and identify the...
BACKGROUND
This study aimed to investigate the prevalence of preoperative deep venous thrombosis (DVT) following intertrochanteric fractures in the elderly and identify the associated factors, based on which a risk prediction model was developed.
METHOD
This was a retrospective single-center study of elderly patients presenting with intertrochanteric fractures between our institution between January 2017 and December 2020. Patients' duplex ultrasound (DUS) or venography results were retrieved to evaluate whether they had a preoperative deep venous thrombosis (DVT) of bilateral extremities, whereby patients were dichotomized. Various variables of interest on demographics, comorbidities, injury and biomarkers were extracted and their relationship between DVT were investigated. Statistically significant variables tested in multivariate logistics regression analyses were used to develop a risk prediction model.
RESULTS
There were 855 patients eligible to be included in this study, and 105 were found to have preoperative DVT, with a prevalence rate of 12.3%. Ten factors were tested as significantly different and 2 marginally significant between DVT and non-DVT groups in the univariate analyses, but only 6 demonstrated the independent effect on DVT occurrence, including history of a VTE event (OR, 4.43; 95%CI, 2.04 to 9.62), time from injury to DVT screening (OR, 1.19; 95%CI, 1.13 to 1.25), BMI (OR, 1.11; 95%CI, 1.04-1.18), peripheral vascular disease (OR, 2.66; 95%CI, 1.10 to 6.40), reduced albumin (2.35; 95%CI, 1.48 to 3.71) and D-Dimer > 1.0 mg/L(OR, 1.90; 95%CI, 1.13 to 3.20). The DVT risk model showed an AUC of 0.780 (95%CI, 0.731 to 0.829), with a sensitivity of 0.667 and a specificity of 0.777.
CONCLUSION
Despite without a so high prevalence rate of DVT in a general population with intertrochanteric fracture, particular attention should be paid to those involved in the associated risk factors above. The risk prediction model exhibited the improved specificity, but its validity required further studies to verify.
Topics: Aged; Hip Fractures; Humans; Incidence; Prevalence; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 35509097
DOI: 10.1186/s12891-022-05381-y -
Blood Advances Oct 2021Our understanding of postthrombotic syndrome (PTS) predictors in children is evolving. The present study aimed to investigate differences in patient- and deep vein...
Our understanding of postthrombotic syndrome (PTS) predictors in children is evolving. The present study aimed to investigate differences in patient- and deep vein thrombosis (DVT)-related characteristics between central venous catheter (CVC)-related and non-CVC-related thrombosis in children, as well as early PTS predictors. Children aged 0 to 18 years were prospectively recruited ≥6 months after imaging-proven upper- or lower-extremity DVT. PTS was measured using CAPTSure. Early predictors included age at DVT diagnosis, DVT symptoms, DVT burden, and days on therapeutic anticoagulation within 30 days post-DVT diagnosis. Analysis of predictors was stratified by CVC-related and non-CVC-related thrombosis. Generalized estimating equations were used for data analyses. In total, 313 DVT-affected extremities of 256 patients were assessed; 275 (88%) DVT cases were CVC related. Patients with non-CVC-related thrombosis were older (median age, 5.8 years; 25th-75th percentile, 4.9-6.4 years vs 3.5 months; 25th-75th percentile, 0.7-18.7 months; P < .001) and more likely to have thrombophilia (64% vs 22%; P < .001) and obesity (30% vs 13%; P = .01) than patients with CVC-related thrombosis. CAPTSure scores were 9.5 points higher (standard error, 3.0; P = .02) in the non-CVC-related thrombosis stratum. Age at the time of DVT predicted PTS in both strata; DVT burden and time from DVT diagnosis to PTS assessment predicted PTS in CVC-related thrombosis. In sum, PTS severity was higher in non-CVC-related vs CVC-related thrombosis. Increasing age at the time of DVT was associated with higher PTS severity. DVT burden and time from DVT diagnosis to PTS assessment were significant PTS predictors in CVC-related thrombosis, indicating that long-term follow-up of these children is important.
Topics: Central Venous Catheters; Child; Child, Preschool; Extremities; Humans; Postthrombotic Syndrome; Venous Thrombosis
PubMed: 34474480
DOI: 10.1182/bloodadvances.2021004727