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Clinical and Applied... 2022To analyze the relationship between monocyte count and preoperative deep venous thrombosis (DVT) in older patients with hip fracture.
PURPOSE
To analyze the relationship between monocyte count and preoperative deep venous thrombosis (DVT) in older patients with hip fracture.
METHODS
Consecutive older patients with hip fracture undergoing surgery were included from January 2014 to December 2021. Monocyte count was measured on admission, and Doppler ultrasonography was performed for DVT screening prior to surgery. Univariate and multivariate logistic regression analyses were used to assess the association between monocyte count and DVT.
RESULTS
A total of 674 patients were finally included, and 128 patients (19.0%) were diagnosed with preoperative DVT. Patients with DVT exhibited a higher monocyte count than patients without DVT [0.55 (0.43-0.72) × 10/L versus 0.49 (0.38-0.63) × 10/L, = 0.007]. Multivariate logistic regression analysis showed that a high monocyte count (> 0.6 × 10/L) was independently associated with a higher risk of DVT (OR = 1.705, 95% : 1.121-2.593, = 0.013), and for every 0.1 × 10/L increase in monocyte count, the risk of DVT increased by 8.5% (OR = 1.085, 95% : 1.003-1.174, = 0.041). Other risk factors associated with DVT included intertrochanteric fracture (OR = 1.596, 95% : 1.022-2.492, = 0.040), and elevated fibrinogen level (OR = 1.236, 95% : 1.029-1.484, = 0.023).
CONCLUSION
A high monocyte count is associated with an increased risk of DVT in older patients with hip fracture. Future studies should evaluate the potential role of monocyte in the prevention and treatment of thrombosis.
Topics: Aged; Hip Fractures; Humans; Incidence; Monocytes; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 35538853
DOI: 10.1177/10760296221100806 -
Journal of Ultrasound in Medicine :... Jul 2021Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit.... (Observational Study)
Observational Study
OBJECTIVES
Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit. Reported findings indicate that a direct viral-mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID-19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID-19 who developed PE.
METHODS
In this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID-19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound.
RESULTS
The study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54-73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%-11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low-molecular-weight heparin. Patients without DVT had higher median d-dimer levels: 25,688 μg/dL (interquartile range, 80,000-1210 μg/dL) versus 5310 μg/dL (P < .05).
CONCLUSIONS
Our study showed a low incidence of DVT in a cohort of patients with COVID-19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.
Topics: COVID-19; Female; Humans; Incidence; Inflammation; Male; Middle Aged; Pulmonary Embolism; Risk Factors; SARS-CoV-2; Thrombosis; Venous Thrombosis
PubMed: 33017480
DOI: 10.1002/jum.15524 -
European Journal of Vascular and... Feb 2023
Topics: Humans; Venous Thrombosis; Postthrombotic Syndrome; Iliac Vein; Thrombolytic Therapy; Treatment Outcome
PubMed: 36343750
DOI: 10.1016/j.ejvs.2022.11.012 -
Journal of Vascular Surgery. Venous and... Mar 2020There is an inter-relationship between thrombosis and inflammation. Previously, we have shown the importance of P-selectin in thrombogenesis and thrombus resolution in...
OBJECTIVE
There is an inter-relationship between thrombosis and inflammation. Previously, we have shown the importance of P-selectin in thrombogenesis and thrombus resolution in many preclinical animal models. The role of E-selectin has been explored in rodent models and in a small pilot study of clinical calf vein deep venous thrombosis. The purpose of this study was to determine the role of E-selectin in thrombosis in a primate model of proximal iliac vein thrombosis, a model close to the human condition.
METHODS
Iliac vein thrombosis was induced with a well-characterized primate model. Through a transplant incision, the hypogastric vein and iliac vein branches were ligated. Thrombus was induced by balloon occlusion of the proximal and distal iliac vein for 6 hours. The balloons were then deflated, and the primates recovered. Starting on postocclusion day 2, animals were treated with the E-selectin inhibitor GMI-1271, 25 mg/kg subcutaneously, once daily until day 21 (n = 4). Nontreated control animals received no treatment (n = 5). All animals were evaluated by magnetic resonance venography (MRV); evaluation of vessel area by ultrasound, protein analysis, hematology (complete blood count), and coagulation tests (bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen, and thromboelastography) were performed at baseline, day 2, day 7, day 14, and day 21 with euthanasia. In addition, platelet function and CD44 expression on leukocytes were determined.
RESULTS
E-selectin inhibition by GMI-1271 significantly increased vein recanalization by MRV vs control animals on day 14 (P < .05) and day 21 (P < .0001). GMI-1271 significantly decreased vein wall inflammation by MRV with gadolinium vein wall enhancement vs control also on day 14 (P < .0001) and day 21 (P < .0001). The thromboelastographic measure of clot strength (maximum amplitude) showed significant decreases in animals treated with GMI-1271 vs controls at day 2 (P < .05) and day 7 (P < .05). Animals treated with GMI-1271 had significant vessel area increase by day 21 vs controls (P < .05) by ultrasound. Vein wall intimal thickening (P < .001) and intimal fibrosis (P < .05) scores were significantly decreased in GMI-1271-treated animals vs controls. Importantly, no significant differences in hematology or coagulation test results were noted between all groups, suggesting that E-selectin inhibition carries no bleeding potential. GMI-1271 did not affect platelet function or aggregation or CD44 expression on leukocytes. In addition, no episodes of bleeding were noted in either group.
CONCLUSIONS
This study suggests that E-selectin modulates venous thrombus progression and that its inhibition will increase thrombus recanalization and decrease vein wall inflammation, without affecting coagulation. The use of an E-selectin inhibitor such as GMI-1271 could potentially change how we treat deep venous thrombosis.
Topics: Animals; Anti-Inflammatory Agents; Disease Models, Animal; E-Selectin; Fibrinolytic Agents; Glycolipids; Iliac Vein; Papio; Signal Transduction; Venous Thrombosis
PubMed: 32067728
DOI: 10.1016/j.jvsv.2019.08.016 -
Journal of Vascular Surgery. Venous and... May 2020The most frequent complication of deep venous thrombosis (DVT) is post-thrombotic syndrome (PTS). We recently showed inhibition of varicose vein development by...
OBJECTIVE
The most frequent complication of deep venous thrombosis (DVT) is post-thrombotic syndrome (PTS). We recently showed inhibition of varicose vein development by atorvastatin and rosuvastatin. The aim of this study was to test the influence of lipid-lowering therapy with statins on PTS development.
METHODS
All patients between January 2002 and June 2018 with diagnosed DVT were enrolled in this study and analyzed retrospectively. Documentation was performed using the standardized system M1 (CompuGroup Medical, Koblenz, Germany) throughout the observation period. Patients received therapeutic anticoagulation and compression stockings. In case of recurrent DVT, patients received lifelong therapeutic anticoagulation. All patients received clinical examination and duplex ultrasound evaluation 3 to 6 months after primary diagnosis and annually thereafter.
RESULTS
A total of 579 patients with DVT were enrolled in this study. Of these patients, 414 (71%) developed PTS (337/414 [81%] presented with the mild version; mean Villalta score, 5.79). Risk factors for PTS development were recurrent DVT (P = .001) and malignant disease (P = .001). Protective factors were therapy with platelet aggregation inhibitors (P = .049) and lipid-lowering therapy with statins (P = .001). After multivariable analysis, the only risk factor was recurrent DVT (P = .001), and the only protective factor was lipid-lowering therapy (P = .001).
CONCLUSIONS
Post-thrombotic changes might be reduced by lipid-lowering therapy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Germany; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Incidence; Male; Middle Aged; Platelet Aggregation Inhibitors; Postthrombotic Syndrome; Prognosis; Protective Factors; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Venous Thrombosis; Young Adult
PubMed: 31843481
DOI: 10.1016/j.jvsv.2019.10.012 -
Journal of Thrombosis and Haemostasis :... Apr 2023Postthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) in children.
BACKGROUND
Postthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) in children.
OBJECTIVES
We aimed to assess the impact of pediatric PTS on functioning as assessed by movement ability, mobility, functional disability, and physical activity levels in children after diagnosis of limb DVT.
METHODS
Patients aged 8-21 years in follow-up care after objectively documented limb DVT were prospectively recruited in this cross-sectional study. Measures of functioning (outcomes) included self-reported questionnaires that assessed: 1) movement ability, measured with the Movement Ability Measure-Computer Adaptive Test version; 2) mobility, evaluated with the Computer Adaptive Test version of the Patient-Reported Outcomes Measurement Information System Pediatric Physical Functioning, Mobility domain; 3) functional disability, evaluated with the Functional Disability Inventory; and 4) physical activity levels, evaluated with the Godin Leisure-Time Exercise Questionnaire. The main predictor was PTS severity, which was assessed using the index for the Clinical Assessment of PTS in children. The association between PTS and outcomes was analyzed using linear models.
RESULTS
Eighty-seven patients (median age, 16 years; 25th-75th percentile, 15-18 years; 56% boys) were enrolled. Adjusted for age, sex, and underlying condition, increasing PTS severity was associated with lower current movement ability, a wider gap between current vs preferred movement ability, lower mobility, and slightly higher functional disability scores. There was a nonsignificant effect of PTS severity on moderate-strenuous physical activity.
CONCLUSION
In children, increased PTS severity is associated with lower movement ability and impaired mobility. Reducing the gap between the patients' current vs preferred movement ability is a relevant aspect of PTS management in children.
Topics: Male; Humans; Child; Adolescent; Female; Postthrombotic Syndrome; Venous Thrombosis; Cross-Sectional Studies; Surveys and Questionnaires; Extremities
PubMed: 36739234
DOI: 10.1016/j.jtha.2023.01.004 -
Journal of the American College of... Jan 2020
Topics: Heart Failure; Humans; Pulmonary Embolism; Venous Thromboembolism; Venous Thrombosis
PubMed: 31948644
DOI: 10.1016/j.jacc.2019.11.028 -
JAMA Network Open Mar 2022Previous venous thrombosis (VT) is associated with risk of future VT, but quantification of risk over the life course is poorly understood. More information is needed...
IMPORTANCE
Previous venous thrombosis (VT) is associated with risk of future VT, but quantification of risk over the life course is poorly understood. More information is needed for clinicians to understand the association of remote history of VT with the risk of VT in older patients.
OBJECTIVE
To assess the association between a remote history of VT and the development of VT in older age.
DESIGN, SETTING, AND PARTICIPANTS
The Age and Thrombosis, Acquired and Genetic Risk Factors in the Elderly case-control study enrolled patients 70 years and older with VT and control individuals 70 years and older without VT between June 2008 and August 2011. The Age and Thrombosis, Acquired and Genetic Risk Factors in the Elderly study is a 2-center, population-based case-control study that was conducted in Burlington, Vermont, in the US and in Leiden, the Netherlands. Consecutively diagnosed patients with an objectively proven episode of VT (deep vein thrombosis of the leg or pulmonary embolism) were included. Control individuals were identified in the same geographic areas as the patients and were randomly selected. Data were analyzed between May 2021 and October 2021.
EXPOSURES
Self-reported remote VT (occurring >10 years before to enrollment).
MAIN OUTCOMES AND MEASURES
The main outcome was the risk of VT at older age. The association of self-reported history of remote VT with VT at older age was assessed by calculating odds ratios (ORs) as estimates of relative risk with 95% CIs.
RESULTS
A total of 460 patients with VT and 456 control participants were included. There were slightly more women than men in both groups (60.2% of patients [n = 277] were women and 52.4% of control participants [n = 239] were women), and the mean (range) age of patients was 78.7 (70.0-100.9) years, which was similar to the control participants. Compared with individuals without remote VT, those with a remote history of VT had an increased risk of VT (OR, 2.54; 95% CI, 1.56-4.13). The crude risk estimate was robust to adjustment and time since remote VT, that is, individuals with a VT 10 to 30 years ago (OR, 2.74; 95% CI, 1.34-5.57) and those with a VT more than 30 years ago (OR, 2.42; 95% CI, 1.21-4.84) had a an increased risk of VT. The population-attributable fraction of a remote history of VT was 7.7%.
CONCLUSIONS AND RELEVANCE
In this study, a remote history of VT was associated with risk of VT in older individuals. This quantification could assist clinicians in advising patients on VT prevention.
Topics: Aged; Aged, 80 and over; Case-Control Studies; Female; Humans; Male; Risk Factors; Venous Thrombosis
PubMed: 35333359
DOI: 10.1001/jamanetworkopen.2022.4205 -
The Journal of Thoracic and... Mar 2020Deep vein thrombosis (DVT) remains a common complication following lung transplantation despite universal routine DVT screening. Moreover, many of the previously...
BACKGROUND
Deep vein thrombosis (DVT) remains a common complication following lung transplantation despite universal routine DVT screening. Moreover, many of the previously reported risk factors are incompletely defined. We sought to explore the influence of DVT screening and to more definitively assess predisposing risk factors.
METHODS
A single-institution, retrospective, cohort study of 1141 patients undergoing lung transplantation from January 1, 2005, to December 31, 2014, was performed evaluating for the rate of DVT. Patients were given prophylactic subcutaneous heparin postoperatively. DVT events were noted if they occurred before 90 days after transplant. We compared DVT rates before and after 2008 when universal screening was implemented. We also evaluated the timing of DVT event and location (above the knee vs below the knee). DVTs were treated with standard anticoagulation therapy or an inferior cava filter when patients were unable to tolerate anticoagulation treatment. Univariable and multivariable models were used to identify risk factors for occurrence. A propensity match was performed to match groups across the eras, and a Cox regression was performed to identify differences in 1-year survival trajectory between cohorts.
RESULTS
The rates of DVT before and after routine screening were 8.8% (36 DVT out of 412 transplants) and 17.3% (126 out of 729 transplants), respectively. These 2 rates were significantly different (P < .01); moreover, the observed DVT incidence per year was not significantly different across the 6 years after universal DVT screening was implemented (P > .90 for all comparisons). Observed DVT incidence at day 0 and day 14 were 3.8% and 3.8%, respectively, for the cohort before DVT protocols were established. Observed DVT incidence for the cohort after protocols were established at the same time points was 8.7% and 3.7%, respectively. Univariable analysis revealed that significant factors associated with a DVT include hypercholesterolemia (odds ratio [OR], 6.90; 95% confidence interval [CI], 1.82-26.13; P < .01), the number of days in the intensive care unit (OR, 1.03; 95% CI, 1.00-1.01; P < .01), and the length of stay in the hospital (OR, 1.01; 95% CI, 1.01-1.02; P < .01), whereas having quit smoking (vs never smoked) was associated with a decrease in DVT development (OR, 0.50; 95% CI, 0.33-0.75; P < .01). Multivariable analysis revealed 2 significant variables: hypercholesterolemia (OR, 8.13; 95% CI, 1.22-54.37; P = .03) and length of stay (OR, 1.03; 95% CI, 1.01-1.05; P < .01). There was a trend for better 1-year survival in the post-2008 era (Exp[β], 1.49; P = .09).
CONCLUSIONS
The rate of DVT diagnosis significantly increased after universal DVT screening was implemented. Furthermore, those patients undergoing lung transplantation with extended length of stay and hypercholesterolemia were prone to increased rates of DVT. There was a trend toward better 1-year survival in DVT-screened patients, suggesting DVT screening may result in beneficial outcomes.
Topics: Adult; Aged; Anticoagulants; Drug Administration Schedule; Female; Heparin; Humans; Hypercholesterolemia; Incidence; Length of Stay; Lung Transplantation; Male; Mass Screening; Middle Aged; Pennsylvania; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vena Cava Filters; Venous Thrombosis
PubMed: 31839224
DOI: 10.1016/j.jtcvs.2019.08.030 -
Journal of Vascular Surgery. Venous and... Mar 2020Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence...
BACKGROUND
Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence guidelines suggest that this can be reduced by prompt thrombolytic therapy or thrombectomy. We aimed to evaluate the characteristics of IFDVT patients and to identify whether patients are being offered the recommended treatment pathway.
METHODS
A multicenter cross-sectional study was conducted across eight hospital sites in the North West London region, of which two were hub hospitals in their local vascular service networks. Patients with proximal DVT were identified using International Classification of Diseases, Tenth Revision coding during a 1-year period. Data on demographics, diagnostic methods used, interventions, and referrals were extracted from electronic and paper medical records.
RESULTS
During the study period, 132 patients with IFDVT were identified (mean age, 59.4 years; 55% female); 75% of these patients had an IFDVT. In this cohort, the biggest predisposing factors were previous DVT (n = 35), malignant disease (n = 35), and immobility (n = 20). In total, 104 patients were administered anticoagulation, and 88 of these patients received anticoagulation within 24 hours. The cases of 45 patients were either discussed with or promptly referred to a vascular service, after which 20 patients were treated solely with anticoagulation, whereas 20 patients received thrombolysis of varying methods.
CONCLUSIONS
A significant proportion (56%) of symptomatic IFDVT patients are not being appropriately referred to or discussed with vascular services. Of these, 43% would have been eligible for consideration of early thrombus removal. Adherence to the National Institute for Health and Care Excellence guidelines could be improved by increasing awareness among emergency department colleagues.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Cross-Sectional Studies; Female; Femoral Vein; Guideline Adherence; Humans; Iliac Vein; London; Male; Middle Aged; Postthrombotic Syndrome; Practice Guidelines as Topic; Practice Patterns, Physicians'; Referral and Consultation; Thrombolytic Therapy; Time Factors; Treatment Outcome; Venous Thrombosis
PubMed: 31327742
DOI: 10.1016/j.jvsv.2019.04.011