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Journal of Vascular and Interventional... Nov 2019Inadvertent arterial placement of central venous catheters carries serious sequelae, including pseudoaneurysm development and stroke. Although numerous strategies for...
Inadvertent arterial placement of central venous catheters carries serious sequelae, including pseudoaneurysm development and stroke. Although numerous strategies for therapeutic repair after arterial injury have been employed, no treatment provides a definitive standard of care. All articles published between January 2000 and July 2018 involving the placement of central venous catheters in the brachiocephalic or subclavian arteries, carotid artery, vertebral artery, and aortic arch and subsequent treatment were systematically reviewed. Arterial repair consisted of manual pressure, endovascular techniques (balloon tamponade, percutaneous closure devices, and covered stent placement), and open surgery. Success rates favored endovascular techniques and surgery over manual compression.
Topics: Algorithms; Arteries; Catheterization, Central Venous; Central Venous Catheters; Clinical Decision-Making; Consensus; Decision Support Techniques; Equipment Design; Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Risk Factors; Treatment Outcome; Vascular System Injuries
PubMed: 31530491
DOI: 10.1016/j.jvir.2019.05.017 -
Brain Hemorrhages Dec 2021In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review... (Review)
Review
INTRODUCTION
In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH).
METHODS
We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria.
RESULTS
The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury.
CONCLUSION
Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.
PubMed: 34786548
DOI: 10.1016/j.hest.2021.11.003 -
Disaster Medicine and Public Health... Feb 2023Among natural disasters, earthquake is associated with heavy fatalities and financial damages, causing considerable mortality. The complications resulting from getting... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Among natural disasters, earthquake is associated with heavy fatalities and financial damages, causing considerable mortality. The complications resulting from getting trapped in rubble, secondary traumas, obligation to reside in temporary shelters, along with other factors such as limited mobility, stress, and dehydration, predispose earthquake survivors to Deep Vein Thrombosis (DVT). The aim of the present study is to investigate the rate of DVT after an earthquake using a systematic review and meta-analysis.
METHODS
To perform the present study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used. The protocol of this review study has been registered in the International Perspective Register of Systematic Review (PROSPERO) with the code of CRD42021290375. Credible data resources including PubMed, Scopus, Web of Science, Science Direct, Google Scholar, Magiran, SID, and Embase were used for extracting relevant studies. Random effect model was used to perform the meta-analysis. I was ritualized to investigate heterogeneity across the studies. Publication bias of studies was evaluated using the Begg test.
RESULTS
In this study, 267 primary studies were identified and extracted. After removing the duplicate ones and the screening, eventually 1 final studies were chosen for the meta-analysis. Based on the meta-analysis results, the total rate of DVT was 9.07% (95% confidence interval [CI]: 7.32-10.81; I = 97.9%; = 0<0.001). Analysis of DVT in the subgroups of the general population and patient survivors were 11.43% (95% CI: 9.06-13.79; I = 98%; = 0<0.001) and 2.51% (95% CI: 0.04-4.63; I = 77.7%; = 0.001). Also, based on the Begg test, the publication bias in the chosen studies was not considerable.
CONCLUSIONS
DVT rate in earthquake survivors is higher compared with other disasters, and over time it finds a growing trend. After earthquake, the focus of rescue and health-care teams is on individuals with observable injuries and damages. Because DVT is first asymptomatic but has fatal consequences, including pulmonary embolism and sudden death, it should be incorporated in health's status assessment of earthquake-stricken people as well as screening and diagnostic programs of health-care providers.
Topics: Humans; Venous Thrombosis; Earthquakes; Pulmonary Embolism; Disasters
PubMed: 36785532
DOI: 10.1017/dmp.2022.268 -
Journal of Orthopaedic Trauma Sep 2017Clinical practice has shifted from therapeutic anticoagulation of any lower extremity venous thromboembolism (VTE) to only thromboses with risk of proximal extension or... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Clinical practice has shifted from therapeutic anticoagulation of any lower extremity venous thromboembolism (VTE) to only thromboses with risk of proximal extension or embolization-clinically important VTE (CIVTE). Isolated operative fractures of the tibia or distal bone of the lower extremity are associated with low-to-intermediate VTE risk, and there is wide variability in the choice to anticoagulate as well as anticoagulant. We sought to evaluate the role for chemoprophylaxis of VTE and CIVTE in these injuries by meta-analysis of Level I evidence.
DATA SOURCES
Articles in English, Chinese, French, and German in MEDLINE, Biosis, and EMBASE from 1988 to 2016.
STUDY SELECTION
Randomized controlled trials describing chemoprophylaxis of VTE after operative management of fractures of the tibia and distal bones. Independent review of 1502 citations yielded 5 studies (1181 patients) meeting inclusion criteria.
DATA EXTRACTION
Chemoprophylaxis regimen, VTE, CIVTE, and major bleeding events were recorded. Study quality was assessed with regard to randomization, outcome assessment allocation and treatment concealment, and commercial funding.
DATA SYNTHESIS
A random-effects model meta-analysis determined that chemoprophylaxis with a low-molecular-weight heparin (LMWH) compared with placebo or no intervention significantly reduced the risk of any VTE [pooled relative risk (RR) = 0.696, 95% confidence interval (0.490-0.989), P = 0.043; homogeneity P = 0.818, I = 0%]. However, chemoprophylaxis with a LMWH compared with placebo did not significantly reduce the risk of CIVTE [RR = 0.865, 95% confidence interval (pooled RR = 0.112-3.863), P = 0.790; homogeneity P = 0.718, I = 0%]. No major bleeding events occurred. Funnel plots did not suggest publication bias. The number needed to treat was 31 patients treated with chemoprophylaxis using a LMWH to prevent 1 VTE and 584 patients to prevent 1 CIVTE.
CONCLUSIONS
Meta-analysis of Level I evidence suggests that routine postoperative anticoagulation after surgical management of an isolated fracture of the tibia or distal bone in patients without risk factors for VTE is unlikely to provide a clinical benefit, based on the absence of a treatment effect for preventing VTE warranting therapeutic anticoagulation.
LEVEL OF EVIDENCE
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Topics: Anticoagulants; Antithrombins; Chemoprevention; Fibula; Fracture Fixation, Internal; Humans; Male; Postoperative Complications; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Tibial Fractures; Treatment Outcome; Venous Thromboembolism
PubMed: 28459774
DOI: 10.1097/BOT.0000000000000873 -
JAMA Nov 2022It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.
Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
IMPORTANCE
It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.
OBJECTIVE
To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions.
DATA SOURCES
PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022.
STUDY SELECTION
English-language randomized clinical trials and prospective cohort studies of fair or good quality.
DATA EXTRACTION AND SYNTHESIS
Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available.
MAIN OUTCOMES AND MEASURES
Morbidity and mortality related to chronic conditions; health-related quality of life.
RESULTS
Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year.
CONCLUSIONS AND RELEVANCE
Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.
Topics: Female; Humans; Advisory Committees; Chronic Disease; Estrogens; Fractures, Bone; Hormone Replacement Therapy; Hormones; Postmenopause; Primary Prevention; Progestins; Prospective Studies; Quality of Life; Risk Assessment; United States; Urinary Incontinence; Venous Thromboembolism
PubMed: 36318128
DOI: 10.1001/jama.2022.18324 -
Medicine May 2019Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime,...
BACKGROUND
Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries.
METHODS
To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes.
RESULTS
Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc).
CONCLUSION
We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.
Topics: Amputation, Surgical; Ankle Brachial Index; Blast Injuries; Blood Vessel Prosthesis; Decompression, Surgical; Emergency Medicine; Extremities; Fasciotomy; Fractures, Bone; Humans; Military Medicine; Military Personnel; Retrospective Studies; Skin Transplantation; Time Factors; Trauma Severity Indices; United States; Vascular Surgical Procedures; Vascular System Injuries
PubMed: 31045795
DOI: 10.1097/MD.0000000000015406 -
Journal of Orthopaedic Trauma 2009Pelvic and acetabular fractures have been identified as risk factors for deep venous thrombosis (DVT) and thromboembolic complications. A systematic review was performed... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Pelvic and acetabular fractures have been identified as risk factors for deep venous thrombosis (DVT) and thromboembolic complications. A systematic review was performed to evaluate the effectiveness of thromboprophylactic strategies to prevent DVT or pulmonary embolism (PE) after pelvic or acetabular fractures.
DATA SOURCES
Relevant articles were identified by searching MEDLINE, MEDLINE In Process & Other Non-indexed Citations, EMBASE, CENTRAL, and the Cochrane Database of Systematic Reviews. All languages and years indexed were searched.
STUDY SELECTION
Manuscripts were included if (1) the study included an intervention or strategy aimed at preventing thromboembolic disease, (2) the subjects in the study had suffered a pelvic or acetabular fracture, and (3) the primary outcome of the study was DVT or PE.
DATA EXTRACTION
The intervention, sample size, DVT, and/or PE incidence, and method of diagnosis were recorded for each study.
DATA SYNTHESIS
Eleven studies with 1760 subjects were included. Included studies were grouped into 5 types of interventions: mechanical compression devices, inferior vena cava filters, low-molecular weight heparins, ultrasound screening, and magnetic resonance venography screening. Most studies were observational designs with minimal control data for comparison. Quantitative pooling was not possible based on significant study heterogeneity.
CONCLUSIONS
Although several strategies have been used to prevent thromboembolism in pelvic and acetabular fracture patients, our results suggest that clinicians have limited data to guide their prophylactic decisions. Well-designed clinical trials to prevent and detect venous thromboembolism in pelvic and acetabular trauma are still needed.
Topics: Acetabulum; Comorbidity; Fibrinolytic Agents; Fractures, Bone; Humans; Incidence; Pelvic Bones; Risk Assessment; Risk Factors; Thrombosis; Treatment Outcome
PubMed: 19390367
DOI: 10.1097/BOT.0b013e3181a5369c -
Health Technology Assessment... Dec 2019Thromboprophylaxis can reduce the risk of venous thromboembolism (VTE) during lower-limb immobilisation, but it is unclear whether or not this translates into meaningful...
BACKGROUND
Thromboprophylaxis can reduce the risk of venous thromboembolism (VTE) during lower-limb immobilisation, but it is unclear whether or not this translates into meaningful health benefit, justifies the risk of bleeding or is cost-effective. Risk assessment models (RAMs) could select higher-risk individuals for thromboprophylaxis.
OBJECTIVES
To determine the clinical effectiveness and cost-effectiveness of different strategies for providing thromboprophylaxis to people with lower-limb immobilisation caused by injury and to identify priorities for future research.
DATA SOURCES
Ten electronic databases and research registers (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, the Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluation Database, Science Citation Index Expanded, ClinicalTrials.gov and the International Clinical Trials Registry Platform) were searched from inception to May 2017, and this was supplemented by hand-searching reference lists and contacting experts in the field.
REVIEW METHODS
Systematic reviews were undertaken to determine the effectiveness of pharmacological thromboprophylaxis in lower-limb immobilisation and to identify any study of risk factors or RAMs for VTE in lower-limb immobilisation. Study quality was assessed using appropriate tools. A network meta-analysis was undertaken for each outcome in the effectiveness review and the results of risk-prediction studies were presented descriptively. A modified Delphi survey was undertaken to identify risk predictors supported by expert consensus. Decision-analytic modelling was used to estimate the incremental cost per quality-adjusted life-year (QALY) gained of different thromboprophylaxis strategies from the perspectives of the NHS and Personal Social Services.
RESULTS
Data from 6857 participants across 13 trials were included in the meta-analysis. Thromboprophylaxis with low-molecular-weight heparin reduced the risk of any VTE [odds ratio (OR) 0.52, 95% credible interval (CrI) 0.37 to 0.71], clinically detected deep-vein thrombosis (DVT) (OR 0.40, 95% CrI 0.12 to 0.99) and pulmonary embolism (PE) (OR 0.17, 95% CrI 0.01 to 0.88). Thromboprophylaxis with fondaparinux (Arixtra, Aspen Pharma Trading Ltd, Dublin, Ireland) reduced the risk of any VTE (OR 0.13, 95% CrI 0.05 to 0.30) and clinically detected DVT (OR 0.10, 95% CrI 0.01 to 0.94), but the effect on PE was inconclusive (OR 0.47, 95% CrI 0.01 to 9.54). Estimates of the risk of major bleeding with thromboprophylaxis were inconclusive owing to the small numbers of events. Fifteen studies of risk factors were identified, but only age (ORs 1.05 to 3.48), and injury type were consistently associated with VTE. Six studies of RAMs were identified, but only two reported prognostic accuracy data for VTE, based on small numbers of patients. Expert consensus was achieved for 13 risk predictors in lower-limb immobilisation due to injury. Modelling showed that thromboprophylaxis for all is effective (0.015 QALY gain, 95% CrI 0.004 to 0.029 QALYs) with a cost-effectiveness of £13,524 per QALY, compared with thromboprophylaxis for none. If risk-based strategies are included, it is potentially more cost-effective to limit thromboprophylaxis to patients with a Leiden thrombosis risk in plaster (cast) [L-TRiP(cast)] score of ≥ 9 (£20,000 per QALY threshold) or ≥ 8 (£30,000 per QALY threshold). An optimal threshold on the L-TRiP(cast) receiver operating characteristic curve would have sensitivity of 84-89% and specificity of 46-55%.
LIMITATIONS
Estimates of RAM prognostic accuracy are based on weak evidence. People at risk of bleeding were excluded from trials and, by implication, from modelling.
CONCLUSIONS
Thromboprophylaxis for lower-limb immobilisation due to injury is clinically effective and cost-effective compared with no thromboprophylaxis. Risk-based thromboprophylaxis is potentially optimal but the prognostic accuracy of existing RAMs is uncertain.
FUTURE WORK
Research is required to determine whether or not an appropriate RAM can accurately select higher-risk patients for thromboprophylaxis.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42017058688.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Anticoagulants; Cost-Benefit Analysis; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Lower Extremity; Quality-Adjusted Life Years; Technology Assessment, Biomedical; Treatment Outcome; Venous Thromboembolism; Venous Thrombosis
PubMed: 31851608
DOI: 10.3310/hta23630 -
Medicine Dec 2017Bazedoxifene may be promising to treat osteoporosis of postmenopausal women. We conducted a systematic review and meta-analysis to explore the efficacy and safety of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Bazedoxifene may be promising to treat osteoporosis of postmenopausal women. We conducted a systematic review and meta-analysis to explore the efficacy and safety of bazedoxifene in postmenopausal women with osteoporosis.
METHODS
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of bazedoxifene on osteoporosis of postmenopausal women were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were vertebral fracture and spine BMD at 3 and 7 years.
RESULTS
Four RCTs are included in the meta-analysis. Overall, compared with placebo intervention in postmenopausal women with osteoporosis, bazedoxifene intervention can significantly reduce the risk of vertebral fracture [risk risks (RRs) = 0.69; 95% confidence interval (95% CI) = 0.52-0.93; P = .01], and increase spine BMD at 3 years (Std. mean difference = 1.71; 95% CI = 1.55-1.87; P < .005) and 7 years (Std. mean difference = 8.31; 95% CI = 8.07-8.55; P < .005). Bazedoxifene intervention results in no increase in adverse events (RR = 1.00; 95% CI = 0.99-1.00; P = .34), serious adverse events (RR = 1.04; 95% CI = 0.97-1.12; P = .31), myocardial infarction (RR = 0.88; 95% CI = 0.51-1.52; P = .64), stroke (RR = 0.97; 95% CI = 0.64-1.46; P = .87), venous thromboembolic event (RR = 1.56; 95% CI = 0.92-2.64; P = .10), and breast carcinoma (RR = 1.03; 95% CI = 0.59-1.79; P = .92).
CONCLUSIONS
Compared with placebo intervention for the osteoporosis of postmenopausal women, bazedoxifene intervention is found to significantly reduce the incidence of vertebral fracture and increase spine BMD at 3 and 7 years, and results in no increase in adverse events, serious adverse events, myocardial infarction, stroke, venous thromboembolic event, and breast carcinoma.
Topics: Bone Density; Bone Density Conservation Agents; Female; Humans; Indoles; Middle Aged; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Randomized Controlled Trials as Topic; Spinal Fractures; Spine; Time Factors; Treatment Outcome
PubMed: 29245225
DOI: 10.1097/MD.0000000000008659 -
Clinical Neurology and Neurosurgery Dec 2018Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to...
Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: A prospective observational study and systematic review of the literature.
OBJECTIVES
Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation.
PATIENTS AND METHODS
A 1-year prospective analysis of consecutive patients with severe TBI admitted to a Level-I trauma centre was conducted. In addition, we systematically reviewed the literature to identify studies on VTE and anticoagulant prophylaxis after severe TBI.
RESULTS
64 severe TBI patients were included. 83% of patients received anticoagulant prophylaxis, initiated ≥3d post-TBI in 67%. The in-hospital VTE incidence was 16% and there was no significant difference between patients who received early (<3d) versus late (≥3d) prophylaxis (10% vs. 16%). Rates of ICH progression (0% vs. 7%) were similar between groups. Our systematic review identified 5 studies with VTE rates ranging from 5 to 10% with prophylaxis, to 11-30% without prophylaxis. The effect of timing of anticoagulant prophylaxis initiation on ICH progression was not reported in any study.
CONCLUSION
VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Brain Injuries, Traumatic; Female; Humans; Male; Middle Aged; Post-Exposure Prophylaxis; Prospective Studies; Severity of Illness Index; Treatment Outcome; Venous Thromboembolism; Young Adult
PubMed: 30384119
DOI: 10.1016/j.clineuro.2018.09.032