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Supportive Care in Cancer : Official... Jun 2024To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies. (Review)
Review
PURPOSE
To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies.
METHODS
A systematic review of observational studies that evaluated the occurrence of PICC-related venous thrombosis in children, adults, and older people with hematological malignancies was conducted. Searches were carried out on June 12th, 2023 on PubMed, CINAHL, Embase, Web of Science Core Collection, Scopus, and LILACS, and to gray literature on Google Scholar, and ProQuest Dissertations and Theses Global. Eligibility criteria were applied independently by two reviewers, first on the titles and abstracts on the Rayyan platform and then on the full text of eligible studies. Risk of bias was assessed by the JBI checklist. Data were summarized descriptively, and the meta-analysis was carried out using the MetaXL 5.3 software. The review followed JBI guidelines and PRISMA for reporting.
RESULTS
In the 40 studies included, prevalence of PICC-related venous thrombosis was 9% in general, 9% in adults, and 6% in children with hematological malignancies. Most studies only evaluated cases of symptomatic thrombosis (n = 25; 64%).
CONCLUSION
Patients with hematological malignancies using PICC have an estimated prevalence of PICC-related venous thrombosis of 9%, and this rate may be underestimated due to the consideration of mostly symptomatic cases.
Topics: Humans; Hematologic Neoplasms; Prevalence; Catheterization, Peripheral; Venous Thrombosis; Child; Adult; Catheterization, Central Venous
PubMed: 38922487
DOI: 10.1007/s00520-024-08636-7 -
Annals of the Academy of Medicine,... Nov 2023Emicizumab is a bispecific monoclonal antibody that mimics the function of factor VIII by binding to factor IXa and factor X to achieve haemostasis in haemophilia A. The... (Observational Study)
Observational Study
INTRODUCTION
Emicizumab is a bispecific monoclonal antibody that mimics the function of factor VIII by binding to factor IXa and factor X to achieve haemostasis in haemophilia A. The long half-life and subcutaneous mode of administration makes emicizumab a compelling treatment option for bleeding prophylaxis. There is still limited real-world data on its use and management considerations, especially during surgical procedures. The objective of the study is to describe the real-world experience of emicizumab in a cohort of adult and paediatric haemophilia A patients in Singapore, including its use in the periprocedural setting.
METHOD
This was an observational study conducted at the 2 main haemophilia treatment centres in Singapore. All haemophilia A patients who commenced treatment with emicizumab before 1 July 2022 were recruited.
RESULTS
A total of 18 patients with haemophilia A were included in this study. Ten (55.6%) patients had active inhibitors. The median annual bleeding rate for all patients before emicizumab use was 4.5 events (interquartile range [IQR] 2.8-8.3) compared with 0 events (IQR 0-0) after emicizumab was commenced (P=0). There were no adverse events of venous or arterial thrombosis, thrombotic microangiopathy, or death. A total of 6 procedures in 5 patients were performed during the study period with no major bleeding complications.
CONCLUSION
Emicizumab effectively protects against bleeding in haemophilia A patients with and without inhibitors, including in children less than 12 years old. More studies are required to address clinical nuances, such as periprocedural management and the role of immune tolerance in patients with inhibitors on emicizumab.
Topics: Humans; Hemophilia A; Antibodies, Bispecific; Singapore; Antibodies, Monoclonal, Humanized; Adult; Male; Child; Hemorrhage; Adolescent; Middle Aged; Young Adult; Child, Preschool; Female
PubMed: 38920147
DOI: 10.47102/annals-acadmedsg.2023100 -
Minerva Urology and Nephrology Jun 2024The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa)...
The impact of venous thromboembolism before open or minimally-invasive radical cystectomy in the USA: insurance claims data on perioperative outcomes and healthcare costs.
BACKGROUND
The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).
METHODS
Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.
RESULTS
Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.
CONCLUSIONS
Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.
Topics: Humans; Cystectomy; Venous Thromboembolism; Male; Female; United States; Aged; Middle Aged; Postoperative Complications; Urinary Bladder Neoplasms; Health Care Costs; Minimally Invasive Surgical Procedures; Patient Readmission; Retrospective Studies; Preoperative Period
PubMed: 38920012
DOI: 10.23736/S2724-6051.24.05699-4 -
The Archives of Bone and Joint Surgery 2024Deep Vein Thrombosis (DVT) is a significant medical concern characterized by the formation of blood clots within the venous system. Surgical procedures are known to...
OBJECTIVES
Deep Vein Thrombosis (DVT) is a significant medical concern characterized by the formation of blood clots within the venous system. Surgical procedures are known to increase the risk of DVT. While enoxaparin has proven to be highly effective in treating DVT, concerns about bleeding and accurate dosage regulation may restrict its application. Recent research has focused on aspirin's potential in preventing DVT after various surgeries. This study aimed to determine whether aspirin was as effective as enoxaparin in preventing DVT after spine surgery.
METHODS
This randomized controlled trial enrolled study patients who underwent spine surgery at Shahid Kamyab Emergency Hospital in Mashhad, and had a Caprini score > 5, indicating a higher risk of DVT. In the control group, patients received subcutaneous injections of enoxaparin at a dosage of 40 mg, while the intervention group received oral aspirin tablets with a daily dosage of 81 mg. An experienced radiologist performed a Doppler ultrasound of the lower limbs' veins seven days after surgery to diagnose DVT. The outcomes of the two groups were then compared.
RESULTS
A total of 100 patients participated in the clinical trial and were equally assigned to the aspirin and enoxaparin groups. Both groups were homogeneous regarding the basic and clinical characteristics. The incidence of postoperative DVT was 4.0% in the aspirin group and 10.0% in the enoxaparin group (p=0.092). The incidence of hemorrhage was 2.0% in the aspirin group and 4.0% in the enoxaparin group (p=0.610).
CONCLUSION
These findings indicate that aspirin may be a promising alternative to enoxaparin for DVT prevention after surgery, but additional research is essential to validate these results and further assess the benefits and risks associated with aspirin usage in this context.
PubMed: 38919740
DOI: 10.22038/ABJS.2024.74693.3458 -
The Iowa Orthopaedic Journal 2024Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies... (Review)
Review
BACKGROUND
Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies on early pain and function. The purpose of this study is to describe peri-operative management variability among a group of experienced surgeons and review the literature supporting these practice patterns.
METHODS
We surveyed 16 surgeons that perform PAO to document various aspects of peri-operative management at four stages: pre-operative, intra-operative, post-operative in the hospital, and at discharge. Our goal was to report current surgical pain management strategies, adjunct medications, type of anesthesia, deep venous thrombosis and heterotopic ossification prophylaxis strategies, initiation of physical therapy, and use of continuous passive motion (CPM). We reviewed current literature to identify studies supporting these perioperative strategies and identify knowledge gaps that would benefit from further investigation.
RESULTS
Of the 16 surgeons surveyed, 75% had been in practice greater than 10 years and most had not altered their post-operative protocol for more than 3 years. 15/16 surgeons felt that length of stay could be reduced at their institution with improved peri-operative pain management. 6/16 were considering or had already implemented outpatient PAO as a part of their practice. We found significant variability in the pain medications provided at all peri-operative stages. 14/16 utilized general anesthesia, and many utilized epidural or peripheral nerve blocks. 6/16 surgeons utilized surgical field block (also referred to as periarticular block). These surgeons advocated that surgical field block was an effective intervention with no/minimal complication risk. There is very little literature critically evaluating efficacy of these perioperative management strategies for PAO.
CONCLUSION
There is significant practice variability in peri-operative management of PAO surgery. We report various strategies utilized by a group of experienced surgeons and review supporting literature. There are significant knowledge gaps in best surgical pain management strategies, adjunct medications, surgical field blocks, and use of CPM that need further investigation. .
Topics: Humans; Osteotomy; Acetabulum; Perioperative Care; Practice Patterns, Physicians'; Pain Management; Hip Dislocation; Pain, Postoperative
PubMed: 38919350
DOI: No ID Found -
Indian Journal of Thoracic and... Jul 2024Extracorporeal membrane oxygenation (ECMO) plays a crucial role in managing heart and respiratory failure. However, it is associated with complications such as bleeding,...
Extracorporeal membrane oxygenation (ECMO) plays a crucial role in managing heart and respiratory failure. However, it is associated with complications such as bleeding, acute renal failure, neurological issues, and thrombosis. Cerebral venous sinuses thrombosis (CVST) is a rare condition that primarily affects young females, especially those of childbearing age. CVST can result from multiple factors, both congenital and acquired, such as pregnancy, dehydration, oral contraceptives, and the postpartum period. The most common and nonspecific symptom is headache. Notably, the occurrence of CVST during ECMO has not been documented in adult patients. In this case report, we present the case of a 29-year-old lactating mother who was admitted to our hospital with complaints and clinical features indicative of community-acquired pneumonia. Despite conventional treatment, her oxygen requirement increased; therefore, she was placed on veno-venous ECMO (VV ECMO). Her condition gradually improved, and she was extubated while still on ECMO support (Awake ECMO). However, a day later of successful weaning from ECMO, she reported blurred vision and proptosis. Magnetic resonance imaging (MRI) and MR venography (MRV) of the brain showed features suggestive of CVST. She was promptly treated with anticoagulation and later discharged with minimal residual complications. This paper emphasizes the importance of early clinical recognition and treatment with anticoagulants in cases of CVST during ECMO for improved outcomes.
PubMed: 38919201
DOI: 10.1007/s12055-023-01672-8 -
Blood Advances Jun 2024
Topics: Humans; Venous Thrombosis; Intracranial Thrombosis; Animals; Mice; Janus Kinases
PubMed: 38916898
DOI: 10.1182/bloodadvances.2024012977 -
Frontiers in Medicine 2024The COVID-19 pandemic related to SARS-CoV-2 virus was responsible for global pandemic. The severe form of the disease was linked to excessive activation of immune...
BACKGROUND
The COVID-19 pandemic related to SARS-CoV-2 virus was responsible for global pandemic. The severe form of the disease was linked to excessive activation of immune pathways together with a systemic cytokine storm response and thrombotic venous or arterial complications. Factors predicting severe outcomes including venous and/or pulmonary thrombosis (VT) and death were identified, but the prognostic role of their combination was not addressed extensively.
OBJECTIVES
We investigated the role of prognostic factors from the coagulation or inflammatory pathways to better understand the outcome of the disease.
METHODS
For this, we prospectively studied 167 SARS-CoV-2-positive patients from admission in intensive care units (ICU) or emergency departments from four academic hospitals over a 14-month period. Besides standard biology, we assessed serum concentrations of inflammatory markers, coagulation factors and peripheral blood cells immunophenotyping.
RESULTS
Thirty-nine patients (23.3%) developed VT and 30 patients (18%) died. By univariate analysis, C-reactive protein (CRP) level > 150 mg/L, interleukin-6 (IL-6) ≥ 20 pg/mL, D-dimers > 1,500 μg/L, ADAMTS13 activity ≤ 50%, Von.
CONCLUSION
A combination of coagulation and inflammatory markers can refine the prognostication of severe outcome in COVID-19, and could be useful for the initial evaluation of other types of viral infection.
PubMed: 38915768
DOI: 10.3389/fmed.2024.1399335 -
Journal of Vascular Surgery. Venous and... Jun 2024Surgical decompression via transaxillary first rib resection (TFRR) is often performed in patients presenting with venous thoracic outlet syndrome (VTOS). We aimed to...
OBJECTIVE
Surgical decompression via transaxillary first rib resection (TFRR) is often performed in patients presenting with venous thoracic outlet syndrome (VTOS). We aimed to evaluate the outcomes of TFRR based on chronicity of completely occluded axillo-subclavian veins in VTOS.
METHODS
We performed a retrospective institutional review of all patients who underwent TFRR for VTOS and had a completely occluded axillo-subclavian vein between 2003 to 2022. Patients were categorized into three groups based on the time of inciting VTOS event to TFRR acuity of their venous occlusion: <4 weeks, 4-12 weeks and >12 weeks. We evaluated the association of TFRR timing with one-year outcomes including patency and symptomatic improvement. We used Chi-square test to compare baseline characteristics and postoperative outcomes.
RESULTS
Overall, 103 patients underwent TFRR for VTOS with a completely occluded axillo-subclavian vein (median age 30.0 years, 42.7% female, 8.8% non-White), of which 28 patients had occlusion < 4 weeks, 36 patients had occlusion 4-12 weeks, and 39 patients had occlusion >12 weeks. Postoperative venogram performed 2-3 weeks after TFRR demonstrated that 78.6% in the <4 weeks group, 72.2% in the 4-12 weeks group and 61.5% in the >12 weeks group had some degree of recanalization (p=0.76). Postoperative balloon angioplasty was successfully performed in 60 patients with stenosed/occluded axillo-subclavian vein at the time of postoperative venogram. At 10-14-month followup, 79.2% in the <4 weeks group, 73.3% in the 4-12 weeks group, and 73.3% in the >12 weeks group had patent axillo-subclavian veins based on duplex ultrasound (p=0.86). Among patients who underwent postoperative balloon angioplasty, 80.0%, 85.0% and 100% in the <4 weeks, 4-12 weeks and >12 weeks groups respectively demonstrated patency at 10-14 months (p=0.31). Symptomatic improvement was reported in 95.7% in the < 4 weeks group, 96.7% in the 4-12 weeks group and 93.5% in the >12 weeks group (P=0.84).
CONCLUSION
TFRR offers excellent postoperative outcomes for symptomatic VTOS patients, even in cases of completely occluded axillo-subclavian veins, regardless of the chronicity of the occlusion. By 14 months, 95.2% of patients experienced symptomatic improvement, and 75% attained venous patency.
PubMed: 38914374
DOI: 10.1016/j.jvsv.2024.101925 -
Thrombosis and Haemostasis Jun 2024Venous thromboembolism (VTE) is predisposed by thrombotic mutations in patients with hereditary thrombophilia. Although prothrombin deficiencies caused by homozygous or...
BACKGROUND
Venous thromboembolism (VTE) is predisposed by thrombotic mutations in patients with hereditary thrombophilia. Although prothrombin deficiencies caused by homozygous or compound heterozygous mutations are associated with bleeding diathesis, rare cases have shown a correlation between heterozygous prothrombin mutations and thrombosis.
MATERIAL AND METHODS
We surveyed genetic variants involved in thrombosis and hemostasis in 347 patients with unprovoked VTE or having a positive family history of thrombosis. For patients identified with heterozygous prothrombin mutations, we conducted family investigations and performed thrombin generation test (TGT) to elucidate the thrombotic risk. Novel mutants were expressed and subjected to functional assays to clarify the underlying thrombotic mechanisms.
RESULTS
Heterozygous prothrombin mutations were identified in 3.5% of patients (12/347), including three novel mutations Phe382Ser, Phe382Leu and Asp597Tyr found in one patient each, as well as previously reported Arg541Trp mutation in four patients and Arg596Gln mutation in five patients. A total of 42 mutation carriers were identified within the 12 pedigrees, among whom 64.3% (27/42) had experienced thrombotic events. TGT results demonstrated hypercoagulability for carriers of the five mutations, with Arg596Gln showing the highest thrombin generation potential followed by Arg541Trp. The Phe382-associated mutations severely impaired thrombomodulin binding ability of thrombin, resulting in obviously reduced protein C (PC) activation. The Asp597Tyr mutation exhibited a mild reduction in both antithrombin inhibition and PC activation reactions.
CONCLUSIONS
The presence of heterozygous prothrombin mutations represents a potential genetic predisposition for VTE. All thrombosis associated mutations potentiate coagulation activity by either conferring antithrombin resistance and/or impairing PC pathway activity.
PubMed: 38914130
DOI: 10.1055/a-2350-8338