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Thrombotic and Thromboembolic Complications After Vaccination Against COVID-19: A Systematic Review.Cureus Apr 2023Thromboembolic complications after the COVID-19 vaccination have been reported from all over the world. We aimed to identify the thrombotic and thromboembolic... (Review)
Review
Thromboembolic complications after the COVID-19 vaccination have been reported from all over the world. We aimed to identify the thrombotic and thromboembolic complications that can arise after receiving various types of COVID-19 vaccines, their frequency, and distinguishing characteristics. Articles published in Medline/PubMed, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, the Cochrane Library, the CDC database, the WHO database, ClinicalTrials.gov, and servers like medRxiv.org and bioRxiv.org, as well as the websites of several reporting authorities between December 1, 2019, and July 29, 2021, were searched. Studies were included if they reported any thromboembolic complications post-COVID-19 vaccination and excluded editorials, systematic reviews, meta-analyses, narrative reviews, and commentaries. Two reviewers independently extracted the data and conducted the quality assessment. Thromboembolic events and associated hemorrhagic complications after various types of COVID-19 vaccines, their frequency, and distinguishing characteristics were assessed. The protocol was registered at PROSPERO (ID-CRD42021257862). There were 59 articles, enrolling 202 patients. We also studied data from two nationwide registries and surveillance. The mean age of presentation was 47 ± 15.5 (mean ± SD) years, and 71.1% of the reported cases were females. The majority of events were with the AstraZeneca vaccine and with the first dose. Of these, 74.8% were venous thromboembolic events, 12.7% were arterial thromboembolic events, and the rest were hemorrhagic complications. The most common reported event was cerebral venous sinus thrombosis (65.8%), followed by pulmonary embolism, splanchnic vein thrombosis, deep vein thrombosis, and ischemic and hemorrhagic stroke. The majority had thrombocytopenia, high D-dimer, and anti-PF4 antibodies. The case fatality rate was 26.5%. In our study, 26/59 of the papers were of fair quality. The data from two nationwide registries and surveillance revealed 6347 venous and arterial thromboembolic events post-COVID-19 vaccinations. COVID-19 vaccinations have been linked to thrombotic and thromboembolic complications. However, the benefits far outweigh the risks. Clinicians should be aware of these complications because they may be fatal and because prompt identification and treatment can prevent fatalities.
PubMed: 37182082
DOI: 10.7759/cureus.37275 -
Animal Models and Experimental Medicine Oct 2022The association between blood eosinophil (EOS) counts and arterial/venous thrombosis is unclear. We aim to explore whether EOS count is a risk factor for thrombosis. We... (Meta-Analysis)
Meta-Analysis
The association between blood eosinophil (EOS) counts and arterial/venous thrombosis is unclear. We aim to explore whether EOS count is a risk factor for thrombosis. We searched several databases and preprint platforms using core terms 'eosinophil', 'myocardial infarction', 'ischemic stroke', and 'venous thromboembolism' (VTE), among others. Studies comparing the odds ratios (ORs) or risk ratios (RRs) of EOSs with the abovementioned diseases were eligible. Overall, 22 studies were included. A high EOS count was associated with acute coronary artery thrombosis events (OR: 1.23, 95% CI: 1.15-1.32), short-term cerebral infarction and mortality (RR: 2.87, 95% CI: 1.49-5.51). The short-term risk of VTE was more common in patients with EOS-related diseases (RR: 6.52, 95% CI: 2.42-17.54). For coronary artery disease, a high EOS count was a protective factor against 6-month to 1-year mortality (RR: 0.56, 95% CI: 0.45-0.69) but was associated with long-term mortality (RR: 1.64, 95% CI: 1.25-2.14). Therefore, we conclude that for coronary artery thrombosis, EOS count is not associated with AMI events in general population. It may be associated with NSTEMI and STEMI in CAD patients, but more studies are needed to confirm this. In addition, EOS count is associated with an increased risk of both short- and long-term mortality but is not predictive of the composite endpoints. For cerebral artery thrombosis, EOS count may be associated with cerebral infarction and could lead to an increased risk of poor short-term prognosis. For VTEs, EOS count was a risk factor for some patients, especially those with acute-phase EOS-related diseases.
Topics: Humans; Venous Thromboembolism; Venous Thrombosis; Myocardial Infarction; Coronary Thrombosis; Cerebral Infarction
PubMed: 36205251
DOI: 10.1002/ame2.12277 -
Journal of Thrombosis and Haemostasis :... Sep 2016Essentials It is unclear if thrombophilia increases the risk of catheter-associated thrombosis in children. We conducted a meta-analysis on thrombophilia and pediatric... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Essentials It is unclear if thrombophilia increases the risk of catheter-associated thrombosis in children. We conducted a meta-analysis on thrombophilia and pediatric catheter-associated thrombosis. Presence of ≥1 trait confers additional risk of venous thrombosis in children with catheters. Limitations of included studies preclude us from recommending routine thrombophilia testing.
SUMMARY
Background The association between thrombophilia and deep vein thrombosis (DVT) associated with central venous catheter (CVC) use, the most important pediatric risk factor for thrombosis, is unclear in children. Pediatric studies with small sample sizes have reported conflicting results. We sought to evaluate whether, among children with CVCs, thrombophilia increases the risk of CVC-associated DVT (CADVT). Materials and methods We systematically searched MEDLINE, EMBASE, the Web of Science, the Cochrane Central Register for Controlled Trials, PubMed and reference lists for controlled studies published from the inception of the database until September 2015. Included were studies of children aged <21 years with CVCs who were systematically tested for thrombophilic traits that are commonly screened for in clinical practice. Pooled prevalence rates and pooled odds ratios (pORs) of CADVT with thrombophilia were estimated by use of a random effects model. Results We analyzed 16 cohort studies with 1279 children, 277 of whom had CADVT, and with 12 traits tested. There was significant heterogeneity in the included studies. The presence of one or more traits was associated with CADVT (pOR 3.20; 95% confidence interval [CI] 1.56-6.54). Although the prevalence of most traits was < 0.10, children with protein C deficiency, elevated factor VIII levels and the FV Leiden mutation had an increased prevalence of CADVT. The association with thrombophilia seemed to be stronger for symptomatic CADVT (pOR 6.71; 95% CI 1.93-23.37) than for asymptomatic CADVT (pOR 2.14; 95% CI 1.10-4.18). Conclusions On the basis of the low prevalence of specific traits, the relatively weak association with CADVT, and the limitations of the included studies, we cannot recommend routine testing of thrombophilias in children with CADVT.
Topics: Adolescent; Catheterization, Central Venous; Central Venous Catheters; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Infant, Newborn; Male; Odds Ratio; Retrospective Studies; Thrombophilia; Venous Thrombosis; Young Adult
PubMed: 27306795
DOI: 10.1111/jth.13388 -
Journal of Vascular Surgery. Venous and... Nov 2018The objective of this review was to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) with or without catheter-directed thrombolysis (CDT)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this review was to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) with or without catheter-directed thrombolysis (CDT) in the treatment of lower extremity deep venous thrombosis (DVT).
METHODS
We searched PubMed for clinical trials and prospective or retrospective case series (comparative or single-arm studies) that focused on PMT ± CDT in the treatment of DVT, published before March 2, 2017. We meta-analyzed perioperative outcomes and complications and long-term outcomes of this procedure. We also compared the results between PMT ± CDT and CDT alone, using the data from comparative studies.
RESULTS
Overall, 1323 PMT ± CDT patients from 35 studies were included in our study. The rate of patients experiencing successful thrombolysis with a partial or complete lysis rate was 93.4% (95% confidence interval [CI], 90.1%-95.6%) or 67.0% (95% CI, 59.1%-76.4%), respectively. The pooled proportion of 30-day rethrombosis rate was 11.9% (95% CI, 6.7%-20.3%). The 30-day DVT-related mortality was 2.4% (95% CI, 1.6%-3.7%). The perioperative incidence of major bleeding and pulmonary embolism was 4.6% (95% CI, 2.9%-7.3%) and 3.8% (95% CI, 2.5%-6.7%), respectively. During the follow-up, the late rethrombosis rate was 10.7% (95% CI, 8.7%-13.0%; the average follow-up period ranged from 2.8 to 32.1 months). About 15.1% (95% CI, 9.6%-22.9%) of patients developed post-thrombotic syndrome during follow-up (the average follow-up period varied from 3.8 to 29.6 months). In comparing the results of PMT ± CDT with CDT alone, six studies were included (195 patients in the PMT ± CDT group and 193 patients in the CDT group). The partial thrombolysis rate was higher in the PMT ± CDT group (odds ratio [OR], 2.64; 95% CI, 1.34-5.21; P = .005), whereas the complete lysis rate was not (OR, 1.38; 95% CI, 0.87-2.18; P = .17). The difference between the Villalta scores of the two groups during follow-up had no statistical significance (OR, -0.50; 95% CI, -1.34 to 0.34; P = .24). The thrombolytic drug dose in the PMT ± CDT group was much lower than that in the CDT group (standard mean difference, -0.98; 95% CI, -1.59 to -0.38; P = .001), and the procedural time was shorter in the PMT ± CDT group (mean difference, -16.94; 95% CI, -22.38 to -11.50; P < .00,001). There was no significant difference in major bleeding (OR, 1.20; 95% CI, 0.50-2.90; P = .24) or pulmonary embolism (OR, 1.18; 95% CI, 0.16-8.73; P = .87) between the two groups.
CONCLUSIONS
PMT with or without CDT is a relatively effective and safe approach for lower extremity DVT patients because of the acceptable incidence of perioperative complications and satisfying short- or long-term outcomes.
Topics: Adolescent; Adult; Female; Fibrinolytic Agents; Hemorrhage; Humans; Male; Middle Aged; Postthrombotic Syndrome; Pulmonary Embolism; Recurrence; Risk Factors; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome; Venous Thrombosis; Young Adult
PubMed: 30336908
DOI: 10.1016/j.jvsv.2018.08.002 -
Journal of Orthopaedics and... Apr 2022A meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
A meta-analysis.
BACKGROUND
Hip fracture (HF), as common geriatric fracture, is related to increased disability and mortality. Preoperative deep vein thrombosis (DVT) is one of the most common complications in patients with hip fractures, affecting 8-34.9% of hip fracture patients. The study aimed to assess the risk factors of preoperative DVT after hip fractures by meta-analysis.
METHODS
An extensive search of the literature was performed in the English databases of PubMed, Embase, and the Cochrane Library; and the Chinese databases of CNKI and WAN FANG. We collected possible predictors of preoperative DVT from included studies, and data analysis was conducted with RevMan 5.3 and STATA 12.0.
RESULTS
A total of 26 English articles were included, and the rate of DVT was 16.6% (1627 of 9823 patients) in our study. Our findings showed that advanced age [p = 0.0003, OR = 0.13 95% CI (0.06, 0.21)], female patients [p = 0.0009, OR = 0.82 95% CI (0.72, 0.92)], high-energy injury [p = 0.009, OR = 0.58 95% CI (0.38, 0.87)], prolonged time from injury to admission [p < 0.00001, OR = 0.54 95% CI (0.44, 0.65)], prolonged time from injury to surgery [p < 0.00001, OR = 2.06, 95% CI (1.40, 2.72)], hemoglobin [p < 0.00001, OR = - 0.32 95% CI (- 0.43, - 0.21)], coronary heart disease [p = 0.006, OR = 1.25 95% CI (1.07, 1.47)], dementia [p = 0.02, OR = 1.72 95% CI (1.1, 2.67)], liver and kidney diseases [p = 0.02, OR = 1.91 95% CI (1.12, 3.25)], pulmonary disease [p = 0.02, OR = 1.55 95% CI (1.07, 2.23)], smoking [p = 0.007, OR = 1.45 95% CI (1.11, 1.89)], fibrinogen [p = 0.0005, OR = 0.20 95% CI (0.09, 0.32)], anti-platelet drug [p = 0.01, OR = 0.51 95% CI (0.30, 0.85)], C-reactive protein [p = 0.02, OR = 5.95 95% CI (1.04, 10.85)], < 35 g/l albumin [p = 0.006, OR = 1.42 95% CI (1.1, 1.82)], and thrombosis history [p < 0.00001, OR = 5.28 95% CI (2.85, 9.78)] were risk factors for preoperative DVT.
CONCLUSIONS
Many factors, including advanced age, female patients, high-energy injury, prolonged time from injury to admission, prolonged time from injury to surgery, patients with a history of coronary heart disease, dementia, liver and kidney diseases, pulmonary disease, smoking, and thrombosis, fibrinogen, C-reactive protein, and < 35 g/l albumin, were found to be associated with preoperative DVT. Our findings suggested that the patient with above characteristics might have preoperative DVT.
LEVEL OF EVIDENCE
Level III.
Topics: Aged; C-Reactive Protein; Dementia; Female; Fibrinogen; Hip Fractures; Humans; Incidence; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 35391566
DOI: 10.1186/s10195-022-00639-6 -
Journal of Orthopaedics and... Jan 2024Several clinical investigations have compared different pharmacologic agents for the prophylaxis of venous thromboembolism (VTE). However, no consensus has been reached.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several clinical investigations have compared different pharmacologic agents for the prophylaxis of venous thromboembolism (VTE). However, no consensus has been reached. The present investigation compared enoxaparin, fondaparinux, aspirin and non-vitamin K antagonist oral anticoagulants (NOACs) commonly used as prophylaxis following total hip arthroplasty (THA). A Bayesian network meta-analysis was performed, setting as outcomes of interest the rate of deep venous thrombosis (DVT), pulmonary embolism (PE) and major and minor haemorrhages.
METHODS
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. All randomised controlled trials (RCTs) comparing two or more drugs used for the prophylaxis of VTE following THA were accessed. PubMed, Web of Science and Google Scholar databases were accessed in March 2023 with no time constraint.
RESULTS
Data from 31,705 patients were extracted. Of these, 62% (19,824) were women, with age, sex ratio, and body mass index (BMI) being comparable at baseline. Apixaban 5 mg, fondaparinux, and rivaroxaban 60 mg were the most effective in reducing the rate of DVT. Dabigatran 220 mg, apixaban 5 mg, and aspirin 100 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, ximelagatran 2 mg and aspirin 100 mg were associated with the lowest rate of major haemorrhages, while rivaroxaban 2.5 mg, apixaban 5 mg and enoxaparin 40 mg were associated with the lowest rate of minor haemorrhages.
CONCLUSION
Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following THA. Level of evidence Level I, network meta-analysis of RCTs.
Topics: Female; Humans; Male; Arthroplasty, Replacement, Hip; Aspirin; Enoxaparin; Fibrinolytic Agents; Fondaparinux; Hemorrhage; Network Meta-Analysis; Rivaroxaban; Venous Thromboembolism
PubMed: 38194191
DOI: 10.1186/s10195-023-00742-2 -
Journal of Vascular Surgery May 2012The anticoagulant treatment of acute deep venous thrombosis (DVT) has been historically directed toward the prevention of recurrent venous thromboembolism. However, such... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The anticoagulant treatment of acute deep venous thrombosis (DVT) has been historically directed toward the prevention of recurrent venous thromboembolism. However, such treatment imperfectly protects against late manifestations of the postthrombotic syndrome. By restoring venous patency and preserving valvular function, early thrombus removal strategies can potentially decrease postthrombotic morbidity.
OBJECTIVE
A committee of experts in venous disease was charged by the Society for Vascular Surgery and the American Venous Forum to develop evidence-based practice guidelines for early thrombus removal strategies, including catheter-directed pharmacologic thrombolysis, pharmacomechanical thrombolysis, and surgical thrombectomy.
METHODS
Evidence-based recommendations are based on a systematic review and meta-analysis of the relevant literature, supplemented when necessary by less rigorous data. Recommendations are made according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, incorporating the strength of the recommendation (strong: 1; weak: 2) and an evaluation of the level of the evidence (A to C).
RESULTS
On the basis of the best evidence currently available, we recommend against routine use of the term "proximal venous thrombosis" in favor of more precise characterization of thrombi as involving the iliofemoral or femoropopliteal venous segments (Grade 1A). We further suggest the use of early thrombus removal strategies in ambulatory patients with good functional capacity and a first episode of iliofemoral DVT of <14 days in duration (Grade 2C) and strongly recommend their use in patients with limb-threatening ischemia due to iliofemoral venous outflow obstruction (Grade 1A). We suggest pharmacomechanical strategies over catheter-directed pharmacologic thrombolysis alone if resources are available and that surgical thrombectomy be considered if thrombolytic therapy is contraindicated (Grade 2C).
CONCLUSIONS
Most data regarding early thrombus removal strategies are of low quality but do suggest patient-important benefits with respect to reducing postthrombotic morbidity. We anticipate revision of these guidelines as additional evidence becomes available.
Topics: Acute Disease; Evidence-Based Medicine; Fibrinolytic Agents; Humans; Patient Selection; Postthrombotic Syndrome; Risk Assessment; Risk Factors; Thrombectomy; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 22469503
DOI: 10.1016/j.jvs.2011.12.081 -
Frontiers in Surgery 2022To search and obtain the relevant evidence of prevention and management of lower extremity deep venous thrombosis (DVT) after gynecological malignant tumor operation and...
The Best Evidence for the Prevention and Management of Lower Extremity Deep Venous Thrombosis After Gynecological Malignant Tumor Surgery: A Systematic Review and Network Meta-Analysis.
BACKGROUND
To search and obtain the relevant evidence of prevention and management of lower extremity deep venous thrombosis (DVT) after gynecological malignant tumor operation and to summarize the relevant evidence.
METHODS
We searched the JBI evidence summary, up to date, the national comprehensive cancer network of the United States, the guide library of the National Institute of clinical medicine of the United Kingdom, PubMed, the Chinese biomedical literature database, CNKI, Wanfang, and other relevant evidence on the prevention and management of DVT in patients with gynecological malignant tumors. It includes clinical practice guidelines, best practice information book, expert consensus, evidence summary, original research, etc. The retrieval time limit is from database establishment till August 20, 2021. Two researchers independently evaluated the literature quality, combined with professional judgment, and extracted the literature that met the standards.
RESULTS
Finally, 18 literatures were included, including eight guidelines, three evidence summaries, four systematic evaluations, two expert consensuses, and one best practice information volume. A total of 26 pieces of the best evidence on the prevention and management of postoperative venous thrombosis in gynecological malignant tumors were summarized. It includes risk assessment, drug prevention, mechanical prevention, management strategy, and health education.
CONCLUSION
This study summarized the best evidence of risk, prevention, and health management of DVT in postoperative patients with gynecological malignant tumors to provide evidence-based basis for clinical nurses and to improve the nursing level.
PubMed: 35392060
DOI: 10.3389/fsurg.2022.841275 -
Sports Health May 2015Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL...
CONTEXT
Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL reconstruction are not well documented.
OBJECTIVE
To determine the rates of deep vein thrombosis (DVT) and symptomatic pulmonary emboli (PE) after ACL reconstruction.
DATA SOURCES
Five publicly available databases (PubMed, Cochrane Database of Systematic Reviews, Scopus, Embase, and CINAHL Complete) were utilized.
STUDY SELECTION
All studies that screened patients for DVT and reported rates of DVT and PE after ACL reconstruction were eligible for inclusion. Level 5 evidence, cadaver, biomechanical, and basic science studies; studies reporting only multiligament reconstruction outcomes; studies where rates of DVT and PE could not be separated out from patients undergoing other types of arthroscopic knee procedures; and classification studies were excluded.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
All study, subject, and surgical data were analyzed. Descriptive statistics were calculated.
RESULTS
Six studies met the inclusion criteria, with a mean Modified Colman Methodology Score of 30 ± 8.22. A total of 692 patients (488 men [70.5%]; mean age, 31.6 ± 2.82 years; mean follow-up, 7 ± 18.4 months) underwent ACL reconstruction using either semitendinosus-gracilis autograft (77.6%), bone-patellar tendon-bone (BTB) autograft (22%), or allograft (0.4%). No patient received postoperative pharmacological anticoagulation. Fifty-eight patients (8.4%) had a DVT (81% below knee and 19% above knee), while only 1 patient (0.2%) had a symptomatic PE. When reported, 27% of DVT episodes were symptomatic.
CONCLUSION
The rate of DVT after ACL reconstruction in patients who did not receive postoperative pharmacological anticoagulation is 8.4%, while the rate of symptomatic PE is 0.2%. Of the DVT episodes that occurred, 73% were asymptomatic.
PubMed: 26131305
DOI: 10.1177/1941738115576927 -
Journal of Orthopaedics and... May 2023There is a paucity of data regarding the prevalence of preoperative deep vein thrombosis (DVT) in patients with long bone (including femur, tibia and fibula) fractures... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is a paucity of data regarding the prevalence of preoperative deep vein thrombosis (DVT) in patients with long bone (including femur, tibia and fibula) fractures of the lower limbs. We performed a meta-analysis to address the issue.
METHODS
Electronic databases, including PubMed, EMBASE, the Web of Science, the Cochrane Library, the VIP database, CNKI, and the Wanfang database, were systematic searched for original articles that reported the prevalence of preoperative DVT in long bone fractures of the lower limbs from January 2016 to September 2021. The prevalence of preoperative DVT was pooled using random-effects models, and subgroups were established according to study type, detection method, sample size and fracture site.
RESULTS
Twenty-three articles reporting on 18,119 patients were eligible. The overall pooled preoperative DVT prevalence was 24.1% (95% CI 19.3-28.8%). In different subgroups, the preoperative DVT prevalences were 18.2-27.3%, 15.2-28.6%, 23.1-24.9%, 18.2-26.0% and 23.2-23.4% for different study designs, sample sizes, age groups, detection methods and fracture sites, respectively.
CONCLUSIONS
Despite the heterogeneity among studies, this systematic review suggests that the prevalence of preoperative DVT, which may seriously affect the prognosis of patients, is high. Therefore, greater efforts should be devoted to the improvement of screening and prevention strategies for preoperative DVT in lower-extremity long bone fractures.
LEVEL OF EVIDENCE
Level III. Trial Registration The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42022324706.
Topics: Humans; Venous Thrombosis; Prevalence; Fractures, Bone; Lower Extremity; Risk Factors; Retrospective Studies
PubMed: 37156964
DOI: 10.1186/s10195-023-00699-2