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Chylous leakage is an uncommon and serious clinical condition, especially occurring after retroperitoneal operations. Here, we report a case of cervical chylous leakage combined with chylothorax in a 57‐year‐old woman postretroperitoneal surgery, and our conservative approach led to resolution/clinical improvement. The causes of this rare complication are discussed. We considered that the venous thrombosis, the increased intra‐abdominal pressure, or the patient positioning during the surgery may lead to the chylous particles leakage and chylothorax. Because of its rarity, we hope this case report will improve clinicians' understanding of cervical chylous leakage combined with chylothorax and provide suitable treatment options for future clinical reference. [ABSTRACT FROM AUTHOR]

The article discusses a multicentre study on the impact of cigarette smoking on Behcet's disease outcomes. The study included 445 Behcet's disease patients and found that smoking was associated with higher disease severity and visual impairment. Despite no significant difference in disease activity or remission rates between smokers and non-smokers, smokers had more severe damage. The study highlights the importance of considering smoking as a factor in managing Behcet's disease. [Extracted from the article]

Background: Patients with spinal cord injury (SCI) are at higher risk of developing pulmonary infection (PI), and plasma fibrinogen level may be an independent risk factor for PI. However, the relationship between fibrinogen level and PI incidence in the SCI population remains unclear. This study aimed to elucidate the association between plasma fibrinogen level and the occurrence of PI among SCI patients. Methods: We conducted a retrospective analysis of 576 SCI patients admitted to the Rehabilitation Medicine Department between January 1, 2017, and December 31, 2021. Following exclusions, 491 patients were included in the final analysis, with 139 PI cases identified. Results: Surgery, level of injury and chest comorbidities were covariates in the relationship between fibrinogen level and PI incidence. Other identified potential risk factors for PI included age, D-dimer level, urinary tract infections (UTI), deep vein thrombosis (DVT), anticoagulant therapy, injury mechanism, and the American Spinal Injury Association Impairment Scale (AIS) grades. After adjusting for these factors, we found that for every 1 g/L increase in fibrinogen level, the risk of developing PI increased by 18% (HR = 1.18, P = 0.011), and indicating a positive linear relationship between fibrinogen level and PI incidence. Conclusion: Plasma fibrinogen was an independent risk factor for PI in patients with SCI, especially for AIS-B and C grades. Proactive management of fibrinogen level after admission to rehabilitation medicine department could be crucial in reducing the incidence of PI in this vulnerable population. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical features and outcomes of patients with lower extremity deep vein thrombosis in different affected limbs. Methods: The medical records of 80 patients with deep venous thrombosis of lower extremity were reviewed, and the clinical characteristics and prognosis of thrombosis under different treatment conditions were analyzed. Results: The proportion of thrombus in both lower limbs was 18.75% (15/80) and 81.25% (65/80) in non-both lower limbs. Double lower extremities thrombosis patients aged 60 or higher, injury to operating time 7 d or higher, hemoglobin, albumin, red blood cell volume than in the lower extremities thrombosis is high, short part activated clotting time live enzymes (P<0.05). There were differences in the treatment plan between patients with bilateral and non-bilateral deep vein thrombosis, and there were differences in the proportion of patients with and without bilateral deep vein thrombosis in the treatment outcome (Pall <0.05). Treatment time of 15 d or thrombosis better/disappear is higher than obviously less treatment group (P<0.05). Conclusion: The incidence of deep vein thrombosis of both lower extremities was 18.75%. The age ≥ 60 years old, the time from injury to operation ≥ 7 days, activated partial thromboplasmosis time, hemoglobin, albumin, and hematocrit were higher. The prevention and treatment of deep vein thrombosis of lower extremities should be paid attention to in clinical practice. And it is recommended that the anticoagulation course ≥ 15 d. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this risk, such as heparin, intermittent pneumatic compression (IPC), and graduated compression stockings (GCS). The optimal thromboembolic prophylaxis approach remains uncertain due to the lack of randomized controlled trials (RCTs) comparing all interventions. Aims: We conducted a network meta-analysis and meta-analysis to systematically review and synthesize evidence from RCTs and non-randomized studies on the efficacy and safety of thromboembolic prophylaxis strategies in hospitalized ICH patients. Summary of findings: Our study followed a registered protocol (PROSPERO CRD42023489217) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines incorporating the extension for network meta-analyses. Search for eligible studies was performed up to December 2023. We considered the occurrence of DVT, PE, hematoma expansion (HE), and all-cause mortality as outcome measures. A total of 16 studies, including 7 RCTs and 9 non-randomized studies, were included in the analysis. Network meta-analysis revealed that IPC demonstrated the highest efficacy in reducing DVT incidence (odds ratios (OR) 0.30, 95% confidence interval (CI) 0.08–1.16), particularly considering only RCTs (OR 0.33, 95% CI 0.16–0.67). GCS showed the highest safety profile for HE (OR 0.67, 95% CI 0.14–3.13), but without efficacy. Chemoprophylaxis did not reduce the risk of PE events (OR 1.10, 95% CI 0.17–7.19) with a higher occurrence of HE (OR 1.33, 95% CI 0.60–2.96), but the differences were not significant. Conclusion: Our study supports the use of IPC as the primary thromboembolic prophylaxis measure in ICH patients. Further research, including head-to-head RCTs, is needed to strengthen the evidence base and optimize clinical decision-making for thromboembolic prophylaxis in this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Background/Objectives: Diagnosing acute pulmonary embolism (PE) is challenging due to its wide range of symptoms and numerous differential diagnoses. Medical professionals must balance performing all essential examinations and avoiding unnecessary testing. This study aimed to retrospectively audit the diagnosis and treatment of acute PE at a Swiss public teaching hospital to determine the adherence to current guidelines and to identify the factors associated with the delayed initiation of anticoagulation in PE patients. Methods: In this retrospective observational cohort study, we included all adult patients hospitalized with PE at the Cantonal Hospital Baselland (KSBL) between November 2018 and October 2020, where the diagnosis was made within the first twelve hours of their arrival to the emergency department (ED). LASSO regression was employed to identify clinical characteristics associated with delayed anticoagulation initiation. Results: A total of 197 patients were included (mean age: 70 years, 54% female). The audit revealed that diagnostic workup was conducted according to guidelines in 57% of cases. Often, D-dimer levels were measured although not strictly necessary (70%). Pretest probability was assessed and documented using the Wells or Geneva score in only 3% of patients, and risk assessment via the Pulmonary Embolism Severity Index (PESI) score was documented in 21% of patients. The median time from ED arrival to CT scan was 120 min (IQR 89.5–210.5), and the median time to anticoagulation initiation was 193 min (IQR 145–277). Factors identified by LASSO associated with delayed anticoagulation included prolonged time from ED arrival to CT scan, the presence of distended jugular veins on examination, ED arrival in the morning, and presenting symptoms of weakness or tiredness. Complementary leg ultrasound was performed in 57% of patients, with 38% of these cases lacking prior clinical examination for deep vein thrombosis. The duration of the anticoagulation treatment was not specified in the discharge report for 17% of patients. A medical follow-up after discharge was recommended in 75% of the patients. Conclusions: In conclusion, while the management of PE at the KSBL generally adheres to high standards, there are areas for improvement, particularly in the morning performance, the use of a pretest probability assessment, D-dimer measurement, risk assessment via the PESI score, the performance of complementary leg ultrasounds, clarification of the anticoagulation duration, and follow-up management. [ABSTRACT FROM AUTHOR]

The most common causes of morbidity and mortality in the myeloproliferative neoplasms (MPNs), with the exception of myelofibrosis, are venous and arterial thrombosis, as well as more recently discovered cardiovascular disease (CVD). Clonal hematopoiesis of indeterminate potential (CHIP) is the subclinical finding in an individual of somatic mutations that are also found in clinically overt MPNs and other myeloid malignancies. The prevalence of "silent" CHIP increases with age. CHIP can transform into a clinically overt MPN at an estimated rate of 0.5 to 1% per year. It is likely, therefore, but not proven, that many, if not all, MPN patients had antecedent CHIP, possibly for many years. Moreover, both individuals with asymptomatic CHIP, as well as clinically diagnosed patients with MPN, can develop thrombotic complications. An unexpected and remarkable discovery during the last few years is that even CHIP (as well as MPNs) are significant, independent risk factors for CVD. This review discusses up-to-date information on the types of thrombotic and cardiovascular complications that are found in CHIP and MPN patients. A systemic inflammatory state (that is often subclinical) is most likely to be a major mediator of adverse reciprocal bone marrow–cardiovascular interplay that may fuel the development of progression of MPNs, including its thrombotic and vascular complications, as well as the worsening of cardiovascular disease, possibly in a "vicious cycle". Translating this to clinical practice for hematologists and oncologists who treat MPN patients, attention should now be paid to ensuring that cardiovascular risk factors are controlled and minimized, either by the patient's cardiologist or primary care physician or by the hematologist/oncologist herself or himself. This review is intended to cover the clinical aspects of thrombosis and cardiovascular complications in the MPN, accompanied by pathobiological comments. [ABSTRACT FROM AUTHOR]

Objective: It remains unclear whether low-molecular-weight heparin (LMWH) is effective and safe for intracerebral hemorrhage (ICH) patients. This study presents a meta-analysis for elucidating effect of LMWH on preventing venous thromboembolism (VTE) among ICH patients. Methods: Articles were located by systematically searching PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG DATA, VIP, and SinoMed databases. The literature was independently screened by two authors, who also extracted data and conducted a qualitative evaluation. With regard to outcomes, their risk ratios (RRs) and 95% confidence intervals (CIs) were computed, and the findings were combined using the random effects model by using Mantel-Haenszel approach. Results: 30 studies involving 2904 patients were analyzed and compared to control group. According to our findings, early low-dose LMWH, prophylaxis for VTE, was related to the markedly reduced deep vein thrombosis (DVT) (3.6% vs. 17.5%; RR, 0.25; 95% CI, 0.18–0.35; p-value<0.00001) and pulmonary embolism (PE) (0.4% vs. 3.2%; RR, 0.29; 95% CI, 0.14–0.57; p-value = 0.003), while the non-significantly increased hematoma progression (3.8% vs. 3.4%; RR, 1.06; 95% CI, 0.68–1.68; p-value = 0.79) and gastrointestinal bleeding (3.6% vs. 6.1%; RR, 0.63; 95% CI, 0.31–1.28; p-value = 0.20). Also, mortality (14.1% vs. 15.8%; RR, 0.90; 95% CI, 0.63–1.28; p-value = 0.55) did not show any significant difference in LMWH compared with control groups. Conclusions: Our meta-analysis suggested that early low-dose of LMWH are safe and effective in ICH patients. More extensive, multicenter, high-quality randomized clinical trials (RCTs) should be conducted to validate the findings and inform clinical practice. [ABSTRACT FROM AUTHOR]

Background: Thromboembolic events are a well-recognized cause of in-hospital deaths of patients with infectious diseases. However, thromboembolic events in patients with scrub typhus, caused by Orientia tsutsugamushi have rarely been reported. This study aimed to assess risk factors associated with thromboembolic events in patients with scrub typhus. Methods: All 93 scrub typhus patients' diagnoses were confirmed serologically or by positive nested polymerase chain reaction (PCR). The clinical and laboratory findings from 12 scrub typhus patients with thromboembolic events and 81 scrub typhus patients with nonthromboembolic events were retrospectively studied. To determine the factors implicated in thromboembolic events, we performed multivariate logistic regression analysis using the six independent factors identified by the univariate analysis. Findings: The mean age of the patients in the thromboembolic group was 76.4 years (median, 76 years), and in nonthromboembolic group it was 64.6 years (median, 65 years) (P<0·001). Thromboembolic events were observed in 12 patients. These events included acute coronary syndrome (n = 5), acute limb ischemia (n = 4), ischemic stroke (n = 1), deep vein thrombosis combined with pulmonary thromboembolism (n = 1), and left common iliac artery aneurysm with a thrombus (n = 1). According to multivariate analysis, the following four factors were significantly associated with the thromboembolic events: 1) treatment with rifampin (OR = 57.6; CI 1.2–2700.3), 2) Taguchi genotype (OR = 41.5, P = 0.028; CI 1.5–1154.6), 3) atrial fibrillation (OR = 9.4, P = 0.034; CI 1.2–74.0), and 4) age (OR = 1.1, P = 0.046; CI 1.0–1.3). Conclusions: Our study suggests that clinicians should be cautious when managing patients with scrub typhus to avoid the development of thromboembolic events, especially in patients with risk factors such as treatment with rifampin, Taguchi genotype, atrial fibrillation, and advanced age. Author summary: Scrub typhus, a disease caused by Orientia tsutsugamushi, is typically treated with antibiotics. It can sometimes lead to serious complications, including thromboembolic events. These events can be life-threatening but have been rarely reported due to under-suspicion in clinical practice, as their rarity often leads to them being overlooked. In this regard, our study suggests that clinicians should be cautious when managing patients with scrub typhus to prevent the development of thromboembolic events, especially in patients with risk factors such as treatment with rifampin, Taguchi genotype, atrial fibrillation, and advanced age. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis has not been reported in anti-N-methyl-d-aspartate receptor-antibody encephalitis in the absence of an underlying thrombotic state while rituximab induced cerebral venous sinus thrombosis is rarely reported. We report a patient with anti-N-methyl-d-aspartate receptor-antibody encephalitis without a prothrombotic state who developed cerebral venous sinus thrombosis following rituximab treatment. Case presentation: A 15-year-old Sri Lankan girl who had been in remission following an episode of anti-N-methyl-d-aspartate receptor-antibody encephalitis 2 years ago, presented with a relapse of anti-N-methyl-d-aspartate receptor-antibody encephalitis characterized by recurrent seizures, mutism, and cognitive abnormalities. Since response was inadequate to first-line immunotherapy, she was administered four doses of rituximab at weekly intervals. Two days after the fourth dose, she developed increasing headaches, and her cranial magnetic resonance venogram confirmed the development of cerebral venous sinus thrombosis. Screening for prothrombotic states were negative. She made an unremarkable recovery following anticoagulation. Conclusion: This case highlights the occurrence of the rare but serious complication of cerebral venous sinus thrombosis following rituximab in the context of anti-N-methyl-d-aspartate receptor-antibody encephalitis and informs the clinician to be wary of new onset headache in patients with anti-N-methyl-d-aspartate receptor-antibody encephalitis treated with immunotherapy. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. To investigate the impact of age on the incidence of vascular complications in patients undergoing anterior lumbar approach surgery. Background. Anterior approach lumbar spinal surgery may facilitate the use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature. Patients and Methods. In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement, or hybrid procedures (ALIF and total disc replacement) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications (deep vein thrombosis and/or pulmonary embolism). Rates of vascular complications were compared across age groups. In addition, the mean age of patients was compared between those with versus without vascular complications. Results. Overall mean age was 50.4 years (range: 20--83 yr). The mean estimated blood loss was 91.3 mL (range: 10--2800 mL). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721 mL, and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed deep vein thrombosis and/or pulmonary embolism (one patient had both). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates across the age group (P > 0.38). In addition, there were no statistically significant differences in the mean ages of patients with versus those without vascular complications (P > 0.17). Conclusion. Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of tibial plateau fractures (TPF) has been on the rise. Deep vein thrombosis (DVT) may lead to poor prognosis in patients. The systemic immune-inflammation index(SII) are novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model. This study used binary logistic regression analysis to predict the predictive effect of SII on the occurrence of DVT in tibial plateau fracture patients. And use R studio to construct nomogram model. The results showed that Age (1.03 [1, 1.06], p = 0.032), SII (3.57 [1.68, 7.61], p = 0.04), and NC (7.22 [3.21, 16.26], p < 0.001) were independent predictive factors for DVT. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them. The nomogram constructed based on SII can assist clinicians in early assessment of the probability of DVT occurrence. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening subtype of stroke. Prompt and appropriate anticoagulation is crucial for improving the prognosis of CVST and preventing its recurrence. Identifying the underlying cause of CVST is decisive for guiding anticoagulant selection and determining treatment duration. Case Presentation: A 50-year-old man presented with a 35-day history of headache, nausea, vomiting, and blurred vision. Digital subtraction angiography performed at another facility revealed CVST. A contrast-enhanced black-blood MRI at our center confirmed the diagnosis, which was supported by a high intracranial pressure of 330mmH2O. Laboratory tests showed elevated leukocytes and platelet counts, raising suspicion of an underlying myeloproliferative neoplasms (MPNs). A bone marrow biopsy demonstrated increased megakaryocytes and granulocytes, and genetic testing identified the presence of the Janus kinase 2 V617F (JAK2 V617F) mutation, leading to a diagnosis of pre-primary myelofibrosis (pre-PMF). During hospitalization, anticoagulation with nadroparin calcium and fibrinolytic therapy were initiated. Upon discharge, rivaroxaban and aspirin were prescribed to prevent CVST recurrence and arterial thrombosis. Conclusion: This case highlights the importance of recognizing dynamic changes in routine blood tests that may link CVST to underlying hematological disorders. The JAK2 mutation is not only associated with MPNs but also increases the risk of thrombosis, including CVST. Further investigation is warranted to better understand the mechanisms by which JAK2 mutations contribute to thrombosis and to explore the potential benefits of JAK2 inhibitors in reducing this risk. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. Methods: A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48 h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. Results: A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. Conclusion: The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation. [ABSTRACT FROM AUTHOR]

Background: Major surgeries are being carried for certain ailments. Surgeries can be major or minor depending on the extent of intervention. Major surgeries are prone to cause lots of complications such as shock, haemorrhage, wound infection, deep vein thrombosis, pulmonary complications, organ rejection, reactions to anaesthetics etc. Early identification of complications could reduce morbidity and mortality. Laboratory variables used in the assessment of hypovolemia include blood urea nitrogen, sodium, osmolality, hematocrit, and arterial blood gas. This study was undertaken to assess the utility of blood urea nitrogen: creatinine ratio (BCR) in the utility of assessment of hypovolemia in the first post-operative day in individuals who had major surgeries. Methods and materials: The retrospective cross-sectional study included participants from the Departments of Orthopedic Surgery, Obstetrics and Gynecology, General Surgery and Cardiothoracic Surgery. Patients who underwent major surgeries between January 2019 and January 2020 were included. Study participants of 30 to 60 years of both genders were recruited into the study. Data were collected from the Medical Records of a tertiary care hospital in Chennai, India. Ethics approval was obtained, the institutional ethics committee (Ref: CSP/21/SEP/99/479 dated 30–12-2021). Waiver of consent was obtained since the patients were treated and discharged from the hospital. The data were analyzed by SPSS version 16. P value ≤ 0.05 was taken to be significant. Results: BCR showed statistically significant difference across the groups with P = 0.02. BCR showed statistically significant difference between cardiac patients with total knee replacement and total abdominal hysterectomy surgeries. BCR showed positive correlation with age, fluids intake and negative correlation with pulse rate and respiratory rate. Conclusion: BCR is a simple diagnostic tool for identifying hypovolemia in individuals who undergo major surgeries especially in the first postoperative day. It is significantly altered across the groups with highest value in individuals who have undergone knee replacement surgeries. BCR has high specificity and positive predictive value. [ABSTRACT FROM AUTHOR]

Venous thrombosis (VT) is a common vascular disease associated with reduced survival and a high recurrence rate. VT is initiated by the accumulation of platelets and neutrophils at sites of endothelial cell activation. A role for platelet αIIbβ3 in VT is not established, a task complicated by the increased bleeding risk caused by partial agonists such as tirofiban. Here, we show that m-tirofiban, a modified version of tirofiban, does not agonize αIIbβ3 based on lack of neoepitope expression and the cryo-EM structure of m-tirofiban/full-length αIIbβ3 complex. m-tirofiban abolishes agonist-induced platelet aggregation while preserving clot retraction ex vivo and, unlike tirofiban, it suppresses venous thrombogenesis in a mouse model without increasing bleeding. These findings establish a key role for αIIbβ3 in VT initiation and suggest that m-tirofiban and compounds with a similar structurally-defined mechanism of action merit consideration as potential thromboprophylaxis agents in patients at high risk for VT and hemorrhage. Tirofiban is an inhibitor of platelet αIIbβ3 which may contribute to venous thrombosis. Here the authors developed a non-agonizing modified tirofiban, defined by its cryo-EM structure bound to platelet αIIbβ3 and elucidated the pathogenic role of αIIbβ3 in venous thrombogenesis. [ABSTRACT FROM AUTHOR]

Background: Thromboembolism (TE) is a well-known complication during chemotherapy in cancer patients. However, the risk of TE associated with immune checkpoint inhibitors (ICIs) is unknown. This study was performed to investigate the incidence of TE and associated risk factors in patients treated with ICIs. Methods: We conducted a retrospective chart survey of patients receiving at least one ICI at Shinshu University Hospital between September 2014 and October 2021. Age, sex, cancer type, body mass index, medical history, laboratory data at commencement of treatment, and medication data were obtained from electronic medical records. TE events (venous thromboembolism [VTE], arterial thromboembolism [ATE]) were identified after ICI initiation. Results: The study population consisted of 548 patients with a median age of 70.0 (19–89) years, 71.4% men, and a median follow-up of 15.1 months (range; 0.16–72.0 months). Nivolumab was the most commonly used ICI (45.8%), followed by pembrolizumab (23.9%), pembrolizumab plus anticancer drugs (7.8%), and nivolumab plus ipilimumab (5.1%). Thirty-eight cases of TE (6.9%) occurred (22 VTE, 16 ATE). Risk factors significantly associated with TE in multivariate logistic analysis were dyslipidemia (OR 2.44; 95% CI 1.17–5.09; p = 0.017), Khorana score ≥ 2 (HR 2.40; 95% CI 1.14–5.04; p = 0.021). Overall survival was not significantly different from patients without TE (p = 0.963). Conclusion: These results suggested that the frequency of TE is higher than expected and should be considered and monitored in patients treated with ICIs. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study is to compare the adverse events (AEs) associated with pralsetinib and selpercatinib. Methods: To evaluate the imbalance of AEs linked to pralsetinib and selpercatinib in real-world data, the reporting odds ratio (ROR) was utilized to detect potential signals of AEs. Stratified analysis was conducted to examine the differences in AEs occurring among different genders and age groups taking pralsetinib and selpercatinib. Results: FAERS received 891 reports for pralsetinib and 569 reports for selpercatinib. Our analysis confirmed expected AEs like hypertension, fatigue, and elevated transaminase levels. Unexpected AEs such as rhabdomyolysis, myocardial injury and cognitive disorder were associated with pralsetinib, while selpercatinib was linked with pulmonary embolism, deep vein thrombosis, and pericardial effusion. The risk of AEs such as decreased platelet count, anemia, decreased white blood cell count, pneumonitis, asthenia, and edema caused by pralsetinib is significantly higher than that of selpercatinib. In contrast, the risk of AEs such as ascites, elevated alanine aminotransferase, and elevated aspartate aminotransferase caused by selpercatinib is significantly higher than that of pralsetinib. Women treated with pralsetinib experience higher rates of hypertension, pulmonary embolism, and blurred vision than men, who are more susceptible to rhabdomyolysis. Adults between 18 and 65 years are more likely to experience taste disorder, edema, and pulmonary embolism than individuals older than 65, who are particularly vulnerable to hypertension. For patients treated with selpercatinib, males demonstrate a significantly higher incidence of QT prolongation, urinary tract infection, and dysphagia. Individuals aged 18 to 65 are more likely to experience pyrexia and pleural effusion than those older than 65, who are more prone to hypersensitivity. Conclusion: In the clinical administration of pralsetinib and selpercatinib, it is crucial to monitor the effects of gender and age on AEs and to be vigilant for unlisted AEs. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis is a multifactorial disease in which thrombus formation occurs in deep veins. Its early recognition and treatment are important, because it can cause pulmonary embolism and its most dangerous complication, death. The goal of these guidelines is a standardized approach to the patient in the emergency medical service, which will enable quick and accurate diagnosis and timely treatment in hospital or home conditions. In the diagnostic sense, it is first important to assess the clinical probability using the Wells score, then to determine D-dimers and, if necessary, to perform a Collor Doppler ultrasound according to the procedure. Anticoagulant therapy is the basis of deep vein thrombosis treatment, which prevents thrombus progression and potential embolization, and thus serious life-threatening complications. [ABSTRACT FROM AUTHOR]

Pulmonary thromboembolism is a disease with high mortality and morbidity, which can be recurrent, difficult to diagnose, yet preventable and treatable. In this study, our aim was to evaluate comorbidities, risk factors, laboratory results, and clinical scoring in patients diagnosed with pulmonary embolism. Our primary goal was to detect genetic mutations in cases of pulmonary embolism with acquired risk factors. Our study is a prospective study that includes clinical information, laboratory tests, Wells scoring, admission, and the prospective history of 60 patients with no previous history of venous thromboembolism (VTE) and no history of anticoagulation use. These patients were admitted to the chest diseases outpatient clinic, emergency department, or hospitalized for another reason and diagnosed with pulmonary thromboembolism. The mean age of the patients was 59.9 ± 18.7 years. The most common presenting complaints were shortness of b reath and sharp chest pain. Nearly half of the patients had at least one comorbid disease. There was at least one genetic/congenital risk factor in all cases, and at least two risk factors were present in more than half of the cases. The most common mutations were plasminogen activator inhibitor type 1 (PAI -1) and Methylenetetrahydrofolate Reductase (MTHFR) heterozygote mutations. Pulmonary embolism continues to be a more prevalent disease with increasing age and associated risk factors. Since there is at least one acquired risk factor in all of our cases, we believe that almost every patient may have an acquired risk factor if the history is thoroughly investigated. We also believe that genetic or thrombophilic conditions may be detected in almost all cases diagnosed with pulmonary embolism. It has been concluded that immobilization and obesity are the most common preventable risk factors associated with VTE. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the phenotypes, predictive factors, and treatment approach of Behçet's patients with vascular involvement. Material and Method: This retrospective study analyzed 123 patients with Behçet's disease, 28 of whom had vascular involvement, and were followed up in our center. The study presented the vascular involvement patterns of the patients along with their clinical characteristics and comorbid conditions. The drugs usage by the patients were analyzed based on the first line and current medications, duration of medical therapy, and drug retention rate. Results: In Behçet's patients with vascular involvement, the male sex ratio was statistically higher compared to those without vascular involvement (60.7% vs 37.9%; OR=2.82 (1.17-6.77); p=0.018). The frequencies of Behçet's clinical manifestations, smoking, and comorbidities were similar in both groups. The most common subtype of vascular Behçet's is deep vein thrombosis (18; 64.2%), followed by superficial thrombophlebitis (5; 17.8%), neurovascular involvement (5; 17.8%), cardio-aortic (2; 7.1%) and pulmonary arterial (2; 7.1%). Azathioprine, glucocorticoids, and cyclophosphamide are the most preferred immunosuppressives in vasculo-Behçet's. Anticoagulant therapy was initiated in 67.8% (19; 28) of the patients at the first vascular event. Conclusion: The study presented that male gender predicts vascular involvement in Behçet's disease, with deep vein thrombosis being the most common vascular subtype. Although immunosuppressive drugs represent the cornerstone of treatment for vasculo-Behçet's disease, most patients had also received anticoagulant therapy following the initial attack. [ABSTRACT FROM AUTHOR]

Introduction: G20210A (c.*97G>A) prothrombin gene variant, found in white population has been associated with an increased risk of venous thromboembolism (VTE). Other rare polymorphisms in F2 gene (C20209T) have been reported, more rare and touching black people, but its potential association with VTE remain uncertain. Methods: About a 69 years‐old Caucasian woman presenting an unprovoked deep venous thrombosis of the leg, we analyzed retrospectively 25.000 thrombophilia tests on a 11‐year period of time (2007–2018), at Nice and Marseille University Hospitals, and performed extensive review of the literature. Results: Genetic determination included a similar PCR protocol and sequencing. Twenty‐one heterozygous cases out of 25.585 determinations (0.08%) was found. The C20209T mutation detected in our Caucasian patient is rare, with a frequency that differed from what was reported in the previous literature, mainly in non‐Caucasian patients (Africans, Africans‐Americans, and Caribbeans). One hundred and thirteen patients with this mutation have been described in the literature, of which only one homozygous. Conclusion: This study is the most important on C20209T mutation performed at present, allowing to precise its frequency and its potential role in venous thromboembolism. [ABSTRACT FROM AUTHOR]

Summary: Background: Observational studies consistently indicate an association between early‐life body mass index (BMI) and several cardiovascular diseases (CVDs). However, the causal relationship remains uncertain. The primary objective of this study was to assess the causal relationship between early‐life BMI and six types of CVDs using the Mendelian Randomization (MR) approach. Methods: The dataset for this study was derived from large‐scale, summary‐level Genome‐Wide Association Studies. Specifically, the following datasets we used, early‐life BMI (n = 61 111, age = 2–10), heart failure (HF) dataset (n = 977 323), atrial fibrillation (AF) dataset (n = 1 030 836), coronary artery disease (CAD) dataset (n = 184 305), peripheral artery disease (PAD) dataset (n = 243 060), deep venous thrombosis (DVT) dataset (n = 1 500 861) and myocardial infarction (MI) dataset (n = 638 000). Multiple MR methods were utilized to evaluate the causal relationship between exposure and outcomes, accompanied by sensitivity analysis. Results: Early‐life BMI positively correlates with the risk of developing the six distinct CVDs included in this study. Specifically, elevated BMI during childhood is associated with a 31.9% risk for HF (Odds ratio [OR] = 1.319, 95% CI [1.160 to 1.499], p = 2.33 × 10−5), an 18.3% risk for AF (R = 1.183, 95% CI [1.088 to 1.287], p = 8.22 × 10−5), an 14.8% risk for CAD (OR = 1.148, 95% CI [1.028 to 1.283], p = 1.47 × 10−2), a 40.5% risk for PAD (OR = 1.405, 95% CI [1.233 to 1.600], p = 3.10 × 10−7) and 12.0% risk for MI (OR = 1.120, 95% CI [1.017 to 1.234], p = 2.18 × 10−2). Interestingly, the risk for deep venous thrombosis only increased by 0.5% (OR = 1.005, 95% CI [1.001 to 1.008], p = 2.13 × 10−3). Conclusion: Genetically inferred early‐life BMI is significantly associated with six distinct CVDs. This indicates that elevated early‐life BMI is a significant risk factor for multiple cardiovascular disorders. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. Materials and Methods: A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. Results: A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. Conclusions: EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation. [ABSTRACT FROM AUTHOR]

Distinguishing lupus nephritis (LN) from other glomerulopathies, such as immunoglobulin A nephropathy (IgAN), poses a diagnostic challenge owing to overlapping clinical and histopathologic findings. Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a rare and potentially fatal disorder characterized by the presence of lupus anticoagulant and acquired factor II deficiency. We report a pediatric case of LN with LAHPS, which was initially diagnosed as IgAN. An 8-year-old girl presented with gross hematuria with nephrotic syndrome. Based on the kidney biopsy results, treatment for IgAN with membranoproliferative pattern was initiated. Two months later, she developed left upper extremity swelling with multiple vein thromboses requiring anticoagulation; treatment led to remission, allowing discontinuation of immunosuppressants within 8 months. Gross hematuria recurred 10 months later and was accompanied by hypocomplementemia; positive antinuclear, anti-double stranded DNA, and triple antiphospholipid antibodies; and factor II deficiency, prompting revision of the diagnosis to LN and LAHPS. Initial delay in LN diagnosis was attributed to the patient's young age, nonspecific symptoms, and inconclusive laboratory and histopathological findings. Immunosuppressive therapy for IgAN partially improved LN, further complicating the diagnosis. This case emphasized the importance of clinical suspicion; integrating clinical, serological, and histopathological data; and considering LAHPS in differential diagnosis of glomerulonephritis with coagulopathy. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 test positivity has been reported among asymptomatic individuals and asymptomatic people are also considered to be at risk for thromboembolic events. The aim of this study was to compare the results of patients who underwent lower extremity Doppler ultrasonography (DUS) with a preliminary diagnosis of deep vein thrombosis (DVT) before and after the pandemic, regardless of COVID-19 testing. Method: Patients who underwent RDUS in the Department of Radiology during a total period of 35 months (01/08/2018 - 01/07/2021) were analyzed. A total of 599 patients underwent RDUS during the study period. Results: More positive DVT findings were observed after the pandemic (n=43, 18.3%, p=0.005) (only two of these patients had a positive COVID-19 result). History of hospitalization in the last three months, D-dimer, Platelet (PLT) count, Mean platelet volume (MPV), White blood cell (WBC) count, neutrophil count, lymphocyte count, neutrophil/lymphocyte ratio (NLR) values, comorbidity and antiaggregant use were not different (p>0.05). Conclusion: Even individuals (especially elderly individuals) who have been exposed to the virus during the pandemic but who do not show symptoms are at risk of DVT. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to investigate the incidence and risk factors of lower extremity deep vein thrombosis (DVT) in elderly women undergoing colpocleisis for pelvic organ prolapse and to evaluate the predictive efficacy of the Caprini scores. Methods: Data from patients who underwent colpocleisis from August 2019 to April 2024 were retrospectively analyzed. The primary endpoint was DVT detected by ultrasonography within 7 days of surgery. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors. Efficacy parameters of the Caprini scores were analyzed and optimal cut-off values were selected. Results: A total of 262 patients were enrolled in the study, of whom 8.4% (22 out of 262) developed DVT postoperatively. After statistical analysis, the duration of menopause, history of inflammatory bowel disease, as well as higher levels of preoperative cholesterol and preoperative D-dimer, were identified as independent risk factors. There was a significant difference in the Caprini scores between the DVT and non-DVT groups (7.27 ± 1.28 vs 6.15 ± 0.80, p < 0.001), and the risk of DVT tended to increase with higher Caprini scores. The best performance was achieved when the threshold for the Caprini score was set to 7, at which point the area under the receiver operating characteristic curve was 0.758, the sensitivity was 0.773, and the specificity was 0.662. Conclusion: There was a strong correlation between the occurrence of DVT after colpocleisis and the Caprini score, with higher Caprini scores indicating a higher risk of postoperative DVT. A significantly increased risk was suggested when this score was ≥ 7. [ABSTRACT FROM AUTHOR]

Blood transfusions are integral to modern medical practice, playing a crucial role in managing various medical conditions. However, concerns have arisen regarding potential complications associated with transfusions, particularly their impact on haemostasis and thrombotic events. Deep vein thrombosis (DVT) and arterial thromboembolism (ATE), serious complications linked to altered haemostasis, present challenges to patient care, and require a nuanced understanding of their relationship with blood transfusions. This retrospective, population-based, cohort study investigated the association between blood transfusions, venous thromboembolism (VTE), ATE and subsequent mortality in patients undergoing recurrent blood transfusions. A total of 1000 patients who received red blood cells (RBCs), platelets, fresh frozen plasma (FFP), and cryoprecipitate between 2015 and 2022 were analysed. Post-transfusion occurrences of VTE and ATE were assessed using the chi-square test and multivariate logistic regression to identify independent risk factors. Multivariable regression analysis revealed a significant association between platelet transfusion and increased odds of development of ATE. However, no correlation was found between blood transfusions and the development of DVT. Notably, patients aged 55-69 years in the blood transfusion cohort exhibited a higher risk of DVT (p < 0.05), particularly those without chronic or cardiovascular diseases. Haematological diseases increased the demand for platelets and FFP, while patients without chronic diseases favoured platelet transfusions. Furthermore, patients with haematological or malignancy diseases, free of chronic diseases, had a higher likelihood of mortality within the blood transfusion cohort. Although the cause-and-effect relationship remains undetermined, these findings underscore the significant association between platelet transfusions and the risk of ATE, emphasising the importance of vigilant blood transfusion management practices. The study's outcomes would facilitate a clear understanding of the potential risks associated with blood transfusion, thereby aiding healthcare providers in making informed decisions, particularly in emergency medicine. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cerebral venous thrombosis (CVT) is a rare type of stroke. Functional outcome (FOC) in CVT can be affected by different factors, and recanalization is an important determinant. This study aimed to identify the FOC predictors including recanalization in patients with CVT. METHODS: This retrospective study reviewed electronic charts of patients with CVT admitted to the King Fahd Hospital of the University, a teaching and referral hospital between January 2012 and March 2023. Demographic and other clinicoradiological characteristics were noted. Factors affecting FOC were investigated using the Chi-square test, odds ratios (ORs), and 95% confidence interval (CI). RESULTS: Out of 64 patients, 78% achieved good FOC. Age was significantly higher in patients having poor FOC as compared to those having good FOC (P ≤ 0.001). Women had more likelihood to be functionally independent as compared to men (OR = 1.35, 95% CI = 1.01-1.80, P = 0.02). Altered consciousness (OR = 2.94, 95% CI = 1.23-6.99, P = 0.01), venous hemorrhagic infarction (OR = 3.26, 95% CI = 1.36-7.82, P = 0.008), and nonrecanalization (OR = 1.44, 95% CI = 0.97-2.14, P = 0.02) were significantly associated with poor FOC. Hereditary thrombophilia (OR = 0.60, 95% CI = 0.31-1.12, P = 0.03) and infections (OR = 0.59, 95% CI = 0.31-1.12, P = 0.01) were associated with less likelihood of good FOC. Age ≥50 years (P = 0.01) and illness of more than 1-month duration (P = 0.01) were associated with nonrecanalization. CONCLUSION: Older age, male sex, presence of venous hemorrhagic infarction, and nonrecanalization can predict poor FOC in CVT. The recanalization process can be affected by late presentation, and the plausible reason could be a delay in therapeutic anticoagulation. Further prospective and multicenter studies are needed to determine the predictors of FOC and to understand the process of recanalization in CVT. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis assesses venous thromboembolism (VTE) risk in adults with hereditary thrombophilia, including Factor V Leiden (FVL) mutation, prothrombin G20210A (FII) mutation, compound heterozygosity, protein C (PC), protein S (PS), and antithrombin (AT) deficiency. Eligibility criteria included studies suitable for quantitative synthesis with extractable information on VTE risk in adults (> 15 years). There were no restrictions on VTE type, location, or occurrence. Two authors reviewed all studies and extracted data from 107 publications, encompassing 107,130 individuals (21,560 experiencing VTE). We used a random effects model and calculated odds ratios (ORs) with 95% confidence intervals (CIs). The highest risk was associated with homozygous FVL (OR 5.58, 95% CI 4.61–6.74), homozygous FII (OR 5.16, 95% CI 3.12–8.52), and compound heterozygosity (OR 4.64, 95% CI 2.25–9.58). In contrast, VTE risk was lowest for FVL heterozygosity (OR 2.97, 95% CI 2.41–3.67) and FII heterozygosity (OR 2.21, 95% CI 1.70–2.87), whereas PC (OR 3.23, 95% CI 2.05–5.08), PS (OR 3.01, 95% CI 2.26–4.02), and AT deficiency (OR 4.01, 95% CI 2.50–6.44) demonstrated an intermediate VTE risk. These results highlight an increased risk of venous thromboembolism in adults with hereditary thrombophilia. However, the risk for patients with PC, PS, and AT deficiency appears to be lower than previously stated, likely due to varying thrombogeneity of the underlying genetic mutations. Further research addressing this aspect of VTE risk in hereditary thrombophilia is imperative to improve patient management. Trial registration: PROSPERO registration number CRD42022376757. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) poses a significant challenge in the context of multiple myeloma, with an incidence of up to 10% in newly diagnosed patients and varying frequency in the relapsed/refractory setting. Accurate VTE risk assessment and personalized thromboprophylaxis strategies are important parts of supportive care in myeloma. There are three validated risk assessment models for prediction of VTE risk in newly diagnosed myeloma-SAVED, IMPEDE-VTE, and PRISM. In this review, we delve into the practical applications of VTE risk prediction models in the context of current therapies. By emphasizing the necessity of a tailored approach, we underscore the importance of considering patient-specific, disease-specific, and treatment-specific risk factors in each clinical scenario, and using that data to complement the output from risk assessment models. We also provide a summary of currently available data on VTE thromboprophylaxis in myeloma, and highlight specific situations where direct oral anticoagulants should be strongly considered. Our objective is to fill the critical gaps in VTE prophylaxis and management through the analysis of specific patient cases and provide a practical overview for clinicians. [ABSTRACT FROM AUTHOR]

The article discusses the history, clinical characteristics, diagnosis, genetic factors, pathophysiology, treatment, and prognosis of Adamantiades‐Behcet's disease (ABD), a chronic inflammatory disorder. ABD primarily affects the Eastern Mediterranean area and Central and East Asia, with a suspected autoimmune etiology. Diagnosis is based on clinical presentation, and treatment varies depending on the severity and organs involved. Biologic agents are increasingly used in managing severe and refractory cases of ABD. The article emphasizes the importance of multidisciplinary care and reference centers for optimal management of ABD. [Extracted from the article]

D‐dimer is widely used in the diagnosis of deep vein thrombosis (DVT), but the specificity is low. The study examined the diagnostic value of long non‐coding RNA (lncRNA) SNHG12 in DVT, and preliminarily discussed its mechanism. SNHG12 levels were detected in 200 elderly fracture patients via RT‐qPCR, including 38 DVTs. Logistic regression analysis and receiver operating characteristic (ROC) curve were applied for diagnostic value evaluation. HUVECs were used for function study. Cell proliferation, migration, apoptosis, release of inflammatory cytokines, and adhesion factors were detected. Student's t test and one‐way ANOVA were applied for data comparison between two or among three or more groups. Correlation analysis of indicators was completed via Pearson's correlation analysis. Bioinformatics analysis predicted the target miRNAs and genes of SNHG12, with GO and KEGG for the function enrichment. It was found that SNHG12 was at low expression in DVT patients, and negatively correlated with D‐dimer concentration (r = −0.535). SNHG12 and D‐dimer were independent influence factors related to the development of DVT. SNHG12 and D‐dimer combination had the best performance in DVT diagnosis. In HUVECs, SNHG12 promoted cell proliferation and migration and restricted the release of inflammatory cytokines and adhesion factors, but these influences were counteracted by miR‐424‐5p. A total of 208 overlapping target genes of miR‐424‐5p were identified, and their function was enriched in cellular cycle and senescence. PI3K‐Akt signaling pathway was the most significant pathway based on KEGG results. In conclusion, SNHG12 had good diagnostic potential for DVT combined with D‐dimer. SNHG12 maintains vascular endothelial cell function by acting as a competitive endogenous RNA (ceRNA) for miR‐424‐5p. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Percutaneous precutaneous mechanical thrombectomy has been used for clot dissolution and removal in selected cases of iliofemoral deep vein thrombosis. Intravascular Hemolysis and hemoglobinuria caused by pharmachomechanical chather directed thrombolysis (PCDT) devices like the Angiojet is associated with an increased risk of acute kidney injury (AKI). Acute tubular necrosis that is severe enough to require hemodialysis can occur. Clinicians should be aware of this potential risk to ensure early recognition and timely referral to the nephrologist, and a clear explanation of the risk of AKI should be given to the patients undergoing this procedure. Lower extremity deep vein thrombosis (DVT) is a frequently encountered medical condition, and one that can lead to death or major disability if not promptly treated. Anticoagulation alone may not always be enough for complete treatment. It has been reported that early thrombus removal can rapidly relieve symptoms and prevent disease progression in some selected cases. Percutaneous pharmacomechanical thrombectomy has been used for clot dissolution and removal in such cases. AngioJet is an increasingly used method of percutaneous mechanical thrombectomy for DVT that can cause intravascular hemolysis and potentially acute kidney injury (AKI). We report here a case of a 39 years old lady who developed severe AKI (illustrated by creatinine level of 664 μmol/L (7.5 mg/dL), bicarb of 13 mmol/L and being anuric), requiring hemodialysis secondary to intravascular hemolysis and hemoglobinuria that occurred immediately after the use of AngioJet pharmacomechanical catheter‐directed technique to treat an extensive iliofemoral DVT. [ABSTRACT FROM AUTHOR]

Digital replantation is a challenging and at-time tedious operation, but if approached thoughtfully and with reasonable expectations can be a reliable and rewarding undertaking. This article summarizes technical considerations for digital replantations involving flexor tendon zone II. The article has been ordered according to the recommended sequence of a structure-by-structure repair in a non-thumb digit. Special considerations are described for thumb, multiple digits, and heterotopic replantation. [ABSTRACT FROM AUTHOR]

Postoperative care is essential to upper extremity replantation success and includes careful and frequent monitoring of the replanted part. During this period, pharmacologic agents such as antithrombotic and anticoagulants may prevent complications such as arterial thrombosis and venous congestion. Dressings and therapy can also impact short- and long-term outcomes following replantation. This article reviews the literature to provide guidance for postoperative protocols following upper extremity replantation. [ABSTRACT FROM AUTHOR]

Purpose: While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries. Methods: The NTDB (2015–2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities. Results: 2325 patients met inclusion criteria. 532 (23.0%) sustained complications, and 72 (3.2%) died within the first 30 days. The most common complications were deep vein thrombosis (DVT) (5.7%), acute kidney injury (AKI) (4.6%), and unplanned intensive care unit (ICU) admission (4.4%). In a multivariate analysis, days to procedure was independently significantly associated with complications, with an adjusted odds ratio (95% confidence interval) of 1.06 (1.03–1.09, P < 0.001), best interpreted as a 6% increase in the odds of complication or death for each additional day. Conclusion: Time to pelvic fixation is a significant and modifiable risk factor for major complications and death. This suggests we should prioritize time to pelvic fixation on trauma patients to minimize mortality and major complications. [ABSTRACT FROM AUTHOR]

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the diagnostic value of fibrinogen (FIB) in patients with rib fractures complicated by lower extremity deep venous thrombosis (DVT). Methods: Analyzing data from 493 patients at Shijiazhuang Third Hospital, FIB levels at 24, 48, and 72 h post-injury were compared between DVT and non-DVT groups. Results: DVT group had elevated FIB levels at all times (p <.001). FIB at 24 h showed highest AUC, particularly in patients with BMI <28. Conclusion: In conclusion, measuring FIB at 24 h post-injury enhances DVT detection in rib fracture patients, with potential BMI-related variations. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) may jeopardise excellent treatment results of germ cell tumours (GCT). We previously constructed a VTE risk score for GCT patients qualified for first‐line chemotherapy (CTH), including vein compression, clinical stage (CS) and haemoglobin concentration. Aim: Validating our score in a separate cohort and establishing the cut‐off point for the score. Re‐assessing the numerical score in the training cohort. Materials and Methods: We retrospectively analysed a new cohort of GCT patients staged IS–IIIC. Area under the curve of receiver‐operating characteristic (AUC‐ROC) was calculated for the developed score, Khorana Risk Score (KRS) and Padua Prediction Score (PPS). AUC‐ROC of the integer score was calculated for the training cohort. Cut‐off point was established by Youden's and Liu's indices. Results: Among 336 eligible patients in the validation cohort, VTE occurred in 41 (12.2%). AUC‐ROC for our score, KRS and PPS were 0.818 (95% confidence interval (CI): 0.746–0.891), 0.608 (0.529–0.688) and 0.634 (0.547–0.720), respectively, p < 0.001. The optimal cut‐off point for a low/high risk was 6 (≤ 6 vs. ≥ 7). In the training cohort, 369 patients had complete data on vein compression. AUC‐ROC for our score, KRS and PPS were 0.819 (95% CI: 0.758–0.879), 0.710 (0.637–0.782) and 0.725 (0.651–0.800), p ≤ 0.001 and 0.015, respectively. Positive and negative predictive values were 30.8% and 96.5%, respectively. Conclusions: Our VTE risk score is a handy tool for GCT patients before first‐line CTH for metastatic disease. Outperforming KRS and PPS, it has a good discriminatory value, especially for identifying low‐risk patients. [ABSTRACT FROM AUTHOR]

Background: Surgery often leads to bleeding associated with hypofibrinogenemia. Supplementation with fibrinogen concentrate appears to be effective and safe, although findings from studies are inconsistent. The primary aim of this study was to assess the safety of fibrinogen concentrate during the perioperative period. Methods: This single-centre, prospective, observational study included adult patients undergoing scheduled or emergency surgery related to bleeding coagulopathy and the administration of fibrinogen concentrate. Patients were followed until their discharge from the institution. Comprehensive data were collected, including age, sex, type of surgery, associated comorbidities, anticoagulant and/or anti-aggregating therapy, and the number of blood transfusions. Laboratory data on plasma fibrinogen concentration, haemoglobin, and platelet count before and after surgery were also collected. The primary outcomes were the mortality rate at discharge and any reported thrombotic or thromboembolic events, including deep vein thrombosis, pulmonary embolism, and myocardial infarction. Results: The study included 91 adult patients who had undergone surgery, with 29 surgeries (32%) conducted in an emergency setting. The mean age was 59.2 years, and 53.8% were male. Major bleeding occurred in 29 cases, mainly in older males and those on anticoagulant therapy. The pre-operative fibrinogen level averaged 161 mg/dL, and the average dosage of fibrinogen concentrate administered was 2.7 g. Eight patients died (8.8%), mostly due to septic or cardiogenic shock, with deaths being more frequent in emergency settings. Thromboembolic events occurred in eight patients, none of whom died. No additional adverse events directly related to the administration of fibrinogen concentrate were reported. Conclusions: Our findings suggest a favourable safety profile for fibrinogen concentrate in surgical patients, as evidenced by a low incidence of deaths and thromboembolic events, which were primarily attributed to other factors. Future research should strive to increase statistical robustness to further illuminate clinically significant patient safety measures. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, there was increased interest in the issue of thrombotic complications of acute respiratory infections. Clinical reports and pathological studies have revealed that thrombus formation in COVID-19 may involve the venous and arterial vasculature. As thrombotic complications of infectious respiratory diseases are increasingly considered in the context of COVID-19, the fact that thrombosis in lung diseases of viral and bacterial etiology was described long before the pandemic is overlooked. Pre-pandemic studies show that bacterial and viral respiratory infections are associated with an increased risk of thrombotic complications such as myocardial infarction, ischemic stroke, pulmonary embolism, and other critical illnesses caused by arterial and venous thrombosis. This narrative review article aims to summarize the current evidence regarding thrombotic complications and their pathogenesis in acute lower respiratory tract infections. [ABSTRACT FROM AUTHOR]

Introduction: Soluble C-type lectin-like receptor -2 (sCLEC-2) has been recognized as a marker of platelet activation, and attention has been drawn to formulas combining sCLEC-2 levels with platelet count and D-dimer levels. Methods: In this study, sCLEC-2 levels, as well as sCLEC-2/platelet count (sCLEC-2/PLT), sCLEC-2 × D-dimer (sCLEC-2xDD), and sCLEc-2xDD/PLT formulas were used to detect thrombotic diseases, including microvascular thrombosis (MVT), arterial thromboembolism (ATE), and venous thromboembolism (VTE), with the aim of evaluating the ability of the three parameters combined in these formulas to diagnose thrombotic diseases. Results: The plasma sCLEC-2 levels were significantly higher in patients with infectious or thrombotic diseases than in those with neither thrombosis nor infection; however, there was no significant difference among patients with infection, ATE, VTE, and MVT; the correlations among sCLEC-2, platelet count, and D-dimer level were poor. The sCLEC-2/PLT ratio was the highest in patients with MVT, and the sCLEC-2 × D-dimer value was higher in patients with MVT and VTE than in those with neither thrombosis nor infection. Although receiver operating characteristic (ROC) analysis shows the differential diagnosis of thrombotic diseases from non-thrombosis without infection, the sCLEC-2 × D-dimer/platelet count was useful for differential diagnosis among MVT and infection or non-thrombotic diseases. Conclusions: sCLEC-2 is useful for the diagnosis of thrombosis, and the formulas of sCLEC-2 with platelet count or D-dimer are useful for the diagnosis of thrombosis using ROC analyses for the thrombosis group vs. the non-thrombosis group without infection. [ABSTRACT FROM AUTHOR]

Critically ill patients in the intensive care unit (ICU) are often immobilized and on mechanical ventilation, placing them at increased risk for thromboembolic diseases, particularly deep vein thrombosis (DVT) and, to a lesser extent, pulmonary embolism (PE). While these conditions are frequently encountered in the emergency department, managing them in the ICU presents unique challenges. Although existing guidelines are comprehensive and effective, they are primarily designed for patients presenting with PE in the emergency department and do not fully address the complexities of managing critically ill patients in the ICU. This review aims to summarize the available data on these challenging cases, offering a practical approach to the prevention, diagnosis, and treatment of PE, particularly when it is acquired in the ICU. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma (HCC) associated with portal vein thrombosis (PVT) represents an advanced stage of the tumor, with a subsequently poor prognosis and reduced therapeutic perspectives. These patients could present severe complications such as ascites, metastases, an increase in portal hypertension and potentially fatal gastrointestinal bleeding. The intricate molecular patterns at the basis of the development of TVP could also represent possible biomarkers in the early detection of patients at high risk of PVT. Hepatocellular carcinoma (HCC) represents the sixth most diagnosed cancer worldwide and is the second leading cause of cancer-related death in the world. The association of HCC and portal vein thrombosis (PVT) represents an advanced stage of the tumor. PVT has a prevalence of about 25–50% in HCC, determining poor prognosis and a remarkable reduction in therapeutic perspectives in these patients, leading to severe complications such as ascites, metastasis, an increase in portal hypertension and potentially fatal gastrointestinal bleeding. The aim of this review is to evaluate the molecular mechanisms that are at the basis of PVT development, trying to evaluate possible strategies in the early detection of patients at high risk of PVT. [ABSTRACT FROM AUTHOR]

This collection of research posters covers a range of medical topics. The first poster highlights the underutilization of endovascular thrombectomy in patients with end-stage kidney disease and acute ischemic stroke, leading to high mortality rates. The second poster focuses on a risk stratification tool for venous thromboembolism in cancer patients, aiming to improve compliance with prophylaxis. The third poster examines fibromuscular dysplasia and spontaneous coronary artery dissection, exploring their prevalence and clinical manifestations. Other posters discuss claudication in Filipino patients with peripheral artery disease, the association between vascular risk factors and atherosclerotic cardiovascular disease in high-risk Jordanian women, and the epidemiology of chronic thromboembolic pulmonary hypertension. Further research is needed to address disparities and improve patient care in these populations. [Extracted from the article]

Introduction: Direct oral anticoagulants (DOACs) have overtaken warfarin in the treatment of nonvalvular atrial fibrillation (AF) and venous thromboembolism (VTE). Limited data explore the safety of DOACs in obesity. Methods: This multicenter retrospective study between June 2015 and September 2019 uses the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry to compare DOACs and warfarin across weight classes (not obese: body mass index (BMI) ⩾ 18.5 and < 30; obese: BMI ⩾ 30 and < 40; severely obese: BMI ⩾ 40). Primary outcomes include major, clinically relevant nonmajor (CRNM), and minor bleeding events per 100 patient-years. Secondary outcomes include stroke, recurrent VTE, and all-cause mortality. Results: DOACs were prescribed to 49% of the 4089 patients with AF and 46% of the 3162 patients with VTE. Compared to patients treated with warfarin, those treated with DOACs had a higher estimated glomerular filtration rate across BMI categories regardless of indication. In the AF population, severely obese patients treated with DOACs had more major (3.4 vs 1.8, p = 0.004), CRNM (8.6 vs 5.9, p = 0.019), and minor bleeding (11.4 vs 9.9, p = 0.001). There was no difference in stroke or all-cause mortality. In the VTE population, both CRNM (7.5 vs 6.7, p = 0.042) and minor bleeding (19.3 vs 10.5, p < 0.001) events occurred at higher rates in patients treated with DOACs. There was no difference in recurrent pulmonary embolism, stroke, or all-cause mortality. Conclusion: There is a higher rate of bleeding in severely obese patients with VTE and AF treated with DOACs compared to warfarin, without a difference in secondary outcomes. Further studies to compare the anticoagulant classes and understand bleeding drivers in this population are needed. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Cerebral venous thrombosis (CVT) is a rare complication of ear, nose and throat (ENT) infections. Although recent guidelines recommend the systematic use of anti‐coagulation therapy (ACT) in the treatment of these CVT, literature data are scarce. The present study's objective was to determine the value of ACT in achieving recanalisation after thrombosis and its effect on patient outcomes.All paediatric patients with CVT and a concomitant ENT infection who attended Lille University Hospital (Lille, France) between January 2012 and December 2021 were retrospectively included.We included 43 children (63% boys), with a mean age of 4 years. The most frequent infection was mastoiditis (54%). ACT was initiated in 23 patients (53%), one of whom had an intracranial haemorrhage. Partial or full recanalisation was observed in 33 (80%) of the 41 survivors. In patients with no neurological signs and symptoms on admission and in patients with mastoiditis‐related CVT, the clinical and radiological outcomes were favourable and did not differ according to the administration of ACT. Likewise, ACT did not appear to influence the recanalisation rate or sequelae.ACT was not necessary for all patients with mastoiditis‐related CVT and those with no neurological signs and symptoms on admission. [ABSTRACT FROM AUTHOR]

Background: The opioid crisis caused a huge health concern in the United States. Despite this, few studies have examined the influence of opioid-related disorders (OD) on outcomes after bariatric surgery. The major goal of this study is to determine the impact of OD on in-hospital outcomes for patients undergoing bariatric surgery. Method: The National Inpatient Sample (NIS) database from 2016 to 2020 was used to evaluate patients with OD who underwent bariatric operations including sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The non-OD comparison group was created using a propensity score match (1:1). Weighted analysis was carried out utilizing NIS-provided weights. The odds ratios were obtained using multivariate logistic regression. Results: A total of 159,455 patients who underwent bariatric surgery were evaluated. Propensity score matching and weighted analysis were used to compare 11,025 in the OD group and 11,025 in the non-OD group. OD was an independent predictor for postoperative complications (odds ratio: 1.29, 95% confidence interval: 1.19–1.39, p < 0.001). Among complications, OD was a predictor for bleeding complications, postoperative nausea and vomiting, anastomotic leak, and mechanical ventilation. In addition, the OD group experienced significantly longer lengths of stay (LOS) and a higher total hospital charges. Conclusion: In patients undergoing bariatric surgery, OD is associated with a significantly higher risk of postoperative complications, as well as increased LOS and total hospital charges. These patients may benefit from further preoperative optimization, including decreasing the opioid dose and closer postoperative monitoring. [ABSTRACT FROM AUTHOR]