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Background: Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce. Methods: In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively. Results: Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1–2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1 mg/L, higher than the 8.98% in those with levels of < 0.5 mg/L, and 10.61% in those with levels 0.5-1 mg/L (P < 0.05). In patients with Caprini scores of 1–2 and D-dimer levels ≤ 0.5 mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0 mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group. Conclusion: Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0 mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions to mitigate the risk of DVT. [ABSTRACT FROM AUTHOR]

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Abstract Background Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce. Methods In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively. Results Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1–2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P

We report on a 20-year-old pregnant woman who tested positive for SARS-CoV-2 and was diagnosed with KILT syndrome, a rare condition that increases the risk of thrombotic events. The patient showed signs of deep vein thrombosis that extended from the bilateral iliac vein to the inferior vena cava (IVC), which was treated with placement of an IVC filter and endovascular thromboaspiration/thrombolysis. The IVC was successfully recanalized; however, during follow-up, thrombotic restenosis occurred at the filter level, requiring filter removal. This case highlights the potential benefits of endovascular thromboaspiration/thrombolysis and IVC filter placement in patients with KILT syndrome presenting with acute thrombotic events.

The subject of this guideline from the Institute of Family Medicine at the University of Zurich (IHAMZ) is the management of venous thrombosis. The review summarizes the current evidence and recommendations from international guidelines (1-6). The IHAMZ-guidelines focus on primary care, they also provide guidance on the coordination of general and specialist medical care as well as on the transition between outpatient and hospital care taking into account the special features of the Swiss healthcare system. The guideline is devided in two parts. Part 1 discusses the diagnosis and treatment of deep vein thrombosis (DVT). A validated algorithm is recommended for the diagnostic process, which begins with the assessment of the clinical probability. With the inclusion of the D-dimer test, the need for subsequent imaging diagnostics can be reduced. The differences between the evaluation of an initial and recurrent DVT are shown and the indications and scope of evidence-based environmental diagnostics (thrombophilia and tumor search) are presented. All patients with DVT should receive anticoagulation (AC) for 3-6 months, as there is a high risk of recurrence with AC < 3 months. The duration of the subsequent secondary prophylaxis depends on the presumed risk of recurrence on the one hand and the risk of bleeding on the other. Part 2 is dedicated to special thrombosis situations such as shoulder-arm vein thrombosis (SAVT), cancer-associated thrombosis (CAT) and superficial vein thrombosis (SVT). The article on hormone-and pregnancy-associated DVT, developed together with the Department of Gynecology at the University Hospital of Zurich, discusses the importance of hormonal contraception and menopausal hormone replacement therapy (HRT) as a thrombogenic risk factor as well as special features in the diagnosis and treatment of thrombosis in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of thrombosis. They often need parenteral nutrition (PN) requiring intravenous access for prolonged periods. We assessed the risk of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs) and tunneled catheters for patients with IBD receiving home PN (HPN). Methods: Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter‐associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan‐Meier graphs to illustrate longevity of CADVT‐free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT. Results: We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140–7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637–4.696; P = 0.013). Conclusion: Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days. [ABSTRACT FROM AUTHOR]

This article, titled "Pulmonary Embolism and Cardiovascular Care: Revolutionary Advances for the Decade Ahead," provides an overview of the current state of care for pulmonary embolism (PE) and explores new possibilities for reducing its impact. The article emphasizes the importance of timely diagnosis and management by a team of specialists, including the use of artificial intelligence for improved triage and diagnosis. It also discusses different diagnostic tools, risk assessment, and management approaches for PE. Additionally, the article highlights innovative treatment strategies, such as catheter interventions and balloon pulmonary angioplasty, and the importance of a multidisciplinary team for managing chronic thromboembolic pulmonary hypertension. Overall, the article offers hope for revolutionary advances in the care of PE in the coming decade. [Extracted from the article]

Inferior vena cava (IVC) anomalies are uncommon congenital causes of deep vein thrombosis (DVT). KILT syndrome (kidney and IVC abnormalities with leg thrombosis) has only been described as case reports in the literature. Therefore, the characteristics, evaluation, and management of patients with KILT syndrome have not yet been standardized. This study aimed to systematically review and analyze the clinical and radiographic data and treatment of previously reported cases of KILT syndrome. In this systematic review, we performed a literature search of the PubMed, Scopus, and Web of Science databases in December 2023, with no restrictions on the publication date. After duplicate extractions, 4195 articles were screened. Case reports and case series reporting on KILT syndrome were included. In addition to previously published cases, we included a new case of a previously healthy 25-year-old man with KILT syndrome in the analysis. A total of 34 cases were therefore included in this study. The majority (76.5%) were male patients with a median age of 24 years. In most patients, unprovoked bilateral iliofemoral thrombosis was diagnosed, and 64.7% had left kidney abnormalities. Our study suggests that anomalies of the IVC should be suspected in all young patients, especially male patients, with proximal, recurrent, or idiopathic DVT. If an IVC anomaly is confirmed, the kidneys should be examined to monitor and preserve healthy kidneys in cases of KILT syndrome. The data collected from all patients emphasize the requirement of long-term anticoagulation and risk factor control. Surgical measures may be effective for treating symptomatic refractory cases. [ABSTRACT FROM AUTHOR]

Objectives: The primary strategy against Deep Vein Thrombosis (DVT) in athletes is systemic anticoagulation, which aims to mitigate risks such as Pulmonary Embolism (PE), thrombus propagation, and recurrent venous thrombosis. Argatroban, a synthetic thrombin inhibitor that functions independently of antithrombin, is evaluated here for its effectiveness and safety in treating athletes with lower extremity DVT. Methods: A cohort of 189 athletes diagnosed with DVT based on clinical assessments and duplex ultrasonography results were enrolled and randomly assigned into three groups. Group A (n=63) received Low-Molecular-Weight Heparin (LMWH) via subcutaneous injection, Group B (n=63) was treated with Argatroban, and Group C (n=63) received a combination of LMWH and Argatroban. Results: Statistical analysis revealed significant differences within and around the thigh and calf regions by the 14th day between Group A and C, and Group B and C, with p-values less than 0.05. Further, comparisons from day 0 to day 14 showed significant differences in thrombus regression across all groups, with p-values less than 0.01 or 0.001. The chi-squared test indicated that Group C had a more favorable outcome in thrombus regression compared to Groups A and B. Notably, Argatroban treatment was associated with a lower risk of bleeding and higher efficiency in DVT management among athletes. Conclusions: Anticoagulation with Argatroban, alone or in combination with LMWH, offers a viable and potentially safer therapeutic option for athletes suffering from DVT. Its use could facilitate quicker recovery and return to training or competition, emphasizing its role in sports medicine where rapid and effective treatment is crucial. [ABSTRACT FROM AUTHOR]

Background: Pelvic venous obstruction (PVO), defined as greater than 50% stenosis or occlusion of pelvic veins, is a known risk factor for deep vein thrombosis (DVT). DVT is a known risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), but the prevalence of PVO in CTEPH is unknown. Methods: This cross-sectional study at Temple University's tertiary referral center for Pulmonary Hypertension, Right Heart Failure, and CTEPH sought to identify the presence of PVO in patients with CTEPH who underwent cardiac catheterization, pulmonary angiography, and venography. Results: A total of 193 CTEPH patients were referred for pulmonary angiography, and among these, 148 underwent venography. PVO was identified in 65 (44%) patients. Lower extremity (LE) DVT was associated with PVO (p = 0.004). The severity of pulmonary hypertension was similar with and without PVO (mean pulmonary artery pressure 43.0 ± 10.3 mm Hg vs. 43.8 ± 12.4 mm Hg, p = 0.70), as was the need for pulmonary thromboendarterectomy (69.2% vs. 61.4%, p = 0.32). Conclusions: Pelvic vein obstruction is common and a novel clinical association in patients with CTEPH, particularly in patients with a history of LE DVT. PVO and its role in CTEPH warrants further study, including the potential role of revascularization to mitigate further risk. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess and improve VTE prophylaxis practices in major abdominal surgery through a hospital audit and nurses' survey. Primary aims: Evaluate adherence to VTE prophylaxis guidelines in abdominal surgery, identify improvement opportunities in VTE prevention and assess the effectiveness of current prophylactic measures. Nurses' survey: Evaluate surgical nurses' knowledge and implementation of VTE prophylaxis and identify educational gaps to improve VTE prevention. Secondary aims: Integrate audit and survey insights: Gain insight into VTE management practices, to develop quality improvement programs for better prophylaxis and outcomes. Background: Guidelines for the prevention of venous thromboembolism (VTE) in surgical patients involve risk assessment, followed by chemical and mechanical prophylaxis. Often, VTE risk assessments are not completed which leads to inappropriate or inadequate prophylaxis. The current guidelines suggest that a healthcare provider, such as a nurse or physician, should conduct the VTE risk assessment for each patient. Study design and methods: Initially, a prospective audit was conducted to examine VTE prophylaxis practices at a tertiary hospital. This VTE audit was conducted alongside a nurses' survey to assess current VTE prophylaxis practices. Both measures were taken to review the quality of care provided to surgical patients. Results: The practice of VTE prophylaxis shows high utilisation of all three prophylactic modalities but a lack of risk assessment documentation in the medical records. Nurses, although perceiving it as their responsibility, do not conduct assessments for venous thromboembolism risk. Conclusion: Based on the audit and survey results, the hospital has not fully adopted the guidelines for venous thromboembolism prophylaxis in major abdominal surgery cases. There is a lack of proper risk assessment documentation, and nurses are not consistently engaged in conducting these. Implications for research, policy, and practice: This paper presents valuable insights into the current prescribing practices for VTE prophylaxis after major abdominal surgery, as gleaned from a clinical audit and a survey of nurses. The hospital audit indicates that overall, all three are being used, instead of two. While this approach does not contravene current guidelines, the use of both stockings and compression devices is not needed, instead adding new risks, unnecessary nursing workload and financial cost to health services. Further, this approach may prolong recovery with patients unable to mobilise while wearing compression devices to take part in rehabilitation programs. [ABSTRACT FROM AUTHOR]

It is uncertain whether monitoring or targeting anti-Xa levels is necessary when using low-molecular-weight-heparin (LMWH) to prevent venous thromboembolism (VTE). This stratified meta-analysis assessed whether monitoring trough or peak anti-Xa levels with LMWH dosing would reduce risk of VTE. Twelve non-randomized studies involving 3604 hospitalized patients met the inclusion criteria and were subject to meta-analysis. Eight studies assessed the association between VTE and peak anti-Xa levels (between.2 and.5 IU/ml) and four studies assessed the benefits of targeting the trough anti-Xa levels (>.1 IU/ml). Achieving an adequate peak or trough anti-Xa level was associated with a reduced risk of VTE (random-effects model odds ratio [OR].52, 95% confidence interval [CI].34-.77; P =.001, I2 = 30% and P -value for heterogeneity =.171) compared with using a fixed standard dose of LMWH. Targeting the trough level (OR.40, 95%CI 0.22–.75, P =.004) appeared to be more effective than targeting the peak level (OR.62, 95%CI 0.37–1.03, P =.066), although a formal interaction analysis did not confirm they were statistically different (ratio of ORs = 1.52, 95%CI 0.68–3.40; z score = 1.03, P =.306). Targeting a higher anti-Xa level did not appear to increase the risk of bleeding or transfusion (OR 1.20, 95%CI 0.46–3.17, P =.707). [ABSTRACT FROM AUTHOR]

Background: Patients with lymphedema and lipedema share physical exam findings that may lead to misdiagnosis. Poor mobility is common in patients with obesity and patients with lymphedema and lipedema. This may constitute a risk factor for venous thromboembolism (VTE). Our objective was to evaluate the association of VTE in obese patients with lymphedema and lipedema. Methods: The National Inpatient Sample (NIS) was searched from 2016 to 2020 to identify hospital admissions of obese female patients with lymphedema and lipedema. Patients were analyzed in the context of presence or absence of VTE while adjusting for complex cluster sampling techniques. Predictors of VTE were accessed by multivariable regression. Results: Lymphedema was identified in 189,985 patients and lipedema in 50,645 patients. VTE was observed in 3.12% (n = 374,210) of patients with obesity. In patients with obesity, VTE was more common in patients with lymphedema than without (2.6% vs 1.6%; p < 0.01). Similarly, VTE was more common in patients with lipedema than without (0.6% vs 0.4%; p < 0.01). After multivariable logistic regression, VTE events in obese patients with lymphedema were higher versus without (OR 1.6; CI 1.08–2.43; p = 0.02). Similarly, VTE events were more common in obese patients with lipedema versus obese patients without lipedema (OR 1.20; CI 1.03–1.41; p = 0.02). Conclusions: In this hypothesis-generating study, lymphedema and lipedema show a positive association with VTE after adjusting for baseline patient characteristics such as obesity, which is a known independent risk factor for VTE. Mechanisms whereby lymphedema and lipedema are associated with VTE should be investigated. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Venous thromboembolism (VTE) is commonly treated with oral anticoagulants, including warfarin or direct oral anticoagulants (DOACs). Although DOACs are associated with favorable treatment satisfaction, few studies have assessed whether quality of life differs between DOAC and warfarin users. MATERIALS AND METHODS: We invited adults enrolled in two California-based integrated health care delivery systems and with a history of VTE between January 1, 2015 and June 30, 2018 to complete a survey on their experience with anticoagulants. Health-related quality of life (QOL) was assessed using the RAND 36-item Short Form Health Survey (SF-36), which measures QOL in 2 general component scores (physical and mental). We used multivariable linear regression to compare mean QOL component scores between DOAC-users and warfarin-users, adjusting for patient and clinical characteristics. RESULTS: Overall, 2230 patients (43.1 % women and 31.8 % >75 years of age) taking anticoagulants answered at least 1 question on the SF-36, 975 taking DOACs and 1255 taking warfarin. After adjustment for patient-level factors, there were no significant differences in either physical component scores (39.2 v 38.3, p = 0.24) or mental component scores (48.5 v 49.0, p = 0.42) between DOAC and warfarin users. CONCLUSIONS: Health-related QOL did not significantly differ between DOAC and warfarin users with a history of VTE.

The spectrum of venous thromboembolic (VTE) disease encompasses both acute deep venous thrombosis (DVT) and chronic postthrombotic changes (CPC). A large percentage of acute DVT patients experience recurrent VTE despite adequate anticoagulation, and may progress to CPC. Further, the role of iliocaval venous obstruction (ICVO) in lower-extremity VTE has been increasingly recognized in recent years. Imaging continues to play an important role in both acute and chronic venous disease. Venous duplex ultrasound remains the gold standard for diagnosing acute VTE. However, imaging of CPC is more complex and may involve computed tomography, magnetic resonance, contrast-enhanced ultrasound, or intravascular ultrasound. In this narrative review, we aim to discuss the full spectrum of venous disease imaging for both acute and chronic venous thrombotic disease. [ABSTRACT FROM AUTHOR]

Background: Deep vein thrombosis (DVT) of the lower limbs is a common and potentially life-threatening condition. This clinical study aimed to investigate the clinical characteristics, risk factors, diagnostic methods, and treatment outcomes of DVT in the lower limbs. Methods: A retrospective analysis was conducted on medical records of patients diagnosed with lower limb DVT over a specific period. Demographic data, comorbidities, and potential risk factors were assessed. Diagnostic methods, including imaging modalities and laboratory tests, were utilized to confirm the diagnosis of DVT. Treatment interventions and outcomes were also evaluated. Results: The study included a cohort of patients with lower limb DVT. The incidence of DVT in the lower limbs within the study population was determined. Common risk factors, such as immobility, prior history of DVT, and underlying medical conditions, were identified. Clinical manifestations of DVT, including symptoms and complications, were documented. Diagnostic methods, such as ultrasound imaging and Ddimer assays, were found to be effective in diagnosing DVT. The treatment outcomes, including the efficacy and safety of different therapeutic interventions, were assessed. Conclusion: This clinical study provides valuable insights into the clinical characteristics, risk factors, diagnostic methods, and treatment outcomes of DVT in the lower limbs. The findings contribute to the understanding of this vascular disorder, aiding in the development of effective management strategies and improved patient care. Further research is warranted to explore preventive measures and optimize treatment approaches for DVT in the lower limbs. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE), a condition involving deep vein thrombosis and embolism, can cause death when left untreated. Hospitalized patients and those who have recently undergone surgery or have a cancer diagnosis are at increased risk for VTE development. The updated AORN "Guideline for prevention of venous thromboembolism" provides perioperative nurses with a variety of evidence‐based recommendations associated with the topic. This article provides an overview of the guideline and discusses recommendations for a VTE protocol, VTE and bleeding risk assessments, pharmacologic and mechanical VTE prophylaxis, postoperative ambulation, and patient and family education. It also includes a scenario that illustrates the importance of the VTE assessment and the use of mechanical prophylaxis for high‐risk patients undergoing operative or other invasive procedures. Perioperative nurses should review the guideline in its entirety and implement recommendations in operative and procedural settings. [ABSTRACT FROM AUTHOR]

Objective: The purpose of our study was to examine risk factors for venous thromboembolism (VTE) and VTE associated mortality in elderly acute lymphocytic leukemia (ALL) patients receiving different treatment options. Methods: We analyzed data from the United States SEER-Medicare database (2007–2015) for patients ≥65 years diagnosed with ALL. Data were stratified by treatment options into three groups as chemotherapy: the use of antimetabolites, anthracyclines, alkylating agents or vinca alkaloids; other treatment: the use of corticosteroids/tyrosine kinase inhibitors without chemotherapy; and no treatment. Logistic regression was used to examine risk factors for VTE and Cox proportional regression was used to evaluate Hazard Ratios (HRs) for the effect of VTE on mortality in ALL patients. Results: In a cohort of 1088 elderly ALL patients, 17.4 % patients had a diagnosis of VTE. VTE was diagnosed in 27.7 % of 159 patients who received chemotherapy, 16.2 % of 328 patients who received other treatment, and 15.3 % of 601 patients who did not receive any treatment (p

Abstract Background To explore the diagnostic value of Caprini risk assessment model (2005) combined with D-dimer for deep vein thrombosis, and to exclude patients with low incidence of thrombosis who might not need anticoagulation after surgery. Methods A total of 171 colorectal cancer patients who underwent surgery from January 2022 to August 2022 were enrolled in this study. Caprini risk assessment model was used to evaluate patients the day before surgery, and full-length venous ultrasonography of lower extremity was used to assess whether patients had thrombosis one day before surgery and the sixth day after surgery. The value of D-dimer was measured by enzyme-linked immunosorbent assays on the first day after surgery, and clinical data of patients were collected during hospitalization. Results A total of 171 patients were divided into IPC Group and IPC + LMWH Group according to whether low molecular weight heparin (LMWH) were used to prevent thrombus after surgery. Eventually, 17.6% (15/85) patients in IPC Group and 7% (6/86) patients in IPC + LMWH Group developed DVT. Through separate analysis of IPC Group, it is found that Caprini score and D-dimer were independent risk factors for DVT (Caprini OR 3.39 [95% CI 1.38–8.32]; P = 0.008, D-Dimer OR 6.142 [95% CI 1.209–31.187]; P = 0.029). The area under ROC curve of Caprini risk assessment model is 0.792 (95% CI 0.69–0.945, P 10 and D-dimer > 0.835 μg/mL, the incidence of DVT is 38.7% (12/31) and LMWH should be considered. Conclusions The Caprini risk assessment model and D-dimer can provide more accurate risk stratification for patients after laparoscopic radical resection of colorectal cancer.

Aims: The modern prevalence of primary tumours causing metastatic bone disease is ill-defined in the oncological literature. Therefore, the purpose of this study is to identify the prevalence of primary tumours in the setting of metastatic bone disease, as well as reported rates of pathological fracture, postoperative complications, 90-day mortality, and 360-day mortality for each primary tumour subtype. Methods: The Premier Healthcare Database was queried to identify all patients who were diagnosed with metastatic bone disease from January 2015 to December 2020. The prevalence of all primary tumour subtypes was tabulated. Rates of long bone pathological fracture, 90-day mortality, and 360-day mortality following surgical treatment of pathological fracture were assessed for each primary tumour subtype. Patient characteristics and postoperative outcomes were analyzed based upon whether patients had impending fractures treated prophylactically versus treated completed fractures. Results: In total, 407,893 unique patients with metastatic bone disease were identified. Of the 14 primary tumours assessed, metastatic bone disease most frequently originated from lung (24.8%), prostatic (19.4%), breast (19.3%), gastrointestinal (9.4%), and urological (6.5%) malignancies. The top five malignant tumours resulting in long bone pathological fracture were renal (5.8%), myeloma (3.4%), female reproductive (3.2%), lung (2.8%), and breast (2.7%). Following treatment of pathological fractures of long bones, 90-day mortality rates were greatest for lung (12.1%), central nervous system (10.5%), lymphoma (10.4%), gastrointestinal (10.1%), and non-renal urinary (10.0%) malignancies. Finally, our study demonstrates improved 90-day and 360-day survival in patients treated for impending pathological fracture compared to completed fracture, as well as significantly lower rates of deep vein thrombosis, pulmonary embolism, urinary tract infection, and blood transfusion. Conclusion: This study defines the contemporary characteristics of primary malignancies resulting in metastatic bone disease. These data should be considered by surgeons when prognosticating patient outcomes during treatment of their metastatic bone disease. Cite this article: Bone Jt Open 2023;4(6):424–431.

Anticoagulation, deep vein thrombosis (DVT), pulmonary embolism (PE), venous thromboembolism (VTE) Keywords: anticoagulation; deep vein thrombosis (DVT); pulmonary embolism (PE); venous thromboembolism (VTE) EN anticoagulation deep vein thrombosis (DVT) pulmonary embolism (PE) venous thromboembolism (VTE) 481 486 6 10/10/23 20231001 NES 231001 What is venous thromboembolism (VTE)? What to expect after DVT or PE is diagnosed The next steps after diagnosis of DVT and/or PE vary based on the medical history, age of the patient, and the circumstances surrounding the clot. [Extracted from the article]

Background: To explore the diagnostic value of Caprini risk assessment model (2005) combined with D-dimer for deep vein thrombosis, and to exclude patients with low incidence of thrombosis who might not need anticoagulation after surgery. Methods: A total of 171 colorectal cancer patients who underwent surgery from January 2022 to August 2022 were enrolled in this study. Caprini risk assessment model was used to evaluate patients the day before surgery, and full-length venous ultrasonography of lower extremity was used to assess whether patients had thrombosis one day before surgery and the sixth day after surgery. The value of D-dimer was measured by enzyme-linked immunosorbent assays on the first day after surgery, and clinical data of patients were collected during hospitalization. Results: A total of 171 patients were divided into IPC Group and IPC + LMWH Group according to whether low molecular weight heparin (LMWH) were used to prevent thrombus after surgery. Eventually, 17.6% (15/85) patients in IPC Group and 7% (6/86) patients in IPC + LMWH Group developed DVT. Through separate analysis of IPC Group, it is found that Caprini score and D-dimer were independent risk factors for DVT (Caprini OR 3.39 [95% CI 1.38–8.32]; P = 0.008, D-Dimer OR 6.142 [95% CI 1.209–31.187]; P = 0.029). The area under ROC curve of Caprini risk assessment model is 0.792 (95% CI 0.69–0.945, P < 0.01), the cut-off value is 9.5, and the area under ROC curve of D-dimer is 0.738 (95%CI 0.555–0.921, P < 0.01), the cut-off value is 0.835 μg/mL, and the area under the ROC curve was 0.865 (95% CI 0.754–0.976, P < 0.01) when both of them were combined. Based on decision curve analysis, it is found that Caprini risk assessment model combined with D-dimer can benefit patients more. All patients are divided into four groups. When Caprini score < 10 and D-dimer < 0.835 μg/mL, only 1.23% (1/81) of patients have thrombosis and LMWH has little significance. When Caprini score > 10 and D-dimer > 0.835 μg/mL, the incidence of DVT is 38.7% (12/31) and LMWH should be considered. Conclusions: The Caprini risk assessment model and D-dimer can provide more accurate risk stratification for patients after laparoscopic radical resection of colorectal cancer. [ABSTRACT FROM AUTHOR]

Patients with venous thrombosis of splanchnic circulation represent a group of high risk with significant morbidity and mortality, if treatment is delayed. We present a patient with thrombosis of portal vein and its tributaries combined with deep venous thrombosis (DVT) of the lower extremities who was successfully treated with conservative management. This patient case highlights the importance of early empiric anti-inflammatory therapy along with systemic anticoagulation to reduce the intestinal inflammation and enteritis and break the vicious circuit resulting in secondary progressive thrombosis of the splanchnic veins, fluid shifts, and functional ileus. Case presentation: A previously healthy 61-years-old female patient with no significant medical history was admitted with progressive upper abdominal pain, nausea and vomiting, low-grade fever, mild signs of ileus, and malaise. Imaging studies revealed portal venous dilation reaching ~20mm with near-total obliteration of the lumen by a thrombus. In addition, thrombosis of superior mesenteric and splenic veins with thrombophlebitis was found. Imaging studies also confirmed the presence of DVT of lower extremities including thrombus propagation into the iliac veins. An immediate therapy was started with parenteral antibiotics, anti-inflammatory medications, systemic anticoagulants, and intravenous fluid infusions to restore the circulating volume deficit and treat electrolyte disbalance. With such therapy, the patient's symptoms resolved within a month, and she was discharged from the hospital with full recovery. Heparin infusion was started to reach systemic anticoagulation. With resolution of symptoms, anticoagulation was continued with warfarin. We used non-steroidal anti-inflammatory drugs (NSAIDs) as a component in management of intestinal and systemic inflammation and multifocal thrombosis when the antiphospholipid syndrome was also on the list of differential diagnoses. Conclusion: We present a previously asymptomatic patient with progressive portal venous thrombosis and ascending DVT. Early establishment of diagnosis and initiation of therapy with systemic anticoagulants, anti-inflammatory and antibacterial drugs helped to stop thrombus progression, prevent irreversible intestinal ischemia, and allow for recanalization of the occluded veins. This case highlights the importance of early interventions to improve the treatment outcome. [ABSTRACT FROM AUTHOR]

Rivaroxaban (RXB), a novel Xa inhibitor having groundbreaking therapeutic potential. However, this drug is associated with few limitations, including its pharmacokinetics related toxicities. Here, we developed RXB-loaded SLNs (RXB-SLNs) to improve its biopharmaceutical profile. Methods: High pressure homogenizer was used to prepare RXB-SLNs, followed by their particle characterization, Transmission electron microscopy (TEM), Dynamic light scattering (DSC), and Powder X-ray diffraction (PXRD) analysis. Beside this, in-vitro, ex-vivo, and in-vivo evaluation, prothrombin time assessment and toxicity was investigated. RXB-SLNs had their particle size in nano range (99.1 ± 5.50 nm) with excellent morphology and low polydispersity index (0.402 ± 0.02) and suitable zeta potential (−25.9 ± 1.4 mV). The incorporation efficiency was observed around 95.9 ± 3.9%. In-vitro release profiles of the RXB-SLNs exhibited enhanced dissolution (89 ± 9.91%) as compared to pure drug (11 ± 1.43%) after 24 h of the study. PK study demonstrated a seven times enhanced bioavailability of RXB-SLNs when compared with pure drug. Furthermore, RXB-SLNs exhibited an expressive anti-coagulant behavior in human and rat blood plasma. Also, the final formulation exhibited no toxicity after oral administration of the SLNs. All together, these studies revealed the capability of the SLNs for carrying the RXB with enhanced therapeutic efficacy and no toxicity, most importantly for the treatment of deep vein thrombosis. [ABSTRACT FROM AUTHOR]

Background: The expression of serine protease granzyme-B (GzmB) by circulating CD8+ T lymphocytes has been recently suggested as a biomarker for poor immunotherapy response and severe disability in patients with Neuromyelitis Optica spectrum disorders (NMOSD). In parallel, venous thromboembolism (VTE) has been reported mainly in NMOSD patients exhibiting transverse myelitis. Case presentation: Here, we describe an Aquaporin-4 positive (AQP4-positive) NMOSD patient who showed short myelitis (SM) and experienced a fatal pulmonary thromboembolism/lower extremity deep vein thrombosis during anti-CD20 treatment. Flow cytometry analyses from the peripheral blood revealed an enhanced cytotoxic behavior through circulating CD8+GzmB+ T, CD4+GzmB+ T lymphocytes, and residual CD19+GzmB+ B cells. Conclusions: Fatal VTE may be a rare outcome, particularly in patients exhibiting SM, and may share poorly understood immunological mechanisms with AQP4-positive NMOSD severity. [ABSTRACT FROM AUTHOR]

Background: The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. Methods: We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. Results: As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98–10.6). Conclusions: Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation. [ABSTRACT FROM AUTHOR]

Scales to qualify the risk of thrombosis do not include all thrombogenic factors that are generated in esthetic plastic surgery. Methods: We performed a systematic review to assess the risk of thrombosis in plastic surgery. Thrombogenic factors in esthetic surgery were analyzed by a panel of experts. We proposed a scale with 2 versions. In the first version, factors were stratified according to their impact on the possible risk of thrombosis. The second version includes the same factors but in a simplified form. We evaluated the efficacy of the proposed scale by comparing it with the Caprini score; we scored the risk in 124 cases and controls. Results: Using the Caprini score, we found that 81.45% of the patients studied and 62.5% of the cases of thrombosis were observed in the low-risk group. Only 1 case of thrombosis was reported in the high-risk group. Using the stratified version of the scale, we found that the low-risk group comprised 25% of the patients, and there were no cases of thrombosis. The high-risk group included 14.51% of patients; 10 presented thrombosis (62.5%). The proposed scale was very effective in detecting both low-risk and high-risk patients undergoing esthetic surgery procedures. [ABSTRACT FROM AUTHOR]

Introduction: High incidence of thrombotic events has been reported in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Objective: To assess the risk factors of deep vein thrombosis (DVT) in intensive care patients with COVID-19 by comparing the clinical features of patients in groups with thrombosis, venous stasis and without deep vein thrombosis. Material and methods: A prospective cross-sectional study was conducted that included all consecutive adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. We investigated chronic comorbid conditions in patients, including arterial hypertension, diabetes mellitus, obesity, chronic kidney failure (CRF), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and cancer which may be a risk factor for thrombosis. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%). Doppler ultrasound (DUS) confirmed deep vein thrombosis in 60 patients (13.8%), which was associated with older age (71.12±13.98 vs. (79.57%), chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases - 25 (5.38%). Hypertension (p=0.02), diabetes mellitus (p=0.041) and obesity (p=0.01) were significant risk factors for DVT. D-dimer was a statistically significant predictor of DVT formation (p Conclusion: The study identified risk factors for deep vein thrombosis in intensive care patients with COVID-19. These include: age, high levels of D-dimer, and comorbidities such as hypertension, obesity, and diabetes mellitus.

Abstract Background In the diagnostic work-up of deep vein thrombosis (DVT), the use of point-of-care-test (POCT) D-dimer assays is emerging as a promising patient-friendly alternative to regular D-dimer assays, but their cost-effectiveness is unknown. We compared the cost-effectiveness of two POCT-based approaches to the most common, laboratory-based, situation. Methods A patient-level simulation model was developed to simulate the diagnostic trajectory of patients presenting with symptoms of DVT at the general practitioner (GP). Three strategies were defined for further diagnostic work-up: one based on current guidelines (‘regular strategy’) and two alternative approaches where a POCT for D-dimer is implemented at the 1) phlebotomy service (‘DVT care pathway’) and 2) GP practice (‘fast-POCT strategy’). Probabilities, costs and health outcomes were obtained from the literature. Costs and effects were determined from a societal perspective over a time horizon of 6 months. Uncertainty in model outcomes was assessed with a one-way sensitivity analysis. Results The Quality-Adjusted Life Years (QALYs) scores for the three DVT diagnostic work-up strategies were all around 0.43 across a 6 month-time horizon. Cost-savings of the two POCT-based strategies compared to the regular strategy were €103/patient for the DVT care pathway (95% CI: -€117–89), and €87/patient for the fast-POCT strategy (95% CI: -€113–67). Conclusions Point-of-care-based approaches result in similar health outcomes compared with regular strategy. Given their expected cost-savings and patient-friendly nature, we recommend implementing a D-dimer POCT device in the diagnostic DVT work-up.

Patients with venous thrombosis of splanchnic circulation represent a group of high risk with significant morbidity and mortality, if treatment is delayed. We present a patient with thrombosis of portal vein and its tributaries combined with deep venous thrombosis (DVT) of the lower extremities who was successfully treated with conservative management. This patient case highlights the importance of early empiric anti-inflammatory therapy along with systemic anticoagulation to reduce the intestinal inflammation and enteritis and break the vicious circuit resulting in secondary progressive thrombosis of the splanchnic veins, fluid shifts, and functional ileus. Case presentation: A previously healthy 61-years-old female patient with no significant medical history was admitted with progressive upper abdominal pain, nausea and vomiting, low-grade fever, mild signs of ileus, and malaise. Imaging studies revealed portal venous dilation reaching ∼20 mm with near-total obliteration of the lumen by a thrombus. In addition, thrombosis of superior mesenteric and splenic veins with thrombophlebitis was found. Imaging studies also confirmed the presence of DVT of lower extremities including thrombus propagation into the iliac veins. An immediate therapy was started with parenteral antibiotics, anti-inflammatory medications, systemic anticoagulants, and intravenous fluid infusions to restore the circulating volume deficit and treat electrolyte disbalance. With such therapy, the patient’s symptoms resolved within a month, and she was discharged from the hospital with full recovery. Heparin infusion was started to reach systemic anticoagulation. With resolution of symptoms, anticoagulation was continued with warfarin. We used non-steroidal anti-inflammatory drugs (NSAIDs) as a component in management of intestinal and systemic inflammation and multifocal thrombosis when the antiphospholipid syndrome was also on the list of differential diagnoses. Conclusion: We present a previously asymptomatic patient with progressive portal venous thrombosis and ascending DVT. Early establishment of diagnosis and initiation of therapy with systemic anticoagulants, anti-inflammatory and antibacterial drugs helped to stop thrombus progression, prevent irreversible intestinal ischemia, and allow for re-canalization of the occluded veins. This case highlights the importance of early interventions to improve the treatment outcome.

BackgroundThe expression of serine protease granzyme-B (GzmB) by circulating CD8+ T lymphocytes has been recently suggested as a biomarker for poor immunotherapy response and severe disability in patients with Neuromyelitis Optica spectrum disorders (NMOSD). In parallel, venous thromboembolism (VTE) has been reported mainly in NMOSD patients exhibiting transverse myelitis.Case presentationHere, we describe an Aquaporin-4 positive (AQP4-positive) NMOSD patient who showed short myelitis (SM) and experienced a fatal pulmonary thromboembolism/lower extremity deep vein thrombosis during anti-CD20 treatment. Flow cytometry analyses from the peripheral blood revealed an enhanced cytotoxic behavior through circulating CD8+GzmB+ T, CD4+GzmB+ T lymphocytes, and residual CD19+GzmB+ B cells.ConclusionsFatal VTE may be a rare outcome, particularly in patients exhibiting SM, and may share poorly understood immunological mechanisms with AQP4-positive NMOSD severity.

Acute pancreatitis results in high morbidity and mortality. Gallstones and alcoholism are considered leading causes of acute pancreatitis. However, increasing prevalence of obesity, diabetes and lifestyle choices has resulted in Hypertriglyceridemia induced pancreatitis (HTAP) becoming more common. HTAP is said to be more severe than other causes. The treatment options available vary including intravenous (IV) insulin, heparin, plasma exchange, fibrates, niacin, omega three fatty acids and dietary restrictions. This is a case report of a patient presenting with HTAP and the dilemma treating physicians faced in trying to balance the need for urgent treatment with invasiveness of procedure and paucity of evidence. Keywords: Hypertriglyceridemia induced Acute pancreatitis (HTAP), Lipoprotein lipase (LPL), Triglycerides (TG). Deep vein thrombosis (DVT), Systemic inflammatory response syndrome (SIRS), Hypertriglyceridemia (HTG), Infusions, Intravenous (IV).

Introduction: Deep Vein Thrombosis (DVT) is the third most common vascular disease after myocardial infarction and ischemic stroke. DVT is a multi-factorial disorder with many inherited and acquired risk factors playing in its etiopathogenesis. Homocysteine (Hcy) is a sulphur-containing amino acid which plays a vital role for development of the tissues. Hyperhomocysteinemia is a disorder of methionine metabolism and a modifiable risk factor of myocardial infarction, peripheral arterial thrombosis as well as deep vein thrombosis and pulmonary embolism. Increasing prevalence of DVT worldwide causes increased morbidity & mortality & have increased economic burden in the community. Pathogenesis of DVT may be associated with the destruction of vascular endothelial cells resulting from immune and inflammatory mediators.mStudies about the role of Homocysteine in the pathogenesis of vascular thrombo embolism, shown conflicting results hence any reliable clue will be considered valuable. Aims & Objective: To estimate serum Homocysteine in female DVT patients and to assess the relation between hyperhomocysteinemia and deep vein thrombosis. Materials and Methods: This cross-sectional study included 60 female patients of DVT. Venous blood sample was collected in heparinized vial and analyzed for homocysteine levels. Results: In our study we found significantly raised serum homocysteine levels (p value <0.05) in females belonging to more than 40 yrs. of age as compared to the other age group. Conclusion: In our study we found that women are more susceptible to the pathological effects of elevated homocysteine levels in age group more than 40 yrs. which may be a risk factor for DVT. [ABSTRACT FROM AUTHOR]

We examined risk factors for severe COVID-19 among health care workers at an academic medical center. Health care workers in high-risk settings who also have a history of deep vein thrombosis (DVT) pulmonary embolism (PE)/stroke should be prioritized for workplace preventive measures, vaccination, and early treatment for COVID-19. Objective: Evaluate potential risk factors for severe coronavirus disease 2019 (COVID-19) among health care workers (HCWs) at the University of Virginia Medical Center in Charlottesville, Virginia. Methods: We conducted a retrospective manual chart review of data from HCWs who were diagnosed with COVID-19 from March 2020 to March 2021. Using data from patient medical histories, we ascertained risk factors for COVID-19–related emergency department encounter, hospitalization, or death. Results: We had 634 patients in total, and 9.8% had a severe COVID-19–related outcome. A history of deep vein thrombosis/pulmonary embolism/stroke (odds ratio, 19.6; 95% confidence interval, 5.11 to 94.7), as well as asthma, chronic lung disease, diabetes, or current immunocompromised status, was associated with increased adjusted odds of COVID-19–related emergency department encounter/hospitalization/death. Conclusions: A preexisting history of deep vein thrombosis/pulmonary embolism/stroke is a novel risk factor for poor COVID-19 outcomes among a cohort of HCWs. [ABSTRACT FROM AUTHOR]

Introduction: Patients with malignant brain tumors frequently exhibit hypercoagulation and are at a high risk of postoperative thrombosis-related complications. However, the risk factors for postoperative thrombosis-related complications remain unclear. Methods: In this retrospective, observational study, we consecutively enrolled elective patients undergoing resection of malignant brain tumors from 26 November 2018 to 30 September 2021. The primary objective of the study was to identify risk factors for a composite of three major adverse events including postoperative lower limb deep venous thrombosis, pulmonary embolism, and cerebral ischemia. Results: A total of 456 patients were enrolled in this study, where 112 (24.6%) patients had postoperative thrombosis-related complications, 84 (18.4%) with lower limb deep venous thrombosis, 0 (0.0%) with pulmonary embolism, and 42 (9.2%) with cerebral ischemia. In a multivariate model, age more than 60 years (OR: 3.98, 95% CI: 2.30-6.88, P < 0.001), preoperative abnormal APTT (OR: 2.81, 95% CI: 1.06-7.42, P = 0.037), operation duration longer than 5 h (OR: 2.36, 95% CI: 1.34-4.16, P = 0.003), and admission to ICU (OR: 2.49, 95% CI: 1.21-5.12, P = 0.013) were independent risk factors of the postoperative deep vein thrombosis. Intraoperative plasma transfusion (OR: 6.85, 95% CI: 2.73-17.18, P < 0.001) was associated with significantly increased odds of deep vein thrombosis. Conclusion: Patients with craniocerebralmalignant tumors have a high incidence of postoperative thrombosis-related complications. There is an increase in the odds of postoperative lower limb deep venous thrombosis in patients; over 60 years old, with preoperative abnormal APTT, undergoing surgeries longer than 5-h, admission to ICU, or receiving intraoperative plasma infusion. Fresh frozen plasma infusion should be used more cautiously, especially in patients with a high risk of thrombosis. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is a frequent cause of morbidity and mortality in hospitalized patients. Although most patients can be treated safely with anticoagulation, inferior vena cava filters (IVCF) represent an important alternative to anticoagulation in a small subset of patients. After the introduction of temporary IVC filters, the number of implantations has had an upward trend. Indications for IVCF insertion have been liberalized despite limited evidence supporting the practice. In addition, IVC filters are associated with a number of serious complications. In this article, we comprehensively review the entire issue of IVCF, including indications, placement technique, and complications. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE), a disorder associated with a significant risk of morbidity and mortality, is composed of deep vein thrombosis (DVT) and pulmonary embolism (PE). Objectives: The aim of this study was to compare between rivaroxiban and warfarin regarding efficacy, safety and complications of treatment in patients with DVT. Patients and methods: This is a randomized controlled clinical trial. From April 2021 to April 2022, seventy patients with DVT were diagnosed and followed up in Vascular Surgery Department in Qena University Hospital regarding clinical presentation and venous duplex ultrasonography scans. Studied patients were divided into two groups, Group A treated by rivaroxiban and Group B treated by warfarin. Comparison between variables of two groups was performed regarding efficacy, safety and complications of treatment. Results: No significant differences between two groups were noticed regarding efficacy and clinical improvement while there was significant difference regarding bleeding as a complication e.g. bleeding in warfarin group as P value