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Autoimmune diseases and thrombophilic disorders, notably antiphospholipid syndrome (APS) and protein S deficiency, present a formidable challenge in pregnancy, substantially increasing the risk of thromboembolic complications by up to 20%. Pulmonary thromboembolism (PTE), characterized by a significantly higher maternal mortality rate, is of particular concern.APS, defined by the presence of antiphospholipid antibodies, emerges as a pivotal risk factor for PTE during pregnancy, especially in women exhibiting triple negativity. Concurrently, protein S deficiency further amplifies vulnerability to thromboembolic events, establishing a high-risk scenario for pregnant individuals.In a case involving a 29-year-old pregnant woman with a history of generalized lupus erythematosus, triple-negative antiphospholipid syndrome, and protein S deficiency, sudden-onset dyspnea prompted thorough investigation. Despite her complex medical history, a multidisciplinary approach led to the accurate diagnosis and successful management of subsegmental pulmonary thromboembolism, ensuring the well-being of both mother and fetus.Effectively managing PTE during pregnancy demands a comprehensive, multidisciplinary approach involving collaboration among obstetricians, internists, rheumatologists, and hematologists. Accurate diagnosis, tailored anticoagulation strategies, and continuous monitoring stand as indispensable pillars for maternal and fetal well-being.

Background: Computed tomography pulmonary angiography (CTPA) is an imaging technique widely used in the diagnosis of acute pulmonary thromboembolism (PTE). Despite its disadvantages and potential risks, the overuse of CTPA has been a growing concern over the past decades. Objectives: The objective of this study was to investigate the rate of avoidable overuse of CTPA in patients with suspected PTE and to identify factors contributing to this overuse. The study aimed to highlight the importance of proper training for physicians in using validated diagnostic algorithms to minimize the overuse of CTPA and improve patient outcomes. Methods: In a cross-sectional study conducted between April 2016 and March 2019 at Shariati Hospital at Tehran University of Medical Sciences (TUMS), 1058 patients underwent CTPA due to suspected PTE. Wells scores were calculated retrospectively for all patients. The study defined avoidable overuse of CTPA as an imaging request without prior D-dimer testing or ignoring a negative D-dimer result in patients with low clinical pre-test probability. Results: Two hundred and seventy-three patients were excluded from the study due to unavailable documentation or pregnancy. Among the included 785 patients, 139 (17.7%) revealed PTE on CTPA. Based on the Wells scores, 480 patients were identified as the "PTE-unlikely" group. In this group, 299 patients (62.3%) underwent CTPA directly despite recommendations to order a D-dimer test first. Of these patients, 281 (94%) cases showed negative results. Moreover, CTPA was performed inappropriately in 52 "PTE-unlikely" cases despite negative D-dimer serum levels, and only one patient was diagnosed with PTE. Conclusions: The study revealed that 44.7% of the CTPA requests for patients with suspected PTE were avoidable, indicating the need for better adherence to current diagnostic guidelines to reduce unnecessary radiologic investigations and improve patient care. [ABSTRACT FROM AUTHOR]

Background: Pulmonary artery sarcoma (PAS) is a very rare malignancy with a poor prognosis; however, its clinical manifestations and imaging findings are often indistinguishable from pulmonary thromboembolism (PTE). We thus aimed to accurately diagnose PAS by comparing the clinical and computed tomography pulmonary angiography (CTPA) and magnetic resonance imaging (MRI) imaging characteristics of PAS and PTE., Methods: This case-control study retrospectively enrolled 20 patients with PAS (from March 2017 to September 2022), 40 patients with central acute PTE, and 40 patients with central chronic PTE (from January 2021 to December 2022) in the China-Japan Friendship Hospital. The following clinical and imaging findings were compared between the three groups: initial symptoms; D-dimer, C-reactive protein, and N-terminal pro B-type natriuretic peptide levels; wall-eclipsing sign (WES); scope of lesion involvement; and morphological characteristics. Signal intensity was also observed on different MRI sequences., Results: The D-dimer level in PAS was significantly lower than that in central acute PTE (P<0.001). The WES was present in 17 cases of PAS (85.0%), which was a greater proportion than that of the central acute PTE and chronic PTE groups (all P values <0.001). The involvement of the pulmonary valve or right ventricular outflow tract was observed in five PAS cases but none of the central acute PTE or chronic PTE cases (all P values =0.001). In 19 PAS cases (95.0%), the lesions grew expansively in the central pulmonary artery. The proximal margin of 18 patients with PAS (90.0%) was bulging or lobulated. Nine cases of PAS (45.0%) showed aneurysm-like dilatation (grape-like sign) of the distal pulmonary artery, representing significantly greater proportion than that of the central acute PTE and chronic PTE groups (all P values <0.001). In 37 patients with central acute PTE (92.5%), the clots were observed to be floating in the pulmonary artery lumen with saddle, tubular or polypoid shape. Eccentric filling defects attached to the pulmonary artery wall were observed in 32 cases of central chronic PTE (80.0%). On MRI, PAS lesions were hyperintense on fat-suppressed T2-weighted imaging and diffusion-weighted imaging, demonstrating heterogeneous enhancement., Conclusions: Comprehensive analysis of the clinical data and imaging features on CTPA and MRI can aid in the accurate differential diagnosis of PAS and PTE., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-992/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

During the recent years, paradoxical embolism and Patent Foramen Ovale (PFO) have drawn great attention because of their strong correlation with cryptogenic stroke in young patients. The coexistence of pulmonary and paradoxical embolism is even rarer. Awareness of this complication with prompt recognition and treatment could prevent significant disability and death. We presented a 51-year-old man with evidence of concomitant pulmonary embolism and overload due to Pulmonary Thromboembolism and stroke, which suggests the presence of Patent Foramen Ovale. He was successfully treated with anticoagulation and PTO closure was performed.

Pulmonary thromboembolism (PTE) is a common complication in coronavirus disease 2019 (COVID-19) patients. Elevated D-dimer levels are observed even in the absence of PTE, reducing its discriminative ability as a screening test. It is unknown whether conventional D-dimer cut-off values, as used in the YEARS algorithm, apply to COVID-19 patients. This study aimed to determine the optimal D-dimer cut-off value to predict PTE in COVID-19 patients. All confirmed COVID-19 patients with a computed tomography pulmonary angiography (CTPA) performed ≤5 days after admission due to suspicion of PTE between March 2020 and February 2021, at Medisch Spectrum Twente, The Netherlands, were retrospectively analyzed. The association between PTE and D-dimer levels prior to CTPA, and other potential predictors, was analyzed using logistic regression analyses. The optimal cut-off value was identified using receiver operating characteristic (ROC) curve analyses. In 142 patients, PTE prevalence was 20.4%. The optimal cut-off value was 750 ng/mL (sensitivity 100%; specificity 19.5%; negative predictive value 100%; positive predictive value 24.2%). In total, 15 of 113 (13%) patients without PTE had a D-dimer level ≥500 and <750 ng/mL. In our population of patients hospitalized with COVID-19, a D-dimer level <750 ng/mL safely excluded PTE. Compared to the YEARS 500 ng/mL cut-off value, 13% fewer patients are in need of a CTPA, with similar sensitivity. Future research is required for external validation., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-870/coif). I.H.P.A.A.v.V. has given presentations in collaboration with Sanofi Genzyme and Astra Zeneca, and participated in the advisory board of GSK, Astra Zeneca and Sanofi Genzyme. The other authors have no conflicts of interest to declare., (2023 Journal of Thoracic Disease. All rights reserved.)

Objective: To determine the incidence of deep vein thrombosis (DVT) in patients undergoing spinal surgeries receiving prophylactic doses of Deltaparin in a single center in central Iran.Method: This cross-sectional study was conducted in Shariatee hospital of Isfahan during a 12-month period. We included all the patients undergoing elective spinal surgeries in our center during the study period who received prophylactic dosages of subcutaneous Dalteparin (5000 unit daily) the first postoperative day. Those with absolute contraindications of anticoagulation therapy were not included in the study. Patients were followed for 3 months clinically and the incidence of DVT was recorded. DVT was suspected clinically and was confirmed by color Doppler sonography.Results: Overall we included 120 patients with mean age of 44.8 ± 12.6 years among whom there were 54 (45%) men and 66 (55%) women. Lumbar discectomy (32.9%) and laminectomy (20.2%) were the most common performed procedures. DVT was detected in 1 (0.83%) patient in postoperative period. None of the patients developed pulmonary embolism and none hemorrhagic adverse event was recorded. The patient was treated with therapeutic unfractionated heparin and was discharged with warfarin. Conclusion: Our results shows the efficacy of LMWH (Dalteparin) in reducing the incidence of DVT to 0.83%. These results also show the safety of Dalteparin in spine surgery because of lack of bleeding complication.

Objective: To determine the incidence of deep vein thrombosis (DVT)in patients undergoing spinal surgeries receiving prophylactic doses of Deltaparin in a single center in central Iran. Method: This cross-sectional study was conducted in Shariatee hospital of Isfahan during a 12-month period. We included all the patients undergoing elective spinal surgeries in our center during the study period who received prophylactic dosages of subcutaneous Dalteparin (5000unit daily) thefirst postoperative day. Those with absolute contraindications of anticoagulation therapy were not included in the study. Patients were followed for 3 months clinically and the incidence of DVT was recorded. DVT was suspected clinically and was confirmed by color Doppler sonography. Results: Overall we included 120 patients with mean age of 44.8 ± 12.6years among whom there were 54 (45%) men and 66 (55%) women. Lumbar discectomy (32.9%)and laminectomy (20.2%)were the most common performed procedures. DVT was detected in 1 (0.83%) patient in postoperative period. None of the patients developed pulmonary embolism and none hemorrhagic adverse event was recorded. The patient was treated with therapeutic unfractionated heparin and was discharged with warfarin. Conclusion: Our results shows the efficacy of LMWH (Dalteparin) in reducing the incidence of DVT to 0.83%. These results also show the safety of Dalteparin in spine surgery because of lack of bleeding complication.

Background: Considering the importance of using more appropriate imaging technique for accurate diagnosis of pulmonary thromboembolism (PTE) with less side effects, we aimed to evaluate the quality of pulmonary 64-multidetector computed tomographic (MDCT) angiography in pregnant and postpartum women with suspected PTE in Isfahan. Materials and Methods: In this descriptive study, radiological findings of pregnant and postpartum women with suspected PTE who underwent pulmonary 64-MDCT angiography were evaluated. Prevalence of PTE in pregnant and postpartum women, mean of pulmonary arteries density for right and left pulmonary arteries, and their lobar and segmental branches, diagnostic quality of the pulmonary arteries density and their scoring, frequency of diagnostic and nondiagnostic images, mean of radiation dose and mean of bolus time, and the correlation between the quality of the vascular density with the peak density of the pulmonary artery were determined. Results: In this study, 44 pregnant and postpartum women with suspected PTE were selected. The overall prevalence of PTE was 9.1% (4/44). PTE was diagnosed in 1 (3.7%) pregnant and 3 (17.5%) postpartum women (P = 0.14). Mean density of pulmonary trunk was 278.81± 108.16 Hounsfield unit (HU) and 308.41 ± 59.30 HU in pregnant and postpartum women, respectively. Mean of bolus timing, kilovoltage peak (kVp), tube current, and dose length product (DLP) were 12.53 ± 2.36 s, 105.22± 45.71 milliamperage (MA), 382.9 ± 173.5 MA, and 317.98 ± 78.92 mGy/cm, respectively. The rate of nondiagnostic images was 4.5%. Conclusion: Our findings indicated that pulmonary 64-MDCT angiography is an appropriate imaging method for diagnosing PTE in pregnant and postpartum women with suspected PTE. It seems that, using fast CT systems (64-MDCT), in accordance with high flow rate, high contrast medium concentration and low kVp could explain the obtained appropriate quality of images more efficiently than computed tomographic pulmonary angiography (CTPA).

Cost reduction associated with the use of rivaroxaban compared with the enoxaparin + warfarin combination for for deep vein thrombosis and pulmonary thromboembolism when treated in the inpatient setting. The choice of the cost reduction method is conditioned by the evidence from the randomized controlled studies EINSTEIN DVT and EINSTEIN PE, stating that rivaroxaban is no less effective compared with enoxaparin in combination with warfarin. The difference in the cost of the drugs is calculated from the healthcare perspective taking into account the risk of major bleeding. The price values were sourced from public procurement tenders (zakupki.gov.ru) in quarters I-IV 2013 and quarter I 2014. Costs associated with the treatment of major bleeding were defined on the basis of the obligatory medical insurance rates for Moscow in 2013. The authors demonstrated that use of rivaroxaban compared with enoxaparin and warfarin results in cost savings for the medicinal treatment of DVT and PTE in the amount of 2,020.71 and 3,353.35 rubles per patient, respectively. The revealed pattern is resistant to real-life fluctuations in prices for medicines.

Amaç: Bu çalışma; üniversite hastanesinde venöz tromboembolizmi (VTE) teşhisi ve tedavisi hakkında açıklayıcı veri toplanmasını ve böylece bir referans hastanesindeki VTE yaklaşımını yansıtmak için planlanmıştır. Materyal ve Metod: Çalışmamızda derin ven trombozu (DVT) ve pulmoner tromboembolizmi (PTE) tanısı konulan hastaların arşiv kayıtlarını değerlendirdik. Hastaların birçoğunun yaşı ileri ve cinsiyeti kadındı. PTE için en sık kullanılan tanı yöntemi; bilgisayarlı tomografi (CT), DVT için ise ultrasondu. VTE acil servislerde ve polikliniklerde en yaygın tanısı konulan hastalıktır. Hastalara sırasıyla DVT, PTE, DVT ve PTE uygulandı. VTE için en sık rastlanan kronik risk faktörleri kanser, kalp yetmezliği/romatizmal kalp rahatsızlığı, hiperlipidemi/ateroskleroz ve obesitedir. Ataklara özgü risk faktörleri hareketsizlik, ameliyat, gebelik, oral kontraseptif ilaç ve travmaydı. Bulgular: Hemostatik risk faktörlerinin araştırıldığı hastalarda; sırasıyla faktör V Leiden, protrombin 20210 ve MTHFR mutasyonları bulundu. PTE"li hastalarda bulunan bulgular ve semptomlar; dispne-takipne, taşikardi, palpitasyon, göğüs ağrısı, öksürük, ateş, boğaz ağrısı, hemoptiz, diyaforez ve hırıltılı solunumdu (vizing). Elektrokardiyografi, PTE vakalarının çoğu için olumlu sonuçlar verdi. D-Dimer testi ise yüksek oranda duyarlı bulunmuştur. Akut ataklar sırasında uygulanan tedaviler; düşük molekül ağırlıklı heparin (LMWH), standart heparin, trombolitik tedavi, ameliyat, aspirin ve inferior vena kava filtresi yerleştirilmesidir.Akut dönem komplikasyonları ölüm, kanama ve heparin kaynaklı trombositopeniydi. Sonuç: Bu retrospektif çalışma bir referans hastanesindeki VTE tanı ve tedavi yaklaşımlarını yansıtmakta olup ileriye dönük çalışmalar için yol gösterici olabilir.

Purpose: This study was designed for collecting descriptive data about diagnosis and treatment of patients diagnosed with venous thromboembolism (VTE) in an university hospital and for reflecting approach to VTE in such a reference hospital in this way. Material and Methods: We evaluated archive records of patients disgnosed with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) between 2000 an 2005. Age average of patients was advanced and most of them were women. They had DVT, PTE, DVT and PTE respectively. Most common diagnostic method used for PTE was computed thomogrphy (CT), for DVT was ultrasonography (USG). VTE was diagnosed most frequently in emergency services and policlinics. Most common chronic risk factors for VTE were cancer, heart failure/romathismal cardiac disease, hyperlipidemia/atherosclerosis and obesity. Risk factors spesific to the attacks (or temporary) were immobilization, surgery, pregnancy, taking oral contraseptive drugs and trauma. Results: In patients investigated for hemostatic risk factors, Factor V Leiden, Prothrombin 20210 A , and MTHFR mutations were found respectively. Symptoms and findings of patients admitted with PTE were dyspnea-tachipnea, tachycardia, palpitation, pleural pain, caugh, fever, anginal pain, hemopthysis, diaphoresis and wheezing . Echocardiography gave positive results for the most of PTE cases. D-dimer test was found high sensitive. Treatments during accute attacks were low moleculer weight heparin (LMWH), standart heparin, thrombolytic therapy, surgery, aspirine and vena cava inferior filter placement. Acute term complications were death, bleeding and heparin induced thrombocytopenia. Conclusion: This retrospective study reflects the approach of VTE diagnosis and treatment in a reference hospital and it may guide for prospective studies. [Cukurova Med J 2013; 38(4.000): 610-616]

Objectives: The purpose of this study was to determine whether dual-energy computed tomography (DECT) angiography could differentiate pulmonary thromboembolism (PTE) from pulmonary artery sarcoma (PAS).Methods: We prospectively enrolled 19 patients that had a filling defect in the main pulmonary artery on DECT. Six patients who had PAS and underwent DECT were retrospectively enrolled for comparison. Pathological results or follow-up CT after anticoagulation therapy were used to make the final diagnosis. Two investigators measured the following parameters at the filling defect in the main pulmonary artery: CT attenuation density [Hounsfield units (HU)], iodine-related HU (IHU) and iodine concentration (IC, mg/ml).Results: From a total of 25 patients (M:F = 10:15; mean age, 65 years old), 19 were categorised into the PTE group and six were categorised into the PAS group. The mean HU values were not significantly different between the PTE and PAS groups (45.5 ± 15.9 vs 47.1 ± 9.2 HU; P = 0.776). However, the mean IHU and IC values of the lesions were significantly different between the PTE and PAS groups (10.6 ± 7.2 vs 27.9 ± 9.1 HU; P = 0.004, and 0.61 ± 0.39 vs 1.49 ± 0.57; P = 0.001).Conclusions: DECT angiography using a quantitative analytic methodology can be used to differentiate PTE and PAS.Key Points: • DECT can be useful for differentiation of PAS and PTE. • With quantitative analysis, DECT offers tissue characterisation by detecting lesion parameter increases. • The patients without predisposing factors for PTE can be candidates for DECT. [ABSTRACT FROM AUTHOR]

Background: Considering the importance of using more appropriate imaging technique for accurate diagnosis of pulmonary thromboembolism (PTE) with less side effects, we aimed to evaluate the quality of pulmonary 64-multidetector computed tomographic (MDCT) angiography in pregnant and postpartum women with suspected PTE in Isfahan. Materials and Methods: In this descriptive study, radiological findings of pregnant and postpartum women with suspected PTE who underwent pulmonary 64-MDCT angiography were evaluated. Prevalence of PTE in pregnant and postpartum women, mean of pulmonary arteries density for right and left pulmonary arteries, and their lobar and segmental branches, diagnostic quality of the pulmonary arteries density and their scoring, frequency of diagnostic and nondiagnostic images, mean of radiation dose and mean of bolus time, and the correlation between the quality of the vascular density with the peak density of the pulmonary artery were determined. Results: In this study, 44 pregnant and postpartum women with suspected PTE were selected. The overall prevalence of PTE was 9.1% (4/44). PTE was diagnosed in 1 (3.7%) pregnant and 3 (17.5%) postpartum women (P = 0.14). Mean density of pulmonary trunk was 278.81± 108.16 Hounsfield unit (HU) and 308.41 ± 59.30 HU in pregnant and postpartum women, respectively. Mean of bolus timing, kilovoltage peak (kVp), tube current, and dose length product (DLP) were 12.53 ± 2.36 s, 105.22± 45.71 milliamperage (MA), 382.9 ± 173.5 MA, and 317.98 ± 78.92 mGy/cm, respectively. The rate of nondiagnostic images was 4.5%. Conclusion: Our findings indicated that pulmonary 64-MDCT angiography is an appropriate imaging method for diagnosing PTE in pregnant and postpartum women with suspected PTE. It seems that, using fast CT systems (64-MDCT), in accordance with high flow rate, high contrast medium concentration and low kVp could explain the obtained appropriate quality of images more efficiently than computed tomographic pulmonary angiography (CTPA). [ABSTRACT FROM AUTHOR]

Purpose: It has been known for years that deep vein thrombi (DVT) start to develop during total joint arthroplasty. Previously, we reported effective prevention of venous stasis by transcutaneous electrical nerve stimulation (TENS). It is hypothesized that TENS might be a thromboprophylactic tool for the limb undergoing surgery. The purpose of this study is to clarify the clinical efficacy and safety of TENS in patients during total knee arthroplasty (TKA).Methods: Ninety patients undergoing primary TKA were involved and randomly allocated to the TENS or control group. In the TENS group, electrical stimulation of the common fibular nerve, which produced a brisk dorsiflexion of the ankle, was performed for the operated leg during surgery. In the control group, no electrical stimulation was applied. Serum D-dimer and soluble fibrin monomer complex (SFMC) levels were measured before surgery, immediately after surgery, and post-operative day (POD) 1. Ultrasonography was performed on POD 1.Results: Immediately after surgery, D-dimer and SFMC levels of each group were significantly lower in the TENS group compared with control (p < 0.05). The incidence of DVT was 11 % (five cases) in the TENS group while 31 % (14 cases) in control (p = 0.02). There were no adverse effects related to TENS.Conclusions: TENS during TKA showed significant effects on preventing DVT. Sustaining muscle pump activation during surgery prevented not only venous stasis, but also hypercoagulability of blood. Intraoperative TENS is a safe and novel strategy against early post-operative thromboembolism, which is difficult to be completed through existing prophylaxis after total joint arthroplasty.Level Of Evidence: Randomized controlled trial, Level I. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed for collecting descriptive data about diagnosis and treatment of patients with venous thromboembolism (VTE) in an university hospital and for reflecting approach to VTE in such a reference hospital in this way. Material and Methods: We evaluated archive records of patients diagnosed with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). Age average of patients was advanced and most of them were women. They had DVT, PTE, DVT and PTE respectively. Most common diagnostic method used for PTE was computed thomogrphy (CT), for DVT was ultrasonography (USG). VTE was diagnosed most frequently in emergency services and policlinics. Most common chronic risk factors for VTE were cancer, heart failure/romathismal cardiac disease, hyperlipidemia/atherosclerosis and obesity. Risk factors spesific to the attacks (or temporary) were immobilization, surgery, pregnancy, taking oral contraseptive drugs and trauma. Results:In patients investigated for hemostatic risk factors, Factor V Leiden, Prothrombin 20210 A and MTHFR mutations were found respectively. Symptoms and findings of patients admitted with PTE were dyspnea-tachipnea, tachycardia, palpitation, pleural pain, caugh, fever, anginal pain, hemopthysis, diaphoresis and wheezing . Echocardiography gave positive results for the most of PTE cases. D-dimer test was found high sensitive. Treatments during accute attacks were low moleculer weight heparin (LMWH), standart heparin, thrombolytic therapy, surgery, aspirine and vena cava inferior filter placement. Acute term complications were death, bleeding and heparin induced thrombocytopenia. Conclusion: This retrospective study reflects the approach of VTE diagnosis and treatment in a reference hospital and it may guide for prospective studies. [ABSTRACT FROM AUTHOR]

Purpose: Thromboprophylaxis with subcutaneous heparin or low molecular weight heparin is now an integral part of national surgical quality and safety assessment efforts, and has been incorporated into the current AUA Best Practice Statement. We evaluated familiarity and compliance with the AUA Best Practice Statement, assessed practice patterns in terms of perioperative thromboprophylaxis and specifically examined self-reported compliance in high risk patients undergoing radical cystectomy. Materials and Methods: An electronic survey was sent to AUA members with valid e-mail addresses (10,966). Associations between AUA Best Practice Statement adherence and factors such as urological specialty, graduation year and guideline familiarity were assessed using chi-square analyses and generalized estimating equations. Results: With 1,210 survey responses the largest group of respondents was urological oncologists and/or laparoscopic/robotic specialists (26.0%). This group was more likely to use thromboprophylaxis than nonurological oncologists and/or laparoscopic/robotic specialists in high risk patients (OR 1.3, CI 1.1–1.5). Respondents aware of the AUA Best Practice Statement guidelines (50.7%) were more likely to use thromboprophylaxis (OR 1.4, CI 1.2–1.6). Although 18.1% of urological oncologists and/or laparoscopic/robotic specialists and 34.2% of nonurological oncologists and/or laparoscopic/robotic specialists avoided routine thromboprophylaxis in patients undergoing radical cystectomy, the former were more likely to use thromboprophylaxis (p <0.0001) than other respondents. Urologists graduating after the year 2000 used thromboprophylaxis in high risk patients undergoing radical cystectomy more often than did earlier graduates (79.2% vs 63.4%, p <0.0001). Conclusions: Although younger age and self-reported urological oncologist and/or laparoscopic/robotic specialist status correlated strongly with thromboprophylaxis use, self-reported adherence to AUA Best Practice Statement was low, even in high risk cases with clear AUA Best Practice Statement recommendations such as radical cystectomy. These data identify opportunities for quality improvement in patients undergoing major urological surgery. [Copyright &y& Elsevier]

Abstract: The risk of pulmonary thromboembolism (PTE) after total knee arthroplasty (TKA) with tourniquet is still controversial. In this study, we determined whether plasma D-dimer could be used as a marker of PTE, and whether intraoperative use of tourniquet is a risk factor for symptomatic PTE after TKA. We divided 86 patients (12 males and 74 females) who underwent primary TKA into four groups based on (i) operation method (unilateral/bilateral) and (ii) use of pneumatic tourniquet during surgery (with/without). Plasma D-dimer values were measured preoperatively and on Day 1 postoperatively. “D1-value” was defined as the difference between postoperative and preoperative plasma D-dimer levels. We determined the cutoff level of “D1-value” for symptomatic PTE, monitored by O2 saturation (SAT) and lung scintigraphy. “D1-values” for patients with PTE symptoms were higher than those without symptoms (p&#60;0.001). Furthermore, “D1-values” for TKA without tourniquet procedures were significantly lower than those with tourniquet both in unilateral (p=0.003) and bilateral groups (p=0.004). At a cutoff level of ≥8.6 μg/mL, the sensitivity, specificity, and positive and negative predictive values were 100%, 82.5%, 30.0% and 100% for symptomatic PTE, respectively. The results of our pilot study showed that elevated plasma “D1 value” is a sensitive marker for detection of PTE. Further studies will be needed, in order to evaluate the risk of tourniquet, and to reduce PTE after TKA. [Copyright &y& Elsevier]

Background: A specific risk-stratification tool is needed to facilitate safe and cost-effective approaches to the prophylaxis of acute pulmonary thromboembolism (PTE) in lung cancer surgery patients. This study aimed to develop and validate a simple nomogram model for the prediction of PTE after lung cancer surgery using readily obtainable clinical characteristics., Methods: A total of 14,427 consecutive adult patients who underwent lung cancer surgery between January 2015 and July 2018 in our institution were retrospectively reviewed. Included in the cohort were 136 patients who developed PTE and 544 non-PTE patients. The patients were randomly divided into the derivation group (70%, 95 PTE patients and 380 non-PTE patients) and the validation group (30%, 41 PTE patients and 164 non-PTE patients). A nomogram model was developed based on the results of multivariate logistic analysis in the derivation group. The cut-off values were defined using Youden's index. The prognostic accuracy was measured by area under the curve (AUC) values., Results: In the derivation group, multivariate logistic analysis was carried out to evaluate the risk score. The risk assessment model contained five variables: age [95% confidence interval (CI): 1.008-1.083, P=0.016], body mass index (95% CI: 1.077-1.319, P=0.001), operation time (95% CI: 1.002-1.014, P=0.008), the serum level of cancer antigen 15-3 (CA15-3) before surgery (95% CI: 1.019-1.111, P=0.005), and the abnormal results of compression venous ultrasonography before surgery (95% CI: 2.819-18.838, P<0.001). All of them were independent risk factors of PTE. To simplify the risk assessment model, a nomogram model was established, which showed a good predictive performance in the derivation group (AUC 0.792, 95% CI: 0.734-0.853) and in the validation group (AUC 0.813, 95% CI: 0.737-0.890)., Conclusions: A high-performance nomogram was established on the risk factors for PTE in patients undergoing lung cancer surgery. The nomogram could be used to provide an individual risk assessment and guide prophylaxis decisions for patients. Further external validation of the model is needed in lung cancer surgery patients in other clinical centers., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-21-109). RHP receive speaker fee from Medtronic and Advisory Board AstraZeneca. The authors have no other conflicts of interest to declare., (2021 Translational Lung Cancer Research. All rights reserved.)

Background and Aims: The risk of pulmonary thromboembolism (PTE) in patients with exacerbated chronic obstructive pulmonary disease (e-COPD) is higher than in non-COPD states. This study aimed to evaluate the prevalence and the parameters that are critical for finding the incidence of PTE in patients with e-COPD., Methods: This cross-sectional study was performed on 68 consecutive patients with the e-COPD, referred to the Pulmonary Disease Department at the Shariati Hospital in Tehran between 2013 and 2014. In addition to collecting data on the history of disease and physical examination, arterial blood sampling, spirometry, electrocardiography and echocardiography were performed for all patients. All patients underwent the computed the tomography pulmonary angiography (CT-PA) as a method of choice for diagnosing PTE., Results: Out of 68 cases (7.4%), five were had CT angiography findings suggesting PTE. These patients were all male and had a higher mean age (79 vs. 65 years), lower mean systolic blood pressure (88.36 vs. 118.33 mmHg), and a higher mean heart rate (133.12 vs 90.33 beats/min), compared to e-COPD patients without PTE. Arterial blood gas analysis in patients with PTE demonstrated a lower HC03 (2.33 vs. 9.44 mEq/l) and PC02 (44.35 vs. 51.43 mmHg) levels. The mean LVEF was lower in patients with PTE (34.14 ±4.49% vs. 46.94 ± 8.27%)., Conclusion: The prevalence of PTE in our series of patients with e-COPD was 7.4%. According to the study results, male gender, advanced age, hypotension, tachycardia, and respiratory alkalosis are factors indicating possible PTE among patients with e-COPD.

Purpose: Patients with fractures of the pelvis and/or lower extremities are at a high risk of developing postoperative venous thromboembolism (VTE). The purpose of this study was to determine whether the thrombin-antithrombin III complex (TAT) tests could be used for postoperative screening of VTE in patients with lower limb or pelvic fractures., Methods: We enrolled 133 patients who underwent surgical treatment for fracture of the pelvis or lower extremities. TAT and D-dimer levels were compared in patients with and without VTE. Receiver operating characteristic (ROC) curve analysis was done and the appropriate TAT and D-dimer cutoff levels were determined for VTE screening., Results: VTE was diagnosed in 41 patients (30.8%). Patients with VTE had significantly higher levels of TAT and D-dimer on postoperative days 1, 3, and 7 than those without VTE, respectively. ROC curve analysis suggested that TAT test at postoperative day 7 had the highest accuracy for predicting postoperative VTE. With the optimal cutoff TAT level of 3.0 ng/mL, sensitivity and specificity were 93.3% and 70.1%, respectively. With the optimal cutoff D-dimer level of 7.4 µg/mL, sensitivity and specificity were 93.3% and 57.0%, respectively., Conclusion: TAT levels measured at postoperative day 7 could be the most useful parameter for screening postoperative VTE. TAT can be used as a screening tool for screening postoperative VTE in patients with lower limb and pelvic fractures.

Background: Pulmonary thromboembolism (PTE) is a common and potentially lethal disease. It is significant to investigate the gene mutations of protein C for clarifying the etiology of PTE. In this present study, we investigated the promoter region polymorphism sites including -1654C/T, -1641A/G and -1476A/T of the protein C gene in a Chinese population., Methods: A total of 110 cases of PTE and one hundred and ninety healthy controls in a Chinese population were genotyped for three polymorphisms (-1654C/T, -1641A/G and -1476A/T) of the protein C promoter. The statistical analysis was performed by Stata 11.0., Results: The single nucleotide polymorphisms (SNPs) (-1654C/T, -1641A/G and -1476A/T) in protein C gene were associated with the susceptibility to PTE in Chinese population. According to the binary logistic regression analysis, the independently significant risk factors for PTE were the complications of deep vein thrombosis (DVT) or cancer, history of operation or injury, and the homozygous carriers of the TT genotype (protein C -1654C/T)., Conclusions: The SNPs (-1654C/T, -1641A/G and -1476A/T) of protein C promoter gene are associated with the susceptibility to PTE in a Chinese population. Especially, the homozygous carriers of genotype TT (-1654C/T) increase the risk of PTE in a Chinese population. Confirmation of our preliminary observations in a larger scale study is needed.

Introduction: Pulmonary thromboembolism (PTE) is the most serious manifestation of thromboembolic disease., Objective: To determine the most common risk and etiologic factors of pulmonary tromboembolism in patients treated in Intensive care unit of Clinic for Pulmonary Diseases and TB "Podhrastovi" in three-year- period from 2008. to 2010., Material and Methods: We retrospectively analysed patients with PTE treated in Intensive care unit of Clinic for Pulmonary Diseases and TB "Podhrastovi" in three-year period from 2008. to 2010. PTE was diagnosed by high resolute computed tomography, in most of them ventilatory /perfusion scintigraphy (V/P SPECT) was made, with proper laboratory analyses (D-dimmer, platelets , fibrinogen, and if it was needed protein C, S and AT III factor were examined). In all of them echosonography of abdomen and pelvis was done, also the examination by angiologist, and in patients with indications echosonography of the heart and Color Doppler of leg veins was made. We analysed risk and etiologic factors for PTE in each patient., Results: In 222 treated patients with PTE risk factors were found in 124 or 55.86% patients, etiologic factors were found in 31 or 13.96%, and both risk and etiologic factors in one patient were found in 18 or 8.11% patients., Conclusion: PTE is very serious disease that very often has fatal prognosis, and can develop with previously entirely healthy people, and as soon as we become suspicious of its presence we have to made appropriate diagnostic procedures and include appropriate therapy. We can after look for risk and etiologic factors and try to influence them.