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K D Driest, M S Sturm, S H O'Brien, C H Spencer, J R Stanek, S P Ardoin
OBJECTIVE: The risk of thrombosis is increased in patients with systemic lupus erythematosus (SLE). Few studies have assessed factors associated with thrombosis within the pediatric SLE (pSLE) population. We sought to better characterize these associated factors in pSLE patients using the Childhood Arthritis & Rheumatology Research Alliance (CARRA) registry. METHODS: Within the CARRA registry, patients with a history of thrombosis were compared to those without...
June 2016: Lupus
Wei Huang, Robert J Goldberg, Frederick A Anderson, Alexander T Cohen, Frederick A Spencer
Venous thromboembolism (VTE) has multiple risk factors and tends to recur. Despite the benefits of anticoagulation, the prevalence of, and case-fatality rate associated with, recurrent VTE remains a concern after an acute episode; it is particularly high during the acute treatment phase. We sought to quantify the magnitude, identify predictors, and develop risk score calculator of recurrence within 3 years after first-time VTE. This was a population-based surveillance study among residents of central Massachusetts (MA), USA, diagnosed with an acute first-time pulmonary embolism and/or lower-extremity deep vein thrombosis from 1999 to 2009 in hospital and ambulatory settings in all 12 central MA hospitals...
April 2016: Journal of Thrombosis and Thrombolysis
John A Heit, Frederick A Spencer, Richard H White
Venous thromboembolism (VTE) is categorized by the U.S. Surgeon General as a major public health problem. VTE is relatively common and associated with reduced survival and substantial health-care costs, and recurs frequently. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and VTE risk factors, including increasing patient age and obesity, hospitalization for surgery or acute illness, nursing-home confinement, active cancer, trauma or fracture, immobility or leg paresis, superficial vein thrombosis, and, in women, pregnancy and puerperium, oral contraception, and hormone therapy...
January 2016: Journal of Thrombosis and Thrombolysis
Spencer W Greaves, Stefan D Holubar
BACKGROUND: An important factor in the pathophysiology of venous thromboembolism is blood stasis, thus, preoperative hospitalization length of stay may be contributory to risk. OBJECTIVE: We assessed preoperative hospital length of stay as a risk factor for venous thromboembolism. DESIGN: We performed a retrospective review of patients who underwent colorectal operations using univariate and multivariable propensity score analyses. SETTINGS: This study was conducted at a tertiary referral hospital...
August 2015: Diseases of the Colon and Rectum
W Huang, R J Goldberg, A T Cohen, F A Anderson, C I Kiefe, J M Gore, F A Spencer
INTRODUCTION: Contemporary trends in health-care delivery are shifting the management of venous thromboembolism (VTE) events (deep vein thrombosis [DVT] and/or pulmonary embolism [PE]) from the hospital to the community, which may have implications for its prevention, treatment, and outcomes. MATERIALS AND METHODS: Population-based surveillance study monitoring trends in clinical epidemiology among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) diagnosed with an acute VTE in all 12 WMSA hospitals...
June 2015: Thrombosis Research
Clive Kearon, Frederick A Spencer, Denis O'Keeffe, Sameer Parpia, Sam Schulman, Trevor Baglin, Scott M Stevens, Scott Kaatz, Kenneth A Bauer, James D Douketis, Steven R Lentz, Craig M Kessler, Stephan Moll, Jean M Connors, Jeffrey S Ginsberg, Luciana Spadafora, Jim A Julian
BACKGROUND: Normal D-dimer levels after withdrawal of anticoagulant therapy are associated with a reduced risk for recurrence in patients with unprovoked venous thromboembolism (VTE) and may justify stopping treatment. OBJECTIVE: To determine whether patients with a first unprovoked VTE and negative D-dimer test result who stop anticoagulant therapy have a low risk for recurrence. DESIGN: Prospective management study with blinded outcome assessment...
January 6, 2015: Annals of Internal Medicine
Luciane Cruz Lopes, John Eikelboom, Frederick A Spencer, Elie A Akl, Clive Kearon, Ignacio Neumann, Sam Schulman, Neera Bhatnagar, Gordon Guyatt
INTRODUCTION: Venous thromboembolism (VTE) is a major disease associated with short-term and long-term morbidity and mortality. Patients with a VTE provoked by surgery or immobilisation are at low risk of recurrence and do not require long-term anticoagulation; those with a VTE and metastatic cancer are at high risk of recurrence and require lifetime thromboprophylaxis. In those at intermediate risk of recurrence, it remains controversial whether prolonging anticoagulation and thus incurring treatment burden and bleeding risk is warranted...
July 4, 2014: BMJ Open
Mohammadreza Mortazavi, Mitra M Samiee, Frederick A Spencer
The incidence of deep vein thrombosis (DVT) in patients with erysipelas and cellulitis of the lower extremities is unknown. As such, the indication and efficacy of prophylactic anticoagulation for prevention of DVT in these patients is unclear. The main goal of this review is to provide an estimate of the incidence of DVT in erysipelas and cellulitis based on existing literature. A comprehensive search of the electronic sources: MEDLINE, EMBASE, CINAHL, LILAC and Cochrane without any language limitation was performed from 1950 to April 2011 for articles focused on the occurrence of DVT in cellulitis or erysipelas of the lower extremities...
March 2013: International Journal of Dermatology
R Scott Evans, Jamie H Sharp, Lorraine H Linford, James F Lloyd, Scott C Woller, Scott M Stevens, C Gregory Elliott, Jacob S Tripp, Spencer S Jones, Lindell K Weaver
BACKGROUND: As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity DVT rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT. METHODS: A 3-year, prospective, observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level I trauma and tertiary referral hospital during January 1, 2008, through December 31, 2010...
March 2013: Chest
Gregory Piazza, Samuel Z Goldhaber, Aimee Kroll, Robert J Goldberg, Catherine Emery, Frederick A Spencer
PURPOSE: The majority of epidemiological studies demonstrate an increased risk of venous thromboembolism among diabetic patients. Our aim was to compare clinical characteristics, prophylaxis, treatment, and outcomes of venous thromboembolism in patients with and without previously diagnosed diabetes. METHODS: We studied diabetic patients in the population-based Worcester Venous Thromboembolism Study of 2488 consecutive patients with validated venous thromboembolism...
July 2012: American Journal of Medicine
Nancy S Lloyd, James D Douketis, Ji Cheng, Holger J Schünemann, Deborah J Cook, Lehana Thabane, Menaka Pai, Frederick A Spencer, R Brian Haynes
OBJECTIVE: Deep vein thrombosis (DVT) prophylaxis remains underused in hospitalized medical patients despite strong recommendations that at-risk patients should receive prophylaxis. To understand this gap between knowledge and practice, we surveyed clinicians' perceptions about the importance of DVT prophylaxis, barriers to guideline implementation, and interventions to optimize prophylaxis. METHODS: Paper- and electronic mail-based surveys were sent to 1553 internists, nurses, pharmacists, and physiotherapists in Ontario, Canada...
January 2012: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Alex C Spyropoulos, Frederick A Anderson, Gordon FitzGerald, Herve Decousus, Mario Pini, Beng H Chong, Rainer B Zotz, Jean-François Bergmann, Victor Tapson, James B Froehlich, Manuel Monreal, Geno J Merli, Ricardo Pavanello, Alexander G G Turpie, Mashio Nakamura, Franco Piovella, Ajay K Kakkar, Frederick A Spencer
BACKGROUND: Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization. METHODS: Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission...
September 2011: Chest
Timir S Baman, Krit Jongnarangsin, Aman Chugh, Arisara Suwanagool, Aurelie Guiot, Arin Madenci, Spencer Walsh, Karl J Ilg, Sanjaya K Gupta, Rakesh Latchamsetty, Suveer Bagwe, James D Myles, Thomas Crawford, Eric Good, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral
INTRODUCTION: Up to 6% of patients experience complications after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). The purpose of this study is to determine the prevalence and predictors of periprocedural complications after RFA for AF. METHODS AND RESULTS: The subjects were 1,295 consecutive patients (age = 60 ± 10 years) who underwent RFA (n = 1,642) for paroxysmal (53%) or persistent AF (47%) from January 2007 to January 2010. A complication occurred in 57 patients (3...
June 2011: Journal of Cardiovascular Electrophysiology
Frederick A Spencer, Shannon M Bates, Robert J Goldberg, Darleen Lessard, Cathy Emery, Alla Glushchenko, Joel M Gore, Richard H White
BACKGROUND: Our study objective was to describe the frequency, indications, and outcomes after inferior vena cava (IVC) filter placement in a population-based sample of residents of the Worcester, Massachusetts, metropolitan area who had been diagnosed as having acute venous thromboembolism (VTE) in 1999, 2001, and 2003. METHODS: A retrospective chart review of inpatient and outpatient medical records was conducted. Recorded indication(s) for IVC filter placement was determined among a subset of cases from 3 Worcester tertiary care hospitals...
September 13, 2010: Archives of Internal Medicine
Wee-Shian Chan, Agnes Lee, Frederick A Spencer, Mark Crowther, Marc Rodger, Tim Ramsay, Jeffrey S Ginsberg
BACKGROUND: Clinicians' assessment of pretest probability, based on subjective criteria or prediction rules, is central to the diagnosis of deep venous thrombosis (DVT). Pretest probability assessment for DVT diagnosis has never been evaluated in pregnant women. OBJECTIVE: To evaluate the accuracy of clinicians' subjective assessment of pretest probability for DVT diagnosis and identify prediction variables that could be used for pretest probability assessment in pregnant women with suspected DVT...
July 21, 2009: Annals of Internal Medicine
Winnie W Sia, Raymond O Powrie, Ann B Cooper, Lucia Larson, Maureen Phipps, Patricia Spencer, Nadine Sauve, Karen Rosene-Montella
INTRODUCTION: Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States. Cesarean delivery is a known risk factor. This study was to determine the incidence of deep vein thrombosis (DVT) post cesarean delivery. MATERIALS AND METHODS: This was a prospective cohort study where two patients having undergone cesarean delivery each day were randomly selected. A lower extremity compression ultrasound was performed prior to hospital discharge...
2009: Thrombosis Research
Daniel A Hatef, Jeffrey M Kenkel, Marilyn Q Nguyen, Jordan P Farkas, Fatemeh Abtahi, Rod J Rohrich, Spencer A Brown
BACKGROUND: There is a paucity of evidence within the plastic surgery literature concerning risk stratification and management of patients with respect to thromboembolic disease. A retrospective chart review was conducted to examine whether the Davison-Caprini risk-assessment model could stratify patients undergoing excisional body contouring surgery, allowing prophylaxis to be managed in an evidence-based manner. METHODS: Three hundred sixty excisional body contouring patients at the University of Texas Southwestern Medical Center in Dallas, Texas, under the senior authors' (J...
July 2008: Plastic and Reconstructive Surgery
Jennifer Voke, Jane Keidan, Sue Pavord, Neil H Spencer, Beverley J Hunt
This prospective observational study reports on 126 women from 25 UK centres with image-proven antenatal venous thromboembolism (VTE), 62% deep vein thrombosis and 38% pulmonary embolism. Thrombophilia screening was of limited benefit except to identify antithrombin deficiency. Sixteen (13%) patients had previous VTE, all but one was related to previous pregnancy or combined oral contraceptive and 12 received no thromboprophylaxis in the index pregnancy, the other four thus received inadequate low molecular weight heparin (LMWH) doses...
November 2007: British Journal of Haematology
Frederick A Spencer, Cathy Emery, Darleen Lessard, Robert J Goldberg
PURPOSE: The purpose of this study was to examine the magnitude, risk factors, management strategies, and outcomes in a population-based investigation of patients with upper, as compared with lower, extremity deep vein thrombosis diagnosed in 1999. METHODS: The medical records of all residents from Worcester, Massachusetts (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible deep vein thrombosis at all Worcester hospitals during 1999 were reviewed and validated...
August 2007: American Journal of Medicine
Frederick A Spencer, Darleen Lessard, Cathy Emery, George Reed, Robert J Goldberg
BACKGROUND: There has been great interest in optimizing prophylaxis against venous thromboembolism (VTE) in the hospital setting. However, data from earlier studies suggest that most VTEs occur in the outpatient setting. The purposes of this observational study were to describe the frequency of VTEs occurring in the outpatient setting, characterize the prevalence of previously identified risk factors for VTE, and identify previous use of VTE prophylaxis. METHODS: The medical records of residents from the Worcester metropolitan area diagnosed as having International Classification of Diseases, Ninth Revision codes consistent with possible VTE during 1999, 2001, and 2003 were independently validated and reviewed by trained abstractors...
July 23, 2007: Archives of Internal Medicine
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