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Linda B Thompson, Michael C Kurz
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March 2018: Western Journal of Emergency Medicine
David R Vinson, E Margaret Warton, Dustin G Mark, Dustin W Ballard, Mary E Reed, Uli K Chettipally, Nimmie Singh, Sean Z Bouvet, Bory Kea, Patricia C Ramos, David S Glaser, Alan S Go
Introduction: Many patients with atrial fibrillation or atrial flutter (AF/FL) who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED). Methods: This prospective study included non-anticoagulated adults at high risk for ischemic stroke (ATRIA score ≥7) who received emergency AF/FL care and were discharged home from seven community EDs between May 2011 and August 2012...
March 2018: Western Journal of Emergency Medicine
Hui Yin Lim, Harshal Nandurkar, Prahlad Ho
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs...
March 20, 2018: Seminars in Thrombosis and Hemostasis
Jia-Xuan Xu, Jun Dong, Hong Ren, Xiao-Jie Chen, Yong Yang, Ren-Xiong Chen, Guo-Dong Wang, Hong-Zhi Wang
PURPOSE: The occurrence of venous thromboembolism (VTE) in Chinese cancer patients admitted to intensive care unit (ICU) for postoperative care is poorly characterized. This study was designed to investigate the incidence of VTE in this polulation and to evaluate the utility of the Caprini score in risk stratification. METHODS: We conducted a retrospective cohort study of 2127 consecutive adult patients admitted to a 10-bed surgical ICU in a tertiary care academic hospital during a 4-year period (January 1,2013 to December 31,2016)...
January 2018: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
Gang Zheng, Qian Tang, Ping Shang, Xiao-Yun Pan, Hai-Xiao Liu
Arthroscopic knee surgery is the most commonly performed orthopedic procedure worldwide and whether thromboprophylaxis should be undertaken after knee arthroscopy is still controversial. To evaluate the efficacy of thromboprophylaxis for deep venous thrombosis (DVT) and venous thromboembolism (VTE) after knee arthroscopic surgery. A meta-analysis was conducted using data from eight randomized trials (4148 patients) to compare thromboprophylaxis with placebo or no prophylactic treatment in patients undergoing knee arthroscopy...
March 16, 2018: Journal of Thrombosis and Thrombolysis
Maria Sunseri, Tania Ahuja, Tanya Wilcox, David Green
Unfractionated heparin and low-molecular-weight heparins are commonly used as thromboprophylaxis for hospitalized patients. Though generally considered safe at prophylactic doses, cases of catastrophic hemorrhage have been reported. The proposed mechanism involves bioaccumulation of heparin through saturation of the rapid-elimination pathway in its metabolism. We present an unusual case of an average-weight man with metastatic melanoma who suffered hemorrhage with syncope and end-organ damage while on prophylactic three times daily unfractionated heparin...
2018: Case Reports in Hematology
Yaseen Arabi, Fahad Al-Hameed, Karen E A Burns, Sangeeta Mehta, Sami Alsolamy, Mohammed Almaani, Yasser Mandourah, Ghaleb A Almekhlafi, Ali Al Bshabshe, Simon Finfer, Mohammed Alshahrani, Imran Khalid, Yatin Mehta, Atul Gaur, Hassan Hawa, Hergen Buscher, Zia Arshad, Hani Lababidi, Abdulsalam Al Aithan, Jesna Jose, Sheryl Ann I Abdukahil, Lara Y Afesh, Maamoun Dbsawy, Abdulaziz Al-Dawood
BACKGROUND: The Pneumatic CompREssion for Preventing VENous Thromboembolism (PREVENT) trial evaluates the effect of adjunctive intermittent pneumatic compression (IPC) with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on venous thromboembolism (VTE) in critically ill adults. METHODS/DESIGN: In this multicenter randomized trial, critically ill patients receiving pharmacologic thromboprophylaxis will be randomized to an IPC or a no IPC (control) group...
March 15, 2018: Trials
Stacy A Voils, Mohamed H Shahin, Timothy J Garrett, Reginald F Frye
OBJECTIVE: Incidence of venous thromboembolism (VTE) in critically ill patients remains unacceptably high despite widespread use of thromboprophylaxis. A systems biology approach may be useful in understanding disease pathology and predicting response to treatment. Metabolite profile under specific environmental conditions provides the closest link to phenotype, but the relationship between metabolomics and risk of VTE in critically ill patients is unknown. In this study, metabolomics signatures are compared in patients with and without VTE...
March 8, 2018: Thrombosis Research
Masoumeh Shohani, Akram Mansouri, Siros Norozi, Naser Parizad, Milad Azami
Background: There is not enough studies to determine the frequency of using the prophylaxis against deep venous thrombosis (DVT) based on the American College of Chest Physician's (ACCP) guidelines in Iran. Thus, providing such statistics is essential to improve thromboprophylaxis in hospital. The present study aimed to determine the frequency of using the prophylaxis against DVT based on ACCP guidelines in patients hospitalized in surgical wards in one of teaching hospital in Ilam, Iran...
2018: International Journal of Preventive Medicine
Audrey A Merriam, Yongmei Huang, Cande V Ananth, Jason D Wright, Mary E D'Alton, Alexander M Friedman
OBJECTIVE:  This article evaluates trends in venous thromboembolism (VTE) prophylaxis during delivery hospitalizations in the United States. METHODS:  We utilized an administrative database to determine if women hospitalized for vaginal or cesarean delivery received pharmacologic VTE prophylaxis, mechanical VTE prophylaxis, or both from January 2011 through March 2015. Mechanical prophylaxis included sequential compression devices, graduated compression stockings, and other pneumatic devices...
February 2, 2018: American Journal of Perinatology
Ewa Zabrocka, Marek Z Wojtukiewicz, Ewa Sierko
Advanced cancer patients in hospice are at notably increased risk of venous thromboembolism (VTE) due to age, local and distal advancement of the malignancy and bed confinement, among other factors. Asymptomatic VTE prevalence among palliative care patients has been found to reach 50%, whereas the clinically overt form occurs in 10%. Hospice patients are frequently given medications increasing VTE risk, for instance megestrol which is a drug commonly used in cancer cachexia. Many of the available guidelines encourage the implementation of thromboprophylaxis (TPX) in cancer patients, e...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Robert F Łukaszuk, Krzysztof Plens, Anetta Undas
BACKGROUND: Underuse of thromboprophylaxis in hospitalized medical patients is still common worldwide. Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice. OBJECTIVES: The aim of this study was to assess the use of pharmacological prophylaxis of venous thromboembolism (VTE) in real-life patients with pulmonary diseases. MATERIAL AND METHODS: In this retrospective study, 2 validated scoring systems, i...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Bülent Özin, Kudret Aytemir, Özgür Aslan, Türkay Özcan, Mehmet Kanadaşı, Mesut Demir, Mustafa Gökçe, Mehmet Murat Sucu, Murat Özdemir, Zerrin Yiğit, Mustafa Ferzeyn Yavuzkır, Ali Oto
OBJECTIVE: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life. METHODS: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Jonathan G Stine, Blake A Niccum, Alex N Zimmet, Nicolas Intagliata, Stephen H Caldwell, Curtis K Argo, Patrick G Northup
OBJECTIVE: Patients with cirrhosis are at increased risk for venous thromboembolism (VTE) and portal vein thrombosis (PVT). Cirrhosis due to non-alcoholic steatohepatitis (NASH) appears to be particularly prothrombotic. We investigated hospitalized patients with NASH cirrhosis to determine if they are at increased risk for VTE. METHODS: Data on adult hospitalized patients with cirrhosis and VTE (deep vein thrombosis and/or pulmonary embolism) between November 1, 2010 and December 31, 2015 were obtained...
March 6, 2018: Clinical and Translational Gastroenterology
Majed S Al Yami, Sawsan Kurdi, Ivo Abraham
Background: Standard-duration (7-10 days) thromboprophylaxis with low molecular weight heparin, low dose unfractionated heparin, or fondaparinux in hospitalized medically ill patients is associated with ~50% reduction in venous thromboembolism (VTE) risk. However, these patients remain at high risk for VTE post-discharge. The direct oral anticoagulants (DOACs) apixaban, rivaroxaban and betrixaban have been evaluated for extended-duration (30-42 days) thromboprophylaxis in this population...
2018: Journal of Blood Medicine
Jose A Blanco, Gemma Slater, Jitendra Mangwani
The incidence of venous thromboembolic (VTE) events (deep vein thrombophlebitis [DVT] or pulmonary embolism [PE]) in foot and ankle trauma has been low, and the risk/benefit ratio associated with chemoprophylaxis is controversial. We compared the 90-day incidence of VTE events in 3 cohorts: group 1, tendo-Achillis (TA) ruptures managed with full weightbearing in a walker boot; group 2, ankle fractures immobilized non-weightbearing in a below-the-knee cast; and group 3, ankle fractures managed surgically, followed by non-weightbearing in a below-the-knee cast...
March 1, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Margaret Smith, Glenn Wakam, Thomas Wakefield, Andrea Obi
Anticoagulation pharmacy has been dramatically altered with US Food and Drug Administration (FDA) approval of 5 direct oral anticoagulants, 1 novel reversal agent and, a second designated for fast-track approval. Trial data surrounding current trends in anticoagulant choice for VTE, reversal, and bridging are constantly redefining practice. Extended therapy for unprovoked VTE has expanded to include low-dose direct oral anticoagulants, aspirin, and the use of the HERDOO2 system to identify women who can stop anticoagulant therapy without increased risk of recurrent VTE...
April 2018: Surgical Clinics of North America
Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
Background -Stroke prevention with oral anticoagulants (OACs) is the cornerstone for the management of atrial fibrillation (AF). However, data about the use of OACs among patients aged ≥90 years are limited. We aimed to investigate the risk of ischemic stroke and intracranial hemorrhage (ICH), and the net clinical benefit (NCB) of OAC treatment for very elderly AF patients (≥90 years). Methods -This study used the "National Health Insurance Research Database" in Taiwan. Risks of ischemic stroke and ICH were compared between 11,064 AF and 14,658 non-AF patients aged ≥90 years without antithrombotic therapy from year 1996 to 2011...
February 28, 2018: Circulation
John D Cramer, Andrew G Shuman, Michael J Brenner
Objective The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology-head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology-head and neck surgery in the United States. Data Sources PubMed/MEDLINE. Review Methods A comprehensive review of literature pertaining to VTE in otolaryngology-head and neck surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thromboprophylaxis...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Federico Cicora, Jorgelina Petroni, Javier Roberti
PURPOSE OF REVIEW: Kidney transplant recipients have an increased risk of pulmonary embolism; however, thromboprophylaxis poses a challenge as the risk of thrombosis must be balanced against the risk of bleeding. This review summarizes the evidence on whether thromboprophylaxis is required in kidney transplantation. RECENT FINDINGS: Incidence of venous thromboembolism, comprising pulmonary embolism and deep venous thrombosis, is increased in kidney transplant recipients compared to the general population, with augmented risk of death and graft loss...
February 23, 2018: Current Urology Reports
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