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DVT AND trauma

A Coelho, P Brandão, M Lobo, I Lojo, A Canedo
INTRODUCTION: Major pelvic Ilio-Iliac arteriovenous fistula (AVF) is an exceedingly rare diagnosis with only a few described cases in the literature, most of them related to congenital defects or trauma. In this case report, we aim to present a case of an ilio-iliac AVF with an atypical clinical presentation. CASE REPORT: The patient is a 77-year-old women, with a relevant medical history of a temporally remote hysterectomy. She developed an exuberant unilateral right leg oedema and was diagnosed with a femoro-iliac deep vein thrombosis (DVT) and started on anticoagulation and daily use of elastic compression stockings...
March 5, 2018: Annals of Vascular Surgery
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
Ben A Hickey, Ultan Watson, Andrew Cleves, Raza Alikhan, Neil Pugh, Len Nokes, Anthony Perera
BACKGROUND: Our aim was to determine the evidence for thromboprophylaxis for prevention of symptomatic venous thromboembolism (VTE) in adults with foot or ankle trauma treated with below knee cast or splint. Our secondary aim was to report major bleeding events. METHODS: MEDLINE and EMBASE databases were searched for randomized controlled trials from inception to 1st June 2015. RESULTS: Seven studies were included. All focused on low molecular weight heparin (LMWH)...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Shokei Matsumoto, Kyoungwon Jung, Alan Smith, Raul Coimbra
BACKGROUND: Ligation may be used as part of damage control surgery under critical conditions following inferior vena cava (IVC) injury. IVC ligation could potentially yield greater survival benefit compared to repair following injury. We hypothesized that ligation significantly improve the outcome compared to repair. STUDY DESIGN: The National Trauma Data Bank (NTDB) dataset for 2007-2014 was reviewed. Eligible patients included those sustaining IVC injury who underwent surgical ligation or repair...
February 2, 2018: Journal of the American College of Surgeons
Ian E Brown, Robert R Rigor, Linda M Schutzman, Nasim Khosravi, Karen Chung, James A Becker, Christopher D Pivetti, Gavin T Best, Jessica C Chavez, Joseph M Galante
Pulmonary thromboembolic events cause significant morbidity and mortality after severe trauma. Clinically, these lesions are believed to be emboli arising secondary to deep venous thrombosis (DVT) in the lower extremities. Recently this notion has been challenged by clinical studies showing that pulmonary clots arise after trauma in the absence of DVT. This suggests that pulmonary blood clots arise in situ via de novo thrombosis. In the present study we characterize a murine weight-drop model of lateral blunt thoracic trauma...
February 1, 2018: Shock
Muhammad Khan, Faisal Jehan, Terence O'Keeffe, Mohammad Hamidi, Michael Truitt, Muhammad Zeeshan, Lynn Gries, Andrew Tang, Bellal Joseph
BACKGROUND: Patients with spinal trauma have the highest risk of a venous thromboembolism. While anticoagulation is recommended, its optimal timing is not well-defined. We aimed to assess the impact of early initiation of thromboprophylaxis in spinal trauma patients who were managed non-operatively. STUDY DESIGN: A 2-year (2013-2014) analysis of all isolated spinal-trauma patients managed non-operatively who received thromboprophylaxis in the TQIP. Patients were divided into two groups based on timing of initiation of thromboprophylaxis: Early (<48hours) and Late (≥48hours), and were matched in a 1:1 ratio using propensity score matching for demographics, admission vitals, injury severity, level of spine-injury and type of prophylaxis...
January 27, 2018: Journal of the American College of Surgeons
Won Pyo Cho, Sungsin Cho, Min-Ji Cho, Sanghyun Ahn, Sang-Il Min, Jongwon Ha, Seung-Kee Min
A 62-year-old man with progressive swelling on his left thigh and leg was referred to the Division of Vascular Surgery. Anticoagulation therapy did not prevent or improve the symptoms of chronic deep vein thrombosis (DVT) from his left external iliac vein to posterior tibial vein. He had no trauma history nor any accidents. He underwent femoral endovenectomy, thrombectomy and stent insertion in left iliac vein. The patient had additional balloon angioplasty for stenosis in left common femoral vein. He had an uneventful postoperative recovery without complication...
December 2017: Vascular Specialist International
Michelle Shen, Norele J Cutrera, Ashley C Dodd, Christopher Wallace, Frank R Avilucea, Craig Melbourne, Alex A Jahangir, Hassan H Mir, William T Obremskey, Manish K Sethi
Background: The development of Deep Vein Thrombosis (DVT) is a major concern following orthopaedic surgery. No study has yet to compare the rate and risk factors for DVT between total joint and orthopaedic trauma patients. To evaluate if DVT prophylaxis for trauma should differ from total joints, we explored the rate and risk factors for DVT between both cohorts. Methods: Using a CPT code search from 2005 to 2013 in the ACS-NSQIP database, 150,657 orthopaedic total joint patients and 44,594 orthopaedic trauma patients were identified...
November 2017: Journal of Clinical Orthopaedics and Trauma
Keith J Ruskin
PURPOSE OF REVIEW: Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject of research and debate. RECENT FINDINGS: Elements of the patient's history and physical examination, along with thromboelastography, can be used to predict patients who are at greatest risk of DVT and venous thromboembolism (VTE)...
January 12, 2018: Current Opinion in Anaesthesiology
Richard Othieno, Emmanuel Okpo, Rachel Forster
BACKGROUND: Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein, which can occur after surgery, after trauma, or when a person has been immobile for a long time. Clots can dislodge and block blood flow to the lungs (pulmonary embolism (PE)), causing death. DVT and PE are known by the term venous thromboembolism (VTE). Heparin (in the form of unfractionated heparin (UFH)) is a blood-thinning drug used during the first three to five days of DVT treatment...
January 9, 2018: Cochrane Database of Systematic Reviews
Zi Li, Jiangdong Ni
The present study aimed to investigate the role and mechanism of action of microRNA (miR)-26a in deep vein thrombosis (DVT). Peripheral blood was collected from 45 patients with DVT and 40 healthy controls. Levels of miR-26a, chemokine C-C motif ligand (CCL)2 mRNA and CCL7 mRNA were detected using reverse transcription-quantitative polymerase chain reaction and the value of miR-26a in the clinical diagnosis of DVT was assessed using receiver operating characteristic curve analysis. The correlation of miR-26a with CCL2 and CCL7 levels was analyzed using Spearman's rank correlation...
November 2017: Experimental and Therapeutic Medicine
Kathleen A Cannon, Jayraan Badiee, Jason B Brill, Erik J Olson, Michael J Sise, Vishal Bansal, C Beth Sise, Steven R Shackford
BACKGROUND: Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), remains a common complication following trauma. The role of hereditary thrombophilia (HT) in posttraumatic VTE is unknown. In the general population with a first-time DVT, Factor V Leiden (FVL) and prothrombin G20210A mutation (PGM) are the most common types of HT with an incidence of 20% to 25% and 6% to 18%, respectively. The objective of this study was to identify the incidence of FVL and PGM in posttraumatic VTE to determine whether routine screening for HT in trauma should be performed...
February 2018: Journal of Trauma and Acute Care Surgery
Charles A Karcutskie, Arjuna Dharmaraja, Jaimin Patel, Sarah A Eidelson, Arch G Martin, Edward B Lineen, Nicholas Namias, Carl I Schulman, Kenneth G Proctor
BACKGROUND: No previous studies have established the optimal antifactor Xa (anti-Xa) level to guide thromboprophylaxis (TPX) dosing with enoxaparin in trauma patients. We hypothesize that achieving 0.2-0.4 IU/mL anti-Xa will decrease venous thromboembolism (VTE) rates after trauma. METHODS: This was a retrospective review of 194 intensive care unit patients sustaining blunt or penetrating trauma from January 2015 to March 2017. All received initial enoxaparin (30 mg BID subcutaneous) and mechanical devices for TPX...
December 2017: Journal of Trauma and Acute Care Surgery
Shahab Hajibandeh, Shahin Hajibandeh, George A Antoniou, James Rh Scurr, Francesco Torella
BACKGROUND: Venous thromboembolism (VTE) is a serious but preventable cause of morbidity and mortality. Neuromuscular electrical stimulation systems (NMES) for the prevention of VTE may be beneficial for patients in whom pharmacological or standard mechanical prophylaxis methods are contraindicated or are regarded as unsafe or impractical. Although findings of experimental studies suggest that NMES reduce venous stasis, the clinical utility and effectiveness of NMES in VTE prevention remain controversial...
November 21, 2017: Cochrane Database of Systematic Reviews
Anna Holliday, Damayanti Samanta, Julie Budinger, Jessica Hardway, Audis Bethea
The department of trauma at a Level 1 trauma center sought to improve outcomes by enhancing the continuity of care for patients admitted to trauma services. Departmental leadership explored opportunities to improve this aspect of patient care through expansion of existing trauma nurse practitioner (NP) services. The restructured trauma NP service model was implemented in September 2013. A retrospective study was conducted with patients who presented at the trauma center between September 2012 and August 2015...
November 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Muhammad Umer Butt, Lili A Buzsaki, Susan S Smyth, Samy-Claude Elayi
BACKGROUND Spontaneous retroperitoneal hemorrhage (SRH) is a rare and difficult-to-diagnose entity. It is not associated with trauma, pathology, or iatrogenic manipulations. Few cases have been reported, with the only precipitating factor recognized being bleeding diatheses such as anticoagulation states, inherited coagulopathies, and hemodialysis. However, none of these have been described in combination with septic shock, which itself is associated with platelet dysfunction, coagulation dysfunction, and vasculopathy...
October 30, 2017: American Journal of Case Reports
S R Hamada, C Espina, T Guedj, R Buaron, A Harrois, S Figueiredo, J Duranteau
BACKGROUND: Venous thromboembolism (VTE) is one of the most common preventable causes of in-hospital death in trauma patients surviving their injuries. We assessed the prevalence, incidence and risk factors for deep venous thrombosis (DVT) and pulmonary embolism (PE) in critically ill trauma patients, in the setting of a mature and early mechanical and pharmacological thromboprophylaxis protocol. METHODS: This was a prospective observational study on a cohort of patients from a surgical intensive care unit of a university level 1 trauma centre...
September 12, 2017: Annals of Intensive Care
A Ismail, A M Tabari, K Isyaku
INTRODUCTION: Deep venous thrombosis (DVT) is a serious problem that can potentially lead to many complications including life-threatening pulmonary arterial thrombosis. Screening and confirmation of the diagnosis are critical in the care of this condition. OBJECTIVES: The objective of this study was to evaluate the role of Doppler sonography in diagnosing DVT and to illustrate the pattern in 170 suspected cases from our local environment. MATERIALS AND METHODS: This study was conducted at our department over 18 months...
August 2017: Nigerian Journal of Clinical Practice
Ben A Hickey, Andrew Cleves, Raza Alikhan, Neil Pugh, Len Nokes, Anthony Perera
BACKGROUND: Patients with foot and ankle trauma treated with cast are advised to perform toe movements to prevent venous thromboembolism (VTE). Our aim was to determine the effect of active toe movement on asymptomatic deep vein thrombosis (DVT) and venous calf pump function. METHODS: Patients aged 18-60 years with acute foot and ankle trauma requiring below knee non weight bearing cast were randomized to intervention (regular active toe movement) or control groups (n=100)...
September 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Diana M Sarmiento, Thomas F Northrup, Yu Wah
Over the course of a month, this 34-year-old woman had sought care at our facility--and another--on 3 separate occasions for painful bruises (visits #1 and #3) and deep vein thrombosis (visit #2). The bruises first appeared acutely on her arms, prompting her first visit to our ED and leading to a hospital stay. Several weeks later, the patient developed new bruise-like lesions on her earlobes, face, trunk, and lower extremities. In between these 2 visits, the patient was seen in another ED (and admitted) for right upper extremity DVT and was started on enoxaparin, followed by warfarin...
September 2017: Journal of Family Practice
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