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Thromboprophylaxis AND trauma

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https://www.readbyqxmd.com/read/29618152/altered-plasma-clot-properties-and-trauma-related-venous-thromboembolism-despite-thromboprophylaxis
#1
Sarah Goldman, Paulina Frączek, Krzysztof Szklanny, Elżbieta Papuga-Szela, Andrzej Stanisz, Anetta Undas
BACKGROUND:  Prothrombotic clot phenotype may characterize patients developing deep vein thrombosis (DVT) despite pharmacological thromboprophylaxis. We studied the role of fibrin clot properties and its potential determinants in individuals who experienced DVT after lower limb injury. METHODS:  In a case-control study, we assessed 50 patients who developed DVT despite prophylactic use of low-molecular-weight heparins (the failed thromboprophylaxis group) after a lower limb injury, and three age- and sex-matched control groups, 50 patients each: (1) patients with trauma-related DVT without prior thromboprophylaxis; (2) individuals with unprovoked DVT; (3) patients without history of DVT (the no-DVT controls)...
April 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29613956/optimal-timing-of-initiation-of-thromboprophylaxis-in-spine-trauma-managed-operatively-a-nationwide-propensity-matched-analysis-of-trauma-quality-improvement-program
#2
Muhammad Zeeshan, Muhammad Khan, Terence O'Keeffe, Nina Pollack, Mohammad Hamidi, Narong Kulvatunyou, Joseph V Sakran, Lynn Gries, Bellal Joseph
INTRODUCTION: Patients with spinal trauma are at high-risk for venous-thromboembolism(VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early vs late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention. METHODS: We performed a 2-year (2013-14) review of patients with isolated spine trauma (S-AIS≥3 and no other injury in another body region with AIS>2) who underwent operative intervention and received thromboprophylaxis post-operatively...
April 2, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29590126/risk-of-venous-thromboembolism-during-rehabilitation-of-patients-with-spinal-cord-injury
#3
Sabine Eichinger, Lisbeth Eischer, Hana Sinkovec, Gabriela Wittgruber, Ludwig Traby, Michael Kammer, Paul A Kyrle, Oskar Steinbrecher, Herbert Kaloud, Victoria Kyrle, Hartwig Moser, Renate Wildburger
BACKGROUND: Patients with spinal cord injury (SCI) are at risk of thrombosis and bleeding. Data on the risks during rehabilitation are inconsistent, and thromboprophylactic strategies are heterogeneous. We aimed to evaluate the thrombotic risk and bleeding events of SCI patients during rehabilitation. METHODS: We retrospectively collected hospital record data of 263 consecutive SCI patients admitted at a rehabilitation clinic. 78 patients with acute venous thromboembolism (VTE) at the primary center, without acute trauma or lower extremity paresis, less than one month rehabilitation, or reasons for long-term therapeutic anticoagulation, were excluded...
2018: PloS One
https://www.readbyqxmd.com/read/29544199/metabolomic-association-between-venous-thromboembolism-in-critically-ill-trauma-patients-and-kynurenine-pathway-of-tryptophan-metabolism
#4
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
https://www.readbyqxmd.com/read/29503135/a-prospective-cohort-study-of-symptomatic-venous-thromboembolic-events-in-foot-and-ankle-trauma-the-need-for-stratification-in-thromboprophylaxis
#5
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...
May 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29413769/does-thromboprophylaxis-reduce-symptomatic-venous-thromboembolism-in-patients-with-below-knee-cast-treatment-for-foot-and-ankle-trauma-a-systematic-review-and-meta-analysis
#6
REVIEW
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
https://www.readbyqxmd.com/read/29382561/optimal-timing-of-initiation-of-thromboprophylaxis-after-nonoperative-blunt-spinal-trauma-a-propensity-matched-analysis
#7
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. Although 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 nonoperatively. STUDY DESIGN: A 2-year (2013 to 2014) analysis of all isolated spinal trauma patients managed nonoperatively who received thromboprophylaxis in the American College of Surgeons Trauma Quality Improvement Program...
May 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29351927/bet-2-is-early-chemical-thromboprophylaxis-safe-in-patients-with-blunt-trauma-solid-organ-injury-soi-undergoing-non-operative-management-nom
#8
Craig Ferguson, Jonathan Lewin
A short cut review was carried out to establish whether chemical thromboprophylaxis was a safe early intervention in patients with solid organ injury that is being managed non-operatively. Eight papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is inadequate evidence assessing safety of low molecular weight heparin (LMWH) within 24 hours of trauma...
February 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29190255/relation-of-antifactor-xa-peak-levels-and-venous-thromboembolism-after-trauma
#9
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
https://www.readbyqxmd.com/read/29153864/changes-in-markers-of-thrombin-generation-and-interleukin-6-during-unicondylar-knee-and-total-knee-arthroplasty
#10
Edwin P Su, Lauren E Mount, Allina A Nocon, Thomas P Sculco, George Go, Nigel E Sharrock
BACKGROUND: Total knee arthroplasty (TKA) is associated with a risk of thromboembolism requiring routine thromboprophylaxis, but there is debate about the risk with unicondylar knee arthroplasty (UKA) as it is a more minor procedure. We sought to investigate the relative risk of thromboembolism with UKA compared to TKA and one-staged bilateral TKA (BTKA) by measuring the increase in circulating biochemical markers of thrombin generation during the procedures. Degree of surgical trauma was also assessed by measuring interleukin-6, a marker of metabolic injury...
March 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29088950/neurosurgical-applications-of-viscoelastic-hemostatic-assays
#11
Svetlana Kvint, James Schuster, Monisha A Kumar
Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient's exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29078906/early-thromboprophylaxis-with-low-molecular-weight-heparin-is-safe-in-patients-with-pelvic-fracture-managed-nonoperatively
#12
Faisal Jehan, Terence O'Keeffe, Muhammad Khan, Albert Chi, Andrew Tang, Narong Kulvatunyou, Lynn Gries, Bellal Joseph
INTRODUCTION: Early initiation of thromboprophylaxis is highly desired in pelvic fracture patients, but it is often delayed due to the fear of hemorrhage. Aim of our study was to assess the safety of early initiation of venous thromboprophylaxis in patients with pelvic trauma managed nonoperatively. METHODS: Three-year (2010-2012) retrospective study of trauma patients with pelvic fractures who were managed nonoperatively and received thromboprophylaxis with low-molecular-weight heparin (LMWH)...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29071333/association-of-anti-factor-xa-guided-dosing-of-enoxaparin-with-venous-thromboembolism-after-trauma
#13
Charles A Karcutskie, Arjuna Dharmaraja, Jaimin Patel, Sarah A Eidelson, Anish B Padiadpu, Arch G Martin, Gabriel Lama, Edward B Lineen, Nicholas Namias, Carl I Schulman, Kenneth G Proctor
Importance: The efficacy of anti-factor Xa (anti-Xa)-guided dosing of thromboprophylaxis after trauma remains controversial. Objective: To assess whether dosing of enoxaparin sodium based on peak anti-Xa levels is associated with the venous thromboembolism (VTE) rate after trauma. Design, Setting, and Participants: Retrospective review of 950 consecutive adults admitted to a single level I trauma intensive care unit for more than 48 hours from December 1, 2014, through March 31, 2017...
February 1, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/28900890/high-level-of-venous-thromboembolism-in-critically-ill-trauma-patients-despite-early-and-well-driven-thromboprophylaxis-protocol
#14
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
https://www.readbyqxmd.com/read/28865588/the-effect-of-active-toe-movement-atom-on-calf-pump-function-and-deep-vein-thrombosis-in-patients-with-acute-foot-and-ankle-trauma-treated-with-cast-a-prospective-randomized-study
#15
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
https://www.readbyqxmd.com/read/28461962/anticoagulation-therapy-and-proximal-femoral-fracture-treatment-an-update
#16
Ioannis Ktistakis, Vasileios Giannoudis, Peter V Giannoudis
Hip fractures in the elderly population have become a 'disease' with increasing incidence.Most of the geriatric patients are affected by a number of comorbidities.Coagulopathies continue to be a special point of interest for the orthopaedic trauma surgeon, with the management of this high-risk group of patients a hot topic of debate among the orthopaedic community.While a universal consensus on how to manage thromboprophylaxis for this special cohort of patients has not been reached, multiple attempts to define a widely accepted protocol have been published...
August 2016: EFORT Open Reviews
https://www.readbyqxmd.com/read/28338589/managing-hip-fracture-and-lower-limb-surgery-in-the-emergency-setting-potential-role-of-non-vitamin-k-antagonist-oral-anticoagulants
#17
REVIEW
William Fisher
Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries...
June 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28280942/perioperative-risk-factors-for-death-among-patients-with-symptomatic-pulmonary-thromboembolism
#18
(no author information available yet)
Perioperative pulmonary thromboembolism (PTE) is a fatal complication that may occur in patients who are undergoing surgery. This study aimed to identify risk factors for PTE-related death. This study evaluated data for the most recent 5-year period (2007-2011) from the Japanese Society of Anesthesiologists' database of patients who experienced perioperative PTE. We compared patients who died within 30 days of onset and patients who survived for > 30 days, and used logistic regression analysis to identify the independent risk factors...
June 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28031644/ineffective-treatment-of-low-molecular-weight-heparin-in-obese-subject-with-traumatic-fractures-of-the-leg
#19
Egidio Imbalzano, Michele Creazzo, Giovanni Trapani, Giuseppina Lizio, Antonino Saitta
American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th edition, 2012, suggest no prophylaxis rather than pharmacological thromboprophylaxis in management of venous thromboembolism (VTE) risk of isolated lower leg injuries distal to knee requiring leg immobilization. Low-molecular-weight heparin (LMWH) is a class of drugs commonly used as antithrombotics in surgery and in case of prolonged bed rest and hypomobility. A 35-year-old obese man with no history of health disease (height, 170 cm; weight, 95 kg; and body mass index, 32...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/27906870/effectiveness-of-low-molecular-weight-heparin-versus-unfractionated-heparin-to-prevent-pulmonary-embolism-following-major-trauma-a-propensity-matched-analysis
#20
James P Byrne, William Geerts, Stephanie A Mason, David Gomez, Christopher Hoeft, Ryan Murphy, Melanie Neal, Avery B Nathens
BACKGROUND: Pulmonary embolism (PE) is a leading cause of delayed mortality in patients with severe injury. While low-molecular-weight heparin (LMWH) is often favored over unfractionated heparin (UH) for thromboprophylaxis, evidence is lacking to demonstrate an effect on the occurrence of PE. This study compared the effectiveness of LMWH versus UH to prevent PE in patients following major trauma. METHODS: Data for adults with severe injury who received thromboprophylaxis with LMWH or UH were derived from the American College of Surgeons Trauma Quality Improvement Program (2012-2015)...
February 2017: Journal of Trauma and Acute Care Surgery
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