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Sam Schulman, Peter L Gross, Bruce Ritchie, Susan Nahirniak, Yulia Lin, Lani Lieberman, Marc Carrier, Mark A Crowther, Indy Ghosh, Alejandro Lazo-Langner, Michelle Zondag
Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor-associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide...
March 21, 2018: Thrombosis and Haemostasis
Siavash Piran, Caroline Gabriel, Sam Schulman
Direct oral factor Xa (FXa) inhibitors are widely used for anticoagulation but a targeted antidote is not available. Four-factor prothrombin complex concentrate (4FPCC) has been shown in observational studies to support hemostasis in most patients with major bleeding related to FXa inhibitors with an acceptable rate of thromboembolic events. However, the effectiveness of 4FPCC for reversal of FXa inhibitors prior to emergency surgery or invasive procedures is unclear. A retrospective chart review was performed in patients that received 4FPCC at Hamilton General Hospital from 2015 to 2017...
March 21, 2018: Journal of Thrombosis and Thrombolysis
Xin Xue, Lisheng Jiang, Erich Duenninger, Manuela Muenzel, Shaofeng Guan, Adam Fazakas, Fanzhou Cheng, Juergen Illnitzky, Thorsten Keil, Jiangtao Yu
The prevalence of chronic kidney disease (CKD) is high in patients with atrial fibrillation (AF). Left atrial appendage closure (LAAC) has been recognized as an efficient alternative to oral anticoagulation for the prevention of thromboembolic events in patients with non-valvular AF (NVAF); however, the long-term safety and efficacy of LAAC in patients with CKD remain unclear. This study was designed to provide data regarding the safety and efficacy of LAAC in NVAF patients with CKD. A real-world analysis of the safety and efficacy of LAAC was performed on a cohort of 300 NVAF patients with or without CKD who underwent LAAC using the Watchman (WM) device at our center...
March 22, 2018: Heart and Vessels
Sophia Lazar, Lawrence E Goldfinger
Platelet-derived microparticles (PMPs) have long been known to increase in circulation in the presence of cancer, and have been considered to be cancer promoting by multiple mechanisms including shrouding of circulating tumor cells allowing immune evasion, inducing a procoagulant state associated with increased risk for venous thromboembolic events in cancer patients, and supporting metastatic dissemination by establishment of niches for anchorage of circulating tumor cells. These modes of PMP-enhanced progression of late stage cancer are generally based on the adhesive and procoagulant surfaces of PMPs...
2018: Frontiers in Cardiovascular Medicine
Sarasa Isobe, Masaharu Kataoka, Takashi Kawakami, Keiichi Fukuda
BACKGROUND: The correlation between serum adiponectin concentration and hemodynamics or certain metabolic markers in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is unknown.Methods and Results:We enrolled 30 CTEPH patients who underwent interventional therapy of balloon pulmonary angioplasty or pulmonary endarterectomy. Serum adiponectin concentrations positively correlated with B-type natriuretic peptide (BNP) concentrations, pulmonary vascular resistance, and mean pulmonary arterial pressure...
March 21, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Nicolas Coquoz, Daniel Weilenmann, Daiana Stolz, Vladimir Popov, Andrea Azzola, Jean-Marc Fellrath, Hans Stricker, Alberto Pagnamenta, Sebastian Ott, Silvia Ulrich, Sandor Györik, Jérôme Pasquier, John-David Aubert
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of pulmonary embolism (PE). Its incidence following PE is debated. An active screening for CTEPH in patients with acute PE is yet to be recommended.This prospective, multicentre, observational study (INPUT on PE; ISRCTN61417303) included patients with acute PE from 11 centres in Switzerland from March 2009 to November 2016. Screening for possible CTEPH was performed at 6, 12 and 24 months using a step-wise algorithm that included a dyspnoea phone-based survey, transthoracic echocardiography, right heart catheterisation and radiologic confirmation of CTEPH...
March 21, 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Zeyad Sako, Sindhu Reddy Avula, Elissa Gaies, Rebecca Daniel
Inferior vena cava (IVC) filters are increasingly used in patients with recurrent venous thromboembolism in whom anticoagulation is contraindicated or intolerable. Migration of fragments is a known complication of IVC filter use. We present a case of a 32-year-old man, who presented with right-sided chest pain believed to be caused by a migrated IVC fragment to the right ventricle. The filter was removed by an endovascular cook forceps with the assistance of intracardiac echocardiography. This case serves as an addition to the existing reports of successful removal of intracardiac fragments via minimally invasive endovascular approach, amid a larger number of intracardiac fragments that have been removed by an open-heart approach...
March 21, 2018: BMJ Case Reports
Anne Marie C Neill
Objective Referral audit - are local recommendations required to translate guideline to practice? Study design In total, 50 consecutive, anonymised referral letters reviewed during the initial consultation in a specialist menopause clinic; the reasons for referral along with the patient's age and the source of referral were analysed. Results Several common reasons for referral were identified. Sexual dysfunction, including loss of libido and dyspareunia, resulted in 11 (22%) referrals. Ten (20%) women were troubled by persistent symptoms or side effects from HRT; 9 (18%) women were referred before hormone replacement therapy was discussed or commenced; 7 (14%) women seeking advice for their menopausal symptoms had a family or personal history of cancer; 5(10%) were migraineurs; 2(4%) women had premature ovarian insufficiency; 2(4%) were denied hormone replacement therapy because of concern about venous thromboembolism risk; and 4 (8%) had miscellaneous medical disorders...
January 1, 2018: Post Reproductive Health
C F Song, H Li, B Tian, S Chen, J B Miao, Y L Fu, B You, Q R Chen, T Li, X X Hu, W Q Zhang, B Hu
Objective: To evaluate the incidence of postoperative venous thromboembolism (VTE) after thoracic surgery and its characteristic. Methods: This was a single-center, prospective cohort study. Patients undergoing major thoracic surgeries between July 2016 and March 2017 at Department of Thoracic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled in this study. Besides the routine examination, all patients were screened for deep venous thrombosis (DVT) by using noninvasive duplex lower-extremity ultrasonography after surgery...
April 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Amie Goodin, Ming Chen, Driss Raissi, Qiong Han, Hong Xiao, Joshua Brown
To examine the association between patient and hospital characteristics and inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE).The 2013 to 2014 Nationwide Readmissions Database was used to define a cohort of patients with VTE aged ≥18 after a primary VTE diagnosis. Comorbidities of interest were classified via diagnosis codes and IVCF placement was identified via procedure code. Chi square analysis tested differences between patient and hospital-level characteristics and whether or not IVCFs were placed...
March 2018: Medicine (Baltimore)
Haihong Wang, Tie Xu, Lifen Zheng, Guiling Li
BACKGROUND: Angiogenesis inhibitors showed activity in ovarian cancer, but preliminary data could not accurately reflect the survival benefit. We thus did a systematic review and meta-analysis of randomized controlled trials to reassess the efficacy and safety of angiogenesis inhibitors combined with chemotherapy for ovarian cancer. METHODS: We searched PubMed, EMBASE, Cochrane, and for randomized controlled trials comparing angiogenesis inhibitors containing therapy with conventional chemotherapy alone or no further treatment...
March 21, 2018: International Journal of Gynecological Cancer
Marc Sorigue, Elisa Orna, Juan-Manuel Sancho
Lenalidomide has been associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma. It is unclear whether patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) are also at such risk. We conducted a systematic review of the incidence of VTE in prospective trials of lenalidomide-treated patients with NHL or CLL. Sixty-eight unique reports were assessed for inclusion. For grade ≥3 VTE, 98 events were reported in 3043 patients (60 studies) (crude incidence: 3...
March 21, 2018: Leukemia & Lymphoma
Max Haffner, Nasser Heyrani, John P Meehan, Mauro Giordani
Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. The patient was started on an alternative anticoagulation based on a high suspicion for heparin-induced thrombocytopenia and the wound was monitored without surgical debridement...
March 2018: Arthroplasty Today
John O DeLancey, Eddie Blay, D Brock Hewitt, Kathryn Engelhardt, Karl Y Bilimoria, Jane L Holl, David D Odell, Anthony D Yang, Jonah J Stulberg
BACKGROUND: Adverse postoperative outcomes related to smoking are well established, yet current smokers continue to be offered elective surgery in the US. It is unknown whether patients undergoing low-risk, elective procedures, who actively smoke experience increased risk of complications. We sought to determine the increased burden of complications following elective hernia repair procedures in patients identified as current smokers. METHODS: We identified patients undergoing elective incisional, inguinal, umbilical, or ventral hernia repair from 2011 to 2014 using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database...
March 6, 2018: American Journal of Surgery
Eliza W Beal, Neil D Saunders, Joseph F Kearney, Ezra Lyon, Lai Wei, Malcom H Squires, Linda X Jin, David J Worhunsky, Konstantinos I Votanopoulos, Aslam Ejaz, George Poultsides, Ryan C Fields, Douglas Swords, Alexandra W Acher, Sharon M Weber, Shishir K Maithel, Timothy Pawlik, Carl R Schmidt
The objective of this study is to assess the accuracy of the American College of Surgeons National Surgical Quality Improvement Program online risk calculator for estimating risk after operation for gastric cancer using the United States Gastric Cancer Collaborative. Nine hundred and sixty-five patients who underwent resection of gastric adenocarcinoma between January 2000 and December 2012 at seven academic medical centers were included. Actual complication rates and outcomes for patients were compared. Most of the patients underwent total gastrectomy with Roux-en-Y reconstruction (404, 41...
March 1, 2018: American Surgeon
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
Stefano Grazioli, Maurizio Paciaroni, Giancarlo Agnelli, Monica Acciarresi, Andrea Alberti, Cataldo D'Amore, Valeria Caso, Michele Venti, Luigina Guasti, Walter Ageno, Alessandro Squizzato
BACKGROUND: The association between stroke and cancer is well-known but insufficiently investigated. Aim of this multicentre retrospective cohort study was to estimate the prevalence of cancer-associated ischemic stroke, describe clinical outcomes in patients with cancer-associated ischemic stroke and investigate independent factors associated with active cancer. METHODS: Consecutive adult patients admitted for acute ischemic stroke were included. Included patients were admitted in the Stroke Unit of the Hospital of Perugia, Italy, from March 2005 to March 2015, and in a medical unit of the Hospital of Varese, Italy, from January 2010 till December 2011...
March 15, 2018: Thrombosis Research
Luis Jara-Palomares, Remedios Otero, David Jimenez, Juan Manuel Praena-Fernandez, Carme Font, Conxita Falga, Silvia Soler, David Riesco, Peter Verhamme, Manuel Monreal
The usefulness of a diagnostic workup for occult cancer in patients with venous thromboembolism (VTE) is controversial. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to perform a nested case-control study to validate a prognostic score that identifies patients with unprovoked VTE at increased risk for cancer. We dichotomized patients as having low- (≤2 points) or high (≥3 points) risk for cancer, and tried to validate the score at 12 and 24 months. From January 2014 to October 2016, 11,695 VTE patients were recruited...
2018: PloS One
Marcin Kubik, Alicja Dąbrowska-Kugacka, Ewa Lewicka, Ludmiła Daniłowicz-Szymanowicz, Grzegorz Raczak
Left ventricular noncompaction (LVNC) is a unique inherited cardiomyopathy, characterized by an increased risk of adverse cardiovascular events such as heart failure, arrhythmia or sudden cardiac death. Although in comparison to dilated cardiomyopathy, the number of clinical studies concerning LVNC is still small, it is quickly increasing, which reflects a huge effort of the cardiovascular society to develop data to improve understanding of this cardiomyopathy. However, the predictors of adverse outcomes in LVNC are not well established...
March 16, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Patrick Mouret, Reinhold Kreutz, Katrin Deilmann, Ariane Dihlmann, Gerlind Holberg, Sylvia Haas
BACKGROUND: In global admission studies (RECORD I-IV) Rivaroxaban and enoxaparin as a standard prophylaxis were comparable in safety of treatment, but rivaroxaban appeared more effective in prevention of venous thromboembolism (VTE) when used in elective hip and knee replacement. The worldwide non-interventional cohort study XAMOS confirmed these results in the clinical routine compared to proven anticoagulants. METHOD: Efficacy and safety of rivaroxaban was to be compared with the standard prophylaxis in the prevention of VTE after elective hip and knee replacement surgery in clinical practice in Germany...
October 2017: MMW Fortschritte der Medizin
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