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BACKGROUND: Early initiation of venous thromboembolism (VTE) chemoprophylaxis in adults with blunt solid organ injury (BSOI) has been demonstrated to be safe but this is controversial in adolescents. We hypothesized that adolescent patients with BSOI undergoing non-operative management (NOM) and receiving early VTE chemoprophylaxis (eVTEP) (≤ 48 h) have a decreased rate of VTE and similar rate of failure of NOM, compared to similarly matched adolescents receiving delayed VTE chemoprophylaxis (dVTEP) (> 48 h). METHODS: The 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-17 years of age) with BSOI (liver, kidney, and/or spleen) undergoing NOM. We compared eVTEP versus dVTEP using a 1:1 propensity score model, matching for age, comorbidities, BSOI grade, injury severity score, hypotension on arrival, and need for transfusions. We performed subset analyses in patients with isolated spleen, kidney, and liver injury. RESULTS: From 1022 cases, 417 (40.8%) adolescents received eVTEP. After matching, there was no difference in matched variables (all p > 0.05). Both groups had a similar rate of VTE (dVTEP 0.6% vs. eVTEP 1.7%, p = 0.16), mortality (dVTEP 0.3% vs. eVTEP 0%, p = 0.32), and failure of NOM (eVTEP 6.7% vs. dVTEP 7.3%, p = 0.77). These findings remained true in all subset analyses of isolated solid organ injury (all p > 0.05). CONCLUSIONS: The rate of VTE with adolescent BSOI is exceedingly rare. Early VTE chemoprophylaxis in adolescent BSOI does not increase the rate of failing NOM. However, unlike adult trauma patients, adolescent patients with BSOI receiving eVTEP had a similar rate of VTE and death, compared to adolescents receiving dVTEP.

Introduction: Diagnosing deep venous thromboses and venous thromboemboli (DVT/VTE) in pregnant patients presents a unique challenge for emergency physicians. The risk of DVT/VTE increases during pregnancy, and the potential consequences of misdiagnoses are severe. Point-of-care ultrasonography (POCUS) is frequently a first-line diagnostic imaging modality. However, recent studies have shown a high incidence of thromboses proximal to the common femoral vein during pregnancy, and these would not be visualized using compressive ultrasonography, which traditionally can only visualize thromboses distal to the femoral vein.Case Report: A 38-year-old female, 25-weeks primiparous, presented to the emergency department with a three-day history of left lower extremity swelling. Point-of-care three-point compression testing was used to evaluate for a DVT; however, no thrombus was visualized. Given high clinical suspicion, color and spectral Doppler testing were performed and demonstrated turbulent flow and reduced respiratory variation in the common femoral vein. This prompted further additional testing for a proximal DVT using magnetic resonance venography, which revealed an occlusive left external iliac thrombus. The patient was subsequently started on daily subcutaneous enoxaparin and discharged home with close follow-up.Conclusion: Emergency physicians play a critical role in evaluations for the presence of DVT/VTE, particularly in pregnant patients. We endorse the use of POCUS with three-point compression testing, as well as color and spectral Doppler imaging, to help identify proximal DVTs in this patient population. This case report can aid physicians in the diagnosis of this pathological condition that if left untreated can have severe consequences.

BACKGROUND: In the setting of a known thrombotic event, computed tomography (CT) studies provide reasonable sensitivity for the diagnosis of deep venous thrombosis (DVT). However, the incidence and accuracy of a DVT diagnosis on CT studies not targeted for the detection of DVT are not well described. In addition, the clinical impact of DVTs incidentally identified on CT is unknown. METHODS: In this single-institution retrospective study, we queried all contrasted CT studies of the lower extremities performed over a 10-year period. Regular expressions applied to the radiology reports associated with the CT studies identified studies with positive findings associated with DVT. These selected reports were then manually reviewed to confirm the presence of a DVT. Patient demographics and relevant medical and surgical history were obtained through a chart review. Follow-up information was obtained for 1 year after the incident CT and included treatment course, additional imaging, and adverse events. An incidental DVT was one identified in a patient in whom the DVT was not noted in a prior study and for whom the study indication did not include concern for DVT or pulmonary embolism. RESULTS: Of 16,637 lower extremity contrasted CT studies queried, 37 study reports identified a DVT. However, only 13 patients had a finding of an incidental DVT (10-year incidence of 0.08%). Among these 13 patients, 11 underwent additional imaging, including 9 who had a subsequent venous duplex and 2 who had subsequent CT studies. Among those with a subsequent duplex, DVT was not identified in eight cases, whereas in one case, DVT was confirmed. Among those with subsequent CT studies, DVT was not identified in one case and was confirmed in one case. Of the 13 patients with incidental DVTs, 3 were initiated on anticoagulation based on their initial CT findings alone. Among these, two did not experience any complications from their DVT or anticoagulation regimen. One did experience major bleeding complications, requiring additional procedures. CONCLUSIONS: Incidental DVTs are a rare finding in lower extremity CT studies, noted to occur in only 0.08% of studies. Most patients with incidental DVTs receive additional imaging, with negative findings in 80% of cases. This study identified that 23% of patients were initiated on anticoagulation due to the CT findings, with a 33% rate of significant complications. Currently, a CT venogram is not recommended as a first-line modality for the diagnosis of DVT. However, there is no guidance regarding the need for repeat imaging in patients with incidentally diagnosed lower extremity DVTs identified on CT. Additional study is needed to provide evidence for guideline development.

Introduction: Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported.Methods: In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance. We performed systematic searches in MEDLINE and Embase for original, primary data articles from January 2012–June 2021 comparing the efficacy of POCUS performed by EPs to the local standard. Quality Assessment of Diagnostic Accuracy Studies-2 for individual articles are reported. We obtained summary measures of sensitivity, specificity, and their corresponding 95% confidence intervals (CI) using bivariate mixed-effects regression models. We performed meta-regression, subgroup, and sensitivity analyses as planned in the protocol CRD42021268799 submitted to PROSPERO.Results: Fifteen publications fit the inclusion criteria, totaling 2,511 examinations. Pooled sensitivity and specificity were 90% (95% CI 82%–95%) and 95% (CI 91%–97%), respectively. Subgroup analyses by EP experience found significantly better accuracy for exams performed by EP specialists (93%, CI 88%–97%) vs trainees (77%, CI 60%–94%). Specificity for EP specialists (97%, CI 94%–99%) was higher than for trainees (87%, CI 76%–99%, P = 0.01). Three-point compression ultrasound (CUS) was more sensitive than two-point CUS but was only statistically significant when limited to EP specialists (92% vs 88%, P = 0.07, and 95% vs 88%, P = 0.02, respectively).Conclusion: Point-of-care ultrasound performed by emergency physicians is sensitive and specific for the diagnosis of suspected DVT when performed by trained attending EPs. Three-point compression ultrasound examination may be more sensitive than two-point CUS.

Introduction: Deep vein thrombosis (DVT) is a major cause of cardiovascular disease-related deaths worldwide and is considered a thrombotic inflammatory disorder. IL-1β, as a key promoter of venous thrombus inflammation, is a potential target for DVT treatment. Constructing a nanocarrier system for intracellular delivery of siIL-1β to silence IL-1β may be an effective strategy for alleviating DVT. Methods: ELISA was used to detect the expression levels of IL-1β and t-PA in the serum of DVT patients and healthy individuals. In vitro, HUVEC cells were treated with IL-1β, and changes in VWF and t-PA expression levels were assessed. PBAE/MCM-41@siIL-1β (PM@siIL-1β) nano-complexes were synthesized, the characterization and biocompatibility of PM@siIL-1β were evaluated. A rat hind limb DVT model was established, and PM@siIL-1β was used to treat DVT rats. Morphology of the inferior vena cava, endothelial cell count, IL-1β, vWF, and t-PA levels, as well as changes in the p38 MAPK and NF-κB pathways, were examined in the different groups. Results: IL-1β and t-PA were highly expressed in DVT patients, and IL-1β treatment induced a decrease in VWF levels and an increase in t-PA levels in HUVEC cells. The synthesized PM@siIL-1β exhibited spherical shape, good stability, high encapsulation efficiency, and high drug loading capacity, with excellent biocompatibility. In the DVT model rats, the inferior vena cava was filled with blood clots, endothelial cells increased, IL-1β and VWF levels significantly increased, while t-PA levels were significantly downregulated. Treatment with PM@siIL-1β resulted in reduced thrombus formation, decreased endothelial cell count, and reversal of IL-1β, VWF, and t-PA levels. Furthermore, PM@siIL-1β treatment significantly inhibited p38 phosphorylation and upregulation of NF-κB expression in the DVT model group. Conclusion: IL-1β can be considered a therapeutic target for suppressing DVT inflammation. The synthesized PM@siIL-1β achieved efficient delivery and gene silencing of siIL-1β, demonstrating good therapeutic effects on rat hind limb DVT, including anti-thrombotic and anti-inflammatory effects, potentially mediated through the p38 MAPK and NF-κB pathways. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management. DESIGN: Retrospective, observational cohort study. SETTING: Two ICUs from a tertiary referral academic hospital. PATIENTS: Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022. INTERVENTIONS: None. PRIMARY OUTCOME: Vascular complications frequency related to ECMO cannula. MEASUREMENTS AND MAIN RESULTS: A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46–64 yr), with a median duration of ECMO support of 7 days (IQR, 5–12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) (n = 63, 58%) or arterial thrombosis (n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications. CONCLUSIONS: Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation. [ABSTRACT FROM AUTHOR]

Patients at high risk of deep vein thrombosis are recommended to undergo lower-extremity ultrasonography to screen for pulmonary embolism (PE); however, there are few reports on whether this can effectively reduce the occurrence of fatal pulmonary embolism (FPE). This study aimed to assess the risk factors associated with PE and to investigate whether perioperative ultrasound screening of lower extremity veins in orthopedic patients can effectively reduce the incidence of FPE. We enrolled 137 patients with PE who underwent orthopedic surgery between 2013 and 2020. Patients were divided into survival and non-survival groups based on whether FPE occurred during hospitalization. Demographic and clinical data were compared between groups. Ultrasound screening was effective in reducing the incidence of FPE in orthopedic patients. Thrombolytic therapy and computed tomography pulmonary angiography (CTPA) were highlighted factors that protect against FPE. Coronary heart disease was found to be independent risk factors for FPE. Proximal thrombus associated with an FPE. Ultrasound screening of the lower limb veins should be routinely performed in orthopedic patients during the perioperative period. Prophylactic inferior vena cava filter implantation, thrombolytic therapy, and CTPA can be performed in patients with suspected PE to reduce its incidence. [ABSTRACT FROM AUTHOR]

Background: Screening of deep vein thrombosis (DVT) is an NHS priority for improving community health service. Effective DVT screening and documentation improve patient outcomes, prevent prolonged hospitalisation and lead to fewer expenses. The lack of evidence of DVT screening in the community requires action. This Quality Improvement Project focuses on improving DVT screening and documentation for housebound patients in the community. Aim: To improve screening and documentation of DVT in four months by introducing several interventions in collaboration with one care community. Methods: The authors used a fishbone analysis and driver diagram to form three 'Plan, Do, Study and Act' cycles. The authors also developed a Wells' template, delivered a training session, had a team meeting with community nurses, audited their screening records and collected their feedback. Findings: There was a 74% increase in staff using the National Institute for Health and Care Excellence guidelines and 100% documentation of DVT assessment, of which 82% used the Wells' score template. Conclusions: DVT screening and documentation in community services can be optimised and sustained with training and monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Low rates of venous thromboembolism (VTE) have been found in patients with isolated orthopaedic trauma below the knee. Many surgeons routinely provide chemical thromboprophylaxis in these injuries, however. This is not without inherent risks, and this remains a controversial topic in perioperative care in orthopaedic trauma. This systematic review and meta-analysis was performed to look at rates of VTE in patients with isolated orthopaedic fractures below the knee, grouped by whether they received chemical prophylaxis versus no chemical prophylaxis. Methods: A systematic review was performed comparing VTE with and without chemical thromboprophylaxis following isolated orthopaedic fracture below the knee. A chi-square analysis was then performed on data including patients who received chemical prophylaxis versus those who did not from all 25 included articles. The articles were grouped according to type of study, such as observational versus randomized controlled trial (RCT), and then further subdivided according to surgical intervention status, and whether routine screening for thromboembolism was utilized to diagnose. Risk of bias assessment was performed using the ROBINS-I criteria for cohort studies and the Cochrane RoB 2 tool for randomized controlled trials. A random effects pooled logistic regression and Fisher’s exact tests were then performed. Results: 222,188 patients were found from 25 articles. Chemical prophylaxis was given to 8,666 patients, and VTE was reported in 347 cases (4.0%). 213,522 patients did not receive chemical prophylaxis, and VTE was reported in 2,185 (1.02%) (χ2 (1, n = 222,188) = 656.8, p <.00001). Pooled logistic regression revealed that patients receiving prophylaxis were 0.5 times less likely to develop VTE. With a calculated population baseline risk of 1.5% for developing VTE, the number needed to treat (NNT) with chemical prophylaxis is 134 to prevent 1 VTE after fracture below the knee. Conclusions: In patients with isolated orthopaedic trauma below the knee, indiscriminate use of chemical VTE prophylaxis is not recommended due to the lack of significant benefit and high NNT. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Thrombotic events, the leading cause of death after total knee arthroplasty (TKA), occurred more frequently in simultaneous bilateral TKA than unilateral TKA under conventional perioperative management. The aim of the study was to determine whether the simultaneous bilateral TKA using contemporary blood management strategies would be associated with higher risk of thrombotic events than unilateral TKA. Method: This propensity score-matched cohort study included 1,069 patients, with 324 undergoing simultaneous bilateral TKA and 745 undergoing unilateral TKA. All TKAs were performed without use of a tourniquet and with use of intravenous tranexamic acid administration. For patients receiving chronic antithrombotic therapy, the antithrombotic medications were continued during the perioperative period, including on the day of the operation. The primary outcome was the thrombotic events up to 1 year after TKA. Results: The propensity score-matched cohort consisted of 324 matched pairs of patients. There was no significant difference between simultaneous bilateral and unilateral TKA groups in the occurrence of the thrombotic events (25 of 324 [7.7%] versus 19 of 324 [5.9%] patients, p = 0.44). Additionally, no significant differences were found in the occurrence of the bleeding events (1 of 324 [0.3%] versus 1 of 324 [0.3%] patients, p > 0.99) and death within the postoperative 1 year (1 of 324 [0.3%] versus 3 of 324 [0.9%] patients, p = 0.62). Conclusion: The rate of thrombotic events after simultaneous bilateral TKA with contemporary perioperative blood management strategies did not significantly differ from that after unilateral TKA. [ABSTRACT FROM AUTHOR]

Introduction: Calf muscular vein thrombosis (CMVT) is a type of distal deep vein thrombosis, which is common in geriatric hip fracture patients. However, studies focusing on whether the orthopedic operation has an impact on the prognosis of geriatric hip fracture patients with CMVT are very limited. Therefore, the aim of this study was to explore whether geriatric hip fractures with CMVT affect the mortality of patients within one year postoperatively. The difficulty of the operation, postoperative complications, the status of thrombosis, and function scores were also compared. Materials and methods: Geriatric hip fracture patients who underwent surgery between January 2019 and January 2021 were included. Patients were divided into groups with and without CMVT by preoperative color Doppler ultrasound examination. Propensity score-matching (PSM) was performed in a ratio of 1:1 between the patient with and without CMVT groups. Baseline characteristics, laboratory results, perioperative indicators and prognosis of patients were collected retrospectively. Intraoperative and postoperative comparisons were conducted between patients with and without CMVT. Results: Two hundred and sixty geriatric hip fracture patients were included. Eighty-nine patients in each group were matched after PSM. There was no significant difference in mortality between the two groups at one-month, three-month, six-month, and one-year postoperatively. However, patients with CMVT had longer hospital stays, a higher incidence of postoperative complications, and a higher incidence of thrombosis progression than patients without CMVT in the follow-up. Conclusion: No significant difference in mortality within one year postoperatively was observed in Chinese geriatric hip fracture patients with or without CMVT formation. Strategies such as close monitoring the status of thrombosis, individualized care, and strengthening rehabilitation are recommended to reduce the risk of complications and optimize patient outcomes in this patient population. Trial registration: Chinese Clinical Trial Registry (ChiCTR2300069411). Registered March 15, 2023, https://www.chictr.org.cn/showproj.html?proj=192079. [ABSTRACT FROM AUTHOR]

Background: The relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation. Methods: Data from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle (α) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors. Results: Compared to the non-DVT group, the DVT group had decreased R and K values, while the α, MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389–2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 − 2.709). Conclusions: The hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures. Trial registration: The study was registered in the Chinese Clinical Trial Register (https://www.chictr.org.cn/bin/home) on April 16, 2024, with registration number ChiCTR2400083135. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). We aimed to analyze the risk factors, clinical presentations, evaluation and management strategies as well as outcomes of adult pulmonary thromboembolism cases at a tertiary care center. In a retrospective observational study, all consecutive adult pulmonary thromboembolism cases admitted from January 2019 to September 2020 at our center were enrolled in this study. Forty-eight patients were included in the present study. The commonest presenting features were dyspnea (93.8%) and cough (79.2%). The risk factors included hypertension 11 (23%), diabetes 6 (12%), recent trauma and recent surgery 3 (6%) each, and malignancy in 2 (4%). DVT was present in 12 (25%) cases while history of smoking was significant, 31 present in (64.6%). Tuberculosis was also found to be an important risk factor for PE in 8 (16.7%). The current COVID-19 pandemic has come up as an important risk factor for PTE which was also true in our case with 13 (27%) patients being cases of moderate to severe COVID-19 pneumonia. Electrocardiogram revealed sinus tachycardia (56.25%), precordial lead T-wave changes (6.3%), and S1Q3T3 pattern (16.67%). Diagnosis was confirmed by computed tomographic pulmonary angiography (CTPA) in 81% of cases. Treatment options included low molecular weight heparin (LMWH) in 91%, newer oral anticoagulants (NOACs) in 2% of the patients and thrombolysis was needed in 12.5% of patients. There was no in-hospital mortality; however one patient had major bleeding. The clinical presentation of PE varied from dyspnea to cough, though the commonest feature of dyspnea remains unchanged compared to prior studies. CTPA has been modality of choice for diagnosis, however few patients with high probability for PTE were diagnosed clinically along with suggestive echocardiography and ECG findings. Thus, a high index of suspicion and timely therapeutic anticoagulation with various agents led to effective management and better outcome in the studied patients. [ABSTRACT FROM AUTHOR]

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Gallbladder adenocarcinoma has a high mortality rate, with approximately 1.7% cancer-related deaths worldwide. Cancer-associated thrombosis (CAT), including deep vein thrombosis (DVT), can significantly increase the risk of mortality within cancer patients, especially in pancreatic, brain, and intra-abdominal cancers, as well as in advanced and metastatic cancers. In this case report, there was a 45-year-old male patient diagnosed with advanced gallbladder adenocarcinoma UICC stage IVB with a TNM stage of T2b, N0, M1 with liver metastases who experienced pain and swelling in both lower limbs after undergoing a VI-A cycle of chemotherapy with gemcitabine capecitabine. The risk of thrombosis was calculated using the modified Khorana-Vienna CAT scores, which increased during every chemotherapy session. In this case, the Khorana-Vienna CAT score was calculated during two latest cycle of chemotherapy that somewhat considered delayed as the patient had already shown hypercoagulopathy symptoms and developed a poorer prognosis. Early CAT scoring, ideally before starting chemotherapy session, potentially improves thrombosis prognosis. The patient's condition improved after administration of antithrombotic agents. Chemotherapy agents and other factors, including the cancer site and presence of metastatic cancer, influence the risk of CAT. Risk predictor scores are required to assess the risk of CAT and benefits of prophylactic treatment. Prophylactic therapy can be initiated in patients with high-risk CAT, calculated using the modified Khorana and Vienna CAT scores, to prevent thrombosis and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired deep vein thrombosis (DVT) is an important cause of morbidity and mortality. Objectives: The purpose of this study was to evaluate the prevalence of proximal lower limb DVT and isolated distal DVT (IDDVT) and their relationship to the Padua Prediction Score (PPS) in acutely ill, hospitalized patients. Methods: In a single-center cross-sectional study, all inpatients from medical departments with suspected lower-extremity DVT were evaluated with whole-leg ultrasonography during 183 days from 2016 to 2017. Results: Among the 505 inpatients (age 78.0 ± 13.3, females 59.2%) from medical departments, 204 (40.2%) had PPS ≥ 4, but only 54.4% of them underwent pharmacological thrombo-prophylaxis. Whole-leg ultrasonography detected 47 proximal DVTs (9.3%) and 65 IDDVTs (12.8%). Proximal DVT prevalence was higher in patients with high PPS vs. those with low PPS (12.7% vs. 7.0% p = 0.029, respectively), whereas IDDVT prevalence was similar in patients with high and low PPS (14.7% vs. 11.6% p = 0.311, respectively). The area under the receiver operating curve (AUC) for the PPS was 0.62 ± 0.03 for all DVTs, 0.64 ± 0.04 for proximal DVTs, and 0.58 ± 0.04 for IDDVTs. Conclusions: In hospitalized patients, IDDVT had similar prevalence regardless of PPS risk stratification. Adherence to thrombo-prophylaxis in patients was still far from optimal. [ABSTRACT FROM AUTHOR]

Background: Hairy cell leukemia (HCL) is rare leukemia of mature B cells, accounting for 2% of all lymphoid neoplasms. Although the association of venous thromboembolism (VTE) with cancer is well established, there is no systematic study describing VTE in HCL. Aim: To analyze prevalence and risk factors associated with VTE in HCL patients. Methods: We retrospectively reviewed data from the medical records of 56 consecutive HCL patients evaluated in our Hematology/Oncology clinic between 1998 and 2023. Results: The median age at diagnosis was 59 years (range, 37–94), and 49 patients (87%) were male. With a median follow-up of 122 months (1–291), we identified 11 episodes of VTE in 8 (14%) HCL patients: pulmonary embolism (PE) (5 cases) with or without concurrent deep venous thrombosis (DVT), and DVT alone (6 cases). All thrombotic episodes occurred after the diagnosis of HCL, or at the same time of it, as presenting clinical manifestation of the HCL. Risk factors for VTE other than cancer were identified in only 3 patients. Conclusion: Our study found a high incidence of VTE in patients with HCL, mostly in the absence of other provoking factors, suggesting that this hematologic malignancy is associated with an underlying thrombophilic state. [ABSTRACT FROM AUTHOR]

In the field of orthopedics, deep vein thrombosis (DVT) is a rare but serious condition that can be life-threatening once it occurs. DVT is most commonly reported after hip and knee arthroplasty or multiple traumas, but rarely cases in the foot and ankle regions have been encountered. This paper reports a case of DVT that occurred after ankle ligament repair surgery with a review of relevant literature. [ABSTRACT FROM AUTHOR]

Background: Optimal pharmacologic thromboprophylaxis dosing is not well described in patients with subarachnoid hemorrhage (SAH) with an external ventricular drain (EVD). Our patients with SAH with an EVD who receive prophylactic enoxaparin are routinely monitored using timed anti-Xa levels. Our primary study goal was to determine the frequency of venous thromboembolism (VTE) and secondary intracranial hemorrhage (ICH) for this population of patients who received pharmacologic prophylaxis with enoxaparin or unfractionated heparin (UFH). Methods: A retrospective chart review was performed for all patients with SAH admitted to the neurocritical care unit at Emory University Hospital between 2012 and 2017. All patients with SAH who required an EVD were included. Results: Of 1,351 patients screened, 868 required an EVD. Of these 868 patients, 627 received enoxaparin, 114 received UFH, and 127 did not receive pharmacologic prophylaxis. VTE occurred in 7.5% of patients in the enoxaparin group, 4.4% in the UFH group (p = 0.32), and 3.2% in the no VTE prophylaxis group (p = 0.08). Secondary ICH occurred in 3.83% of patients in the enoxaparin group, 3.51% in the UFH group (p = 1), and 3.94% in the no VTE prophylaxis group (p = 0.53). As steady-state anti-Xa levels increased from 0.1 units/mL to > 0.3 units/mL, there was a trend toward a lower incidence of VTE. However, no correlation was noted between rising anti-Xa levels and an increased incidence of secondary ICH. When compared, neither enoxaparin nor UFH use was associated with a significantly reduced incidence of VTE or an increased incidence of ICH. Conclusions: In this retrospective study of patients with nontraumatic SAH with an EVD who received enoxaparin or UFH VTE prophylaxis or no VTE prophylaxis, there was no statistically significant difference in the incidence of VTE or secondary ICH. For patients receiving prophylactic enoxaparin, achieving higher steady-state target anti-Xa levels may be associated with a lower incidence of VTE without increasing the risk of secondary ICH. [ABSTRACT FROM AUTHOR]

Objective: Deep vein thrombosis (DVT) is a common complication in obstetrics that needs early interaction. The study examined the expression change and clinical value of long non-coding RNA (lncRNA) colorectal neoplasia differentially expressed (CRNDE) in DVT early diagnosis. Methods: One hundred patients with DVT after delivery and 100 healthy parturients without DVT were enrolled. Serum samples were collected one day before delivery and received qRT-PCR for mRNA detection. Prenatal coagulation markers including prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (FIB) and thrombin time (TT), D-dimer (D-D), thrombomodulin (TM), and peroxidase anti-peroxidase soluble complex (PAP) were tested. The receiver operating characteristic (ROC) curve was drawn for the diagnostic value assessment. Results: LncRNA CRNDE levels increased remarkably in the serum of DVT patients compared with the healthy controls, which were negatively correlated with serum concentration of PT, APTT, and TT while positively correlated with FIB, D-D, TM, and PAP. Serum CRNDE (HR = 5.973, 95% CI = 2.990–11.933, p <.001) was independently related to the occurrence of DVT after delivery. Then, ROC curve using serum CRNDE showed a good diagnostic value for DVT with the AUC of 0.899. ROC curve of ultrasonography combined with CRNDE produced an AUC of 0.968, and both sensitivity and specificity were enhanced compared to a single indicator. Conclusions: The increase of CRNDE level was an independent risk factor for postpartum DVT. Prenatal ultrasonography combined with CRNDE can improve the predictive efficacy for DVT. [ABSTRACT FROM AUTHOR]

Objectives: Whether vaginal estradiol use is associated with an increased risk of recurrent venous thromboembolism (VTE) in women with prior VTE is unknown. We sought to evaluate the association between vaginal estradiol use and recurrent VTE in women with prior VTE. Methods: We performed a nationwide nested case–control study among 44 024 women aged ≥45 years who developed a first VTE without a history of vaginal estrogen use prior to VTE diagnosis. Cases with recurrent VTE were matched 1:2 on birth year with controls using incidence density sampling. Exposure to vaginal estradiol tablets was categorized into current use (0–2 months before index), prior use (2–24 months before index) and past use (more than 24 months prior to index). Results: We identified 5066 cases and 10 127 age‐matched controls. In fully adjusted analysis vaginal estrogen was not associated with recurrent VTE with a hazard ratio of 0.75, p =.07 for current use, 0.83, p =.13 for prior use, and 1.24, p =.06 for past use. Conclusion: Use of vaginal estradiol tablets in women with prior VTE was not associated with an increased rate of recurrent VTE. Our study indicates that vaginal estradiol therapy is unlikely to increase risk of recurrent VTE in women with prior VTE. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) and venous thromboembolism (VTE) remain common and potentially lethal disease entities. AP might be an important trigger of systemic inflammtion and may activate the coagulation system with increased VTE risk. The German nationwide inpatient sample was screened for patients admitted due to AP (ICD-code K85) 2005–2019. AP hospitalizations were stratified for VTE as well as risk-factors and the impact of VTE on in-hospital case-fatality rate were investigated. Overall, 797,364 hospitalizations of patients due to AP (aged in median 56.0 [IQR 44.0–71.0] years), 39.2 % females) were detected in Germany 2005–2019. Incidence of VTE in hospitalized AP patients was 1764.8 per 100,000 hospitalizations (1.8 %) with highest VTE rate between 5th and 6th decade. Cancer (OR 1.656 [95 %CI 1.513–1.812], P < 0.001), any surgery (OR 4.063 [95 %CI 3.854–4.284], P < 0.001), and heart failure (OR 1.723 [95 %CI 1.619–1.833], P < 0.001) were independently associated with VTE occurrence. Case-fatality (8.8 % vs. 2.7 %, P < 0.001) was more than 3-fold higher in AP patients with than without VTE. VTE was associated with increased case-fatality in AP patients (OR 3.925 [95 %CI 3.684–4.181], P < 0.001). VTE is a life-threatening event in hospitalized AP patients associated with an almost 4-fold increased case-fatality rate. Cancer, any surgery, thrombophilia and heart failure were important risk factors for occurrence of VTE in AP. [ABSTRACT FROM AUTHOR]

Acute lower extremity deep vein thrombosis (DVT) is a common disorder with significant associated morbidity, including pain and swelling, as well as the risk of pulmonary embolism (PE), recurrent venous thromboembolism (VTE) and chronic debilitating post-thrombotic syndrome (PTS). Anticoagulation is standard of care for DVT treatment. It assists in reducing thrombus progression and the occurrence of PE, but incomplete DVT resolution increases the risk of recurrent VTE, valvular insufficiency, and PTS. Endovascular DVT interventions, such as catheter-directed thrombolysis, pharmacomechanical thrombectomy, and large-bore mechanical thrombectomy offer an alternative therapeutic strategy for DVT management. This paper will discuss technical factors and current issues when performing lower extremity DVT interventions including patient selection, anticoagulation, choice of device for endovascular thrombus removal, adjunctive techniques, and venous stent management. Level of Evidence: No level of evidence for: review articles, basic science, laboratory investigations, and experimental study articles. [ABSTRACT FROM AUTHOR]

Complications after iliofemoral and inferior vena cava stenting are rare, and most can be managed effectively without significant long-term consequences for the patient. Nevertheless, the procedure is not without risk, and clinicians considering starting a venous practice must be aware of the range of complications that can occur, which range from minor access site bleeds to fatal arrhythmia from stent migration to the heart. Most complications can be avoided with appropriate patient selection, stent sizing, and careful access and deployment techniques. [ABSTRACT FROM AUTHOR]

Acute lower extremity deep vein thrombosis (DVT), specifically proximal iliofemoral DVT, is a relatively common disorder that can result in a chronic debilitating post-thrombotic syndrome (PTS), with a significant effect on a patient's quality of life. Anticoagulation is first-line therapy; however, percutaneous interventions have emerged as treatment options for patients where there is concern that anticoagulation alone will not resolve the DVT as well as prevent PTS. This paper will discuss the existing data on these interventions and review current endovascular techniques, including catheter-directed thrombolysis, pharmacomechanical thrombectomy, and large-bore mechanical thrombectomy in the management of DVT. [ABSTRACT FROM AUTHOR]

Background/Objectives: Deep venous thrombosis (DVT), the formation of a blood clot within a large vein, is one of the most common problems among hospitalized patients. The annual prevalence of DVT is 48 per 1,000,000. Nurses' knowledge significantly affects compliance with VTE risk assessment and prevention. This study aimed to assess the knowledge and practices regarding deep venous thrombosis prevention among nurses in Ministry of Health hospitals and King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods: This study was conducted in Jeddah using a quantitative, descriptive, cross-sectional design. A sample of 240 registered nurses were conveniently recruited to complete a self-administered online questionnaire. The data were coded and analyzed through SPSS version 24. Results: The participants had adequate knowledge on the prevention of DVT (75.64 ± 18.88), and the highest level was observed for knowledge about the prevention and prophylaxis of DVT (81.98 ± 45.73%). The practice level of nurses in preventing DVT was 71.92%, with a mean score of 18.7. Conclusions: There is a significant effect of nurses' level of academic qualifications, working ward, and DVT prevention training on their knowledge and practice of DVT prevention. [ABSTRACT FROM AUTHOR]

Many orthopaedic surgeons routinely prescribe aspirin (ASA) as prophylaxis for venous thromboembolism (VTE) following hip fracture surgery (HFS). The purpose of this study is to assess the effectiveness of aspirin to other agents in preventing VTE and mortality following hip fracture surgery. Following PRISMA guidelines, we performed a search for HFS studies from 1998 to 2023 reporting comparisons between aspirin and other chemoprophylaxis methods for VTE (DVT – deep vein thrombosis; PE – pulmonary embolism). SPSS Meta-analysis function was used to calculate Mean Effect Size Estimate (MESE) and 95 % Confidence Intervals for each outcome. Reverse Fragility Index (RFI) and Fragility Quotient (FQ) were calculated for each study. Of the 847 articles screened, 4 studies with 5 comparisons met the search criteria to be included for analysis. A total of 1194 participants were included in these studies. There was a decreased risk of mortality seen with use of aspirin compared to other agents (MESE = 0.86, 95 % CI: [0.07–1.66]; p=.03). There was no increased risk of DVT or PE with use of aspirin (both p>.4). The overall RFI and FQ for all 19 outcomes were 12 (IQR: 6.5–15) and 0.080 (IQR: 0.027–0.110), respectively. Ten studies (52.6 %) reported a loss-to-follow-up (LTF) greater than the overall RFI. Aspirin demonstrates similar protective effects on prevention of VTE compared to other agents and may have significant protective effects on overall mortality following surgical intervention for hip fractures. However, the current evidence concerning its use in this arena is less than robust, with more than half of the studied outcomes considered statistically fragile. • Aspirin demonstrated non-inferiority in preventing VTEs, as well as possible beneficial effects in preventing mortality. • Although the results from these studies are encouraging, the strength of their statistics hinders their clinical application due to the fragility of the p-values and high loss-to-follow-up. • Future studies should utilize fragility indices and quotients to further characterize their strength of their statistical findings. [ABSTRACT FROM AUTHOR]

Background: Identifying factors that correlate with the incidence of venous thromboembolism (VTE) has the potential to improve VTE prevention and positively influence decision-making regarding prophylaxis. In this study, we aimed to investigate the correlation between statin consumption and the incidence of VTE in patients who sustained an ankle fracture. Methods: In this retrospective, case-controlled study, cases were those who developed VTE and controls were those who had no VTE, and the ratio was 1:4. Patients' demographics, history of hyperlipidemia, and reported statins use were obtained. A random forest classifier (RFC) model was used to predict whether statin consumers were at risk of VTE after ankle fracture regardless of VTE prophylaxis administration based on statin consumption, body mass index (BMI), age, and biological sex Results: Of the 1175 patients with ankle fractures, 238 had confirmed VTE (case group), and 937 had no symptomatic VTE (control group; ratio 1:4). Fifty (21%) cases and 407 (43%) controls were on a statin. Statin users had a significantly lower incidence of VTE after ankle fracture, odds ratio (OR) = 0.35, 95% CI: 0.25, 0.49, P <.001. Our model showed an area under the receiving operator curve (AUROC) of 78%, a sensitivity of 73%, and a specificity of 83% in predicting the risk of VTE. The importance of the predictors of VTE, other than the use of statins (model importance = 0.1), were age (model importance of 0.72), BMI (model importance of 0.24), and biological sex (model importance of 0.02). Conclusion: Statins were significantly associated with a lower rate of VTE in our population of patients who sustained an ankle fracture. Levels of Evidence: 3 [ABSTRACT FROM AUTHOR]

Noncardiogenic pulmonary edema after cardiac surgery is a rare but severe complication. The etiology remains poorly understood; however, the issue may arise from multiple sources. Possible causes include a significant inflammatory response or an autoimmune process. Pulmonary edema resulting from noncardiac etiologies can necessitate extracorporeal membrane oxygenation (ECMO) because most of the cases present a substantial volume of fluid expelled from the lungs and the medical team must manage the inability to achieve effective ventilation. A 64-year-old patient with known heart disease was admitted to our clinic with acute pulmonary edema. His medical history included Barlow's disease, severe mitral regurgitation (IIP2), moderate–severe tricuspid regurgitation, and moderate pulmonary hypertension. The patient had a coronary angiography performed in a prior hospitalization before the surgical intervention which indicated the absence of coronary lesions. Preoperative screening (nasal, pharyngeal exudate, inguinal pouch culture, and urine culture) was negative, with no active dental infections. The patient was stabilized, and 14 days post-admission, mitral and tricuspid valve repair was performed via a thoracoscopic approach. After being admitted to intensive care post-surgery, the patient quickly developed pulmonary edema, producing a large volume (4.5 L) of yellow secretions through the intubation tube followed by hemodynamic instability necessitating high doses of medications to support circulation but no cardiorespiratory arrest. Due to his worsening condition, the patient was urgently taken back to the operating room, where veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated to support oxygenation and stabilize the patient. [ABSTRACT FROM AUTHOR]

Aim of the study: This systematic review aims to evaluate the efficacy, safety, and comparative outcomes of endovascular treatments for acute lower limb deep vein thrombosis (DVT), including catheter-directed thrombolysis (CDT), pharmacomechanical thrombectomy (PMT), mechanical thrombectomy, and venous stenting, drawing insights from a diverse range of studies. Materials and methods: A comprehensive literature search identified 33 relevant studies, including randomized controlled trials, cohort studies, systematic reviews, and case reports. Data extraction focused on study design, intervention type, outcome measures, and follow-up duration. Results: Catheter-directed thrombolysis demonstrates promising results in enhancing venous patency and reducing post-thrombotic syndrome, with careful patient selection being crucial. Pharmacomechanical and mechanical thrombectomy devices offer immediate and long-term benefits, emphasizing individualized patient care. Venous stenting serves as a crucial adjunctive therapy, particularly in cases of residual venous obstruction, though further research is needed for optimal patient selection and long-term outcomes. Timing and selection of endovascular interventions remain critical considerations, necessitating multidisciplinary approaches and ongoing research. Conclusion: This review provides valuable insights for clinicians and researchers, guiding evidence-based decision-making and shaping future research directions in the dynamic field of endovascular interventions for acute lower limb DVT. [ABSTRACT FROM AUTHOR]