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Phlebothrombosis is a thrombus which develops within a vein. About 90% of phlebothrombosis takes place in the extremities and constitutes a risk factor for deep venous thrombosis, a life-threatening disease. The occurrence of this lesion in the oral cavity is rare. To our knowledge, besides this case, there is only one previously reported case of tongue phlebothrombosis. Here, we report the second case in addition to a comprehensive discussion of the pathogenesis and potential risks of this uncommon lesion. [ABSTRACT FROM AUTHOR]

Objective: In recent years, periodontal disease has been related to a large number of systemic disorders. The aim of this study was to find a relationship between periodontal disease and venous thromboembolic disease. Method and Materials: A total of 197 patients were included in the study, 97 patients with a diagnosis of venous thromboembolic disease and 100 healthy controls, in order to establish an association between these two conditions. All patients were subjected to periodontal examination, with evaluation of the number of teeth, Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Community Periodontal Index of Treatment Needs, Clinical Attachment Level, Probing Pocket Depth, number of pockets ≥ 4 mm, and number of pockets ≥ 6 mm. Results: A high prevalence of periodontal disease was detected in patients with thromboembolic disease (P < .001). Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Clinical Attachment Level, and Probing Pocket Depth were higher in venous thromboembolic disease patients than in the control group (P < .001).Conclusion: A high prevalence of periodontal disease was detected in venous thromboembolic patients. There exists an association between periodontal disease and venous thromboembolic disease. [ABSTRACT FROM AUTHOR]

Background: Most studies on acute Achilles tendon rupture (AATR) and its treatment contain only a small number of patients, and due to selection criteria, older patients and those with comorbidities are typically excluded. Therefore, little is known about true complication rates in an unselected population reflecting the situation in an ordinary orthopedic department. Method: Patient files of 639 consecutive Achilles tendon repairs in 631 patients with AATR between February 1998 and December 2005 were reviewed, and all complications from the day of surgery until December 2011 were identified using the hospital's patient records and the Swedish national registry. Results: Twenty-five (3.9%) re-operations were done, out of which 22 were due to a re-rupture. Fifty-one (8.6%) cases were of deep vein thrombosis (DVT), no difference between patients given versus patients not given thromboprophylaxis. Nineteen (3.0%) cases were of surgical site infection (SSI), all of which resolved upon oral antibiotics. Conclusions: Surgical repair of acute Achilles tendon rupture was associated with a low risk for re-operations, but the risk for deep vein thrombosis was considerable, despite the use of prophylaxis. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between inflammation/immune-based indexes and deep venous thrombosis (DVT) incidence rate following tibial plateau fractures Methods: Retrospective analysis of a prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was performed. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on biomarkers (neutrophil, lymphocyte, monocyte, and platelet counts) at admission were collected, based on which neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte/lymphocyte (MLR), and systemic immune-inflammation index (SII, neutrophil* platelet/lymphocyte) were calculated. Receiver operating characteristic (ROC) was used to determine the optimal cutoff value for each variable. Multivariate logistic regression analysis was used to evaluate the independent relationship of each biomarker or index with DVT, after adjustment for demographics, co-morbidities, and injury-related variables. Results: Among 1179 patients included, 16.3% (192/1179) of them had a preoperative DVT. Four factors were identified to be significantly associated with DVT, including open fracture, increased D-dimer level. Among the biomarkers and indexes, only platelet and neutrophil were identified to be independently associated with DVT, and the significance remained after exclusion of open fracture. The other independent variables were elevated D-dimer level (> 0.55 mg/L), male gender, and hypertension in the sensitivity analysis with open fractures excluded. Conclusion: These identified factors are conducive to the initial screening for patients at risk of DVT, individualized risk assessment, risk stratification, and accordingly, development of targeted prevention programs. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the number of thromboembolism patients among Japanese users of female hormones. Methods: A survey of confirmed thromboembolism patients among Japanese users of female hormones was conducted at randomly selected hospitals from across Japan. The survey examined six types of venous thromboembolism (VTE) and arterial thromboembolism (ATE) in all users of female hormones, including women and men: pulmonary embolism (PE), deep vein thrombosis (DVT), other venous thrombosis (other VTE), cerebral infarction (stroke), myocardial infarction (MI) and other arterial thrombosis (other ATE). The survey covered 5 years from 2009 to 2013. This study was approved in an ethical review by the Hamamatsu University School of Medicine. Results: The overall number of thromboembolism patients over the 5 years was estimated to be about 3211. They included 452 patients with PE, 795 with DVT, 157 with other VTE, 1228 with stroke, 478 with MI and 101 with other ATE. Among the abovementioned conditions, detailed information was available for 750 thromboembolism patients (645 women and 105 men), including 63 PE, 203 DVT, 159 PE + DVT, 65 other VTE, 189 stroke, 35 MI, 21 other ATE and 15 other cases. Thromboembolism increased year by year. The number of VTE was larger than that of ATE in younger people who used female hormones, while the number of ATE was larger than that of VTE in older people who used female hormones. Conclusion: The number and characteristics of thromboembolism patients among Japanese female hormone users were revealed in this national survey. [ABSTRACT FROM AUTHOR]

Background and Aims. There seems to be a higher risk of ischemic stroke and portal vein thrombosis in liver cirrhosis. Both of them may be associated with hypercoagulability. We aim to explore the association between ischemic stroke and portal vein thrombosis in liver cirrhosis. Study Design and Methods. We selected patients from our prospectively established database of liver cirrhosis from December 2014 to July 2019. The difference between patients with and without stroke was compared. A 1 : 1 propensity score matching (PSM) analysis was performed to adjust the effect of age, sex, Child-Pugh score, and MELD score on our statistical results. Results. There were 349 cirrhotic patients in the cross-sectional study. The prevalence of stroke, ischemic stroke, hemorrhagic stroke, and portal vein thrombosis was 8.88% (31/349), 8.31% (29/349), 1.15% (4/349), and 28.65% (100/349) in liver cirrhosis, respectively. Patients with ischemic stroke were significantly older and had significantly higher proportions of alcohol abuse, smoking, and arterial hypertension and higher levels of white blood cell and low-density lipoprotein. However, statistical analyses with and without PSM did not find any significant association between ischemic stroke and portal vein thrombosis in patients with liver cirrhosis. Conclusion. Ischemic stroke might not be associated with portal vein thrombosis in liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. Sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = − 0.65, 95% CI -0.32, 0.02; P = 0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = − 137.8, 95% CI -241.49, − 34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue. [ABSTRACT FROM AUTHOR]

Objective. To determine the molecular characterization and disease-associated complications of beta-thalassemia intermedia (β-TI) patients in Sulaymaniyah province, northeastern Iraq. Methods. A total of 159 β-TI patients from 114 families were enrolled. Detection of β-thalassemia mutations was done by reverse hybridization technique and direct gene sequencing. Also, the clinical and hematological data were collected through an electronic-based medical recording system using a designed comprehensive questionnaire. Results. Nineteen different β-globin gene mutations arranged in 37 various genotypes were determined. The most frequent were IVS-II-I (G>A) (47.2%), followed by IVS-I-6 (T>C) (23.3%) and IVS-I-110 (G>A) (5%). Among disease-related morbidities documented, bone disease amounted to 53% (facial deformity and osteoporosis), followed by endocrinopathies 17.6% (growth retardation and subclinical hypothyroidism), cholelithiasis 13.8%, pulmonary hypertension 11.3%, and abnormal liver function test 7.5%, whereas venous thrombosis, extramedullary hemopoiesis, and leg ulcer were less frequently observed. Age ≥ 35 and female sex were risk factors for cholelithiasis, while age was an independent risk for hypothyroidism and female sex was associated with increased risk for osteoporosis. Mean serum ferritin of ≥1000 μg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. β+-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to investigate the preoperative incidence and locations of deep venous thrombosis (DVT) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. From January 2016 to June 2019, 1,532 patients undergoing surgery of ankle fractures were included. Their inpatient medical records were inquired for data collection, including demographics, comorbidities, injury-related data and preoperative laboratory biomarkers. DVT of bilateral lower extremities was diagnosed by routine preoperative Doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Totally, 98 patients had a preoperative DVT, indicating an incidence rate of 6.4%. A total of 164 clots for 6 veins were found, representing an average of 1.7 for each patient. The detailed DVTs involving veins were as follows: 2 in femoral common vein, 7 in superficial femoral vein, 2 in deep femoral vein, 16 in popliteal vein, 49 in posterior tibial vein, and 88 in peroneal vein. In the multivariate model, 5 risk factors were identified to be associated with DVT, including age (10-year increase), gender, lower ALB level, reduced LYM count and elevated D-dimer level. There was a tendency for diabetes mellitus to increase the risk of DVT, although there was no statistical significance (p = 0.063). These epidemiologic data on DVT may help counsel patients about the risk of DVT, individualized risk assessment and accordingly the risk stratification. [ABSTRACT FROM AUTHOR]

Objective. This study is aimed at investigating the incidence of deep vein thrombosis (DVT) in the uninjured limb during hospitalization and 1 month after surgery in patients with lower extremity fractures. Methods. We collected the clinical data of patients with lower extremity fractures in Xi'an Honghui Hospital. Doppler ultrasonography was used to diagnose DVT. According to the results of ultrasonography, the patients were divided into two groups: uninjured limb with DVT group and uninjured limb without DVT group. Results. A total of 494 patients who met all inclusion criteria were included in this study. The incidence rate of DVT in the uninjured limb was 19.84% and 18.83% during hospitalization and 1 month after surgery, respectively. Age (OR = 1.035 , 95% CI: 1.013–1.059; P = 0.002) and D-dimer level 1 day after surgery (OR = 1.065 , 95% CI: 1.030–1.102; P < 0.001) were independent risk factors for DVT during hospitalization. Similarly, age (OR = 1.045 , 95% CI: 1.021–1.070; P < 0.001) and D-dimer level 1 day after surgery (OR = 1.048 , 95% CI: 1.014–1.083; P = 0.006) were independent risk factors for DVT 1 month after surgery. During hospitalization and 1 month after surgery, 15.79% and 12.35% of patients had double lower limb thrombosis and 4.04% and 6.48% of patients had DVT in the uninjured limb only, respectively. Conclusion. The actual incidence of DVT in the uninjured limb in patients with lower extremity fractures cannot be ignored despite the use of anticoagulants for prevention or treatment during hospitalization. We should also be aware of DVT in the uninjured limb while focusing on DVT in the injured limb. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a serious, preventable disease occurring frequently in the UK and globally. The costs to NHS related to VTE are likely to be underestimated but the risk of developing VTE is significant in surgical patients. The overall incidence of VTE in orthopaedic patients is up to 40–60%. Patients following orthopaedic surgery have multiple risk factors making them vulnerable to developing VTE. VTE prophylaxis can be divided into general, mechanical and pharmacological methods. General methods, including early mobilization and optimizing hydration, are simple approaches widely. Mechanical methods include anti-embolism stockings, intermittent pneumatic compression devices and foot pumps. These are commonly used in combination with pharmacological agents. The latter include antiplatelet and anticoagulant drugs such as aspirin, unfractionated heparin, low-molecular-weight heparin (LMWH), vitamin K antagonists, factor Xa inhibitors and direct thrombin inhibitors. Chemical thromboprophylaxis and antithrombotic drugs continue to be an area of debate and controversy within orthopaedics. There is no single universal answer to thromboprophylaxis but, in the UK, The National Institute for Health and Care Excellence (NICE) has produced guidelines and every surgeon and hospital should have an evidence-based protocol to adhere to. [ABSTRACT FROM AUTHOR]

Aim: The detailed risk factors of deep vein thrombosis (DVT) remain unknown, and no efficient tool to assess the risk of the development of DVT among older adults has been established. This study aimed to clarify the risk factors, including the level of daily life independence, and develop an assessment score for DVT in older patients. Methods: We recruited 252 patients aged ≧65 years with suspected deep vein thrombosis. Risk factors for deep vein thrombosis, cognitive impairment, laboratory data and level of daily life independence were analyzed to calculate the odds ratios for the onset of DVT with logistic regressions. The Himi score was generated with factors significantly related to DVT by adjusting the respective odds ratios. The discrimination accuracy of the Himi score associated with the onset of DVT was compared with those of conventional scores (Wells score, Padua score) based on the area under the receiver operating characteristic curve. Results: Low levels of daily life independence, D‐dimer level >3.0 μg/mL, anticoagulant use, cancer and immobilization or symptoms of the lower limbs were associated with the onset of DVT. The discrimination accuracy of Himi scores composed of these related factors was significantly higher than those of the Wells and Padua scores. Conclusions: Achieving a better performance than did the Wells and Padua scores, the Himi score could be used to assess the risk of DVT in frail older adults. Geriatr Gerontol Int 2020; 20: 414–421. [ABSTRACT FROM AUTHOR]

Background: Atrial septal aneurysm (ASA) is an uncommon cardiac anomaly that increases maternal morbidity during pregnancy. ASA is related to atrial arrhythmia thromboembolism and it may accompany congenital anomalies such as an atrial septal defect (ASD) or patent foramen ovale (PFO). There are no studies examining pregnancy outcomes in pregnant women with ASA. We aimed to investigate the cardiologic parameters and obstetric outcomes of pregnant women diagnosed with ASA. Methods: This prospective cohort study analyzed 45 pregnant women diagnosed with ASA, who continued their follow-ups in an obstetric tertiary care center. Results: A total of 45 pregnant women were recruited; seven pregnancies ended before the 20th gestational week (six spontaneous abortion, one fetal anomaly), 38 women gave birth. In total, there were 32 term births (≥37 weeks), six preterm births (<37 weeks), two extremely preterm births <28 weeks). Among 38 babies delivered, several obstetrical complications such as oligohydramnios, spontaneous preterm labor, intrauterine growth restriction (IUGR), preeclampsia and gestational diabetes mellitus (GDM) developed in 16 patients, while 22 women ended with term pregnancy without any complications. Deep venous thrombosis (DVT) developed in one patient. Conclusion: ASA may have an increased risk for cardiac complications during pregnancy and may also be associated with poor pregnancy outcomes. Increased attention to these entities with more studies is needed in order to determine a potential risk for pregnant women. [ABSTRACT FROM AUTHOR]

Stroke is a serious neurological complication observed during the ongoing COVID-19 (coronavirus associated disease 2019) pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome, corona virus 2) and includes both ischemic stroke and intracerebral haemorrhage. We reviewed factors that could potentially contribute to the occurrence of stroke among patients with COVID-19. There could be an interaction between the conventional risk factors of stroke, infection, systemic inflammatory response and plaque destabilisation. Inflammatory markers, D-dimer elevation and increased cytokine activity have all been observed in patients with COVID-19. Other probable contributing factors include cardiac injury leading to embolism, a prothrombotic state and a possibility of direct neuroinvasive potential causing vasculopathy. Data from stroke patients gathered in large multicentric cohorts could help shed more light on the occurrence, behaviour, aetiology, pathophysiology, biomarkers and outcomes of stroke occurring during the ongoing pandemic. [ABSTRACT FROM AUTHOR]

HIGHLIGHTS: Ultrasound shows several venous changes in pediatric PIV-containing veins. Changes were visualized by ultrasound in the absence of physical exam findings. Venous luminal narrowing, wall thickening, and thrombosis may explain PIV failure. Background: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients. Methods: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded. Results: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%). Conclusion: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children. [ABSTRACT FROM AUTHOR]

The number of people with chronic kidney disease (CKD) has increased and so has their demand for travel. However, the health risk posed by travel in these patients is unclear. Few reports document the travel risk in CKD and dialysis patients. The aim of this study is to summarize the existing evidence of the influence of travel on risks in CKD patients. We aim to describe the association between the impact of travel risks and patients with CKD. A detailed review of recent literature was performed by reviewing PubMed, Google Scholar, and Ichushi Web from the Japan Medical Abstracts Society. Screened involved the following keywords: "traveler's thrombosis," "venous thromboembolism," "deep vein thrombosis," "altitude sickness," "traveler's diarrhea," "jet lag syndrome," "melatonin," with "chronic kidney disease" only, or/and "dialysis." We present a narrative review summary of the literature from these screenings. The increased prevalence of thrombosis among travelers with CKD is related to a decrease in the estimated glomerular filtration rate and an increase in urine protein levels. CKD patients who remain at high altitudes are at an increased risk for progression of CKD, altitude sickness, and pulmonary edema. Traveler's diarrhea can become increasingly serious in patients with CKD because of decreased immunity. Microbial substitution colitis is also common in CKD patients. Moreover, time differences and disturbances in the circadian rhythm increase cardiovascular disease events for CKD patients. The existing literature shows that travel-related conditions pose an increased risk for patients with CKD. [ABSTRACT FROM AUTHOR]

Physical restraint in clinical settings can lead to potentially lethal complications. Although this is a life-and-death issue, no comprehensive large-scale study relating medical complications to physical restraint has yet been performed. The 1308 psychiatric inpatients in our retrospective cohort study were categorized into two groups: a physical restraint group (those who had been subjected to physical restraint while hospitalized; n = 110) and a non-physical restraint group (those never subjected to physical restraint; n = 1198). We assessed differences between the two groups with respect to the occurrence of medical complications subsequent to restraint. To control for potentially confounding factors, linear discriminant regression analysis was used to identify whether physical restraint itself affected the occurrence of medical complications. The physical restraint group had a higher risk for deep vein thrombosis (P <.01, OR = 6.0, 95%CI: 2.4–13.9) and aspiration pneumonia (P <.01, OR = 4.1, 95%CI: 2.1–7.6) when compared with the non-physical restraint group. Even after controlling for potentially confounding factors, physical restraint substantially raised the risk of deep vein thrombosis and aspiration pneumonia (P <.01, P =.01, respectively). Although this study population was derived from a single psychiatric unit, physical restraint may lead to serious medical conditions. To avoid this unwanted consequence, the use of physical restraint should be minimized and physical therapy is highly recommended. [ABSTRACT FROM AUTHOR]

Objective: Blood pressure (BP), pulse, electrocardiogram (ECG), and clinical cardiovascular (CV) outcomes in patients with episodic or chronic migraine treated for up to 6 months with galcanezumab compared to placebo were evaluated. Background: Calcitonin gene‐related peptide, a potent microvascular vasodilator, has a hypothesized protective role in CV health. Increased CV risks have been reported in patients with migraine. Methods: In 2 similarly designed episodic migraine 6‐month studies and 1 chronic migraine 3‐month study, data from patients randomized (1:1:2) to subcutaneous injection of galcanezumab 120 mg/month (following initial 240 mg loading dose) or 240 mg/month or placebo were pooled. Treatment comparisons for cardiovascular treatment‐emergent adverse events (CV TEAE) and categorical and mean changes in BP, pulse, and ECG were evaluated using the Cochran‐Mantel‐Haenszel test. Mean changes from baseline in BP, pulse, and ECG were evaluated using the analysis of covariance model. Results: Overall, among galcanezumab 120 mg (n = 705) and 240 mg (n = 730), and placebo (n = 1451) groups, the percentage of patients reporting ≥1 CV TEAE was low and was similar between the galcanezumab 120 mg (2.6%; odds ratio [OR] = 0.9; 95% confidence interval [CI]: 0.5,1.5) and galcanezumab 240 mg (3.3%; OR = 1.1; 95% CI: 0.7,1.9), and placebo (2.9%) groups. The frequency of any individual CV TEAE, broad or narrow term, was ≤1.4%. The CV‐related serious adverse events that occurred in the galcanezumab 240 mg group (n = 3; acute myocardial infarction, pulmonary embolism, and transient ischemic attack) and placebo group (n = 3; pulmonary embolism, deep vein thrombosis, and myocardial infarction) were not considered treatment related. Four placebo‐ and 1 galcanezumab‐treated patient discontinued due to a CV TEAE. Least squares mean and categorical changes from baseline in BP, pulse, and QT interval corrected using Fridericia's correction were similar across treatment groups. Conclusions: In this 6‐month treatment trial, the percentages of galcanezumab‐ and placebo‐treated patients that reported CV TEAEs or serious adverse events were low and similar between groups with few discontinuations. Thus, no clinically meaningful treatment group differences were observed for changes in BP, pulse, or ECG parameters. Additional longer‐term studies in a broader and larger cohort are required to better characterize CV safety. [ABSTRACT FROM AUTHOR]

The aim is to study risk factors for retinal vein occlusion (RVO), such as thrombophilic and cardiovascular risk factors (CRF). A retrospective consecutive case series of 60 patients with RVO was made, tested for CRF, hyperhomocysteinemia, lupic anticoagulant, antiphospholipid antibody and 5 gene variants: factor V (FV) Leiden (G1691A), factor II (PT G20210A), 5,1-methylenetetra-hydrofolate reductase (MTHFR; 677 C > T and 1298 A > C), plasminogen activator inhibitor 1 (PAI-1; 4 G/5 G). More than 1 CRF were present in 36 patients (60%), which had a significantly higher mean age at diagnosis (66.7 ± 12.9 versus 59.5 ± 13.7 with ≤1 CRF, [t(57) = −2.05, p = 0.045, d = 0.54). Patients with thermolabile MTHFR forms with decreased enzyme activity (T677T or C677T/A1298C) had a significant lower mean age [57.6 ± 15.1; t (58) = 3.32; p = 0.002; d = 0.846] than patients with normal MTHFR enzyme activity (68.5 ± 10.2). Regarding CRF and thermolabile forms of MTHFR, the mean age at diagnosis could be significantly predicted [F(2,56) = 7.18; p = 0.002] by the equation: 64.8 − 10.3 × (thermolabile MTHFR) − 5.31 × (≤ 1CRF). Screening of MTHFR polymorphisms may be useful in younger RVO patients, particularly when multiple CRF are absent. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TXA) is widely used to reduce blood loss and transfusion rates in total hip arthroplasty(THA). Thromboelastography, which can monitor coagulation changes from clotting to fibrinolysis dynamically. In this study, thromboelastography was used to assess the dynamic changes in the coagulation of patients who underwent THA with the administration of TXA. Methods: This randomized controlled trial consisted of 207 consecutive patients who underwent primary total hip arthroplasty. Patients were randomized into three groups: topical-TXA group received a topical application of TXA, IV-TXA group received an intravenous injection of TXA, and control group. Thromboelastography was performed 1 day before surgery and first, fourth, seventh days after surgery. The primary outcomes were thromboelastography parameters, the rates of deep vein thrombosis(DVT), and pulmonary embolism(PE). Secondary outcomes included perioperative blood loss, transfusion rates, and other perioperative complications. Results: The mean calculated total blood loss in the Topical-TXA group were 832.7 ± 279.84 ml and 834.8 ± 322.94 ml in the IV-TXA group, which were significantly reduced (p < 0.05) compared with control groups at 1093.3 ± 379.7 ml. There were no significant differences between topical-TXA and IV-TXA groups in total blood loss or transfusion rates. K and R have reached a nadir from preoperative levels to 4th day postoperatively and then began to increase.α angle and CI peaked from preoperative levels to the fourth day postoperatively and then began to decline.IV-TXA significantly (p < 0.05) promoted coagulation levels compared with topical-TXA and control groups in the early postoperative period. Almost no significant differences were observed between topical-TXA and control groups in thromboelastography parameters.No significant differences were observed in the incidence of thromboembolic complications and other perioperative complications. Conclusions: The topical administration of TXA had the same hemostatic effect as intravenous injection tranexamic acid. Coagulation function peaked on 4th day postoperatively and then began to decline. IV-TXA was more enhanced coagulation functions compared with topical-TXA. [ABSTRACT FROM AUTHOR]

Portomesenteric venous thrombosis (PMVT) is a rare and potentially life-threatening condition with high morbidity and mortality. Its incidence is low as complication of bariatric surgery and laparoscopic sleeve gastrectomy (LSG) and the reason is unclear and is likely multifactorial. Genetic predisposition, oral contraceptive, thrombophilia, intra-abdominal pressure due to pneumoperitoneum, reverse Trendelenburg position, prolonged operation time, DM, and obesity may be considered as risk factors. Extended low-molecular-weight heparin anticoagulation prophylaxis to prevent PMVT is a reasonable choice for patients after LSG; however, no clear guidelines about the optimal dose, duration, and type of heparin are currently available. In this study, we present a case of a 50-year-old woman who was admitted to the emergency department for abdominal pain 2 weeks after LSG. Her computed tomography scan showed a portomesenteric venous thrombosis. Our review of the English literature found only 137 morbidly obese patients who had developed PMVT after bariatric surgery between 2002 and July 2018, demonstrating rarity of this complication. [ABSTRACT FROM AUTHOR]

Background: Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. Aims: To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. Methods: A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. Results: In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. Conclusions: A structured and systematic SNIM benefited immobile stroke patients' clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals. [ABSTRACT FROM AUTHOR]

Background: The tourniquet is a common medical instrument used in total knee arthroplasty (TKA). However, there has always been a debate about the use of a tourniquet and there is no published meta-analysis to study the effects of a tourniquet on blood loss in primary TKA for patients with osteoarthritis. Methods: We performed a literature review on high-quality clinical studies to determine the effects of using a tourniquet or not on blood loss in cemented TKA. PubMed, Web of Science, MEDLINE, Embase, and the Cochrane Library were searched up to November 2018 for relevant randomized controlled trials (RCTs). We conducted a meta-analysis following the guidelines of the Cochrane Reviewer's Handbook. We used the Cochrane Collaboration's tool for assessing the risk of bias of each trial. The statistical analysis was performed with Review Manager statistical software (version 5.3). Results: Eleven RCTs involving 541 patients (541 knees) were included in this meta-analysis. There were 271 patients (271 knees) in the tourniquet group and 270 patients (270 knees) in the no tourniquet group. The results showed that using a tourniquet significantly decreased intraoperative blood loss (P < 0.002), calculated blood loss (P < 0.002), and the time of operation (P < 0.002), but tourniquet use did not significantly decrease postoperative blood loss (P > 0.05), total blood loss (P > 0.05), the rate of transfusion (P > 0.05), and of deep vein thrombosis (DVT) (P > 0.05) in TKA. Conclusions: Using a tourniquet can significantly decrease intraoperative blood loss, calculated blood loss, and operation time but does not significantly decrease the rate of transfusion or the rate of DVT in TKA. More research is needed to determine if there are fewer complications in TKA without the use of tourniquets. [ABSTRACT FROM AUTHOR]

The study aim was to investigate the risk of venous thromboembolism (VTE) in patients with concurrent depressive, bipolar, and schizophrenic disorders. A population-based cohort study was conducted in which information regarding psychiatric illnesses and medical comorbidities in 29,467 patients with concurrent depressive, bipolar, and schizophrenic disorders and regarding 117,868 controls were extracted. We compared the incidence of VTE between the study and control cohorts. Cox proportional hazard regression models were used to analyze the risk of VTE after adjusting for potential confounders, including sex, age, and comorbidities. Compared with the control cohort, the overall study cohort had a 2.995-fold higher adjusted hazard ratio (aHR) for development of deep vein thrombosis (DVT) and a 2.591-fold higher aHR for development of pulmonary embolism (PE). Moreover, patients with depressive, bipolar, and schizophrenic disorders all exhibited higher aHRs for development of both DVT and PE. The relative risks of DVT and PE were higher in patients with concurrent depressive, bipolar, and schizophrenic disorders than those of the general population. Further research is needed to develop effective prevention strategies for different patient populations. • Considering each psychiatric group separately, patients with depressive, bipolar, and schizophrenic disorders (separately) all had an approximately 3-fold higher risk of developing DVT (PE) than that of the control cohort. • Further research is needed to develop effective prevention strategies for different patient populations. [ABSTRACT FROM AUTHOR]

Venous thromboembolic (VTE) events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in otherwise low‐risk healthy athletes following acute bouts of aerobic exercise. Purpose: To review case reports and assess the commonalities of athletic individuals with VTE, as well as return‐to‐play (RTP) recommendations. Methods: We reviewed 47 reports (20 DVTs, 15 PEs, and 12 DVTs/PEs, 19 women) of trained individuals who were diagnosed with DVT and/or PE following aerobic exercise. We assessed frequency of VTE risk factors, presenting symptoms, and RTP recommendations. Results: The age of women (24.6 ± 7.0 years) was lower (P < .01) than of men (40.6 ± 13.6 years). Of the 19 women, 14 (73.7%) used oral contraceptives. Thirteen cases (27.7%) reported a recent period of prolonged inactivity (>1 hour), and another 12 cases were found to have an antithrombin disorder following testing after diagnosis. The most frequently reported symptoms were muscle pain in 26 of 32 (81.3%) DVT or DVT/PE cases, and dyspnea in 21 of 27 (77.8%) PE or DVT/PE cases. Despite these common symptoms, the estimated time from first report of symptoms to confirmed diagnosis was 56.3 ± 118.7 days and 25 cases (53.2%) were initially misdiagnosed. Twenty‐three cases (48.9%) did not report RTP recommendations, and those which did varied widely. Conclusions: Thirty‐two cases (~70%) had at least one of three major risk factors, suggesting that many cases of VTE in athletes may be preventable with better education and awareness. The wide variety of RTP recommendations highlights the need for standardized guidelines in this population. [ABSTRACT FROM AUTHOR]

Recurrent venous thromboembolism (VTE) is common. Current guidelines suggest that patients with unprovoked VTE should continue anticoagulants unless they have a high bleeding risk, whereas all others can stop. Prediction models may refine this dichotomous distinction, but existing models apply only to patients with unprovoked first thrombosis. We aimed to develop a prediction model for all patients with first VTE, either provoked or unprovoked. Data were used from two population-based cohorts of patients with first VTE from the Netherlands (Multiple Environment and Genetic Assessment of Risk Factors for Venous Thrombosis [MEGA] follow-up study, performed from 1994 to 2009; model derivation; n = 3,750) and from Norway (Tromsø study, performed from 1999 to 2016; model validation; n = 663). Four versions of a VTE prediction model were developed: model A (clinical, laboratory, and genetic variables), model B (clinical variables and fewer laboratory markers), model C (clinical and genetic factors), and model D (clinical variables only). The outcome measure was recurrent VTE. To determine the discriminatory power, Harrell's C-statistic was calculated. A prognostic score was assessed for each patient. Kaplan-Meier plots for the observed recurrence risks were created in quintiles of the prognostic scores. For each patient, the 2-year predicted recurrence risk was calculated. Models C and D were validated in the Tromsø study. During 19,201 person-years of follow-up (median duration 5.7 years) in the MEGA study, 507 recurrences occurred. Model A had the highest predictive capability, with a C-statistic of 0.73 (95% CI 0.71–0.76). The discriminative performance was somewhat lower in the other models, with C-statistics of 0.72 for model B, 0.70 for model C, and 0.69 for model D. Internal validation showed a minimal degree of optimism bias. Models C and D were externally validated, with C-statistics of 0.64 (95% CI 0.62–0.66) and 0.65 (95% CI 0.63–0.66), respectively. According to model C, in 2,592 patients with provoked first events, 367 (15%) patients had a predicted 2-year risk of >10%, whereas in 1,082 patients whose first event was unprovoked, 484 (45%) had a predicted 2-year risk of <10%. A limitation of both cohorts is that laboratory measurements were missing in a substantial proportion of patients, which therefore were imputed. The prediction model we propose applies to patients with provoked or unprovoked first VTE—except for patients with (a history of) cancer—allows refined risk stratification, and is easily usable. For optimal individualized treatment, a management study in which bleeding risks are also taken into account is necessary. Suzanne C. Cannegieter and colleagues present a model for predicting repeat venous thromboembolism. Patients who suffered from a deep vein thrombosis or pulmonary embolism for the first time have an average risk of 3%–5% per year of having a second event. Such a recurrence can be prevented with anticoagulant treatment, but this should be continued indefinitely, which will lead to a substantial risk of bleeding. The risks of both recurrent thrombosis and bleeding differ substantially between individuals. The choice of continuation on the one hand (with a decreased thrombosis risk but an increased bleeding risk) and discontinuation on the other hand (with an increased thrombosis risk but a decreased bleeding risk) is currently difficult to make for both clinicians and patients. Individual differences in risks are hardly taken into account. Data were used from two population-based cohorts of patients with first venous thrombosis from the Netherlands (Multiple Environment and Genetic Assessment of Risk Factors for Venous Thrombosis [MEGA] study; n = 3,750) and from Norway (Tromsø study; n = 663). Four versions of a venous thromboembolism (VTE) recurrence risk prediction model were developed in the MEGA data, differing in number and type of included predictors, of which two were validated in the Tromsø study. During 19,201 person-years of follow-up, 507 recurrences occurred. The predictive capability varied between the models. A substantial proportion of patients with a first venous thrombosis are currently misclassified with respect to duration of anticoagulant treatment. The prediction model we propose applies to all patients, allows refined risk stratification, and is easily usable. A limitation of both cohorts is that laboratory measurements were missing in a substantial proportion of patients, which were imputed. For optimal individualized treatment, a management study is necessary in which bleeding risks are also taken into account. [ABSTRACT FROM AUTHOR]

Background: There are few data regarding the outcome of a combined cryo‐ and radiofrequency (RF)‐catheter ablation of various types of supraventricular tachycardias (SVTs) originating from near the normal conduction system. METHODS: We analyzed all patients undergoing combined cryo‐ and RF‐ catheter ablation at Mayo Clinic, Rochester, MN as part of the ablation of SVTs with potential risks of injury to the normal conduction system. This study aimed to assess the outcome of a combined cryo‐ and RF‐catheter ablation of various types of SVTs. RESULTS: The study population consisted of 54 patients (38 ± 17 years, 32 men). A combined cryo‐ and RF‐catheter ablation was attempted for septal accessary pathways (APs) in 26, atrioventricular nodal reentrant tachycardia (AVNRT) in 14, atrial tachycardia (AT) in 7, and junctional ectopic tachycardia in 7 patients. Forty‐one patients (76%) were successfully ablated with cryoablation, and RF ablation after an unsuccessful cryoablation ablated the SVTs successfully at the same location in 6 patients (11%). Complication occurred in 1 patient (deep vein thrombosis). The cumulative freedom from SVT rate at 30 days after the procedure was 78% and there was no significant difference in the recurrence rate among the SVTs. CONCLUSION: A combined cryo‐ and RF‐catheter ablation is clinically effective in patients undergoing SVT ablation with the potential risk of injury to the normal conduction system. [ABSTRACT FROM AUTHOR]

Background: Neurosurgical patients are varied, encompassing cranial and spinal diseases and trauma, and are admitted under both elective and emergency settings. In all settings, neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT). We conducted a study to identify the factors associated with DVT among neurosurgical patients, and the overall rate of occurrence at our centre. We aimed to also compare our results to the incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis was undertaken. We also included the Well's score to validate its usefulness in screening for DVT in our local setting. Methods: All patients admitted into our centre were screened for eligibility and those who underwent surgery from September 2016 to September 2017 had a D-dimer screening after surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant therapy was not influenced by this study, and observation of the use was in keeping with usual practices in our centre was done. Results: A total number of 331 patients were recruited in this study, however, after the inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate analysis, the Well's score and the number of days in bed remained statistically significant, after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT prophylaxis with an adjusted odd's ratio, and a confidence interval of 95%, and P < 0.05 for each. Conclusion: Well's scoring and number of days in bed were independent factors affecting the rate of DVT in patients undergoing neurosurgical procedures in our centre. [ABSTRACT FROM AUTHOR]

Background: Symptomatic bilateral hip osteoarthritis can be treated surgically with either staged or single-anaesthetic bilateral total hip replacement (BTHR). Today the typical candidate for BTHR is more likely to receive cementless implants. We present the experience of BTHR at our institution using cemented stems combined with cemented and uncemented sockets and, to our knowledge, the largest prospective single-centre series. Patients and methods: This cohort study reviews all patients (319 patients: 638 hips) having BTHR at our institution between December 1977 and December 2015. No case was lost to follow-up. Data were collected prospectively but reviewed retrospectively. Length of stay and complication rates were included, and data were compared with Hospital Episode Statistics figures for operations carried out between March 2005 and June 2014 to confirm local database validity. Patient experience and Oxford Hip Scores were obtained for a subgroup of this cohort, comparing them with patients who underwent bilateral staged operations performed within 1 year. Results: The rates for mortality, deep vein thrombosis, non-fatal myocardial infarction within 6 months were each 0.3% (1 episode) and non-fatal pulmonary embolism 0.6% (2 episodes). There were no intraoperative periprosthetic fractures or readmissions within 30 days. Conclusions: Our study shows a low risk of complications when using cemented and hybrid BTHRs for selected patients and the risk of complications compares favourably with published results. Available functional scores compared favourably to a comparison group of patients undergoing bilateral staged procedures, and a positive impression on treatment experience from a subgroup of interviewed BTHR patients was noticeable. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this prospective single-centre study is to assess the effectiveness and patient experience of the VenaSeal™ Closure System, a novel non-thermal, non-tumescent catheter technique, which uses cyanoacrylate glue to occlude the refluxing truncal superficial veins to treat varicose veins and chronic venous insufficiency, in a multi-ethnic Asian population from Singapore. Methods: Seventy-seven patients (93 legs; 103 procedures) underwent VenaSeal™ Closure System ablation. Forty-nine (63.6%) for great saphenous vein incompetence, 16 (20.8%) bilateral great saphenous vein, 2 (2.6%) small saphenous vein and 10 (13.0%) combined unilateral great saphenous vein and small saphenous vein/anterior thigh vein reflux. In addition, 65/93 legs (69.9%) had C4–C6 disease. Patients were reviewed at 2 weeks, 3, 6 and 12 months post-procedure. Results: There was 100% technical success. 28/77 (36.4%) underwent concomitant phlebectomies. All procedures were well tolerated with a mean post-operative pain score of 3.0 (range: 0–5). After three months, median patient satisfaction was 9.0 (interquartile range: 7.0–10.0). At two-week follow-up, the great saphenous vein was completely occluded in 88/88 (100%) veins and small saphenous vein completely closed in 11/11 (100%) veins. At three-month follow-up, the great saphenous vein was occluded in 51/53 (96.2%) veins and small saphenous vein completely closed in 5/5 (100%) veins. At six-month follow-up, the great saphenous vein was completely occluded in 42/45 (93.3%) veins and small saphenous vein completely closed in 5/7 (71.4%) veins. At one year, great saphenous vein and small saphenous vein occlusion rates were 54/59 (91.5%) and 5/8 (62.5%), respectively. There was one deep vein thrombosis. Transient superficial phlebitis was reported in 10/93 (10.8%) legs, which were all self-limiting. There were 9/103 (8.7%) anatomical recurrences, but no patients required re-intervention as they were asymptomatic. Conclusions: Cyanoacrylate glue is a safe and efficacious modality to ablate refluxing saphenous veins in Asian patients in the short term. There is a high satisfaction rate and peri-procedural pain is low. Early results are promising but further evaluation and longer term follow-up are required. [ABSTRACT FROM AUTHOR]

Background: Invasive procedures are increasingly used in neonatal intensive care units. Umbilical catheters are frequently attached to preterm babies. The aim of this study is to determine the relationship and risk factors of umbilical catheters inserted in our clinic with portal vein thrombosis (PVT). Materials and Methods: We retrospectively evaluated preterm infants with a gestational age of 32 weeks and below, who had a umbilical vein catheter (UVC) inserted in our neonatal intensive care unit between 01 October 2017 and 31 December 2018, and who had a catheter inserted for at least 6 hours. UVC inserted cases were evaluated for portal venous doppler ultrasonograpy (USG) examination before discharge. Perinatal risk factors and properties related to catheter were evaluated. Results: A total of 142 patients underwent UVC insertion. Doppler USG results of 118 patients were achieved. In 15 (9.9%) cases, portal vein thrombosis was detected by doppler USG. None of the patients with PVT had clinical findings. The mean gestational age and birth weight were lower in patients with PVT. Thrombosis was detected in the left branch of portal vein in 14 patients and thrombosis in the main portal vein in one patient. In a patient with PVT, gestational diabetes was present in the mother. Patients with PVT had higher rates of late neonatal sepsis and bronchopulmonary dysplasia, and the length of hospitalization was longer. In this group, the low placement rate of the catheter was higher, and the length of catheter stay was longer than other group. Conclusions: Umbilical vein catheterization is an important risk factor for the development of PVT. Especially low birth weight infants with UVC should be evaluated with portal doppler USG for PVT. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) prophylaxis has a significant impact on mortality and morbidity in trauma patients. This article reviews 9 published studies that investigate and compare low-dose unfractionated heparin (LDUH) with low-molecular-weight heparin (LMWH) for prophylaxis of VTE in the trauma patient population in terms of efficacy, safety, and cost. There is no difference between LDUH and LMWH for VTE prophylaxis. Four databases were utilized to find 9 relevant studies whose patient population was adult trauma patients: PubMed, CINAHL, EMBASE and Scopus. Two studies found statistically significant differences in deep venous thrombosis, and 3 found differences in pulmonary embolism between LDUH and LMWH. Only 1 study demonstrated a significant difference in bleeding complications between the 2 treatment regimens. Two statedthat using LDUH resulted in remarkable cost savings versus LMWH. The 9 studies all came to different conclusions. Contrary findings may have been affected by population variety, different dosing regimens, various applications of mechanical VTE prophylaxis, and/or different VTE-screening tools. All of the studies had major variances leading to conflicting results, which made this review unable to draw concrete conclusions. Limitations of each study, population variety, and disparity of dosing regimens made it difficult for this review to make recommendations for practice. [ABSTRACT FROM AUTHOR]

Objective: The incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) after pediatric knee arthroscopy is unknown. The purpose of this study was to determine the incidence of venous thromboembolism (VTE) after knee arthroscopy in the pediatric and adolescent population in a high-volume center. Design: Retrospective cohort study. Setting: Tertiary care children's hospital. Patients: All patients who underwent arthroscopy of the knee for a sports-related injury by 2 surgeons were reviewed. Chief complaint, past medical/surgical history, medications, procedure performed, intraoperative findings, intraoperative complications, and postoperative recovery were reviewed. The incidences of postoperative VTE within 30 days after the procedure were reviewed. Results: Seven hundred forty-six (358 male and 388 female patients) knee arthroscopies performed from September 2011 to October 2016 by 2 pediatric orthopedic surgeons specializing in sports-related injuries were included. The average age was 15.2 ± 2.72 years. Five patients were suspected to have either DVT or PE postoperatively (0.67%). The overall incidence of symptomatic confirmed VTE after knee arthroscopic procedures was 0.27% (one DVT after a partial lateral meniscectomy and one PE after fixation of an osteochondral lesion). Conclusions: The incidence of VTE after pediatric sports medicine knee arthroscopies is low, 0.27%. Patients who present with calf swelling or pain, chest pain, or shortness of breath after arthroscopic surgery should be examined closely. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Deep vein thrombosis (DVT) is one of the life-threatening complications of total joint arthroplasty (TJA) postoperatively, and its risk factors are still controversial. The aim of this study was to identify the risk factors of DVT after TJA. Study design and methods: A nested case-control study based on a large dataset of 15,326 patients undergoing TJA was performed. Potential risk factors of DVT and demographic information were extracted from the electronic health record. Patients with DVT (73 patients) were treated as study group while non-DVT patients who were matched 1:4 according to the anticoagulant type, were considered as control group (292 patients). These variables of potential risk factors for DVT including age, sex, body mass index (BMI), American Society of Anesthesiologists class, comorbidity, preoperative hemoglobin (HB) level and analgesic use, surgical site (knee or hip) and type, the start time of drug anticoagulation, ambulation time, transfusion, and whether to use tranexamic acid (TXA), drain, human serum albumin, and measures of physical thromboprophylaxis after operation were collected and evaluated by survival analysis and presented as P value and odds ratio with 95% confidence interval. Results: There were 15,326 patients underwent TJA and 73 (0.48%) patients had DVT among them, and the occurrence rates were 0.71% for the patients underwent total knee arthroplasty (TKA) while 0.24% for total hip arthroplasty. The risk factors associated with DVT included TKA (compared with THA), advanced age (> 70 years), drain use, and delayed ambulation (≥ 72 h) postoperatively. Conclusion: The present results suggest that the occurrence rate of DVT on the patients underwent TJA was low (0.48%) relatively. And the risk factors associated with increased risk of DVT included TKA (compared with THA), advanced age, drain use, and delayed ambulation postoperatively. Individualized and more efficient risk stratification protocols of anticoagulation after TJA for Chinese may need to be developed in the future. [ABSTRACT FROM AUTHOR]

Background and method. Following Achilles tendon rupture (ATR)-surgery, patients using intermittent pneumatic compression (IPC) of the calf, compared to a plaster casted control-group (CTRL), exhibit reduced risk of deep venous thrombosis (DVT). Based on data from a randomized controlled trial (RCT), we investigated which dichotomized subgroups (based on age, sex, BMI and time to surgery (TTS)) within the IPC-(n= 66) and CTRL-group (n= 70) that were most likely to sustain a DVT, and which patients that had most benefit from postoperative IPC. Results. Age ≥39y (OR 6.06, p<0.001) and TTS >66h (OR 2.3, p=0.031) significantly increased the risk of DVT, but not sex or BMI. IPC-treatment significantly reduced the DVT-risk (OR 0.46, p=0.042), with more pronounced effect when considering age and TTS (OR 0.40, p=0.032). Although non-significant, females (OR 1.44, p=0.78) and patients with low BMI (OR 1.16, p=0.84) seemed to exhibit less DVT-preventive effect of IPC. Conclusion. Patients with age >38y and TTS>66h are at increased DVT-risk during post-operative leg immobilization, while adjuvant IPC shows good DVT-preventive effects among most patients, especially in those with high DVT-risk. Further trials are however warranted, to examine the low DVT-preventive effects of IPC discovered among females and patients with low BMI. [ABSTRACT FROM AUTHOR]

The article reports on the updated National Institute for Health and Care Excellence guideline on lowering the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NG89). NG89 focuses on areas where advice, emphasis or evidence has changed since the previous guidance CG92. It is said that risk assessment and how to do it composes one of the most challenging areas within the guideline. NG89 proposes to give prophylaxis where the venous thromboembolism risk exceeds bleeding risk.

Background: Despite several studies, controversy has prevailed over the rate of complications following 1-stage and 2-stage bilateral total hip arthroplasty (THA). In the current study, we compare the complications and functional outcomes of 1-stage and 2-stage procedures. Methods: One hundred and eighty patients (ASA class I or II) with bilateral hip osteoarthritis were assigned randomly to two equal groups. The two groups were matched in terms of age and sex. All of the surgeries were performed via the Hardinge approach using uncemented implants. In 2-stage procedures, surgeries were performed with a 6-month to 1-year interval. All patients were evaluated 1 year postoperatively. Results: The Harris Hip Score (HHS) averaged 84.1 and 82.6 in 1-stage and 2-stage groups, respectively (p = 0.528). The hospital stay was significantly longer in the 2-stage group (9.8 days vs. 4.9 days). The cumulative haemoglobin drop and the number of transfused blood units were the same. One patient in each group developed symptomatic deep venous thrombosis which was managed successfully. There was no patient with perioperative death, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotrophic ossification. No patient required reoperation. Two patients in the 1-stage group developed unilateral temporary peroneal nerve palsy, which was resolved after 3–4 months. Conclusion: 1-stage bilateral THA can be used successfully for patients with bilateral hip disease without increasing the rate of complications. Functional and clinical outcomes are comparable and hospital stay is significantly shorter. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 67-year-old man with atherosclerotic cardiovascular disease, stable angina, and hypertension were admitted to the hospital after chest pain. Topics include shows that operating room is a massive myocardial hematoma found on the lateral wall of the left ventricle with two areas of active hemorrhage.

Abstract Venous thromboembolism remains a common cause of direct maternal deaths in high-income settings such as the United Kingdom. Pregnancy alone increases the risk of deep vein thrombosis and pulmonary embolus at least five-fold, and many women develop or have additional risk factors for venous thrombosis during pregnancy and the puerperium, the latter representing the period of highest risk. Early and repeated risk stratification and adequate thromboprophylaxis, usually with low molecular weight heparin, is the key to preventing venous thromboembolism (VTE). Women with a past history of VTE, and those affected by thrombophilia, require multidisciplinary care involving an obstetric haematologist. Women suspected of having acute thromboembolism should be commenced on empirical treatment promptly prior to diagnostic confirmation. Pulmonary embolism should be considered as a differential diagnosis in maternal collapse. [ABSTRACT FROM AUTHOR]

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Purpose: Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid.Methods: This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50 mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events.Results: We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P < 0.001). The mean total blood loss was 769 in topical tranexamic acid group and 1163 in control group with significant differences (P = 0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase.Conclusions: A single dose of 2 g tranexamic acid in 50 mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group. [ABSTRACT FROM AUTHOR]

Abstract Introduction For treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), rivaroxaban is given in fixed doses without routine coagulation monitoring. Patients and methods To determine whether monitoring would enhance its benefit-risk profile, we examined whether peak and trough prothrombin time (PT) values measured in 3797 rivaroxaban-treated patients included in the EINSTEIN DVT and PE studies correlated with subsequent recurrent VTE and major bleeding. In addition, we examined the stability of PT values over time and the impact of clinical variables on PT values. Results The mean peak PT values at months 3 and 6 or 12 were 21.9 ± 5 and 21.7 ± 6.0 s, respectively, while the mean trough PT values at months 2 and 6 were 15.1 ± 5.1 and 15.3 ± 2.9 s, respectively. Although peak and through PT values were higher in females, and with older age, frailty, active cancer, low body weight, impaired renal function and use of moderate to strong inhibitors of CYP3A4 and/or P-glycoprotein, and were lower in patients taking strong CYP 3A4 inducers, the differences were small and results were overlapping. Neither peak nor trough PT values correlated with recurrent VTE or major bleeding. Conclusions PT monitoring is unlikely to improve the benefit-risk profile of rivaroxaban in patients with DVT or PE. The study was registered at www.clinicaltrials.gov as # NCT00440193 (EINSTEIN-DVT) and # NCT00439777 (EINSTEIN-PE). Highlights • Rivaroxaban prolongs the prothrombin time (PT) in a concentration-dependent manner if a sensitive thromboplastin reagent is used • This study was undertaken to determine whether PT monitoring would improve the benefit-risk profile of rivaroxaban in venous thromboembolism patients • In 3797 such patients, peak and trough prothrombin times were stable over time and did not correlate with recurrent thrombosis or major bleeding • Prothrombin time monitoring is unlikely to improve the benefit-risk profile of rivaroxaban [ABSTRACT FROM AUTHOR]

Introduction A wide variety of non-genetic and genetic factors have been shown to associate with increased risk for cerebral venous thrombosis (CVT). However, there is a paucity of risk factor data and conclusions about their impact are often conflicting. Herein, we quantified the associations of non-genetic and genetic risk factors for CVT in adults. Materials and methods Electronic databases were searched up to January 2017. Meta-analyses were performed (RevMan v5.3) to determine pooled odds ratios (ORs and 95% CIs) for risk factors, interstudy heterogeneity and publication bias. Results Twenty non-genetic ( n  = 2314) and 33 genetic ( n  = 2117) studies up to January 2017 met the selection criteria. For non-genetic factors, CVT risk increased in the presence of glucocorticosteroid therapy by 18.3-fold (3.3–102.6), alcohol consumption 2.7-fold (1.8–3.9), infection 7.5-fold (2.6–21.6), surgery 9.6-fold (1.1–83.5), hypercholesterolaemia 2.4-fold (1.3–4.4), hyperhomocysteinaemia 3.1-fold (2.1–4.6), antiphospholipid antibodies 7.0-fold (2.1–23.6), autoimmune diseases 5.6-fold (2.3–13.6), anaemia 4.0-fold (2.1–7.9), malignancy 3.2-fold (1.4–7.1) and pregnancy/puerperium 11.4-fold (5.7–24.3). Smoking, hypertension and diabetes did not associate with CVT risk. For genetic factors, CVT risk increased in the presence of factor V Leiden ( G1691A ) by 2.5-fold (1.9–3.3), protein C deficiency 10.7-fold (3.1–37.7), protein S deficiency 5.7-fold (1.4–22.4), antithrombin deficiency 3.8-fold (1.0–13.8), prothrombin ( G20210A ) 5.5-fold (4.0–7.27) and TAFI gene variant ( C1040T ) 1.6-fold (1.0–2.4). Prothrombin G20210A and factor V Leiden polymorphisms tended to have higher ORs for CVT than for ischaemic stroke. Conclusions We provide quantitative data supporting a strong basis for genetic and non-genetic risk factors in CVT. Its genetic liability seems higher when compared with sporadic ischaemic stroke. [ABSTRACT FROM AUTHOR]

Background Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods The American College of Surgeons’ NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29–22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12–38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79–30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27–6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37–7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03–10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54–8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66–29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27–25.73, p < 0.01). Presence of all three factors was associated with a 54% incidence of deep venous thrombosis. Conclusions Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested. [ABSTRACT FROM AUTHOR]

An editorial is presented which discusses role of endothelial dysfunction in the pathogenesis of venous thrombosis (VT). Topics discussed include role played by endothelium in regulating systemic blood flow and tissue perfusion; characterization of endothelial dysfunction by an imbalance between relaxing and contracting factors and procoagulant and anticoagulant substances; and information on association between venous thromboembolism (VTE) and atherosclerotic disease.

Objectives aPL are frequently present in SLE. In a well characterized SLE cohort we aimed at investigating the prevalence of aPL and assessing their analytical performance and clinical association by testing criteria specificities including LA, aCL IgG and IgM, anti-β2-glycoprotein 1 (antiβ2GP1) IgG and IgM, as well as the non-criteria aPS-PT IgG and IgM and anti-β2GP1 domain 1 (aD1) IgG. Methods We included 178 patients satisfying the ACR SLE classification criteria, from whom 283 samples and thrombotic events were collected longitudinally. Each sample was tested for criteria and non-criteria aPL using validated techniques in a single centre. Results All assays provided highly reproducible results. Of the samples, 42.5% were positive for at least one criteria assay, 20.5% showed double positivity and 12.6% triple positivity. All criteria and non-criteria specificities persisted over time. Most antibody titres were only moderately correlated; however, strong correlation was observed on one hand between aD1 IgG, antiβ2GP1 IgG and aCL IgG, and on the other between aPS-PT IgG and LA. aD1 IgG titres were extremely elevated in triple-positive samples. aPS-PT IgG by itself, and jointly with LA, was associated with thrombosis, an association mostly driven by venous thrombotic events. Conclusions In this SLE cohort, the non-criteria aPL aD1 IgG and aPS-PT IgG performed differently. aD1 IgG was highly enriched in triple-positive samples, and aPS-PT IgG, jointly with LA, was associated with thrombotic events. [ABSTRACT FROM AUTHOR]

Objectives The use of thrombopoietin-receptor agonists (TPO-RAs) has increased as a second-line therapy in ITP, but the efficacy and safety of such drugs has not been evaluated in SLE-associated ITP. Methods This was a multicentre retrospective cohort study from 2009 to 2016. Participating centres (n = 11) were secondary- or tertiary-care hospitals belonging to the French national network for adult ITP. Results We included 18 patients with SLE-ITP treated with TPO-RAs; 10 (55%) had aPL, 5 (27%) showing definite APS. Except for one patient, all (94%) achieved response with TPO-RAs overall. After a median follow-up of 14.7 months with TPO-RAs, four arterial thrombosis events (including one catastrophic APS) occurred in four patients. Two venous thrombosis events occurred in a patient without APS or aPLs. Conclusion Our results suggest that aPLs should be systematically screened before TPO-RA initiation in patients with SLE. With aPL positivity, alternative therapy should be discussed (if possible), especially in patients with definite APS or suboptimal adherence to anti-coagulation therapy. [ABSTRACT FROM AUTHOR]