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Sáez, Giménez Berta. "Venous thromboembolism after lung transplantation." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/666689.
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La enfermedad tromboembólica es una complicación frecuente tras el trasplante de órgano
sólido y, específicamente, tras el trasplante pulmonar. Los objetivos de nuestro trabajo fueron:
describir los factores de riesgo de la enfermedad tromboembólica, evaluar el impacto de un
protocolo de profilaxis extendido y describir los perfiles de coagulación antes y hasta 1 año
tras el trasplante pulmonar.
Con dicho objetivo llevamos a cabo dos estudios; el primero compara retrospectivamente una
cohorte estudio (n=138) que recibió profilaxis con enoxaparina 90 días post-trasplante y una
cohorte control histórica (n= 195) que recibió profilaxis únicamente durante el período de
hospitalización post-trasplante. El segundo estudio, es un estudio prospectivo para describir el
perfil de coagulación de 48 pacientes previamente al trasplante, en las primeras 24-72 horas
post-trasplante, a las 2 semanas, 4 meses y 1 año post-trasplante.
La incidencia de enfermedad tromboembólica en nuestra población fue del 15.3% (95% IC:
11.6-19.4). El tiempo medio del trasplante al evento fue de 40 (p25-75, 14-112) días. En este
estudio, los factores de riesgo que se asociaron a la enfermedad tromboembólica fueron el
género masculino y la enfermedad pulmonar intersticial difusa como enfermedad de base. La
profilaxis extendida con enoxaparina no disminuyó la incidencia de enfermedad
tromboembólica.
En el estudio que describe los perfiles de coagulación transcurrido 1 año tras el trasplante
pulmonar, encontramos que la mayor parte de marcadores de un estado procoagulante se
normalizan a las 2 semanas del trasplante; sin embargo, al año todavía encontramos algunos
pacientes niveles alterados de factor VIII y factor de Von Willebrand. Los pacientes que
presentaron alguna complicación trombótica en los primeros 4 meses tras el trasplante, tenían
niveles más elevados de factor VIII a las 2 semanas.
Se necesitarán estudios multicéntricos con mayor tamaño muestral para poder diseñar
estrategias profilácticas adecuadas.Venous thromboembolism is a frequent complication after solid organ transplantation and, specifically, after lung transplantation. The objectives of this study were to describe risk factors for venous thromboembolism, to assess the impact of an extended prophylaxis protocol and to describe coagulation profiles before and up to 1 year after lung transplantation. We performed 2 studies. The first study compared a cohort (n=138) that received 90-day extended prophylaxis with enoxaparin and a historical control cohort (n= 195) that received prophylaxis only during post-transplant hospitalization. The second study is a prospective study to describe the coagulation profiles of 48 patients before lung transplantation and at 24- 72 hours, 2 weeks, 4 months and 1 year after lung transplantation. The cumulative incidence of venous thromboembolism was 15.3% (95% CI: 11.6-19.4). Median time from transplant to the event was 40 (p25-75, 14-112) days. In this study, the risk factors associated with venous thromboembolism were male gender and interstitial lung disease. Ninety-day extended prophylaxis did not reduce the incidence of VTE. In the second study to describe coagulation profiles up to 1 year after lung transplantation, we found that most markers of a procoagulant state normalize at 2 weeks after lung transplantation and that abnormal values of factor VIII and Von Willebrand factor persist at 1 year. Patients with venous thromboembolism at 4 months had higher values of factor VIII at 2 weeks. Larger, multicenter studies are needed to confirm these results and to design appropriate prophylactic strategies.
2
Parkin, Lianne, and n/a. "Risk factors for venous thromboembolism." University of Otago. Dunedin School of Medicine, 2008. http://adt.otago.ac.nz./public/adt-NZDU20080513.145314.
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Background: Many risk factors for venous thromboembolism have been identified, but two particular exposures - the use of combined oral contraceptives and long-distance air travel - have generated considerable concern in recent years. In contrast, a possible link between venous thromboembolism and a third exposure - the use of psychotropic drugs - was first raised in the 1950s, but has received surprisingly little attention. Information about all three exposures and the risk of fatal events is limited. These risks were examined in three inter-related national population-based studies.
Methods: The underlying study population included all men and women aged 15 - 59 years who died in New Zealand between 1990 and 2000, for whom the underlying cause of death was pulmonary embolism.
The potential associations between fatal pulmonary embolism and the use of oral contraceptives and psychotropic drugs were explored in a general practice records-based case-control study. Non-users were the reference category for all analyses. Contraceptive supply data were used to estimate the absolute risk of death from pulmonary embolism in users of oral contraceptives.
A second case-control study, in which computer-assisted telephone interviews were undertaken with the next of kin of cases who had been resident in New Zealand, and with sex and age-matched controls randomly selected from the electoral roll, investigated the possible association between long-distance air travel and fatal pulmonary embolism.
Finally, the absolute risk of dying from pulmonary embolism following a long-distance flight was estimated in a descriptive study based on official migration data and deaths in recent air travellers.
Results: The adjusted odds ratio for use of any oral contraceptive in the three months before the index date (the onset of the fatal episode) was 13.1 (95% CI 4.4 - 39.0). The odds ratio for formulations containing desogestrel and gestodene was about three times higher than the point estimate for levonorgestrel products; preparations containing cyproterone acetate appeared to carry the highest risk. The estimated absolute risk of fatal pulmonary embolism in current users of oral contraceptives was 10.5 (95% CI 6.2 - 16.6) per million woman-years.
The adjusted odds ratio for current use of any antipsychotic was 13.3 (95% CI 2.3 - 76.3). Low-potency antipsychotics carried a 20-fold increase in risk; thioridazine was the main drug involved. Antidepressant use was also associated with a significantly increased risk (adjusted odds ratio 4.9 [95% CI 1.1 - 22.5]).
Compared with non-travellers, people who had undertaken a flight of more than eight hours� duration in the preceding four weeks were eight times more likely to die from pulmonary embolism (odds ratio 7.9 [95% CI 1.1 - 55.1]). The absolute risk of fatal pulmonary embolism following air travel of more than eight hours was 1.3 (95% CI 0.4 - 3.0) per million arrivals.
Conclusions: The present research was the first to have estimated the relative risks of fatal pulmonary embolism in relation to three exposures: oral contraceptive use in a population in which preparations containing desogestrel and gestodene preparations were widely used, conventional antipsychotics, and long-distance air travel. The findings were consistent with previous, and subsequent, studies of non-fatal events. Increased risks of fatal pulmonary embolism in users of antidepressants, and in people with an intellectual disability, have not been described previously and warrant further investigation. Referral and diagnostic biases are very unlikely in these studies of fatal events, and other types of bias and possible confounding are considered unlikely explanations for the findings.
3
Kelly, James Anthony. "Venous thromboembolism after acute ischaemic stroke." Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405599.
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Hettiarachchi, Rohan Jagath Kumara. "Venous thromboembolism, cancer and low molecular weight heparin." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/84386.
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Kraaijenhagen, Roderik A. "The etiology, diagnosis and treatment of venous thromboembolism." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/84205.
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Patel, Rajesh Kantilal. "Risk factors for venous thromboembolism in the black population." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.416109.
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Wolde, Marije ten. "Management of venous thromboembolism etiology, diagnosis, prognosis and treatment /." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2003. http://dare.uva.nl/document/87021.
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Vink, Roel. "Management of antithrombotic therapy in venous and arterial thromboembolism." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2004. http://dare.uva.nl/document/88049.
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Cheung, Katharine Lana. "Chronic Kidney Disease and the Risk of Venous Thromboembolism." ScholarWorks @ UVM, 2018. https://scholarworks.uvm.edu/graddis/879.
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Chronic kidney disease (CKD) affects more than 30 million adults in the U.S. and is strongly associated with cardiovascular events and mortality. Venous thromboembolism (VTE) is the third leading vascular disease, affects up to 900,000 Americans each year and contributes to as many as 100,000 deaths annually. The relationship of CKD and VTE has been described in patients receiving dialysis, kidney transplants recipients and in nephrotic syndrome, however, data supporting the association of VTE in mild to moderate CKD is conflicted. The overall goal of this research was to study the association of CKD and VTE and to understand the mechanisms of this association. To accomplish this goal we studied participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a nationally representative cohort of 30,239 blacks and whites in the U.S..
The first chapter provides a review of the state-of-the science on CKD and VTE and potential mechanisms for this association. We focus on factor VIII as a potential mediator of VTE risk in CKD by reviewing the biochemistry and epidemiology linking factor VIII and CKD.
In Chapter 2, we use a cohort study design and a competing risk analysis to determine the risk of VTE with albuminuria (ACR) and with various equations for estimated glomerular filtration rate (eGFR). There was no association of ACR and VTE and the risk of VTE was similar among eGFR equations. Compared to a normal eGFR (>90 ml/min/1.73m2), eGFR < 45 ml/min/1.73m2 was associated with a two-fold risk of VTE. The association of eGFR and unprovoked VTE was similar to the association with provoked VTE. The population attributable fraction of CKD (eGFR<60 ml/min/1.73m2) was modest at 5%.
In Chapter 3, we utilize a case-cohort study to determine if biomarkers of inflammation (C-reactive protein) and procoagulation (Factor VIII and D-dimer) attenuate the risk of VTE in CKD. These biomarkers were higher in lower kidney function and were also strongly associated with VTE. Adjustment for factor VIII fully attenuated the risk of VTE in CKD, thus factor VIII is a potential mediator of the association of CKD and VTE. We assessed whether lifestyle factors and medications mitigate the risk of VTE in those with and without CKD. Exercise frequency and use of statins were associated with reduced risk of VTE in the presence and absence of CKD, but normal BMI was associated with reduced VTE risk only in those without CKD.
We conclude that CKD is a risk factor for VTE, and findings shed light on the mechanisms of this association. Interventions that might lower VTE risk in CKD patients include exercise and statin therapy, but not weight loss. Factor VIII is a potential mediator of VTE in CKD and deserves further study. We suggest several avenues for future research to explore the relationship of Factor VIII and CKD.
10
Beutel, Bernhard. "Preventing venous thromboembolism at a district hospital : a quality improvement study." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/97180.
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Thesis (MFamMed)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Background: Pulmonary embolism (PE) is the most common preventable cause of hospital deaths, and almost all hospitalised patients have at least one risk factor for venous thrombo-embolism (VTE). Despite the availability of highly effective thromboprophylaxis in prevent-ing VTE, numerous studies worldwide have demonstrated its under-utilization. The aim of this study was to review and improve the utilization of thromboprophylaxis in the prevention of VTE in hospitalized patients at Oudtshoorn district hospital. Method: A quality improvement cycle (QIC). Retrospective analysis of files of adult patients admitted to the male and female wards at Oudtshoorn district hospital was performed prior to and after a 5 month intervention phase. The target standards for the QIC were: 1) Availability of a written hospital policy on VTE prevention; 2) Every adult admission should have a for-mal VTE risk assessment documented; 3) Every adult admission who is at risk for VTE should receive thromboprophylaxis. Results: Thirty eight percent of adult patients admitted to Oudtshoorn hospital, excluding the maternity ward, were at risk of developing VTE. There was no written hospital policy on VTE prevention. This was developed and made available during the intervention. In the pre-intervention group there were no patients who had a documented VTE risk assessment. The post intervention group showed a considerable increase with 45.2% having had a completed VTE risk assessment on admission (p<0.00001). In the pre-intervention group only 4.6 per-cent of patients who were at risk of VTE received thromboprophylaxis. There was a statisti-cally significant difference in the number of patients at risk who received thromboprophylax-is in the post-intervention group where 36% of these patients received thromboprophylaxis (p<0.00001). Conclusions: The study identified a major shortcoming in the prevention of VTE in those patients at risk who were admitted to Oudtshoorn district hospital. An intervention as part of a quality improvement cycle has been able to demonstrate a significant improvement in the detection of patients who are at risk of VTE and a subsequent improvement in appropriate thromboprophylaxis. A number of barriers to their implementation have been identified and need to be addressed. This QIC may in time be of value to assist other district hospitals in addressing the issue of VTE prevention.
AFRIKAANSE OPSOMMING: No abstract available.
11
Ho, Wai Khoon. "The incidence of venous thromboembolism : a prospective, community-based study." University of Western Australia. School of Medicine and Pharmacology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0031.
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Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable cause of morbidity among individuals and hospital in-patient mortality. Further, it imposes a substantial burden upon the community and its health care system and economy. Studies performed in Western societies suggest that the annual incidence of DVT is about 0.8 to 1.2 per 1,000, PE about 0.3 to 0.6 per 1,000, and VTE about 1.0 to 1.8 per 1,000. However, it is not known if these estimates can be generalised to the Australian population because of differences in ethnic composition and other risk factors for VTE among the different populations. In this thesis, I undertook a prospective, community-based cohort study over a 13-month period in 2003 2004 to determine the incidence and crude event rate of symptomatic, objectively verified VTE in north-east metropolitan Perth. The study population was broadly representative of the national Australian population in terms of age, sex and ethnic distribution. Cases were identified through multiple overlapping sources. The incidence of DVT, PE and VTE in the community were 0.52 (95% confidence interval, CI: 0.41 0.63), 0.31 (95% CI: 0.22 0.40) and 0.83 (95% CI: 0.69 0.97) per 1000 per year, respectively. The annual incidence of DVT, adjusted to the World Standard population, was 0.35 (95% CI: 0.26 0.44) per 1000, PE 0.21 (95% CI: 0.14 0.28) per 1000 and VTE 0.57 (95% CI: 0.47 0.67) per 1000. The crude event rate for VTE was 0.85 (95% CI: 0.71 0.99) per 1000 per year. These findings suggest that the incidence of DVT, PE and VTE are lower than in other Western societies studied. Possible reasons include a lower prevalence of exposure to causal risk factors (genetic and environmental) and incomplete case ascertainment. Knowledge of the local incidence and event rate allows health planners to allocate appropriate resources and evaluate cost-effective preventive measures.
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Rao, Deepa Prema. "The role of growth arrest-specific 6 in venous thromboembolism /." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112349.
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Background. Growth-arrest specific 6 (gas6) is a novel vitamin-K dependent protein whose role in venous thromboembolism was recently characterized in murine models. Gas6 is suggested to be a prothrombotic protein capable of mediating thrombus stability. However, the association between gas6 and venous thromboembolism has yet to be elucidated in humans. The present work aims to delineate the existence of such an association in humans and propose a mechanism by which gas6 expression is related to venous thromboembolic disease.Methods. To analyze the association between gas6 and venous thromboembolism, a highly specific ELISA method was used to measure plasma gas6 levels in 306 patients with a history of deep-vein thrombosis (DVT) and 89 control volunteers. Medication history, comorbid conditions and DVT characteristics were documented for the purposes of statistical analyses. Median gas6 levels were compared between the subgroups, and prevalence rate ratios were calculated. Human umbilical vein endothelial cells were used to measure the effect of gas6 treatment on the expression of various mediators of coagulation. Murine thrombosis models were developed to serve as in vivo models for thrombosis.
Results. The median levels of gas6 were 28.21 ng/ml in patients compared to 26.15 ng/ml in controls (p=0.01). After adjustment for age, sex, comorbidity and medications, DVT patients had a PRR of 2.5 (95% CI 1.36 to 4.61, p=0.003) compared with controls. Within the DVT subgroup, median gas6 levels were significantly higher in those with cancer-associated (vs. unprovoked or secondary) DVT (p<0.001) and in those with more extensive DVT (p=0.037), while levels were significantly lower in those taking warfarin (vs. no warfarin) (p=0.03). Preliminary results with endothelial cell cultures are inconclusive with regards to the effect of gas6 on endothelium derived mediators of coagulation.
Conclusions. Elevated plasma gas6 is associated with venous thromboembolism. The etiology of the clot influences detected levels of gas6, with the highest levels seen in cancer-patients. Furthermore, increasing clot burden correlates with elevated levels of gas6. A mechanistic explanation for how gas6 modulates this association is in its preliminary stages, and is worth pursuing.
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Hurtt, Callie. "Outcomes for Epithelial Ovarian Cancers Diagnosed with Concomitant Venous Thromboembolism." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/603656.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Background and Significance Most large studies on venous thromboembolism (VTE) incidence in gynecologic cancer focus on prevention and management of postoperative VTE. Treatment for preexisting VTE at the time of diagnosis of epithelial ovarian cancer (EOC) includes careful risk assessments, weighing the benefits of debulking and risks of anticoagulation in the setting of a new VTE and new EOC diagnosis, respectively. We aimed to describe perioperative and cancer survival outcomes associated with concomitant diagnoses. Research Question To describe short‐term perioperative outcomes and overall survival (OS) among women who present with VTE at initial EOC diagnosis. Methods Women presenting with VTE within 30 days prior to EOC diagnosis between 1/2/2003 and 12/30/2011 who had primary debulking surgery (PDS) or chemotherapy (CT) alone were included. Descriptive statistics and the Kaplan‐Meier method were used to estimate OS from time of EOC diagnosis, with patient characteristics and process‐of‐care variables retrospectively abstracted. Results Of the 36 women with VTE within 30 days prior to EOC diagnosis, 28 (77.8%; mean age 64.2 years) underwent PDS and 8 (22.2%; mean age 61.4 years) received CT alone. Eastern Cooperative Oncology Group (ECOG) performance status (PS) was ≤2 in 85.7% (n=24) of PDS patients compared to 62.5% (n=5) of CT patients. Advanced stage (III/IV) disease was diagnosed in 71.4% (n=20) of PDS group; all CT patients were advanced stage. Among those who underwent PDS, 26 (92.9%) had a preoperative IVC filter placed; 1 (12.5%) in the CT group received an IVC filter. Perioperative bleeding complications were 7.2% in the PDS group. Within the PDS group, median OS was 25.6 months while the CT group had median OS of 4.5 months.ConclusionsPreoperative VTE in EOC patients can be safely managed with low rates of bleeding complications. Poor OS in CT group may reflect worse overall health or more aggressive cancer. Median OS was notably shorter than previously published; IVC filter utilization on oncologicoutcomes in EOC warrants further investigation.
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Holmes, Valerie Anne. "Early markers of haemostasis in normal pregnancy." Thesis, University of Ulster, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274405.
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Lee, Jung-Ah. "A review of the management of patients at risk for or diagnosed with venous thromboembolism (VTE) at an academic medical center, and the cost-effectiveness of diagnostic strategies for VTE /." Thesis, Connect to this title online; UW restricted, 2008. http://hdl.handle.net/1773/7224.
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Lindmarker, Per. "Treatment of deep vein thrombosis and risk of recurrent venous thromboembolism /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3211-5/.
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Räsänen, Noora. "Venous Thromboembolism after Thoracotomy and Lung LobectomyIn Patients with Lung Malignancy." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-73520.
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Background: Venous thromboembolism, manifesting as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant source of morbidity and mortality and a cause of postoperative complications after invasive surgery. These adverse events are more likely to occur in high risk patients, such as those with cancer or undergoing major surgery with the highest incidence peak taking place within the first month after surgery. Despite the issue being globally recognized, a lack of consensus regarding guidelines for prophylaxis post-discharge still exists. Aim: To determine the incidence of venous thromboembolism within a 30-day postoperative period after thoracotomy and lung lobectomy for lung malignancy, to assess a correlation of the above with administered prophylactic treatment. Method: A retrospective cohort study was conducted as a review of medical records of all patients, appertaining to Örebro county, who had undergone thoracotomy and lung lobectomy for lung cancer or secondary malignant tumor in the lung, during 2015-2017 at the department of Cardiothoracic and Vascular Surgery, Örebro University Hospital. An internally validated register was used to identify the patient population and partial collection of the data. Results: Of the 67 included patients 50,8% were men and the mean age of the population was 67,5 years. The VTE prevalence during the 30-day postoperative period was 1,5%. A total of 59,7% of the patients received thrombosis prophylaxis preoperatively, 98,1% postoperatively and 11,9 % after hospital discharge. Conclusion: The VTE prevalence of 1,5% in this study may suggest the current postoperative prophylactic regiment successful, yet VTE remains a clinically significant complication, and the need for well-defined guidelines is evident.
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Hickey, Benjamin. "Venous blood flow, thromboembolism and below knee cast immobilisation for trauma." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/107891/.
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Venous thromboembolism (VTE) has a background incidence of between 0.7 and 2.69 per 1000 per year (L. N. Roberts et al., 2013). Risk factors are either permanent or transient. Permanent risk factors include thrombophilia (80 x increase risk if homozygous for factor V Leiden), cancer (58 x increase risk if metastatic cancer or diagnosis within last 3 months), increasing age (risk doubles for each decade over age 40 years), family or personal history of deep vein thrombosis (2-3 x increase risk) and increasing body mass index (2 x increase for BMI > 35 kg/m2 in comparison with BMI < 20 kgm2) (Y.-H. Kim & Kim, 2007) (Blom, Doggen, Osanto, & Rosendaal, 2005) (Anderson & Spencer, 2003) (Decramer, Lowyck, & Demuynck, 2008) (Holst, Jensen, & Prescott, 2010). Transient risk factors include surgery (165 x risk in first 6 weeks after total hip or knee replacement, equating to 2% symptomatic VTE rate) (Sweetland et al., 2009). Foot and ankle procedures including ankle fracture fixation, hindfoot fusion and 1st metatarsal osteotomy are associated with 18x, 8x and 2x increase VTE risk respectively (Jameson et al., 2011). Other transient risk factors include postpartum state (21-84 x increase in first 6 weeks), use of oral contraceptive pill or hormone replacement therapy (at least 2 x risk) and lower limb cast immobilization (Jackson, Curtis, & Gaffield, 2011) (Grodstein et al., 1996). Within 90 days of lower limb cast treatment, asymptomatic DVT affects between 4 and 40% of patients, symptomatic DVT affects 1 in 250, symptomatic pulmonary embolism affects 1 in 500, with fatal pulmonary embolism affecting 1 in 15,000 (Jameson et al., 2014). It is apparent that patients will therefore have a differing risks depending on their permanent and transient risks. The types of VTE include asymptomatic events, for which the relevance is not fully understood (often used in studies as a surrogate for symptomatic events). Symptomatic below knee DVT (approximately 20% propagate to become above knee) (Philbrick & Becker, 1988). Symptomatic above knee DVT (affecting popliteal vein or more proximal), which are 4 times more likely to occur (Baglin et al., 2010). Pulmonary embolism can also occur. The clinical relevance of DVT is that 6% of patients will have severe post thrombotic syndrome (venous ulceration, swelling, itching) at 10 years after the event, with 66% of patients displaying some signs (Schulman et al., 2006). Uncomplicated DVT does not appear to impact on quality of life, however if DVT is complicated by post thrombotic syndrome, patients will have significantly reduced quality of life, mental and physical health. Simple non fatal PE reduces physical health and if it is complicated by pulmonary hypertension (affecting approximately 2%) it results in significantly reduced quality of life, mental and physical health (Ghanima, Wik, Tavoly, Enden, & Jelsness-Jørgensen, 2017) (Lubberts, Paulino Pereira, Kabrhel, Kuter, & DiGiovanni, 2016). In view that VTE has significant effects on patients quality of life, it is important to try and prevent it. In order to develop strategies for preventing DVT in patients with lower limb injury treated with leg cast, it is important to investigate the relative contributions of injury, stasis and immobility to thrombogenesis. I start by performing systematic review of the literature to determine whether thromboprophylaxis reduces symptomatic venous thromboembolism in patients with below knee cast treatment for foot and ankle trauma. A systematic review of randomised controlled trials of thromboprophylaxis in patients with foot and ankle injuries treated with cast immobilization was performed, searching MEDLINE and EMBASE from inception to June 2015 (B. A. Hickey, Watson, et al., 2016b). Outcomes of interest were VTE (asymptomatic and symptomatic DVT and PE) and bleeding. 3 reviewers used a data extraction form and assessed the literature according to the Cochrane risk of bias tool. Statistical analysis was performed using RevMan. 7 studies of chemical thromboprophylaxis were included, all except one used venography to assess for DVT, with one study using venous ultrasound. 2 studies reported on mechanical thromboprophylaxis, neither reported symptomatic DVT events. Neither study of mechanical thromboprophylaxis found a reduction in asymptomatic DVT in the intervention group. Funnel plot of studies of chemical thromboprophylaxis suggested no publication bias. Pooled symptomatic DVT occurred in 1.58% of patients in the control group, with 0.43% sustaining symptomatic PE. At meta analysis, symptomatic DVT was reduced in the low molecular weight heparin chemical thromboprophylaxis group (OR 0.29, CI 0.09-0.95). Chemical thromboprophylaxis did not influence PE. There was one non-fatal retroperitoneal haemorrhage (major bleed), which equated to 0.11% (1 in 886). Based on these findings, 11 symptomatic VTE events would be prevented for every 1 major bleed. These findings are comparable with the recent Cochrane review, which included 2 additional studies and a total of 2924 participants. Meta analysis found reported a reduction of VTE in the LMWH chemical thromboprophylaxis group (OR 0.40, 95% CI 0.21-0.76) (Zee, van Lieshout, van der Heide, Janssen, & Janzing, 2017). In order to develop strategies for prediction and prevention of VTE in patients with foot and ankle injury treated with cast immobilization, it is necessary to consider why venous thrombosis occurs in these patients. As previously discussed, patients may have permanent risk factors, which may influence hypercoagulability. The transient risk factors of injury and cast treatment may also influence risk by causing endothelial dysfunction and venous stasis (Virchow, 1856). Several important mechanisms for prevention of venous stasis have previously been found. Weight bearing is important; with Gardner et al (1990) reporting that 30ml of venous contrast was pumped out of the foot during weight bearing (Gardner & Fox, 1983). This is not always possible for a patient with foot and ankle injury treated with a cast, because they may be non-weight bearing. For patients who are non-weight bearing, it is still possible to influence venous flow. For example, Elsner et al (2007) previously found that movement of the 1st metatarsophalangeal joint increased popliteal vein flow from 13 to 39 cm/s (Elsner, Schiffer, Jubel, Koebke, & Andermahr, 2007). In patients without leg casts, intermittent pneumatic compression of the leg or thigh to prevent venous stasis was found to be effective in reducing DVT and PE in a meta analysis of over 16, 000 patients (RR 0.43, 95% CI 0.36-0.52) (Ho & Tan, 2013). It therefore seems that this is a viable mechanism. Furthermore, Whitelaw et al (2001) found that none of the IPC devices studied resulted in significantly better calf pump function when compared with simple passive or active ankle movements (Whitelaw et al., 2001). To assess the influence of toe and ankle movement on venous stasis, I examine the effect of these movements on venous velocities measured at the popliteal vein with ultrasound. To determine whether this is a viable strategy for prevention of DVT, I then assess the impact of application of below knee cast on venous velocities. In this proof of principle study, 20 healthy volunteers were recruited (B. A. Hickey, Morgan, Pugh, & Perera, 2014). All had measurement of calf pump function in the un-casted leg whilst seated, using ultrasound at the popliteal vein. Baseline and peak velocities were measured during active toe movement (dorsiflexion and plantarflexion) and during ankle movement (dorsiflexion and plantarflexion). A below knee cast was then applied and measurements were repeated. Mean resting baseline venous velocity was 10 cm/s, which remained unchanged when the below knee cast was applied.There was approximately 5-fold increase in venous velocities with active toe movement (mean 54 cm/s for toe dorsiflexion, mean 50 cm/s for toe plantarflexion), and 10 fold increase from baseline with ankle movements (mean 115 cm/s ankle dorsiflexion, mean 87 cm/s ankle plantarflexion). All were statistically significant. When the below knee cast was applied, there was no statistically significant decrease in the peak velocities achieved during movement excepting for ankle dorsiflexion (isometric), however this was still increased approximately 8 times compared with baseline (88 cm/s). It was therefore apparent that venous stasis did not occur when a below knee cast was applied to healthy volunteers and that active toe movement may have a role in preventing stasis in patients with injury, with subsequent reduction in DVT.
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Douglas, Randi M., and Lauren N. Parker. "Evaluation of post-operative venous thromboembolism prophylaxis in lung transplant patients." The University of Arizona, 2012. http://hdl.handle.net/10150/623605.
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Class of 2012 AbstractSpecific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post- discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post- order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.
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Douglas, Randi M., Lauren N. Parker, Michael Katz, and Richard Cosgrove. "Evaluation of Post-Operative Venous Thromboembolism Prophylaxis in Lung Transplant Patients." The University of Arizona, 2012. http://hdl.handle.net/10150/614466.
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Class of 2012 AbstractSpecific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post-discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post-order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.
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Lee, Adrian P. S. "Therapy and venous thromboembolism in glioblastoma: a clinical and molecular study." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/22600.
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Glioblastomas are high grade brain tumours with a median survival of approximately 1 year. Amplification of the oncogene EGFR is a common aberration. This thesis assessed the hypothesis that EGFR is an effective target for glioblastoma treatment. A Cochrane review was undertaken that systematically analysed 9 clinical trials in glioblastoma patients that included EGFR targeting therapies. It concluded that the addition of EGFR therapies to standard of care provided no overall survival benefits. Venous thromboembolisms (VTEs) are highly prevalent amongst glioblastomas. Prophylaxis is not recommended, and thus early identification of at-risk patients and initiation of treatment may be beneficial. EGFR enhances activation of the coagulation cascade by upregulating pro-coagulant factors like Tissue Factor (TF). This thesis examined the hypothesis that EGFR-driven glioblastomas have more VTE events and this leads to poorer survival. A retrospective study of 330 glioblastoma patients diagnosed between 2009 and 2014 found no association between VTE incidence and tumour EGFR status or survival. However, a positive correlation was identified between VTE and tumor uPAR expression (p=0.032). An unexpected finding was a positive correlation between overall survival and tumor TF expression (p=0.028). In further work, gene expression profiling of glioblastomas from an independent cohort of 26 patients, 50% of whom developed VTE, identified collagen as an alternative initiator of thrombus formation and confirmed the importance of extracellular matrix in facilitating these malignant activities. Findings from this thesis do not support anti-EGFR therapies in glioblastoma. This thesis identified the potential of uPAR as a predictive biomarker for VTE. It provides support for further investigation of biomarkers that may contribute to a VTE risk assessment for glioblastomas, permitting early identification and intervention of at-risk patients to change their disease outcome.
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Remancus, Kelly. "Examining Venous Thromboembolism Post-Operative Orthopedic Care Using Electronic Order Sets." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3828.
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Venous thromboembolism (VTE) is a serious health concern of patients undergoing orthopedic surgery. Analysis of the study site semiannual reports from January 2014 through March 2015 indicated 10 VTE events in 546 orthopedic cases. The community hospital was classed as an outlier performing in the bottom 10th percentile when compared to other hospitals. To standardize the ordering of VTE prophylaxis, the hospital developed a postoperative electronic VTE order set. The purpose of this project was to assess the difference in orthopedic VTE occurrences in the postoperative total hip arthroplasty (THA) patients before and after the implementation of the electronic VTE order set. The goal of the project was to use an electronic retrospective chart review to evaluate if the order set implementation influenced the adherence to ordering mechanical and pharmacological prophylaxis in the THA patient. Differences in the ordering of VTE prophylaxis and VTE outcomes were evaluated using a retrospective review of 325 preimplementation order set cases and 406 postimplementation order set cases. This evaluation demonstrated that appropriate pharmacological prophylaxis ordering increased and orthopedic VTE occurrences decreased after the standardized electronic order set was implemented. Social change occurred through the empowerment of clinicians when empirical evidence was provided for use at the point of care, which positively impacted patient outcomes undergoing a common surgical procedure. VTE is no longer considered a routine postoperative orthopedic complication as technology-enabled solutions have proven to be appropriate tools to combat and prevent postoperative VTE complications.
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Labiche, Eppie Ann. "Venous Thromboembolism Prevention Education for Practitioners in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6597.
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During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.
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Coleman, Craig I., Jan Beyer-Westendorf, Thomas J. Bunz, Charles E. Mahan, and Alex C. Spyropoulos. "Postthrombotic Syndrome in Patients Treated With Rivaroxaban or Warfarin for Venous Thromboembolism." Sage, 2018. https://tud.qucosa.de/id/qucosa%3A35470.
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Postthrombotic syndrome (PTS) is a frequent complication of venous thromboembolism (VTE). Using MarketScan claims data from January 2012 to June 2015, we identified adults with a primary diagnosis code for VTE during a hospitalization/emergency department visit, ≥6 months of insurance coverage prior to the index event and newly started on rivaroxaban or warfarin within 30 days of the index VTE. Patients with <4-month follow-up postindex event or a claim for any anticoagulant during 6-month baseline period were excluded. Differences in baseline characteristics between rivaroxaban and warfarin users were adjusted for using inverse probability of treatment weights based on propensity scores. Patients were followed for the development of PTS starting 3 months after the index VTE. Cox regression was performed and reported as hazard ratios with 95% confidence intervals (CIs). In total, 10 463 rivaroxaban and 26 494 warfarin users were followed for a mean of 16 ± 9 (range, 4-39) months. Duration of anticoagulation was similar between cohorts (median = 6 months). Rivaroxaban was associated with a 23% (95% CI: 16-30) reduced hazard of PTS versus warfarin. Rivaroxaban was associated with a significant risk reduction in symptoms of PTS compared to warfarin in patients with VTE treated in routine practice.
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Lapidus, Lasse. "Thromboembolism following orthopaedic surgery : outcome and diagnostic procedures after prophylaxis in lower limb injuries /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-111-1/.
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Kadri, Amer N., Misam Zawit, Raed Al-Adham, Ismail Hader, Leen Nusairat, Mohamed F. Almahmoud, Mourad Senussi, et al. "Prevalence of venous thromboembolism in admissions and readmissions with and without syncope: A nationwide cohort study." Oxford University Press, 2021. http://hdl.handle.net/10757/655949.
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Aims: The Pulmonary Embolism in Syncope Italian Trial reported 17.3% prevalence of pulmonary embolism (PE) in patients admitted with syncope. We investigated the prevalence of venous thromboembolism [VTE, including PE and deep vein thrombosis (DVT)] in syncope vs. non-syncope admissions and readmissions, and if syncope is an independent predictor of VTE. Methods and results: We conducted an observational study of index admissions of the 2013-14 Nationwide Readmission Database.National Institutes of Health
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Baggs, Jennifer, Grace Chang, and Jinwen Li. "Evaluation of Adherence to Treatment Standards and Clinical Outcomes Associated with Prophylaxis of Venous Thromboembolism in Hospitalized Patients at University Medical Center in Arizona." The University of Arizona, 2009. http://hdl.handle.net/10150/623985.
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Class of 2009 AbstractOBJECTIVES: To assess whether patients at University Medical Center (UMC) in Arizona who have indications for venous thromboembolism (VTE) prophylaxis receive treatment, determine whether appropriate pharmacologic VTE prophylaxis is implemented, and analyze the incidence of VTE associated with prescribed regimens. METHODS: Data were derived from a retrospective chart review on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis. Two risk assessment models were used to evaluate adherence to treatment standards: the 2008 American College of Chest Physicians (ACCP) evidence-based consensus guidelines and the Caprini score. Clinical outcomes were evaluated with regard to proper thromboprophylaxis including assessment of appropriate time, type, intensity, and duration of treatment. RESULTS: A total of 366 patients met inclusion critera. Based on the Caprini score, 94% of patients were judged to be at risk for VTE. Of those at risk, 90% received thromboprophylaxis; however, only 35% of treated patients received proper thromboprophylaxis. Ten patients (2.7%) experienced a VTE during their hospital stay or within the following 6 months after discharge. There was not a significant difference in incidence of VTE with respect to treatment versus no treatment or proper versus improper prophylaxis (p=0.15 and 0.65, respectively); however, a favorable trend in incidence of VTE was observed for treated patients and patients treated with correct thromboprophylaxis based on risk assessment. CONCLUSIONS: Most patients at UMC who were indicated for VTE prophylaxis received treatment; however, the type, intensity, and duration of thromboprophylaxis were often inappropriate despite the existence of various guidelines.
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Sandén, Per. "Efficacy and safety of warfarin treatment in venous thromboembolic disease." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-133618.
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Background As a major cause of morbidity and mortality treatment of venous thromboembolism is important, with the correct use of anticoagulants it is possible to greatly reduce both mortality and morbidity. Warfarin is among the most widely used anticoagulants being effective in treatment and prevention of venous thromboembolism with few negative side effects other than bleeding complications. With a narrow therapeutic window warfarin treatment requires constant monitoring and adjustments to stay effective without an increased bleeding risk. The aim of this thesis was to study the efficacy and safety of warfarin treatment in venous thromboembolic disease. Methods Using AuriculA, the Swedish national quality register for atrial fibrillation and anticoagulation, a cohort was created of patients registered with warfarin treatment during the study time January 1st 2006 to December 31th 2011, including all different indications for anticoagulation. In all four studies the study design was retrospective with information added to the cohort from the Swedish national patient register about background data and endpoints in form of bleeding complications in all studies and thromboembolic events in study 1 and 2. In study 3 and 4 information was added from the cause of death register about occurrence of death and in study 3 cause of death. In study 3, information from the prescribed drugs register about retrieved prescriptions of acetylsalicylic acid was added. Results In study 1 the mean TTR was found to be high both among patients managed at primary healthcare centres and specialised anticoagulation clinics at 79.6% and 75.7%. There was no significant difference in rate of bleeding between the two types of managing centres being 2.22 and 2.26 per 100 treatment years. In study 2 no reduction in complication rate with increasing centre TTR was seen for patients with atrial fibrillation with few centres having centre TTR below 70% (2.9%), in contrast to previous findings by Wan et al(1). For those with warfarin due to VTE where a larger proportion of the centres had centre TTR below 70% (9.1%) there was a reduction in complication rate with increasing centre TTR. Among the 13859 patients with treatment for VTE in study 3 age (HR 1.02, CI 95% 1.01-1.03), hypertension (HR 1.29, CI 95%1.02-1.64), Cardiac failure (HR 1.55, CI 95% 1.13-2.11), chronic obstructive pulmonary disease (HR 1.43, CI 95% 1.04- 1.96), alcohol abuse (HR 3.35, CI 95% 1.97-5.71), anaemia (HR 1.77, CI 95% 1.29-2.44) and a history of major bleeding (HR 1.75, CI 95% 1.27-2.42) increased the risk of bleeding during warfarin treatment. In study 4 both those with high iTTR and those with low INR variability had a low rate of bleedings at 1.27 (1.14-1.41) or 1.20 (0.94-1.21) per 100 treatment years compared to those with low iTTR and high INR variability having a rate of bleeding at 2.91 (2.61-3.21) or 2.61 (2.36-2.86) respectively. Those with the combination of both low iTTR and high INR variability had an increased risk of bleeding, hazard ratio HR 3.47 (CI 95 % 2.89-4.17). The quartile with both the lowest iTTR and the highest INR variability had an increased risk of bleeding with a hazard ratio 4.03 (3.20-5.08) and 3.80 (CI 95%, 3.01-4.79) compared to the quartile with the highest iTTR and lowest INR variability. Conclusion It is possible to achieve a safe warfarin treatment both in specialised anticoagulation centres and in primary health care. At initiation of treatment some of the patients at high risk of bleeding can be identified using knowledge about their background. With the use of quality indicators as TTR and INR variability during treatment those at high risk of complications can be identified and analysing treatment quality on centre level gives an opportunity to identify improvement areas among managing centres. With the addition of new treatment options warfarin can still be the most suitable option for some patients, being safe and effective when well managed.
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Raman, Rachna. "Inferior vena cava filters in the management of cancer-associated venous thromboembolism: A systematic review." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1307442047.
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Suchon, Pierre. "Identification de variants génétiques associés à la thrombose veineuse." Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0658/document.
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La maladie thromboembolique veineuse (MTEV) résulte de l’interaction entre des facteurs environnementaux et génétiques. Cinq anomalies constitutionnelles constituent le bilan de thrombophilie (BT) : les déficits en AT, PC et PS, le facteur V Leiden et la mutation de la prothrombine. Seule la moitié des déficits « présumés » en PS trouvent une explication moléculaire. Dans le premier article, seuls les patients présentant une mutation délétère du gène de la PS (PROS1) étaient à risque de MTEV. Seuls des taux <30%, permettaient de dépister les mutations délétères. La mutation Heerlen située sur PROS1 est réputée neutre. Dans le second article, la mutation Heerlen était associée à un risque de MTEV de 6,57. De récentes études ont identifié une trentaine de polymorphismes associés à la MTEV. Cependant, leur impact dans les familles présentant un facteur biologique de risque est méconnu. De même, l’impact de facteurs environnementaux tels que l’obésité et le tabagisme est mal évalué dans ces familles. Dans le troisième article, la prise en compte de 5 facteurs de risque fréquents à effet faible (obésité, tabac, groupe sanguin et deux polymorphismes situés sur F11 et FGG) en complément du dépistage de l’anomalie familiale permettait de mieux caractériser le risque individuel. Nous avons testé la même stratégie dans une population spécifique de femmes sous contraceptifs oraux combinés (4ème article). Trois facteurs de risque fréquents (groupe sanguin, obésité et un polymorphisme de F11) étaient associés à un OR de 13 lorsqu’ils étaient combinés. Au total, la prise en compte de facteurs de risque fréquents à effet faible, permettait une meilleure évaluation du risque individuelVenous thromboembolism (VT) results from the interaction between environmental and genetic factors. Five inherited hemostatic defects are part of the thrombophilia screening (TS): AT, PC and PS deficiencies, factor V Leiden and prothrombin mutation. A molecular defect is identified in only half of assumed PS deficiencies. In the first article, only detrimental mutations (DM) located on PROS1 (PS gene) increased VT risk. Only free PS levels below 30% enabled the identification of DM. PS Heerlen mutation located within PROS1 has been considered neutral for a long time. In the second article, the association between PS Heerlen and VT has been tested in a sample of 4173 patients with VT history and 5970 healthy individuals. PS Heerlen was associated with a 6.57 increased risk of VT. Recent genome wide association studies identified nearly 30 polymorphisms associated with VT. However, the impact of such polymorphisms in families with known defects is uncertain. We therefore tested in a third article the association between 11 selected polymorphisms, obesity, smoking and VT in 651 families with known thrombophilia. Considering 5 common risk factors (obesity, smoking, ABO blood group, two polymorphisms located on FGG and F11) together with the TS resulted in a better assessment of VT risk in individuals from families with thrombophilia. We then applied the same strategy in a sample of women using combined oral contraceptives. Three common risk factors (non-O blood groups, obesity and a polymorphism located on F11), when combined, were associated with a 13 OR. In conclusion, considering common risk factors improved the individual assessment of VT risk
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Louzada, Martha. "Evaluating Risk of Recurrent Venous Thromboembolism During the Anticoagulation Period in Patients with Malignancy." Thesis, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19827.
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Background - Current guidelines suggest that all cancer patients with venous thrombosis be treated with long-term low molecular weight heparin. Whether treatment strategies should vary according to clinical characteristics remains unknown. // Systematic review -
A systematic review was performed to determine current understanding of the association between malignancy characteristics in patients with cancer-associated VTE and the risk of VTE recurrence. Four retrospective and 6 prospective studies were included. They suggest that lung cancer, metastases, and adenocarcinomas confer an increased the risk of recurrence and breast cancer a low risk. // Survey - I performed survey to evaluate thrombosis experts’ opinion about the low risk of VTE recurrence they would consider acceptable for patients with cancer- associated thrombosis 103 specialists participated. 80% of respondents agreed that a risk of recurrent VTE during anticoagulation below 7% is low enough. 92% agreed that a CPR that categorizes risk of recurrence is relevant. // Retrospective Study - I performed a single retrospective cohort study to assess the feasibility of derivation of a CPR that stratifies VTE recurrence risk in patients with cancer–associated thrombosis. The study included 543 patients. A multivariate analysis selected female, lung cancer and prior history of VTE as high risk predictors and breast cancer and stage I disease as low risk. // Conclusion - Patients with cancer-associated thrombosis do have varying risks of recurrent VTE depending on clinical characteristics.
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Cullberg, Marie. "Direct Thrombin Inhibitors in Treatment and Prevention of Venous Thromboembolism: Dose – Concentration – Response Relationships." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Universitetsbiblioteket [distributör], 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6872.
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Sabapathy, Christine A. "A population based cohort study: the epidemiology of pediatric venous thromboembolism in Quebec, Canada." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121104.
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Background: Pediatric venous thromboembolism (VTE), although rare, is associated with significant morbidity and mortality. Published incidence and recurrence rates in children vary widely with incidence rates ranging from 0.07 to 0.49 VTE per 10 000 children/year and recurrence risks ranging from 5.5% to 18.5%. There is currently a paucity of studies evaluating temporal incidence trends, as well as risk factors for recurrence. Objectives: To describe the age-adjusted incidence rate of pediatric VTE and its trend over time, to determine VTE recurrence rate and overall all-cause mortality following VTE, and to determine predictors of VTE recurrence and all-cause mortality. Methods: A retrospective population-based cohort of all children (ages 1-17 inclusive) with a first time diagnosis of VTE in the province of Quebec between January 1st, 1994 and December 31st, 2004 was obtained from a comprehensive administrative hospital database (Med-Echo). Provincial census estimates were used to calculate age-standardized incidence rates (IR) of pediatric VTE. The incidence rate trend was then analyzed over the eleven-year study period using Poisson linear regression with time as both a continuous (yearly) and categorical (time periods) variable. Rate of VTE recurrence and all-cause mortality were determined. Univariate Cox-proportional hazards models and log rank testing were used to assess which risk factors would be incorporated into the final multivariate Cox-proportional hazards model evaluating risk of VTE recurrence and all-cause mortality. Results: In total, 487 incident cases of VTE in children 1-17 years of age were documented. Based on the estimated provincial census person-years during the study period, the age-standardized IR was 0.29 VTE per 10 000 person-years (95% confidence interval (CI) 0.26-0.31). Females had a statistically significant higher VTE incidence rate (per 10 000 person-years) than males, 0.37 and 0.21 per 10 000 person-years, respectively with an incidence rate ratio comparing females to males, adjusted for age group of 1.75 (95% CI 1.46-2.10). Trend analysis showed no statistically significant change in the age-standardized IRs over the 11-year period. The VTE recurrence rate was 2.77 (95% CI 2.2-3.4) per 1000 person-months (overall risk of 16%). Recurrence was associated with the presence of a chronic disease, defined as a diagnosis of inflammatory bowel disease, cystic fibrosis, lupus, sickle cell disease or nephrotic syndrome, (hazard ratio (HR) 2.3; 95% CI 1.2-4.3), presence of a central vascular line at time of initial VTE (HR 1.9; 95% CI 1.0-3.3) and portal vein thrombosis as the initial VTE presentation (HR 4.1; 95% CI 1.5-11.0). Overall all-cause mortality was 6.4%, hazard modeling of known risk factors for VTE was inconclusive for mortality. Conclusions: Pediatric VTE is more frequent than previously described, however its incidence appears to be stable over time. Females are more prone to VTE than males in this age group. Risk of recurrence in our cohort is at the higher end of previously reported values, and is higher in those with a pre-existing chronic illness, central vascular line or with an initial diagnosis of portal vein thrombosis. All-cause mortality was lower in our cohort than previous large studies of VTE in this age group. Our findings highlight the need for future studies to address sex differences in the incidence of pediatric VTE to help determine effective primary thromboprophylaxis strategies in children at high risk for VTE, as well as determine effective secondary prophylaxis strategies in children at high risk for VTE recurrence.Introduction: La thromboembolie veineuse (TEV) pédiatrique est un phénomène rare mais dont les séquelles peuvent être dramatiques. Selon la littérature, l'incidence est estimée entre 0.07 et 0.49 TEV par 10 000 enfants/année et la risque de récidive se situe entre 5.5 et 18.5%, toutefois, la qualité et le nombre d'études concernant le sujet demeure un facteur limitatif pour une meilleure compréhension de cette complication. Objectifs: Décrire le taux d'incidence de la TEV pédiatrique selon l'age ainsi que la tendance dans le facteur temps; de déterminer le taux de récidive ainsi que décrire les facteurs de risque de récidive et de mortalité. Méthodologie: En utilisant la base de données Med-Écho, une cohorte rétrospective des enfants âgés entre 1-17 ans (inclusif) avec un diagnostic d'un première TEV dans la province de Québec entre le 1 janvier 1994 et la 31 décembre 2004 a été établi. Une estime basée sur le résultat des recensements provinciaux a été utilisée pour standardiser et calculer les taux d'incidence. Le taux décrit annuellement et en trois catégories de temps, a été évalué en utilisant la méthode de Régression Linéaire Poisson pour établir si une tendance existe. Le taux de récidive et de mortalité ont été détermines et une analyse univariable du modèle de Cox et le « Log Rank » ont été utilises pour établir quels facteurs de risque seront incorporés dans le modèle finale de multivariable de Cox.Résultats: Au total, nous avons observé 487 épisodes de TE chez des enfants âgés entre 1 et 17 ans. Le taux d'incidence de TEV pédiatrique ajusté pour la distribution d'age de la population, calculé en utilisant des estimations basées sur les recensements provinciaux, est de 0.29 TEV par 10 000 personnes-années (intervalle de confiance à 95% (IC) 0.26-0.31). Le taux d'incidence ajusté pour variation en catégories d'age des femmes comparativement aux hommes est 1.75 fois plus élevé (IC à 95% 1.46-2.10) et est statistiquement significatif, avec des taux respectifs de 0.37 et 0.21 par 10 000 personnes-années. L'analyse de l'incidence de TEV pédiatrique entre 1994-2004 ne démontre aucune différence significative pendant cette période. Le taux de récidive est de 2.77 (IC à 95% 2.2-3.4) par 1000 personnes-mois (risque de 16%). La récidive est associée avec le diagnostic d'une maladie chronique, incluant la maladie inflammatoire intestinale, la fibrose kystique, l'anémie falciforme, le lupus, et le syndrome néphrotique (le hazard ratio (HR) 2.3; IC à 95% 1.2-4.3), la présence d'une ligne centrale (HR 1.9; IC à 95% 1.0-3.3) ainsi qu'une une thrombose du système portal comme premier épisode de TEV (HR 4.1; IC à 95% 1.5-11.0). La mortalité à tout cause est 6.4%, estimation de HR pour plusieurs facteurs de risque par modèle de Cox hazard était indécisif. Conclusion: Le TEV pédiatrique est plus fréquente que la littérature ne le suggère, et sa tendance ne semble pas avoir change entre 1994 et 2004. Les femmes semblent avoir une incidence accrue par rapport aux hommes dans ce groupe. Le taux de récidive dans notre cohorte se situe à la limite supérieure des résultats des études précédentes. Le taux de récidive est plus élevé chez les enfants atteints d'une maladie chronique, avec une ligne centrale ou un diagnostic initial de TEV du système portal. La mortalité de notre cohorte est inferieure à ce que la littérature suggère. Nos résultats soulignent la nécessite d'entreprendre de nouvelles études afin de déterminer l'usage de prophylaxie chez les enfants a haut risque de TEV et/ou de récidive.
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Yamashita, Yugo. "Anticoagulation Therapy for Venous Thromboembolism in the Real World ― From the COMMAND VTE Registry ―." Kyoto University, 2019. http://hdl.handle.net/2433/242354.
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Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133529.
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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxisDieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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Li, Lingyi. "Trends of venous thromboembolism risk before and after diagnosis of gout : a population-based study." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63308.
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The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.Medicine, Faculty of
Experimental Medicine, Division of
Medicine, Department of
Graduate
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Duff, Jed. "Preventing venous thromboembolism in hospitalised patients: Using implementation science to close the evidence-practice gap." Thesis, Australian Catholic University, 2013. https://acuresearchbank.acu.edu.au/download/9fa510751053dabf1957f36668e1740def276085ee8cef2a8fc93695da179520/9603440/64851_downloaded_stream_76.pdf.
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Venous thromboembolism (VTE) is the umbrella term covering deep vein thrombosis, pulmonary embolism and a group of associated chronic conditions. This vascular disease process is a common, yet serious adverse complication of hospitalisation that results in significant mortality, morbidity, and healthcare resource expenditure. VTE in hospitalised patients is preventable and there is a robust evidence base supporting the use of prophylactic therapies for at-risk patients. Unfortunately, despite the evidence, research and clinical audit reveal that these therapies are frequently underutilised or inconsistently applied. The substantial VTE prevention evidence-practice gap has been identified internationally as a priority patient safety issue. Implementation science is a relatively new field of research focused on closing evidence-practice gaps by translating research findings into routine clinical practice. This PhD thesis contains five publications from a linked series of four implementation science studies aimed at improving the uptake of research evidence on VTE prevention in hospitalised patients. The studies were conducted at St Vincent?s Private Hospital, a 270 bed acute care facility in Sydney, Australia.
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Lattimore, Lois Eileen. "Factor V Leiden, Prothrombin G20210A, and MTHFR C677T Polymorphisms in Cancer Patients with Venous Thromboembolism." Diss., The University of Arizona, 2010. http://hdl.handle.net/10150/193768.
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Intro/Aims: Venous thromboembolism (VTE) is a common complication in cancer patients. The role of thrombophilic polymorphisms in cancer related VTE remains poorly explored. Aim 1 of this study was to determine if Factor V Leiden (G1691A), Prothrombin (PT) G20210A or methylenetetrahydrofolate reductase (MTHFR) C677T are associated with the increased occurrence of VTE in adult oncology subjects compared to nononcology subjects. Aim 2 of this study was to determine if cancer patients with the MTHFR C677T polymorphism who are treated with antimetabolite therapy have an increased incidence of VTE compared to cancer patients who are treated with other chemotherapy.Setting/Methods: A descriptive, comparative, retrospective chart analysis was utilized for this study in an outpatient hematology, oncology clinic in Southern Arizona. Enrolled were 100 adult subjects (age 18 - 85) with documented history of VTE (27 subjects with cancer and 73 noncancer). Subjects were evaluated for Factor V Leiden, PT G20210A, and MTHFR C677T prior to the study. Eleven subjects were treated with antimetabolite chemotherapy and 8 subjects were treated with other chemotherapy.Results: The overall polymorphism frequency for Factor V Leiden was 21%, PT G20210A 4%, and MTHFR C677T 50%. Factor V Leiden was found in 11.1% of cancer subjects and 24.7% of noncancer subjects. Prothrombin G20210A was found in 3.7% of cancer subjects and 4.1% of noncancer subjects. MTHFR C677T was present in 25.9% of cancer subjects and 58.9% of noncancer subjects. No statistical significance was observed between subjects treated with an antimetabolite and positive for MTHFR C677T compared with those treated with other types of chemotherapy.Conclusion: Analysis of the data collected in this study demonstrated overall higher rates than the expected frequencies of all polymorphism for both the cancer and noncancer patients with documented VTE. In this small retrospective study, the only significant finding was that the MTHFR C677T polymorphism was more prevalent in the noncancer group.Currently, there are no specific guidelines for VTE prevention in the outpatient oncology setting. Identification of risk factors, including prothrombotic mutations may reduce risk of VTE and provide guidance for prophylactic treatment recommendations in the outpatient setting.
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Betancourt, Marisol. "Derivation and internal validation of a clinical prediction rule to identify patients with low risk of recurrent venous thromboembolism who can discontinue oral anticoagulants after five to seven months of treatment for unprovoked venous thromboembolism." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27813.
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Background. Whether to continue or to discontinue oral anticoagulation therapy (OAT) after 6 months of treatment to prevent recurrent or fatal events in unprovoked VTE patients is currently controversial. We sought to develop and internally validate a clinical prediction rule (CPR) to identify patients at low risk of recurrent VTE (at most 3% annual risk) for whom OAT could be safely discontinued.
Methods. Univariate and multivariate analysis techniques were used to identify the best set of predictor variables.
Results and conclusions. We derived and internally validated a CPR for females comprised of D-Dimer over 250 ug/L, post-thrombotic signs present, older age (over 65 years) and obesity (BMI over 30 kg/m2). Women with one or none of the four aforementioned clinical predictors had an annual risk of recurrent VTE of 1.6% and may be able to discontinue OAT. None of the models for males was shown to be safe.
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Kanzow, Gesche. "Thromboseprophylaxe bei Palliativpatienten in Deutschland." Doctoral thesis, Niedersächsische Staats- und Universitätsbibliothek Göttingen, 2013. http://hdl.handle.net/11858/00-1735-0000-000D-F1B8-7.
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Bricola, Solange Aparecida Petilo de Carvalho. "Avaliação dos fatores associados a tromboembolismo pulmonar (TEP), em uma série de autópsias de dez anos." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5159/tde-05032010-172410/.
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INTRODUÇÃO: A literatura demonstra que tromboembolismo venoso permanece como uma doença subdiagnosticada entre os pacientes hospitalizados, com aproximadamente 25% dos casos associados à internação. OBJETIVOS: Avaliar as doenças associadas ao desenvolvimento de tromboembolismo pulmonar (TEP) diagnosticado em autópsias, e demonstrar a frequência de TEP como causa do óbito ou fator contributivo. MÉTODOS: Estudo caso-controle retrospectivo, realizado no Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 1995 a 2004. Revisamos os relatórios diagnósticos das autópsias, identificando TEP fatal, quando TEP foi a causa de morte, e TEP não fatal, quando TEP foi doença associada. RESULTADOS: 1.506 pacientes (502 casos e 1.004 controles), 18.359 óbitos no período, média 2.040; 71,2% desses submetidos a autópsias. Observou-se importante declínio nas taxas de autópsias. De 1995-1999 (87,2%) e 2000-2004 (54,4%); p = 0,016. Dos 502 casos (3,8%), em 328 (2,5%) TEP foi causa de morte e 174 (1,3%), causa contributiva. Gênero: 51,6% homens e 48,4% mulheres. Idade: TEP fatal (328) vs controles (1.004), diferença estatisticamente significativa (p = 0,013). Condições prevalentes: câncer grupo, 31,4%, pós-operatório grupo, 17,2%, infecção grupo, 11,7%, e AVC grupo, 11%. Câncer de pulmão, 3,5%, câncer de cérebro e linfoma, 2,8%. Tempo de internação foi utilizado como indicador de imobilização. Outras doenças: AVCH (7,7%), pós-operatório de abdome (6,7%), pneumonia (5,9%), AVCI (3,1%) e pós-operatório vascular (4%) foram frequentes no grupo controle. Em contrapartida, aterosclerose (1,4%), ITU (1,2%), pós-operatório de ginecologia (0,8%), pós-operatório de obstetrícia (0,6%) e doença falciforme (0,6%) foram frequentes no grupo TEP. Cirrose, média de 14,9 dias de internação dos controles vs TEP com 4,4 dias (p < 0,001). Análise multivariada incluiu as condições com p 0,20 da univariada, idade e tempo de internação. Fator protetor para TEP: aneurisma de aorta (OR 0,02, IC 95% 0,46-0,56; p = 0,004), cirrose (OR 0,16, IC 95% 0,08-0,34; p < 0,001) e SIDA (OR 0,44, IC 95% 0,23-0,84; p = 0,013). Entretanto, AVCI (OR 1,82, IC 95% 1,04-3,19; p = 0,035), câncer de cérebro (OR 2,47, IC 95% 1,28-4,78; p = 0,007), câncer indeterminado (OR 3,12, IC 95% 1,01-9,68; p = 0,049), DPOC (OR 2,83, IC 95% 1,47-5,43; p = 0,002), ICC (OR 1,71, IC 95% 1,11-2,62; p = 0,015) e ITU (OR 4,34, IC 95% 1,05-17,82; p = 0,042) mostraram associação positiva com TEP. Idade vs TEP (OR 1,10, IC 95% 1,04-1,16; p = 0,001). Tempo de internação vs TEP (OR 1,19, IC 95% 1,05-1,36; p = 0,008). DISCUSSÃO: A porcentagem dos pacientes com TEP permanece inalterada, ocorrência de 4,1% e 3,4% no primero e no segundo períodos, com uma média de 3,8%. Em 50,4% dos pacientes não foi realizado o diagnóstico clínico de TEP. CONCLUSÃO: Constatou-se AVCI, câncer de cérebro indeterminado, DPOC, ICC e ITU com significância estatística e associação com TEP. Algumas fraquezas do presente estudo devem ser apuradas, e talvez explicarão as discordâncias com a literatura para algumas doenças. A identificação de fatores associados a TEP auxiliarão no diagnóstico precoceINTRODUCTION: Literature shows that venous thromboembolism (VTE) remains as a sub-diagnostic disease among hospitalized patients, approximately 25% of all cases are associated to hospitalization. PURPOSE: Evaluate diseases associated to pulmonary thromboembolism (PE) development diagnosed in autopsies, and demonstrate the frequency of PE as cause of death or as a contributive factor. METHOD: The reports performed from 1995 to 2004 in a Brazilian tertiary referral medical school we reviewed for a retrospective study the autopsies diagnosis, identified as fatal PE, when PE was the cause of death and nonfatal PE, when PE was an associated disease. RESULTS: 1,506 patients (502 cases and 1004 controls), 18,359 deaths during the period, average 2,040; 71.2% of these were submitted to autopsies. It was observed an important decline in the autopsies rates. From 1995-1999 (87.2%) and 2000-2004 (54.4%) p = 0.016. From 502 cases (3.8%), 328 (2.5%) PE was the cause of death and 174 (1.3%) PE was contributive cause. Gender: 51.6% males and 48.4% females. AGE: fatal PE (328) vs controls (1,004) significant statistic difference (p = 0.013). Prevalent Conditions: cancer group, 31.4%, postsurgical group, 17.2%, infectious group, 11.7%, and CVA group, 11%. Pulmonary Cancer, 3.5%, Brain cancer and Lymphoma, 2.8%. Hospitalization period was taken as immobilization indicator. Other diseases: HCVA (7.7%), abdomen postsurgical (6.7%), pneumonia (5.9%), ICVA (3.1%) and vascular postsurgical (4%) were frequent in the control group. On the other hand, atherosclerosis (1.4%), UTI (Urinary Tract Infection) (1.2%), gynecology postsurgical (0.8%), obstetrics postsurgical (0.6%) and sickle cell anemia (0.6%) were frequent in the PE group. Cirrhosis, average of 14.9 hospitalization days of the controls vs PE with 4.4 days (p < 0.001). Logistic regression analysis includes the in univariated analysis with p 0.20, age and the hospitalization period. Protector factor for PE: Aortic aneurysm (OR 0.02, 95% CI 0.46-0.56; p = 0.004), cirrhosis (OR 0.16, 95% CI 0.08-0.34; p < 0.001) and SIDA (OR 0.44, 95% CI 0.23-0.84; p = 0.013). However, ICVA (OR 1.82, 95% CI 1.04-3.19; p = 0.035); brain cancer (OR 2.47, 95% CI 1.28-4.78; p = 0.007); undetermined cancer (OR 3.12, 95% CI 1.01-9.68, p= 0.049), COPD (OR 2.83, 95% CI 1.47-5.43; p = 0.002), CHF (OR 1.71, 95% CI 1.11-2.62; p = 0.015) and UTI (OR 4.34, 95% CI 1.05-17.82; p = 0.042), showed positive association with PE. Age vs PE (OR 1.10, 95% CI 1.04-1.16; p = 0.001). Hospitalization Period vs PE (OR 1.19, 95% CI 1.05-1.36; p = 0.008). DISCUSSION: The percentage of patients with PE remains unchanged, occurrence of 4.1% and 3.4% in the first and second periods, with an average of 3.8%. In 50.4% of the patients, the clinical diagnosis of TEP was not performed. CONCLUSION: We certified ICVA, brain cancer, undetermined cancer, COPD, CHF and UTI with significant association with PE. Some weaknesses of the present study should be refined, and maybe will explain the disagreement with the literature to some diseases. The identification of factors associated to PE will help in precocious diagnosis
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van, Rooijen Marianne. "Effects of combined oral contraceptives on hemostasis and biochemical risk indicators for venous thromboembolism and atherothrombosis /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-089-3/.
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Lucchesi, Patrik. "Identification of risk factors contributing to venous thromboembolism by Ion Torrent sequencing using an AmpliSeq strategy." Thesis, Högskolan Kristianstad, Sektionen för lärande och miljö, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-17128.
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Venous thromboembolism (VTE) is a common cardiovascular disease that frequently recurs and is associated with significant numbers of death annually. The influence of the hereditary risk factors is not yet firmly established but twin and family studies suggest that heritability is about 50%. Several genetic risk factors have been identified by genomeHwide association studies (GWAS) but they do not explain all of the missing heritability of VTE. NextHgeneration sequencing (NGS) has revolutionized the genetic analysis of disease and has been used to discover the genes underlying unsolved Mendelian disorders. It has also been used to identify rare alleles which may help explain the missing heritability for complex diseases. The study population of this study consisted of 32 randomly chosen VTE patients from the MATSHstudy (Malmö Thrombophilia Study). The seventeen genes that in earlier studies have been shown to be associated with VTE were examined and the identified VTEHrelated mutations were compared to the general population. The results showed that Ion TorrentHsequencing effectively provided good coverage and read depth in all of the sequenced genes. Optimization of the primer panels resulted in higher and more balanced coverage and the quality of the results in this study was on an overall high level. A total of 215 variants were detected – 62 in exons, 8 in splice and 145 in introns. One Mendelian mutation was detected in PROC and rare variants were found in F2 and FGG. The most common risk factor (F5 Leiden) was highly enriched with 25% in this study compared to 3% in a background population.Venös tromboembolism (VTE) är en vanlig, ofta återkommande, kardiovaskulär sjukdom som associeras med åtskilliga dödsfall årligen. De ärftliga riskfaktorernas påverkan är inte fullständigt kartlagda ännu men tvillingH och familjestudier antyder att ärftligheten kan vara runt 50%. Ett flertal genetiska riskfaktorer har identifierats genom genome$wide association studies (GWAS) men de förklarar inte hela den saknade ärftlighetskomponenten för VTE. NästaHgenerationsHsekvensering (NGS) har revolutionerat den genetiska sjukdomsanalysen och har använts för att upptäcka de gener som ligger bakom tidigare olösta Mendelska sjukdomstillstånd. Man har även använt NGS för att identifiera rara alleler som kan hjälpa till att förklara de saknade ärftlighetskomponenterna för nedärvning av komplexa sjukdomar. Studiepopulationen I den här undersökningen utgjordes av 32 slumpmässigt utvalda VTEHpatienter från Malmö Thrombophilia Study (MATS). De sjutton gener som I tidigare studier har visat sig vara associerade med VTE undersöktes och de identifierade VTEHrelaterade mutationerna jämfördes med en normalpopulation. Resultaten visade att Ion TorrentHsekvensering ger bra täckningsgrad och läsdjup i alla de sekvenserade generna. Optimering av primerHpanelerna resulterade i en mer balanserad täckningsgrad och resultatkvaliteten i den här studien var på en generellt hög nivå. Totalt 215 varianter detekterades – 62 i exon, 8 i splice och 145 i introner. En Mendelsk mutation detekterades I PROC och rara varianter hittades i F2 och FGG. Den starkaste och vanligaste riskfaktorn (F5 Leiden) var högt anrikad i den här studien med 25% jämfört med 3% i en bakgrundspopulation.
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Reese, Stephen Waters. "The incidence of venous thromboembolism and pharmacologic thromboprophylaxis following major urologic surgery: a population-based analysis." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12202.
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Thesis (M.A.)--Boston UniversityINTRODUCTION: The incidence of symptomatic venous thromboembolism (VTE), which comprises deep venous thrombosis (DVT) and pulmonary embolism (PE) at a population-based level remains unknown in patients undergoing major urologic surgery. Our aim was to determine the incidence of VTE in major urologic surgery, identify patients who are at high risk for developing these events, and to examine whether the use of pharmacologic thromboprophylaxis is associated with a reduction in the incidence of VTE in major urologic surgery. METHODS: We captured all adult patients who underwent major urologic surgery between January 2005 and December 2010 based on 1CD-9-CM codes from the Perspective Database (Premier, Inc, Charlotte, NC), a nationally representative dataset capturing 25% of US hospital discharges. Major urologic surgery was defined as a radical prostatectomy, radical cystectomy, radical nephrectomy or partial nephrectomy. We used ICD-9-CM codes to identify VTE and major bleeding after major urologic surgery within 90 days after the procedure and hospital billing descriptions to identify if patients had received pharmacologic thromboprophylaxis beginning the day of surgery. Univariate and multivariate analyses were performed using STATA 12 (StataCorp LP, CollegeStation, Texas) after adjusting for sample weights. [TRUNCATED]
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Montroy, Joshua. "Lysine Analogue Use and Thromboembolic Risks: An Evidence Based Analysis." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37181.
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Allogenic blood transfusions, although potentially life-saving, are associated with increased risk of infection, fluid overload, thrombosis, and death. Minimizing exposure to blood products is important for patients and the healthcare system. Antifibrinolytic lysine analogues are effective antihaemorrhagic agents used for the reduction of blood loss and subsequent need for transfusion. However, the pharmacologic mechanism of decreased clot breakdown would suggest the medications should increase the risk of venous thromboembolic adverse events. Trials of lysine analogue administration are often underpowered to detect the effect of these medications on thrombotic events. As lysine analogue use increases for blood loss reduction, there is an important need for research dedicated to the safety of lysine analogues, especially in patients who are at highest risk of venous thromboembolism.
Through systematic review and meta-analyses, we investigated the use of lysine analogues in cancer patients, where VTE is particularly prevalent. We identified that only a small number of trials have been performed in cancer patients. Among available data, similar reduction of transfusion was observed in cancer patients treated with lysine analogues compared to non-cancer patients. However, we also found that existing data was grossly underpowered to determine the effect of lysine analogues on risk of VTE (Peto odds ratio (OR) 0.60; 95% CI 0.28-1.30).
By administering lysine analogues topically, as opposed to intravenously, systemic absorption of the drug may be limited, and the occurrence of unwanted side-effects may be minimized. We also reviewed the published literature to determine if there was sufficient evidence to support topical application of tranexamic acid. Topically applied tranexamic acid effectively reduces both transfusion risk and blood loss and no increased risk of VTE events was observed (pooled OR=0.78, 95% CI 0.47 to 1.29). However, none of these studies included cancer patients and the vast majority of the trials were in orthopedic surgery.
Lastly, we sought to determine the extent to which lysine analogues are currently used at a large tertiary care academic institution. In addition, we explored which factors influenced lysine analogue use, and areas of informational or study need. Surgeons reported low lysine analogue use, and the timing of administration varied considerably. Many surgeons (66%) believed a clinical trial was needed to demonstrate the efficacy of lysine analogues in their respective surgical field, and 59% felt a trial was needed to demonstrate that the medication was safe in their patient population.
We confirmed that there are only a few studies evaluating the effect of lysine analogues in cancer patients and that many surgeons are concerned about the safety profile of these medications. Surgeons may feel more comfortable administering these agents topically as opposed to intravenously, and while this may be a safer option, there has been limited evaluation of this approach outside of orthopedic procedures.
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La, Terza Tassiana. "Avaliação do nível de profilaxia para tromboembolia venosa em uma unidade de terapia intensiva." Botucatu, 2018. http://hdl.handle.net/11449/154909.
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Orientador: Hugo Hyung Bok YooResumo: Introdução: O Tromboembolismo Venoso (TEV) inclui a trombose venosa profunda (TVP) e a tromboembolia pulmonar (TEP), que são doenças com causa de óbito hospitalar evitável mais comum, principalmente em pacientes críticos sejam eles cirúrgicos ou clínicos. Objetivo: Analisar o nível de profilaxia de TEV em pacientes na Unidade de Terapia Intensiva (UTI) por afecções clínicas e cirúrgicas. Verificar fatores clínicos associados ao desenvolvimento de TEV na UTI e diminuir a escassez de estudos na literatura que avaliem as práticas de profilaxia de TEV em UTI no Brasil. Métodos: estudo transversal observacional de caráter descritivo realizado através de análise de prontuários eletrônicos. Participaram pacientes internados na UTI durante o período de março de 2016 a março de 2017 e tiveram seus riscos de tromboembolismo venoso estratificado segundo a 9ª Diretriz para Profilaxia do TEV do American College of Chest Physicians (ACCP). A adequação da tromboprofilaxia foi determinada de acordo com a concordância entre a conduta instituída e a conduta preconizada nas diretrizes. Resultados: Dos 182 pacientes analisados, 60% foram do sexo feminino. A idade média foi de 61,8 ± 18,0 anos, sendo 77% dos pacientes com idade maior que 50 anos. A idade média dos pacientes cirúrgicos foi significativamente maior em relação aos clínicos e dos pacientes do estudo (p=0,046), assim como tempo de internação hospitalar (p= 0,005) e na UTI (p= 0,010) também foi significativamente maior nos cirúrgicos. ... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre
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Rocha, Ronilson Gonçalves. "Prevenção de riscos de tromboembolismo venoso: estratégias para redução da morbimortalidade." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=6649.
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Estudo prospectivo com abordagem quantitativa envolvendo 3 grupos distintos de sujeitos. Grupo 1 constituído por 56 pacientes avaliados para o risco de tromboembolismo venoso (TEV) em um acompanhamento de 30 meses para verificar os desfechos morte, reinternação e profilaxia de TEV. Grupo 2 constituído por 50 enfermeiros assistenciais que responderam questionários sobre TEV, com o propósito de avaliar seus conhecimentos sobre os riscos e profilaxia dessa doença em pacientes clínicos internados. Grupo 3 constituído por 100 enfermeiros assistenciais que responderam questionários similares aos respondidos pelo grupo 2, antes e após treinamento sobre profilaxia de TEV. O objetivo geral foi verificar o grau de conhecimento de enfermeiros sobre tromboembolismo venoso considerando sua inserção no processo de prevenção de riscos; Os objetivos específicos foram: propor e implantar uma estratégia de treinamento para capacitação de enfermeiros no rastreamento de riscos de TEV em pacientes internados; verificar o impacto do treinamento sobre TEV no conhecimento dos enfermeiros para identificação de fatores de risco dessa doença; descrever os desfechos relacionados à TEV em pacientes internados por mais de 24 horas em um hospital quaternário num seguimento de 30 meses. No grupo 1 identificou-se que o evento TEV apresenta alta mortalidade 63,6% para pacientes que não receberam profilaxia. Identificou-se também que a maioria 89,2% desses sujeitos é acompanhada de seus médicos, 53,6% passaram por reinternações e 28,6% continuam usando alguma profilaxia para TEV. No grupo 2 verificou-se que os profissionais não sabem identificar corretamente os fatores de risco para TEV, havendo grande déficit de conhecimento em relação aos fatores de risco e profilaxia da doença, pois 90% da amostra não consegue apontar mais que 5 fatores de risco para TEV considerando-se 24 fatores contemplados por consensos internacionais, demonstrando um grau de conhecimento insuficiente pela utilização de uma escala intervalar proposta nesse estudo. No grupo 3, assim como identificado no grupo 2, houve similaridade no déficit de conhecimento, pois 100% não conseguiram apontar mais que 4 fatores de risco para a doença. Identificou-se que a realização de um treinamento sobre profilaxia de TEV para esses enfermeiros apresenta alto impacto em relação ao grau de retenção de informações sobre TEV, sendo uma ação facilmente replicável para profissionais de instituições hospitalares. Concluiu-se que o uso de um algoritmo/protocolo de avaliação voltado para rastreamento de riscos de TEV por enfermeiros representa uma ferramenta importante no processo de rastreamento e prevenção dessa doença em pacientes clínicos, como proposto nesse estudo, pois nos resultados demonstrou-se que 97% dos enfermeiros do grupo 3 não conhecem qualquer tipo de protocolo relacionado a prevenção de riscos de TEV. Os sujeitos apresentaram excelente nível de conhecimento sobre meios de profilaxia mecânica, mas identificou-se que a maioria 63% nunca deu orientações sobre a profilaxia enquanto cuidam, reforçando o entendimento de que não estão inseridos no processo de prevenção de riscos de TEV para pacientes internados. A inserção dos enfermeiros nesse processo de identificação de riscos deve ser capaz de reduzir a alta taxa de morbimortalidade e reduzir a incidência dessa doença em unidades hospitalares.This was a prospective quantitative study involving 3 distinct subject groups. Group 1 consisted of 56 patients evaluated for the risk of venous thromboembolism (VTE) in a 30-month follow-up. The outcomes of interest were death, rehospitalization and VTE prophylaxis. Group 2 consisted of 50 assistential nurses who answered VTE questionnaires with the purpose of evaluating their knowledge regarding risks and prophylaxis of VTE in hospitalized nonsurgical patients. The third group consisted of 100 assistential nurses who answered similar questionnaires, before and after VTE prophylaxis training. The general objective of this study was to verify nurses knowledge degrees about VTE considering their immersion in the process of risk prevention. Specific objectives were: to propose and implement a training strategy to capacitate nurses on VTE risk screening in hospitalized patients; verify the training impact about VTE on their knowledge to correctly identify VTE risk factors; to describe the VTE related outcomes in patients admitted for more than 24 hours in a quaternary hospital during a 30-month follow-up. In group 1, VTE event presented high mortality 63.6% in patients who did not receive prophylaxis. Moreover, many of these subjects 89.2% had been followed up by their physicians, 53.6% had been rehospitalized at some point and 28.6% had been taking VTE prophylaxis. In group 2, it was verified that nursing staff did not know how to correctly identify VTE risk factors, establishing considerable knowledge deficit related to VTE risk factors and prophylaxis. In view of the fact that 90% of the sample could not recognize more than 5 of the 24 risk factors stated by international consensus, it was demonstrated an insufficient knowledge degree according to the interval scale used in this study. In group 3, similarly to group 2, there was knowledge deficit related to VTE, since 100% of the group could not recognize more than 4 risk factors. After a VTE prophylaxis training, it was identified that this training provides high impact on the degree of information retention about VTE by the subjects, and this action is easily replicable in hospital institutions. It was concluded that the use of an evaluation algorithm/protocol about VTE risk screening by nurses could be an important tool to screen and prevent VTE in nonsurgical patients, which was the purpose of this study, given that the results showed that 97% of group 3 did not know any VTE risk prevention protocol. The subjects had excellent knowledge levels about mechanical prophylaxis, but it was identified that most of them 63% never gave orientations about prophylaxis during patient care, emphasizing the understanding that they are not fully engaged in the process of VTE risk prevention in hospitalized patients. The immersion of nurses in the process of identifying VTE risks must be capable of reducing the high VTE incidence and mortality and morbidity rates in hospital unities.
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Oller, Grau Maria del Mar. "Responsabilidad profesional y seguridad clínica en el tromboembolismo venoso." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/405473.
Full textAbstract:
Introducción: La presencia de un Tromboembolismo Venoso (TEV), que surge de forma súbita durante el curso evolutivo de una enfermedad o en el postoperatorio de una cirugía, constituye no sólo un riesgo clínico, sino un riesgo médico-legal. Las reclamaciones por TEV y, a su vez, la responsabilidad profesional médica, está en estrecha relación con el uso correcto de la profilaxis. Entre los profesionales médicos existe un pobre conocimiento de la probabilidad de que sus pacientes puedan sufrir un TEV (con o sin profilaxis) tras un tratamiento concreto.
Hipótesis y Objetivos: La hipótesis principal del presente estudio es que el seguimiento de las guías de práctica clínica exime de la responsabilidad profesional médica. El objetivo principal es analizar todas las reclamaciones por TEV registradas en el Servicio de Responsabilidad Profesional del Colegio de Médicos de Barcelona. Esto nos permitirá obtener el perfil de las especialidades médicas o quirúrgicas que presentan mayor riesgo de reclamación, así como aquellas patologías más relacionadas o con mayor riesgo de reclamación por TEV. Conocer en profundidad las variables que afectan e influyen en las reclamaciones estudiadas. Analizar el seguimiento realizado por los facultativos de las guías de práctica clínica de profilaxis anti-trombótica. Permitirá conocer mejor el riesgo de reclamación por TEV, así como las consecuencias que se derivan y contribuir de esta manera a mejorar la práctica médica y seguridad clínica.
Material y métodos: La muestra está constituida por todos los expedientes abiertos en el Consejo de Colegios de Médicos de Cataluña, desde 1986 hasta 2014, resultantes de las reclamaciones judiciales y extrajudiciales como consecuencia de supuestas negligencias médicas tras un tromboembolismo venoso, obteniéndose una muestra total de 100 casos. La recogida de datos se llevó a cabo mediante extracción electrónica y la revisión de los expedientes fue presencial, de manera individual y pormenorizada. El análisis estadístico implicó dos fases; un análisis descriptivo de las variables registradas y el estudio de posibles asociaciones con la variable principal (responsabilidad) mediante un análisis bivariable y mulitvariable. En ambos análisis se siguió un diseño descriptivo de corte transversal utilizándose el paquete estadístico SPSS.
Resultados: Durante el período estudiado (1986-2014) se registraron 100 reclamaciones por TEV, 62 fueron por tromboembolismo pulmonar (8 de ellos también con trombosis venosa profunda –TVP–), 30 por TVP y 8 por trombosis venosa superficial. Hubo 24 casos con responsabilidad profesional médica. La especialidad con más reclamaciones fue la Traumatología. Según el motivo de reclamación, 43 casos eran pacientes de bajo riesgo en los que no se prescribió profilaxis pero aun así sufrieron un TEV, 25 casos de profilaxis correcta pero aun así TEV, 18 casos en los no se administro profilaxis y 9 casos con profilaxis pautada pero no bien administrada. En 73 de los casos se actuó según las guías clínicas, mientras que en 25 no hubo un correcto seguimiento de las guías. En el análisis estadístico, la variable responsabilidad se asoció significativamente al no seguimiento de las guías así como a la ausencia del uso de la profilaxis (p<0.05).
Conclusión: El no seguimiento de las guías junto con la no administración de heparina profiláctica son los factores que se relacionan más con la responsabilidad profesional médica en los casos de tromboembolismo venoso. Sin embargo, el seguimiento de las guías no exime de responsabilidad en caso de TEV. Para finalizar, es la profilaxis individualizada, y no la aplicación de protocolos, la que hace segura la práctica clínica y evita, al mismo tiempo, la responsabilidad profesional médica.Introduction: The presence of venous thromboembolism, which arises suddenly either during a disease or the postoperative period of surgery, stand for a clinical risk, as well as a medical-legal risk. In fact, the claims related to Venous Thromboembolism (VTE) and the medical professional responsibility are closely related to the correct use of prophylaxis. Among medical professionals there is a poor knowledge about the likelihood for their patients to go through a VTE (with or without prophylaxis) after a specific treatment. Hypothesis And Objectives: The main hypothesis of this study is that the correct adherence to the clinical practice guidelines exempts to the professional from medical responsibility. The objective is to analyse all the complaints related to VTE registered in the Professional Liability Department of the Medical College of Barcelona. This will allow us to know the profile of the medical or surgical specialties in greater risk for claim, as well as those pathologies linked to claim due to VTE. To know the variables affecting and influencing the claims under study. To analyse the grade of adherence of the clinicians to the clinical practice guidelines for antithrombotic prophylaxis. It will allow a better knowledge about the risk of claiming related to VTE and its derived consequences, helping to the improve of the medical practice and clinical safety. Material And Methods: The sample was all the cases registered at the Council of Medical Colleges of Catalonia from 1986 to 2014, deriving into judicial and extrajudicial claims because of alleged medical negligence following venous thromboembolism. A total of 100 cases were analysed. The data was extracted with electronic support and the review of the files was performed on-site, individually and fully detailed. Statistical analysis was performed in two phases; first one, a descriptive analysis of the variables, followed by the study through a bivariate and multivariable analysis of possible associations with the main variable (responsibility). In both analyses a descriptive cross-sectional design was followed using the SPSS statistical package. Results: From 1986 to 2014, a total of 100 medical claims related to VTE were registered, 62 were related to pulmonary thromboembolism, 8 of them with deep venous thrombosis (DVT) associated, 30 cases of DVT and 8 cases of superficial venous thrombosis. In 24 cases the medical professional responsibility was demonstrated. The specialty with more complaints was Traumatology. According to the chief reason for complaint, 43 cases occurred in low-risk patients with no prophylaxis prescribed but VTE was present, 25 cases of correct prophylaxis but with VTE, 18 cases with no prophylaxis administered and 9 cases with prophylaxis not well managed. Professionals acted according the guidelines in 73 of the cases, while in 25 there was no correct adherence to the guidelines. In the statistical analysis, the variable liability was significantly associated with non-adherence to the guidelines, as well as the absence of the use of prophylaxis (p <0.05). Conclusion: Non-adherence to the guidelines along with the non-administration of prophylactic heparin are the factors mainly related to medical professional responsibility in cases of venous thromboembolism. However, the correct adherence to the guidelines does not exempt to the physician from liability in case of VTE. Finally, the individualized prophylaxis and not the application of the protocols makes safe to the clinical practice and at the same time avoid medical professional responsibility.
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Montgomery, Colin Jaco. "Retrospective review of the incidence of venous thromboembolism in pregnancy and the puerperium and identification of presenting complaints of pregnancy-related venous thromboembolism at Groote Schuur Maternity Centre, Cape Town between 1 January 2016 and 31 December 2016." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31764.
Full textAbstract:
Background: Venous thromboembolism is one of the leading causes of morbidity and mortality around the world. In addition to the immediate morbidity, there is significant implications on delivery plans, future options of contraception and thromboprophylaxis in subsequent pregnancies. At present, no pre-test probability assessments are being used to predict venous thromboembolism in pregnancy. This is the first study in South-Africa, addressing venous thromboembolism in the perinatal period which specifically examines the epidemiology and clinical presentation in pregnancy and the post-partum period. Objectives: To determine the incidence of venous thromboembolism in Groote Schuur Maternity Centre and to identify specific variables in the clinical presentation that had a predictive value of a thromboembolic event. Methods: A quantitative, retrospective study with a descriptive comparative research design, for a twelve-month period from January 2016 to December 2016. All pregnant and postpartum patients who were sent for a venous duplex ultrasound, ventilation perfusion study or computerized tomography pulmonary angiogram from the Groote Schuur Maternity center were included. A folder review was conducted and the diagnosis and clinical presentation of all the patients were documented and analyzed. Incidence of VTE were estimated as the number of events per 1,000 deliveries. The number of hospital deliveries in 2016 were used as the denominator for calculating this incidence. Results: A total of 41 (0.12%) patients had a venous thromboembolism. Six patients had a deep venous thrombosis (0.02%) and 37 had a pulmonary embolism (0.11%). Among the 186 retrieved medical records, 11 (28%) of the diagnosis occurred in the puerperal period and 28 (72%) during pregnancy. Among the 28 events during pregnancy, one (3%) was in the first trimester, nine (23%) in the second trimester and 18 (46%) in the third trimester. The majority of confirmed pulmonary emboli (72.22%) and deep venous thrombosis (66.67%) were diagnosed during the third trimester in pregnancy. Among individuals with deep venous thrombosis, the most frequently reported symptoms and signs were leg pain (66.7%), leg swelling (66.7%) and tachycardia (66.7%). Patients without deep venous thrombosis presented more with leg swelling (76.3%), red discolouration (10.5%) and cellulites (10.5%). The only presenting clinical features that were significantly different were haemoptysis (p=0.01) and coughing (p=0.03). Among those individuals without pulmonary embolus, tachycardia (77.3%) and dyspnoea (49.1%) were commonly reported. Among the patients with a PE, the most frequently reported symptoms were tachypnoea (78.4%), dyspnoea (64.9%), tachycardia (62.2%), chest pain (51.4%) and coughing (46%). Features in the clinical presentation that were statistically significant were chest pain (p=0.01), haemoptysis (p=0.07), tachypnoea (p=0.01) and tachycardia (p=0.03). The greatest statistically significant clinical feature was the symptom of coughing (p< 0.01). The stepwise logistic regression for the univariate analysis showed that coughing (OR=3.83; 95% CI: 1.71 to 8.58; P< 0.01), chest pain (OR=2.57; 95% CI: 1.2-5.53; P=0.02), tachycardia (OR=1.03; 95% CI: 1.0 to 1.06; P=0.03), tachypnoea (OR=1.06; 95% CI: 1.0 to 1.12; P=0.05) and a median symptom of 3.5 (1.58; 95% CI: 1.23 to 2.06; P< 0.01) were the best explanatory variables. The stepwise logistic regression for the multivariate analysis showed that both tachycardia (OR=1.03; 95% CI: 1.0 to 1.06; P=0.03) and coughing (OR=3.43; 95% CI: 0.88 to 11.30; P=0.05) predicted a positive pulmonary embolus. A logistic regression for tachycardia showed a 23% increase in pulmonary embolus for every increase of 5 beats per minute in the heart rate above 100Bpm. This association was statistically significant (OR=1.23; 95% CI:1.08 to 1.39; P=0.0004) A logistic regression analysis of the association between tachycardia, tachypnoea and chest pain and the risk of having a pulmonary embolus showed a 4% increase in the risk of pulmonary embolus for every single unit increase in heart rate. When controlling for tachycardia and tachypnoea, chest pain was also associated with a 3.8 times increase in the odds of having a pulmonary embolus. This association was statistically significant (p=0.0002) Conclusion: In this study, we found that the incidence of venous thromboembolism in the Groote Schuur Maternity Centre was the same as in other developed and developing countries around the world. The majority of confirmed venous thromboembolisms were diagnosed during the third trimester in pregnancy. This study found a lower incidence of deep venous thrombosis in comparison to other studies. The clinical features that had some predictive value for pulmonary embolism were chest pain, coughing, tachypnoea, tachycardia and more than three symptoms or signs. Tachycardia was significant in the univariate-, multivariate analysis and stepwise logistic regression. In addition, there was a statistically significant association between tachycardia, tachypnoea and chest pain and the risk of having a pulmonary embolus. This study has revealed the need to develop pre-assessment algorithms in pregnancy and postpartum patients to reduce maternal and fetal, morbidity and mortality. Until such algorithms are developed, clinicians should use their own clinical judgment and proceed to diagnostic imaging for suspected VTE, where indicated.
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Rees, Peter Adam. "The role of extrinsic clotting pathway activation in the colorectal cancer microenvironment." Thesis, University of Manchester, 2018. https://www.research.manchester.ac.uk/portal/en/theses/the-role-of-extrinsic-clotting-pathway-activation-in-the-colorectal-cancer-microenvironment(3249687f-147d-4a41-9ca1-76471e9baac1).html.
Full textAbstract:
Malignancy is associated with a hypercoagulable state manifested clinically by an increased incidence of venous thromboembolism (VTE). Colorectal cancer (CRC) patients who develop VTE have reduced survival. This increased mortality extends beyond the acute VTE event, suggesting that VTE is associated with aggressive tumour biology. Tissue factor (TF) and other clotting factors have been implicated in this process. However, the significance of clotting factors in the tumour microenvironment (TME) remains unknown. The aim of this thesis is to i) determine if a procoagulant TME is a biomarker for poor prognosis and VTE in patients undergoing resectional surgery for CRC and ii) determine the effect of TF, thrombin and FXa on proliferation and migration in vitro in CRC and if their inhibitors have potential as anticancer therapies. In the in vitro studies, epithelial expression of TF had a modest effect on proliferation and migration when quantified using the PrestoBlue proliferation and transwell migration assays. Exogenous TF, FXa and thrombin all increased migration in DLD-1 wild type cells. In addition, exogenous thrombin increased proliferation amongst SW620 wild type cells. This suggests that coagulation factors from the TME, rather than epithelial expression, may influence tumour biology. Moreover, dabigatran, a direct thrombin inhibitor, abrogated the pro-proliferative effects of thrombin, which highlights its potential role as an anticancer therapy. In a multicentre, prospective cohort study of 159 CRC patients undergoing resectional surgery, rates of duplex screen detected deep vein thrombosis (DVT) were correlated to plasma and tumour markers of hypercoagulability. TF is upregulated in the stroma of cancer compared to normal tissue. However, stromal TF expression decreased in more advanced (T4) tumours. This suggests that a procoagulant TME has a role in early tumourigenesis. In total, 5.4%, 7.0% and 9.1% of patients had an asymptomatic DVT pre- operatively, at six weeks post-surgery and after the commencement of adjuvant chemotherapy respectively. The development of a post-operative complication was a risk factor for DVT, whilst locally advanced tumours resulted in a prolonged hypercoagulable state i.e. raised D-dimer at six weeks. This highlights a possible role for pre- and post- operative screening duplex ultrasonography and super-extended VTE prophylaxis in selected patients. In conclusion, this thesis establishes a role for exogenous coagulation factors in promoting tumour biology in CRC. VTE is more common amongst patients undergoing resectional surgery for CRC than previously estimated. The utility of tumour and plasma hypercoagulabilty as biomarkers for survival in CRC will be further analysed when long term follow-up data is available.