Browsing by Subject "Deep vein thrombosis"

Now showing 1 - 7 of 7
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    A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: Results from a multidisciplinary consensus panel
    (Wiley, 2021-12-15) Kabrhel, Christopher; Vinson, David R.; Mitchell, Alice Marina; Rosovsky, Rachel P.; Chang, Anna Marie; Hernandez-Nino, Jackeline; Wolf, Stephen J.; Emergency Medicine, School of Medicine
    The outpatient treatment of select emergency department patients with acute pulmonary embolism (PE) or deep vein thrombosis (DVT) has been shown to be safe, cost effective and associated with high patient satisfaction. Despite this, outpatient PE and DVT treatment remains uncommon. To address this, the American College of Emergency Physicians assembled a multidisciplinary team of content experts to provide evidence-based recommendations and practical advice to help clinicians safely treat patients with low-risk PE and DVT without hospitalization. The emergency clinician must stratify the patient's risk of clinical decompensation due to their PE or DVT as well as their risk of bleeding due to anticoagulation. The clinician must also select and start an anticoagulant and ensure that the patient has access to the medication in a timely manner. Reliable follow-up is critical, and the patient must also be educated about signs or symptoms that should prompt a return to the emergency department. To facilitate access to these recommendations, the consensus panel also created 2 web-based "point-of-care tools."
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    Development of a Glycosaminoglycan Derived, Selectin Targeting Anti-Adhesive Coating to Treat Endothelial Cell Dysfunction
    (MDPI, 2017-03-29) Wodicka, James R.; Chambers, Andrea M.; Sangha, Gurneet S.; Goergen, Craig J.; Panitch, Alyssa; Medicine, School of Medicine
    Endothelial cell (EC) dysfunction is associated with many disease states including deep vein thrombosis (DVT), chronic kidney disease, sepsis and diabetes. Loss of the glycocalyx, a thin glycosaminoglycan (GAG)-rich layer on the EC surface, is a key feature of endothelial dysfunction and increases exposure of EC adhesion molecules such as selectins, which are involved in platelet binding to ECs. Once bound, platelets cause thrombus formation and an increased inflammatory response. We have developed a GAG derived, selectin targeting anti-adhesive coating (termed EC-SEAL) consisting of a dermatan sulfate backbone and multiple selectin-binding peptides designed to bind to inflamed endothelium and prevent platelet binding to create a more quiescent endothelial state. Multiple EC-SEAL variants were evaluated and the lead variant was found to preferentially bind to selectin-expressing ECs and smooth muscle cells (SMCs) and inhibit platelet binding and activation in a dose-dependent manner. In an in vivo model of DVT, treatment with the lead variant resulted in reduced thrombus formation. These results indicate that EC-SEAL has promise as a potential therapeutic in the treatment of endothelial dysfunction.
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    Incidence, risk factors, and the role of anticoagulation therapy in venous thromboembolism following radical cystectomy
    (POL Scientific, 2024-12-06) Bissette, Randall; Sandberg, Maxwell; Tranchina, Stephen; Waggener, Kimberly; Snipes, Madeline; Ye, Emily; Simmons, Jabrina; Strobel, John; Hemal, Ashok; Rodriguez, Alejandro; Davis, Ronald, III; Medicine, School of Medicine
    Background: Radical cystectomy (RC) for bladder cancer is associated with substantial postoperative complications. Among these complications, venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is particularly notable for its morbidity. Efforts to reduce VTE have been largely revolving around extended thromboprophylaxis (ETP) after discharge, typically with injectable heparins, and, more recently, with oral anticoagulants. Objective: The purpose of this study was to quantify the incidence of VTE within 90 days following RC and to identify risk factors associated with its development. Methods: We conducted a retrospective review of all patients who underwent RC for bladder cancer at our institution between 2012 and 2024, documenting instances of postoperative VTE. Data on demographics, anticoagulation therapy, surgical approach, and hospitalization were collected and analyzed. Results: A total of 372 patients received RC for bladder cancer during the study. Of them, 12 patients (3.2%) developed VTE at some point after surgery. The median time to VTE occurrence was between 31 and 90 days post-discharge. A higher rate of VTE was observed immediately following RC in patients who underwent surgery before 2018 (p = 0.021), the year in which enhanced recovery after surgery (ERAS) protocols were implemented. Demographic factors and operation-related variables did not influence the VTE rate (p > 0.05). Kaplan-Meier analysis revealed that cancer-specific survival was significantly lower in patients who developed VTE after RC compared to those who did not (p < 0.001). Conclusion: These findings underscored the importance of interventions such as ETP and ERAS protocols in reducing the incidence of VTE following RC for bladder cancer.
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    Metabolic syndrome increases risk of venous thromboembolism recurrence after acute deep vein thrombosis
    (American Society of Hematology, 2020-01-09) Stewart, Lauren K.; Kline, Jeffrey A.; Pediatrics, School of Medicine
    An improved understanding of which patients are at higher risk of recurrent venous thromboembolism (VTE) is important to designing interventions to reduce degraded quality of life after VTE. Although metabolic syndrome (MetS), the clustering of hypertension, hyperlipidemia, diabetes mellitus, and obesity has been associated with a hypofibrinolytic state, data linking VTE recurrence with MetS remain limited. The purpose of this study was to measure the prevalence of MetS in patients with deep vein thrombosis (DVT) across a large population and determine its effect on VTE recurrence. This was a retrospective analysis of a large statewide database from 2004 to 2017. We measured the frequency with which patients with DVT carried a comorbid International Coding of Diseases diagnosis of MetS components. Association of MetS with VTE recurrence was tested with a multiple logistic regression model and VTE recurrence as the dependent variable. Risk of VTE recurrence conferred by each MetS component was assessed by Kaplan-Meier curves with the log-rank statistic. A total of 151 054 patients with DVT were included in this analysis. Recurrence of VTE occurred in 17% overall and increased stepwise with each criterion for MetS. All 4 components of MetS had significant adjusted odds ratios (OR) for VTE recurrence, with hyperlipidemia having the largest (OR, 1.8), representing the 4 largest ORs of all possible explanatory variables. All 4 MetS variables were significant on Kaplan-Meier analysis for recurrence of VTE. These data imply a role for appropriate therapies to reduce the effects of MetS as a way to reduce risk of VTE recurrence.
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    Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review
    (Springer, 2022-09-18) Murphy, Patrick B.; de Moya, Marc; Karam , Basil; Menard, Laura; Holder, Erik; Inaba, Kenji; Schellenberg, Morgan; Library and Information Science, Luddy School of Informatics, Computing, and Engineering
    Purpose: The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤ 48 h) VTE chemoprophylaxis initiation following blunt solid organ injury. Methods: An electronic search was performed of medical libraries for English language studies on timing of VTE chemoprophylaxis initiation following blunt solid organ injury published from inception to April 2020. Included studies compared early (≤ 48 h) versus late (> 48 h) initiation of VTE chemoprophylaxis in adults with blunt splenic, liver, and/or kidney injury. Estimates were pooled using random-effects meta-analysis. Odds ratios were utilized to quantify differences in failure of nonoperative management, need for blood transfusion and rates of VTE. Results: The search identified 2,111 studies. Of these, ten studies comprising 14,675 patients were included. All studies were non-randomized and only one was prospective. The overall odds of failure of nonoperative management were no different between early and late groups, OR 1.09 (95%CI 0.92-1.29). Similarly, there was no difference in the need for blood transfusion either during overall hospital stay, OR 0.91 (95%CI 0.70-1.18), or post prophylaxis initiation, OR 1.23 (95%CI 0.55-2.73). There were significantly lower odds of VTE when patients received early VTE chemoprophylaxis, OR 0.51 (95%CI 0.33-0.81). Conclusions: Patients undergoing nonoperative management for blunt solid organ injury can be safely and effectively prescribed early VTE chemoprophylaxis. This results in significantly lower VTE rates without demonstrable harm.
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    Prophylactic Enoxaparin Dosing and Anti-Xa Levels in Medicine Patients With Obesity
    (Sage, 2025-03-29) Phyo, Wint War; Deodhar, Karishma; Chang, Amy; Blair, Mary; Boyd, Allison N.; Geik, Christopher; Medicine, School of Medicine
    Introduction: Previous studies have shown that the manufacturer's standard fixed dosing of enoxaparin for venous thromboembolism (VTE) prophylaxis leads to sub-prophylactic anti-Xa levels in medicine patients with obesity. Yet, there is limited literature describing higher dosing strategies in this patient population, and an optimal dosing regimen has not been well-established. Objective: The primary objective was to evaluate mean doses (mg/kg/d) of prophylactic enoxaparin that are associated with goal anti-Xa levels in medicine patients with obesity across 3 body mass index (BMI) groups (40-49 kg/m2, 50-59 kg/m2, ≥60 kg/m2). Methods: This is a single-center, retrospective cohort study of adult patients (age ≥18 years) with BMI ≥40 kg/m2 admitted to a medicine team with at least 1 appropriately drawn anti-Xa level between January 2018 and July 2023. The institution's goal anti-Xa level for VTE prophylaxis was 0.2 to 0.4 units/mL. The primary outcome was the comparison of mean dose between those within anti-Xa at goal and not at goal. Secondary outcomes included the percentages of initial anti-Xa levels below, within, or above goal range and the incidence of new VTE and major bleeding events during hospitalization while on enoxaparin. All outcomes were stratified into 3 BMI groups: 40-49 kg/m2, 50-59 kg/m2, and ≥60 kg/m2. Results: Median dose of those with final anti-Xa level at goal was significantly higher than that of those not in goal anti-Xa range across all 3 BMI groups (0.57 vs 0.50 mg/kg/d; P < 0.05). The majority of the initial anti-Xa levels were subprophylactic, with only 35.7% of patients (or 75 of 210 patients) had initial anti-Xa within the goal range. There were no statistically significant differences in the number of blood transfusions or VTE events between the groups. Conclusion: Findings suggest that medicine patients with BMI ≥40 kg/m2 may require enoxaparin doses higher than 0.5 mg/kg/d to reach goal prophylactic anti-Xa level. However, more robust data are necessary to further validate these results and the clinical implications.
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    Testosterone Usage Leading to Pulmonary Embolisms and Deep Vein Thrombosis: A Case Report and Review of the Literature
    (MDPI, 2023-04-26) Menakuru, Sasmith R.; Atta, Mona; Dhillon, Vijaypal S.; Salih, Ahmed; Medicine, School of Medicine
    Androgen usage has widely increased in recent times via prescribed and unprescribed means. Testosterone is a popular androgen taken by both athletes and the general population. While there is some evidence of androgens being thrombogenic, we report on a 19-year-old male who presented to the hospital after the usage of testosterone for one month, leading to the development of multiple pulmonary emboli and deep vein thrombosis. The authors hope to elucidate the relationship between testosterone usage and thrombosis formation.