Pathophysiology of deep vein thrombosis

The role of mast cells and the underlying mechanisms in the formation of deep vein thrombosis in asthmatic mice

RATIONALE

Asthma-induced inflammation has been shown to increase the risk of deep vein thrombosis (DVT), but the underlying mechanisms remain unclear.

OBJECTIVE

To verify the associations between asthma exacerbation and the occurrence and development of DVT and explore the potential pathophysiological mechanisms at the molecular level.

METHODS AND RESULTS

By coculturing activated and unactivated mast cells with endothelial cells, we found that activated mast cells could lead to an increase in inflammatory factors. In contrast, this effect was significantly attenuated when we cocultured toll-like receptor 4 (TLR4)-knockdown mast cells with endothelial cells. In a mouse model of DVT induced by partial ligation of the inferior vena cava, we demonstrated that asthma exacerbates DVT in mice. DVT was significantly attenuated in vivo after the administration of mast cell degranulation and TLR4 inhibitors to asthmatic mice, whereas the infusion of differentiated MCs into mice exacerbated thrombosis. However, thrombosis was not significantly aggravated after the infusion of TLR4-knockdown mast cells. Inhibition of MC degranulation as well as TLR4 receptor expression attenuated local and systemic inflammation in asthmatic mice, and reinfusion of NC-MCs reversed this effect, whereas the reversal and degranulation of MCs were attenuated after reinfusion of TLR4-knockdown MCs. The infusion of differentiated MCs into asthmatic mice with inhibited MC degranulation and systemic TLR4 resulted in significant increases in AKT, P38, JNK, and ERK, whereas the infusion of TLR4-knockdown MCs resulted in significantly reduced increases in AKT, P38, JNK, and ERK.

CONCLUSIONS

Asthma may exacerbate DVT via mechanisms related to mast cells, which may exacerbate DVT through endothelium inflammation and the upregulation of AKT, P38, JNK, etc., which is mediated, at least in part, by TLR4.

hsa_circRNA_092488 Exacerbates the Progression of Deep Vein Thrombosis Through the NLRP3/NF-κB Signaling Pathway

Objective

Deep vein thrombosis (DVT) is a vascular disorder with an incidence rate of about 0.1%. Endothelial progenitor cells (EPCs) are precursor cells of endothelial cells and contribute to vascular repair and regeneration. Circular RNA (circRNA) has become a new focus of research as circRNAs are involved in various biological processes including the progression of DVT. This study explored the upregulation of hsa_circRNA_092488 in DVT patients.

Materials and Methods

The expression of hsa_circRNA_092488 was evaluated in venous blood samples obtained from DVT patients (n=42) and healthy controls (n=42). Gain- and loss-of-function studies of hsa_circRNA_092488 were carried out. The expression levels of related RNAs and proteins were examined by quantitative real-time reverse-transcription polymerase chain reaction, western blotting and immunofluorescence assays. The proliferation, migration, cell cycle progression, and apoptosis of transfected cells were measured by CCK-8 assay, transwell assay, and flow cytometry. The association of hsa_circRNA_092488 and NOD-like receptor protein 3 (NLRP3) in EPCs was revealed using RNA pull-down analysis. Furthermore, the stability of NLRP3 mRNA was examined in transfected EPCs.

Results

Upregulation of hsa_circRNA_092488 was detected in blood samples from DVT patients and it had the ability to suppress the proliferation and migration of EPCs, induce cell cycle arrest from the S to the G0/G1 phase, and trigger cellular apoptosis. Furthermore, NLRP3 was identified as the potential downstream target molecule of hsa_circRNA_092488 and it could exert its regulatory functions by activating the NLRP3/nuclear factor (NF)-κB signaling pathway. Overexpression of hsa_circRNA_092488 in cells notably elevated the protein expression of caspase-1, interleukin-1β, P-NF-κB-p65/NF-κB-p65, and P-IκBα/IκBα, while knockdown of hsa_circRNA_092488 significantly reduced the levels of those proteins in EPCs.

Conclusion

hsa_circRNA_092488/NLRP3/NF-κB signaling could be a novel therapeutic candidate for the treatment of DVT.

Liquiritin mitigates lower extremity deep vein thrombosis by inhibiting inflammation and oxidative stress via the NF-κB signaling pathway

BACKGROUND

Lower extremity deep vein thrombosis (LEDVT) is a common vascular disease, with its pathogenesis mainly involving inflammatory responses and oxidative stress. Liquiritin (LIQ) is a flavonoid that exhibits pharmacological effects such as anti-inflammatory and antioxidant properties. This study aimed to investigate the role of LIQ in LEDVT and its potential mechanisms.

METHODS

We established an LEDVT model in mice by ligating the inferior vena cava (IVC) and performed in vitro experiments by stimulating human umbilical vein endothelial cells (HUVECs) with IL-1β (10 ng/mL) to simulate endothelial cell injury.

RESULTS

We found that LIQ significantly reduced the size and weight of thrombi and decreased the concentrations of inflammatory factors TNF-α and IL-6 in the IVC of LEDVT mice. Furthermore, LIQ inhibited the secretion of prothrombotic mediators such as tissue factor (TF) and vascular cell adhesion molecule-1 (VCAM-1). Administration of LIQ resulted in a notable reduction in immune inflammatory cells in the IVC of LEDVT mice. LIQ also demonstrated antioxidant properties, as the treatment of LIQ enhanced SOD activity and restored ROS levels to normal in the IVC. Similarly, LIQ reduced the formation of inflammatory factors and the secretion of prothrombotic mediators by HUVECs while inhibiting oxidative stress in HUVECs. Finally, LIQ effectively suppressed the levels of phosphorylated p65 in both the IVC and HUVECs.

CONCLUSIONS

LIQ reduces inflammatory responses and oxidative stress in LEDVT by inhibiting the NF-κB signaling pathway. This finding provides new insights into the prevention and treatment of LEDVT.

KLF15 regulates macrophage polarization patterns in deep vein thrombosis

BACKGROUND

KLF15 is involved in cardiovascular disease processes by regulating vascular remodeling and metabolic disorders. Macrophages mediate the inflammatory response in deep vein thrombosis (DVT) by secreting inflammatory cytokines and modulating the fibrinolytic system. Therefore, this study aims to discuss the effect of KLF15 on macrophage polarization in DVT.

METHODS

In vivo, a DVT animal model was used to assess KLF15 expression and macrophage polarization. In vitro, PMA-treated THP-1 cells with KLF15 overexpression were differentiated into M1- and M2-like macrophages, with polarization markers analyzed by molecular and cellular assays.

RESULTS

In vivo experiments, levels of KLF15, iNOS, CD206, IL-1β, IL-6, IL-10 and TGF-β were increased in the DVT animal model. In vitro experiments, KLF15 overexpression augmented iNOS, CD86, IL-12, TNF-α, IL-1β, and IL-6 levels in M1-like macrophages. Additionally, KLF15 overexpression diminished CD206, IL-10, ARG1, IL-10 and TGF-β levels in M2-like macrophages. In CUT&Tag, peaks bound to KLF15 and lgG were mainly located in the promoter and intronic regions, and KLF15 protein bound more peaks than lgG near the TSS site. YY1, EIF4E, LCK, HMGB1, GPD2, MORF4L1, HIPK2 and NEK2 were hub genes in the peaks that bind to KLF15. ChIP assay confirmed that KLF15 bound the NEK2 promoter in M1-like macrophages and enhanced its transcription and NF-κB pathway activity.

CONCLUSION

KLF15 facilitates M1 macrophage polarization in DVT via the NEK2/NF-κB pathway, highlighting its potential as a therapeutic target for DVT management. Future studies are warranted to explore its clinical applicability and mechanistic nuances.

Low-Molecular-Weight Fucoidan Inhibits Thromboinflammation and Ameliorates Deep Vein Thrombosis via Targeting S100A8/A9

Deep vein thrombosis (DVT) is a prevalent life-threatening complication among hospitalized patients. DVT is characterized by the hypercoagulability and thromboinflammation in which platelet activation and neutrophil extracellular trap (NET) formation are critically involved. Studies have shown that S100A8/A9 is significantly elevated in patients with DVT, and is closely associated with platelet activation and NET formation. Fucoidan, the marine polysaccharide derived from Fucus algae, has potential anti-inflammatory and cardioprotective effects. We found low-molecular-weight fucoidan (LMF) bound to S100A8/A9 with an equilibrium dissociation constant (KD) of 2.368 × 10-8 M. LMF inhibited S100A8/A9-induced platelet hyperactivity and NET formation in vitro, and ameliorated DVT without significantly perturbing hemostasis in vivo. Our results indicate that the alarmin protein S100A8/A9 is a novel target of LMF. LMF may have therapeutic potential in S100A8/A9-induced thromboinflammation in DVT.

Comparing machine learning models for predicting preoperative DVT incidence in elderly hypertensive patients with hip fractures: a retrospective analysis

Hip fractures in the elderly present a significant public health challenge globally, especially among patients with hypertension, who are at an increased risk of developing preoperative deep vein thrombosis (DVT). DVT not only heightens surgical risks but also severely impacts the rehabilitation and quality of life of patients. Early risk assessment and management in this population are therefore critically important. This study aimed to develop and validate a machine learning-based predictive model to enhance the accuracy of predicting preoperative DVT in elderly patients with hypertension undergoing hip fracture surgery, thereby optimizing preoperative assessment and management. A retrospective study design was employed, selecting patients with hypertension and hip fractures treated at the First Hospital of Qinhuangdao from January 2018 to December 2022. Key predictive factors were identified using LASSO regression, and logistic regression was utilized to construct both a nomogram and an online interactive nomogram. Various machine learning algorithms were also employed to build predictive models. The contribution of variables in the models was explained using SHAP values, and model performance was evaluated through ROC curves, AUC values, and other statistical methods. The study included 637 patients, with LASSO regression selecting key variables that were further used to develop a logistic regression-based nomogram and its online version, providing intuitive tools for assessing DVT incidence. Among the multiple machine learning predictive models, the LightGBM model exhibited the best performance, achieving an AUC of 0.910. The model's effectiveness and reliability were confirmed through decision curves, calibration plots, and precision-recall curves. SHAP value analysis highlighted the significance of factors such as age, time from injury to hospital admission, atrial fibrillation, C-reactive protein, hypoalbuminemia, and D-dimer levels in the predictions, enhancing the model's transparency and interpretability. This study successfully developed a logistic regression-based nomogram and multiple machine learning algorithms to predict the risk of preoperative DVT in elderly hypertensive patients with hip fractures. The nomogram provides clinicians with a practical tool for rapid risk assessment, thus optimizing patient management and prognosis. The LightGBM model, recommended for its high predictive accuracy, along with SHAP value analysis, enhanced the transparency and clinical applicability of the models. These findings not only deepen our understanding of DVT incidence factors but also demonstrate the potential of machine learning technologies in enhancing medical decision-making and advancing precision medicine.

The association between deep vein thrombosis at admission and the time from injury to admission in hip fractures

OBJECTIVE

This study aims to explore the association between deep vein thrombosis (DVT) of the lower limbs at admission and the time from injury to admission (TFITA), providing clinical references for the prevention of DVT at admission.

PATIENTS AND METHODS

Data was collected from patients who were admitted to our hospital for hip fractures between January 2017 and December 2023. Univariable and multivariable logistic regression analyses were conducted to examine the relationship between TFITA and DVT at admission, using both continuous and categorized variables based on thresholds for TFITA. Propensity score matching (PSM) and subanalyses stratified by TFITA and characteristics of DVT at admission were further employed to investigate the relationship. Additionally, restricted cubic splines (RCS) analysis was performed to determine whether a non-linear association exists between TFITA and DVT at admission.

RESULTS

A total of 1230 patients were included in the statistical analysis, comprising 116 patients with DVT at admission and 1114 without. Both Univariable and multivariable logistic regression analyses indicated a positive association between TFITA and DVT at admission before and after matching. Subanalyses revealed significant associations for older age, low-energy injuries, high D-dimer levels, and low platelet counts subgroup with TFITA and DVT at admission. RCS analysis indicated no non-linear relationship between TFITA and DVT at admission.

CONCLUSION

For patients with hip fractures, longer TFITA is positively correlated with the incidence of DVT at admission. These findings support the potential of TFITA as an intervention strategy for managing DVT at admission.

Therapeutic applications of natural products in the management of venous diseases: a comprehensive review

The occurrence of venous diseases among adults is approximately 77% in females and 57% in males. These conditions are prevalent, progressive disorders that significantly affect individuals socially, physically, and psychologically, often resulting in various venous abnormalities that hinder effective blood circulation in the lower limbs. This review provides a comprehensive overview of venous diseases, focusing on their pathophysiology, symptoms, causes, risk factors, diagnosis, and complications. The symptoms associated with venous diseases are diverse and can include pain, heaviness, swelling, ulcers, and skin changes. Risk factors such as age, obesity, hormonal influences, and genetic predispositions are discussed in relation to their contribution to disease progression. The therapeutic modalities for managing venous diseases are explored, with a particular emphasis on natural products in alleviating symptoms and improving vascular health. Natural compounds, i.e., flavonoids, play a vital role in the circulatory system, supporting blood vessels and promoting healthy blood flow, in addition to their vasoprotective, antioxidant, anti-inflammatory, and anti-platelet properties. Overall, the ongoing research efforts on the efficacy of natural products will significantly enhance the management of several venous diseases in the coming years.

The Role of Venous Outflow and Venous Capacity in Predicting Postthrombotic Syndrome following Pharmacomechanical Thrombolysis for Acute Iliofemoral Vein Thrombosis

BACKGROUND

We aimed to evaluate the impact of hemodynamic parameters in predicting the development of postthrombotic syndrome following acute iliofemoral deep vein thrombosis (DVT) after pharmacomechanical thrombolysis.

METHODS

A total of 59 patients with acute DVT undergoing pharmacomechanical thrombolysis were included in this retrospective case-control study and divided into 2 groups according to the development of postthrombotic syndrome; as postthrombotic syndrome group (n = 18) and nonpostthrombotic syndrome group (n = 41). The groups were compared in terms of basic demographic and clinical characteristics, as well as clinical and hemodynamic assessment scores, including venous capacity (Vc) and outflow measured using strain-gauge venous occlusion plethysmography.

RESULTS

There were no significant differences between the groups in terms of basic demographic and clinical characteristics. The groups were statistically similar in terms of preprocedural clinical and hemodynamic assessment scores. However, compared to nonpostthrombotic syndrome group, in postthrombotic syndrome group the mean values of venous outflow (Vo) were significantly lower whereas the mean values of Vc were significantly higher in postprocedural follows at 6 and 24 months.

CONCLUSION

The present study demonstrated the critical role of Vo and Vc for predicting the development of postthrombotic syndrome in patients with acute iliofemoral vein thrombosis undergoing pharmacomechanical thrombolysis.

Effect of mild-to-moderate COVID‑19 on the incidence and risk factors for deep vein thrombosis in patients with hip fracture: a retrospective study

PURPOSE

This retrospective study aimed to investigate the effect of mild-to-moderate COVID-19 on the risk of deep vein thrombosis (DVT) in patients with hip fractures. Hip fractures are common in the elderly, and previous research has shown that they accounted for 58.3% of traumatic fractures in older inpatients during the COVID-19 pandemic in China. Meanwhile, the relationship between COVID-19 and DVT is complex. Some studies have reported that the incidence of DVT in critically ill COVID-19 patients can be as high as 46%, and 20% in those with moderate-to-severe cases. However, the impact of mild-to-moderate COVID-19 on DVT risk in hip fracture patients remains unclear.

METHODS

Adult patients who underwent surgery for hip fractures between December 8, 2022, and January 9, 2023, were included in the study. All patients were tested for SARS-CoV-2 nucleic acid and were assessed for DVT preoperatively using doppler ultrasonography (DUS). Logistic regression was used to identify risk factors for DVT.

RESULTS

The records of 98 patients with hip fractures, were included in the analysis, of whom 63 were SARS-CoV-2 positive and 35 were SARS-CoV-2 negative. Pre-operative DUS showed that 36/98 patients (37%) had DVT, including 25/63 (40%) patients with COVID-19, and 11/35 (31%) patients without COVID-19. Multivariable logistic regression analysis showed that pre-operative leukocyte count and platelet-to-lymphocyte ratio (PLR) were independent risk factors for DVT, whereas mild-to-moderate COVID-19 was not an independent risk factor for DVT. In patients with hip fractures, COVID-19 did not significantly increase the risk of DVT.

CONCLUSIONS

Therefore, in patients with hip fractures, DVT prevention measures should be implemented routinely, regardless of COVID-19 status.

Prediction and Risk Factors of Lower Extremity Deep Vein Thrombosis after Total Joint Arthroplasty

This study was to retrospectively analyze the incidence of deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA) and analyze the risk factors for DVT. 113 patients with TJA were divided into the DVT group (n = 11) and the non-DVT group (n = 102) according to the postoperative ultrasound diagnosis, and the incidence of DVT after TJA was calculated. Logistic regression was used to analyze the correlation between DVT and patients' age, medical history, surgical factors, blood indexes to identify the risk factors of DVT after TJA. Receiver operator characteristic (ROC) curve was constructed to evaluate the diagnostic accuracy of risk factors for DVT. According to the results of ultrasound examination, DVT occurred in 11 of 113 patients after TJA, and the incidence rate of DVT was 9.73%. Univariate analysis showed that the levels of age, diabetes mellitus, operation time, intraoperative blood loss, intraoperative blood transfusion, antithrombin-Ⅲ (AT-Ⅲ), plasma protein C (PC), soluble platelet endothelial cell adhesion molecules-1 (SPECAM-1) and tissue-type plasminogen activator (t-PA) in the DVT group were significantly different from those in the non-DVT group (P < 0.05). Multivariate analysis showed that combined diabetes, decreased PC and t-PA were risk factors for DVT (P < 0.05). ROC analysis showed that PC combined with t-PA had the highest diagnostic accuracy for DVT. Patients with diabetes mellitus are at high risk for DVT after TJA, the increase of D-dimer, the decrease of PC and t-PA after 24 h of TJA is the the risk factors for DVT occurrence.

[Analysis of two cases of hereditary protein C deficiency causing venous thrombosis]

Objective: To investigate the molecular pathogenic mechanism of venous thrombosis caused by heterozygous missense mutations in two protein C (PROC) genes through laboratory phenotype analysis, genetic mutation analysis, and in vitro expression experiments. Methods: Two probands presented with venous thromboembolism at the First Affiliated Hospital of Wenzhou Medical University. Clinical data and blood samples were collected from the probands and their family members to evaluate the plasma protein C (PC) activity (PC∶A), PC antigen (PC∶Ag) levels, and other relevant coagulation parameters. The anticoagulant capacity was assessed using the thrombin generation test (TGT). The mutation sites of the PROC gene were identified using direct DNA sequencing. Bioinformatics software was used to analyze the conservation and pathogenicity of the mutated gene. PyMOL software was used for the analysis of the protein three-dimensional models and interactions between mutated amino acids. Wild-type and two mutant expression vectors were constructed and HEK293T cells were transiently transfected. Total cellular RNA was extracted from positively transfected cells to investigate the transcriptional levels of the mutant PROC gene. Enzyme-linked immunosorbent assay, Western blot, and cellular immunofluorescence assays were used to investigate the translation levels of the mutant PROC protein. Results: Probands 1 and 2 exhibited PC∶A levels of 35% and 40% and PC∶Ag levels of 44% and 39%, with increasing D-dimer levels to 4.42 mg/L and 0.83 mg/L, respectively. Meanwhile, other coagulation parameters revealed no significant abnormalities. TGT demonstrated impaired anticoagulant function in both proband witnesses and their familial PC carriers. Sequencing analysis revealed heterozygous missense mutations c. 833T>C (p. Leu278Pro) in proband 1 and c. 1330T>C (p. Trp444Arg) in proband 2 within exon 9 of the PROC gene. Conservation analysis revealed that Leu278 and Trp444 were highly conserved across homologous species. Pathogenicity analysis indicated that both p. Leu278Pro and p. Trp444Arg mutations are deleterious. Protein modeling analysis demonstrated that both mutations induce structural alterations in the protein. In vitro expression experiments revealed that compared with the wild-type, both p. Leu278Pro and p. Trp444Arg mutations showed no significant differences in the mRNA expression level of the PC protein. However, both mutations caused significantly lower PC∶Ag content and protein expression levels in the cell culture supernatant compared with the wild-type, whereas higher levels were observed in the cell culture lysate. This indicates the association of both mutations with the secretion function of the PC protein. Conclusion: The heterozygous missense mutations p. Leu278Pro and p. Trp444Arg in exon 9 of the PROC gene in both probands are associated with decreased PC levels.

Incidence of venous thromboembolism following achilles tendon rupture. Data from the UK foot and ankle thrombo-embolism (UK-FATE) audit

INTRODUCTION

Achilles tendon rupture (ATR) carries a high risk of venous thrombo-embolism (VTE) whether the injury is managed surgically or non-operatively. This study reports symptomatic VTE rate following ATR. The influence of patient demographics, treatment type and use of chemical thromboprophylaxis is examined.

MATERIALS AND METHODS

Observational cohort study. The data is from a multi-centre, prospective, national audit of patients from 68 participating United Kingdom centres. Data was prospectively collected from hospital records. The study was conducted between June and November 2022, with a 3-month follow up.

RESULTS

Of 11,363 participants in the National Audit, 9.5 % (n = 1084) had experienced an ATR. Management strategies included both non-surgical (74 %) and surgical (26 %). Following ATR, the VTE rate was 3.69 % (n = 40) compared to 0.57 % (n = 59) for other foot and ankle surgeries. Participants who developed symptomatic VTE after ATR were older than those who did not (mean age 54 years (95 %CI 50.5 - 54.7) vs 48 years (95 %CI 47.3 - 49.1)). There was no significant difference in VTE events due to participant sex, ethnicity or number of comorbidities. Differences in treatment regimen, such as weight-bearing status and immobilisation strategy, showed no significant difference in symptomatic VTE events between groups.

CONCLUSION

After ATR, patients are 6.5-times more likely to experience symptomatic VTE than those recovering from surgery for other foot and ankle pathology. There was no significant difference in symptomatic VTE rate after ATR with specific chemical prophylaxis or early mobilisation strategies.

Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis

BACKGROUND

Deep vein thrombosis (DVT) is a common medical condition that is associated with clinically significant sequelae, including postthrombotic syndrome (PTS). Anticoagulation alone remains the guideline-recommended treatment for many patients with iliofemoral DVT. Recent technological advances have led to an increase in the use of mechanical thrombectomy for DVT, but mechanical thrombectomy-based procedures have not yet been compared with standard-of-care anticoagulation therapy in randomized studies.

METHODS

The DEFIANCE study (ClinicalTrials.gov: NCT05701917) is an international and actively enrolling randomized controlled trial (RCT) in lower extremity DVT assessing an interventional strategy that includes mechanical thrombectomy with the ClotTriever System (Inari Medical, Irvine, CA) versus anticoagulation alone. Approximately 300 patients with unilateral iliofemoral DVT and symptom duration ≤ 12 weeks will be randomized 1:1. Study conduct includes an independent core laboratory for duplex ultrasound assessment, an independent medical monitor for safety adjudication, and evaluation of PTS severity on the Villalta scale using best clinical practices. The primary endpoint is a composite outcome structured as a hierarchal win ratio of 1) the occurrence of treatment failure or therapy escalation as adjudicated by the medical monitor, with failure defined as amputation or gangrene of the target leg or venous thromboembolism-related mortality, and 2) the assessment of PTS severity at the 6-month follow-up visit. In addition to being a component of the primary endpoint, the severity of PTS at 6 months is also evaluated as a stand-alone secondary endpoint. An additional secondary endpoint is a composite of outcomes at the 10-day visit and is structured as a hierarchal win ratio of 1) vessel compressibility on duplex ultrasound, 2) patient-reported pain, and 3) improvement of edema. The safety endpoints are access site complications requiring endovascular or surgical repair and the occurrence through the 30-day visit of mortality, major bleeding, or new symptomatic pulmonary embolism.

CONCLUSIONS

DEFIANCE will be the first RCT to evaluate a mechanical thrombectomy-based interventional approach versus anticoagulation therapy alone for DVT. The results will inform the treatment of patients with iliofemoral DVT and the prevention of PTS-associated morbidity.

TRIAL REGISTRATION

DEFIANCE: RCT of ClotTriever System Versus Anticoagulation In Deep Vein Thrombosis (DEFIANCE), ClinicalTrials.gov: NCT05701917, URL: https://clinicaltrials.gov/study/NCT05701917?cond=Deep%20Vein%20Thrombosis&term=defiance&rank=1.

Incidence and Risk Factors of Lower Limb Deep Vein Thrombosis in Psychiatric Inpatients by Applying Machine Learning to Electronic Health Records: A Retrospective Cohort Study

Background

Psychiatric inpatients face an increased risk of deep vein thrombosis (DVT) due to their psychiatric conditions and pharmacological treatments. However, research focusing on this population remains limited.

Methods

This study analyzed 17,434 psychiatric inpatients at Huzhou Third Municipal Hospital, incorporating data on demographics, psychiatric diagnoses, physical illnesses, laboratory results, and medication use. Predictive models for DVT were developed using logistic regression, random forest, support vector machine (SVM), and XGBoost (Extreme Gradient Boosting). Feature importance was assessed using the random forest model.

Results

The DVT incidence among psychiatric inpatients was 1.6%. Predictive model performance, measured by the area under the curve (AUC), showed logistic regression (0.900), random forest (0.885), SVM (0.890), and XGBoost (0.889) performed well. Logistic regression and random forest models exhibited optimal overall performance, while XGBoost excelled in recall. Significant predictors of DVT included elevated D-dimer levels, age, Alzheimer's disease, and Madopar use.

Conclusion

Psychiatric inpatients require vigilance for DVT risk, with factors like D-dimer levels and age serving as critical indicators. Machine learning models effectively predict DVT risk, enabling early detection and personalized prevention strategies in clinical practice.

Association between neutrophile-to-lymphocyte ratio and risk of deep vein thrombosis in patient receiving lower extremity orthopedic surgery: A meta-analysis

OBJECTIVE

This meta-analysis aimed to quantitatively synthesize evidence on the association between the preoperative neutrophil-to-lymphocyte ratio (NLR) and the risk of deep vein thrombosis (DVT) in patients undergoing lower extremity orthopedic surgery.

METHODS

Medline, Embase, Google Scholar, and the Cochrane Library were systematically searched for observational studies that examined the relationship between preoperative NLR and DVT risk in patients undergoing lower extremity procedures. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.

RESULTS

Ten studies involving 5,697 patients were included in the meta-analysis. The pooled incidence of DVT across the studies was 13.8% (95% CI: 9.7%-19.2%). Elevated NLR was associated with a two-fold increase in the risk of DVT (odds ratio [OR] 2.08, 95% confidence interval [CI]: 1.39-3.12, p = 0.0004, I2 = 85%). Patients who developed DVT had a higher NLR than those who did not (mean difference: 0.93, 95% CI: 0.37 to 1.48, p =  0.001, I2 =  86%). Among the patient characteristics, male sex (OR 1.51, 95% CI: 1.12-2.03), diabetes mellitus (OR 1.60, 95% CI: 1.06-2.41), and hypertension (OR 1.43, 95% CI: 1.06-1.93) were significantly associated with increased DVT risk. Subgroup analysis based on the timing of DVT occurrence (preoperative vs. postoperative) revealed no significant difference in the association between NLR and DVT risk.

CONCLUSION

Elevated preoperative NLR was significantly associated with increased DVT risk in patients undergoing lower extremity orthopedic surgery. NLR may serve as a useful biomarker for DVT risk stratification in this population. Prospective studies are needed to validate its predictive value and evaluate NLR-guided thromboprophylaxis strategies.

TRIAL REGISTRATION

PROSPERO registration number: CRD42024577952.

A nomogram model for predicting preoperative DVT in elderly anemic patients undergoing total hip arthroplasty: a retrospective cohort study

OBJECTIVES

Total hip arthroplasty (THA) is classified as a high-risk surgery for venous thromboembolism (VTE) events, especially in elderly individuals and in cases of anemia. This study aims to uncover independent risk factors for predicting preoperative DVT in elderly anemic patients undergoing THA. Furthermore, it seeks to validate these factors' predictive efficacy in diagnosing DVT, with the goal of facilitating prompt identification and treatment to mitigate associated risks.

METHODS

Clinical information and relevant laboratory test data of preoperative deep vein thrombosis (DVT) in 459 elderly patients with anemia who underwent total hip replacement surgery from January 2018 to June 2024 were retrospectively evaluated. Logistic regression analysis and backward stepwise method were used to detect independent predictors of preoperative DVT diagnosis in elderly patients with anemia who underwent total hip replacement surgery. A nomogram prediction model was established through multivariate logistic regression and subsequently utilized the testing group to validate.

RESULTS

A multivariate logistic regression model was used to analyze the data, Hematocrit (HCT) (Odds ratio (OR) = 0.14, 95% confidence intervals (CI):[0.04,0.52]; P = 0.003), Albumin (ALB) (OR = 0.1, 95% CI:[0.03,0.37]; P = 0.001), Prothrombin Time (PT) (OR = 0.29, 95% CI:[0.1,0.83]; P = 0.02), Fibrin Degradation Products (FDP) (OR = 0.15, 95% CI:[0.05,0.49]; P = 0.002) and lymphocyte/Monocyte ratio (LMR) (OR = 0.28, 95% CI:[0.09,0.87], P = 0.028) were independent predictors for DVT before THA in elderly patients with anemia. The area under the curve (AUC) scores were 0.929 for the training group and 0.896 for the testing group, with calibration curve mean errors of 0.017 and 0.023, respectively. The decision curve analysis (DCA) graph indicates that the developed nomogram was highly practical and advantageous for clinical application.

CONCLUSION

The independent predictors of preoperative DVT in elderly anemic patients undergoing total hip replacement primarily include HCT, ALB, PT, FDP, and LMR at admission, which are easy to obtain and can quickly yield results. Moreover, the nomogram based on HCT, ALB, PT, FDP, and LMR can help clinical doctors evaluate the possibility of DVT formation, thereby accurately and quickly assisting clinical doctors in making better clinical judgments.

Assisting significance of lncRNA ASB16-AS1 in the early detection and prognosis prediction of patients with deep venous thrombosis

BACKGROUND

Deep venous thrombosis (DVT) is a kind of vascular obstruction, that commonly and widely occurs in lower limbs. Due to the lack of obvious symptoms in the early stage, the rate of misdiagnosis and missed diagnosis is high. This study evaluated the expression and significance of lncRNA ASB16-AS1 (ASB16-AS1) in DVT aiming to identify a novel biomarker for its screening and monitoring.

METHODS

There were 77 DVT patients and 62 healthy individuals included in this study. Plasma ASB16-AS1 level was evaluated using PCR and compared between DVT and healthy groups. The diagnostic and prognostic values of ASB16-AS1 were assessed with ROC and Cox analyses. The correlation of ASB16-AS1 with patients' conditions, inflammation, and oxidative stress was evaluated by Spearman correlation analysis.

RESULTS

ASB16-AS1 was significantly upregulated in DVT (P < 0.001), which could discriminate DVT patients from healthy individuals with high sensitivity and specificity (AUC of ROC = 0.858). Increased ASB16-AS1 was associated with the incidence of complications (P = 0.033) and especially for pulmonary embolism in patients (P = 0.029). ASB16-AS1 was negatively correlated with prothrombin time (PT, r = -0.763), antithrombin level (AT, r = -0.711), and international normalized ratio (INR, r = -0.764), and showed positive correlation with fibrinogen (FIB, r = 0.793) and D-dimer (D-D, r = 0.731). Additionally, ASB16-AS1 was positively correlated with pro-inflammation cytokines (rIL-6 = 0.853, rIL-10 = -0.836, rhsCRP = 0.787) and pro-oxidative stress factors (rSOD = -0.751, rMDA = 0.842, r8-isoPGF2α = 0.840).

CONCLUSION

Upregulated ASB16-AS1 was identified as a diagnostic and prognostic biomarker of DVT and was closely associated with inflammation and oxidative stress during DVT.

The Mechanisms of Sepsis Induced Coagulation Dysfunction and Its Treatment

Sepsis is a critical condition characterized by organ dysfunction due to a dysregulated response to infection that poses significant global health challenges. Coagulation dysfunction is nearly ubiquitous among sepsis patients. Its mechanisms involve platelet activation, coagulation cascade activation, inflammatory reaction imbalances, immune dysregulation, mitochondrial damage, neuroendocrine network disruptions, and endoplasmic reticulum (ER) stress. These factors not only interact but also exacerbate one another, leading to severe organ dysfunction. This review illustrates the mechanisms of sepsis-induced coagulopathy, with a focus on tissue factor activation, endothelial glycocalyx damage, and the release of neutrophil extracellular traps (NETs), all of which are potential targets for therapeutic interventions.

Different Transcriptome Signatures of the Lymphatic and the Blood Vessels From Rat Mesentery Reveal Distinct Function Characteristics

OBJECTIVE

Lymphatic vessels and blood vessels have some similarities in structure, but they have distinct contraction characteristics and functions. Revealing the detailed transcriptional differences of lymphatic, artery and vein are required for circulation research.

METHODS

The tissues of the mesenteric lymphatic, artery, and vein were collected from Wistar rats. The transcriptome signatures of these tissues from RNA-seq (RNA sequencing) were analyzed using bioinformatic methods.

RESULTS

GO (gene ontology) enrichment showed the three tissues have distinct gene expression patterns in extracellular matrix, cell adhesion molecule binding, receptor ligand activity, and contractile fiber. The genes involved in cell contractility were also differently expressed, which were enriched into the KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways of cytoskeleton in muscle cells, vascular smooth muscle contraction, and renin-angiotensin system. Through PPI (protein-protein interaction) analysis, we identified 43 differently expressed hub genes in the three tissues. Thirty-four transcription factors and cofactors were identified as important for the normal function of the three tissues. Furthermore, we screened out 20 potential marker genes for each tissue.

CONCLUSIONS

Our study described the transcriptome signatures of mesenteric lymphatic, artery, and vein, shedding light on the distinct contraction mechanisms of these tissues. These results also provided potential therapeutic targets for circulation diseases and potential markers for lymphatic and blood vessel studies.

Acute respiratory distress syndrome (ARDS): from mechanistic insights to therapeutic strategies

Acute respiratory distress syndrome (ARDS) is a clinical syndrome of acute hypoxic respiratory failure caused by diffuse lung inflammation and edema. ARDS can be precipitated by intrapulmonary factors or extrapulmonary factors, which can lead to severe hypoxemia. Patients suffering from ARDS have high mortality rates, including a 28-day mortality rate of 34.8% and an overall in-hospital mortality rate of 40.0%. The pathophysiology of ARDS is complex and involves the activation and dysregulation of multiple overlapping and interacting pathways of systemic inflammation and coagulation, including the respiratory system, circulatory system, and immune system. In general, the treatment of inflammatory injuries is a coordinated process that involves the downregulation of proinflammatory pathways and the upregulation of anti-inflammatory pathways. Given the complexity of the underlying disease, treatment needs to be tailored to the problem. Hence, we discuss the pathogenesis and treatment methods of affected organs, including 2019 coronavirus disease (COVID-19)-related pneumonia, drowning, trauma, blood transfusion, severe acute pancreatitis, and sepsis. This review is intended to provide a new perspective concerning ARDS and offer novel insight into future therapeutic interventions.

Barriers and facilitators for improving oral anticoagulant medication adherence in lower extremity deep venous thrombosis patients after spinal surgery: A qualitative study using the COM-B model

BACKGROUND

Deep venous thrombosis (DVT) of the lower extremity causes a major disease burden globally. Currently, oral anticoagulant therapy is used as the first-line treatment of DVT, however, medication non-adherence remains a serious problem for postoperative spinal surgery patients whose DVT incidence is at a high level.

AIMS

To explore barriers and facilitators affecting patient oral anticoagulant medication adherence, based on guidance using the COM-B model.

METHODS

This study was a qualitative study using a descriptive research design with in-depth and semi-structured interviews. Data were analyzed adopting traditional content analysis methods.

RESULTS

Based on the COM-B theoretical model, we identified 9 barriers and facilitators from capability, opportunity, and motivation domains.

CONCLUSIONS

Patients were confronted with barriers from capability, opportunity, and motivation domains, which were not isolated but interrelated. Future interventions should incorporate facilitators and barriers to address medication adherence issue with a holistic approach at multiple levels.

Association between abnormal systemic coagulation inflammation index and recurrence of deep venous thrombosis as well as quality of life: A retrospective study

BACKGROUND

Deep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life.

METHODS

A retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales.

RESULTS

The recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index.

CONCLUSION

The study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Aptamer biosensors for thrombin

Thrombin, a key factor in the coagulation cascade, is a valuable biomarker of great importance for the prognosis, diagnosis, and monitoring of various diseases, including cancer and heart disease. Due to the increasing attention to the development of point-of-care testing (POCT) options, various types of biosensors have been invented to enhance the accuracy and speed of detection of important biomarkers such as thrombin. Implementation of aptamers in biosensors (aptasensors) improves the target recognition capacity due to the high-affinity binding nature of aptamers. Herein, this review presents recent studies of aptasensors for thrombin detection based on different detection mechanisms encompassing optical biosensors, surface-enhanced Raman spectroscopy (SERS), electrochemical detection, piezoelectric detection, and lateral flow assay.

The association of serum total bile acids and deep venous thrombosis

BACKGROUND AND AIM

Bile acid metabolism plays a crucial role in maintaining the delicate balance between coagulation and anticoagulation processes. However, there is a paucity of research exploring the relationship between serum total bile acids (TBA) levels and the risk of deep venous thrombosis (DVT) in Chinese individuals. The primary objective of this study is to investigate the association between TBA levels and DVT occurrence in this population.

METHODS AND RESULTS

A cross-sectional study was conducted involving 4522 patients with suspected DVT, recruited from June 2018 to October 2023, at the First Affiliated Hospital of Xi'an Jiaotong University. After rigorous screening, 3165 patients were included in the final analysis. Participants were categorized into three TBA level groups: low-level (TBA < 2.3 umol/L), moderate-level (2.3 ≤ TBA < 4.3 umol/L), and high-level (TBA ≥ 4.3 umol/L). Logistic regression analysis was utilized to assess the relationship between TBA levels and DVT risk, adjusting for potential confounders. The median age of the study population was 63 years, with a median TBA level of 3.2 (1.9-5.3) umol/L. The findings revealed that, compared to the low-level TBA group, the moderate and high-level TBA groups had significantly higher odds ratios (ORs) for DVT, with ORs of 1.47 (95% CI: 1.21 to 1.78, P < 0.001) and 1.91 (95% CI: 1.58 to 2.32, P < 0.001), respectively. Interestingly, higher TBA levels were also associated with reduced odds of bleeding risk, with ORs of 0.81 (95% CI: 0.63 to 1.03, P < 0.001) and 0.64 (95% CI: 0.5 to 0.81, P < 0.001), respectively.

CONCLUSIONS

Our study provides evidence that serum TBA levels may serve as a risk factor for DVT in Chinese individuals, with higher levels conferring an increased risk. Additionally, unexpectedly, higher TBA levels were found to be associated with a reduced risk of bleeding complications. These findings have significant implications for understanding the complex interplay between bile acid metabolism and deep venous thrombosis, and warrant further investigation.

S100 calcium-binding protein A8 exacerbates deep vein thrombosis in vascular endothelial cells

Previous studies highlighting the pivotal function of the S100A8 protein have shown that inflammation and vascular endothelial harm play a major role in deep vein thrombosis (DVT) development, as evidenced by earlier studies highlighting the pivotal function of the S100 calcium-binding protein A8 (S100A8). Therefore, we aimed to establish a connection between S100A8 and DVT and investigate the role of S100A8 in DVT development. Blood specimens were taken from 23 patients with DVT and 31 controls. The fluctuation and association for S100A8 and interleukin-1 beta (IL-1β) in the specimens was assessed using enzyme-linked immunosorbent assay. We also used the human recombinant protein S100A8 to activate human umbilical vein endothelial cells and created a rat model to explore the possible relationship between them. Studies have shown that the infiltration of S100A8 sustains local inflammation and thrombus formation, which may exacerbate DVT by amplifying NLRP3/Caspase-1/IL-1β signals in the vascular endothelial cells.

Prognostic Nutritional Index as a Potential Biomarker for the Risk of Lower Extremity Deep Venous Thrombosis: A Large Retrospective Study

BACKGROUND

Prognostic nutritional index (PNI) has recently been identified as a novel marker of nutritional status. However, existing evidences on the association between PNI and the risk of lower extremity deep venous thrombosis (LEDVT) are limited and conflicting.

OBJECTIVE

To determine the association between PNI and the risk of LEDVT, and further evaluate its diagnostic value.

METHODS

Over a 10-year period (2012-2022), a total of 12790 patients who underwent compression ultrasonography examinations were consecutively included, and 1519 (11.9%) LEDVT events occurred. Multivariate logistic regression analysis was used to investigate the association, and receiver operating characteristic (ROC) curve was constructed to evaluate its diagnostic performance.

RESULTS

After full adjustment, patients in third quartile (odds ratio [OR] = 1.486, 95% confidence interval [CI]: 1.205-1.832), second quartile (OR = 2.436, 95% CI: 1.993-2.978) and first quartile (OR = 3.422, 95% CI: 2.791-4.195) of PNI were at higher risk of LEDVT compared with those in fourth quartile, and the test for trend was significant. Consistently, each unit decrease in PNI was associated with a 6.0 % (95% CI: 1.052-1.069) increased risk of LEDVT. Moreover, adding PNI to a base model improved the area under the curve (AUC) from 0.721 (95% CI: 0.709-0.734) to 0.746 (95% CI: 0.734-0.758).

CONCLUSION

PNI is inversely associated with the risk of LEDVT, and provides significant incremental diagnostic value for the identification of LEDVT events. These findings suggest that PNI may be a potential biomarker to help clinicians identify patients at risk of thrombosis and make clinical decisions timely.

Antithrombic effects of Piper retrofractum in a rat model of acute thrombosis: modulation of endothelial adhesion molecules and inflammatory factors

Piper retrofractum (PR) is a tropical plant used as a spice in Southeast Asia. This study investigated the antithrombotic effect of PR in rats with acute thrombosis induced by collagen and epinephrine (CE). The rats were divided into four groups, control (CON), CE, PR15, and PR30, with PR administered at 15 and 30 mg/kg body weight. PR treatment significantly reduced paralysis time compared to the CE. The activated partial thromboplastin time in the PR15 group tended to decrease compared to the CE. Histologically, the both sample groups exhibited reduced blood clots within lung tissues and decreased E-selectin expression in aortic tissue. PR also tended to decrease cyclooxygenase levels and significantly reduce intracellular adhesion molecule 1 levels. PR has demonstrated potential for inhibiting thrombosis by regulating coagulation factors, adhesion molecules, and cyclooxygenase. This finding suggests its potential application as a therapeutic agent for lowering the risk of cardiovascular diseases.

Bioinformatics-based discovery of biomarkers and immunoinflammatory infiltrates in hip fractures complicating deep vein thrombosis: A STROBE

Deep vein thrombosis due to hip fracture is a normally concomitant symptom when fracture arrival at middle-aged and olderly people, but its molecular mechanism is still not well explained. We hypothesized that there are several key biomarkers and associated signaling pathways that could predict deep vein thrombosis, our goal was to employ bioinformatics to find important biomarkers of deep vein thrombosis and the results of immune infiltration. From the GEO-NCBI database, venous thrombosis expression profiles were chosen, and hip fracture and venous thrombosis gene datasets were gathered from a comprehensive database that can be searched for human genes, which is called GeneCards. Building networks between proteins with the STRING web application, and Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO), 2 bioinformatic analytic tools, were used to conduct functional enrichment investigations. CIBERSORT was used to assess genetic data on the potential location of immune cells in venous thrombosis. Ultimately, 38 distinct genes from the first round and 10 crucial genes from the second round. GO and KEGG analyses showed that the intersecting distinct targets were enriched in routes of signaling mediated by chemokines, immune responses, and Inflammatory reactions were all involved, with the Jak-STAT and HIF-1 signaling pathways being the most significant. Immune cell infiltration analysis showed that immune inflammatory responses regulated by macrophages, and B cell, T cell all play a significant role in venous thrombosis. In conclusion, HIF-1, Jak-STAT signaling pathway, and mangy hub genes regulating inflammatory factors, and immune cells. They have a significant part in the venous thrombosis disease process.

MicroRNA-181b-5p/HEY2 axis is involved in the progress of deep venous thrombosis via mediating vascular endothelial injury

OBJECTIVES

Deep-venous thrombosis (DVT) refers to abnormal blood clotting in the deep vein cavity, and post-thrombotic syndrome (PTS) is the most frequent complication. The study explored the impact of microRNA 181b-5p on DVT progression based on human umbilical vein endothelial cells (HUVECs).

METHODS

Levels of miR-181b-5p were examined in 150 cases with acute lower extremity DVT. ROC curve and K-M plot were drawn for clinical value assessment. The role of miR-181b-5p in HUVECs viability, migration, apoptosis, inflammatory response and adhesion factors' release was investigated. Target gene of miR-181b-5p was predicted, and its role in cell function was explored.

RESULTS

Low-expressed miR-181b-5p showed favorable diagnostic performance in differentiating DVT with the AUC of 0.948. Patients with low miR-181b-5p had a high incidence of PTS. miR-181b-5p overexpression promoted HUVECs' viability and migration, while inhibiting cell apoptosis and release of inflammatory and adhesion cytokines. As the target gene of miR-181b-5p, HEY2 overexpression reversed the role of miR-181b-5p in HUVECs.

CONCLUSION

MiR-181b-5p serves as a potential biomarker for DVT diagnosis and PTS development. Overexpression of this miRNA targeted HEY2 to alleviate endothelial cell damage.

Clinical significance and underlying mechanism of long non-coding RNA SNHG12 in lower extremity deep venous thrombosis

D-dimer is widely used in the diagnosis of deep vein thrombosis (DVT), but the specificity is low. The study examined the diagnostic value of long non-coding RNA (lncRNA) SNHG12 in DVT, and preliminarily discussed its mechanism. SNHG12 levels were detected in 200 elderly fracture patients via RT-qPCR, including 38 DVTs. Logistic regression analysis and receiver operating characteristic (ROC) curve were applied for diagnostic value evaluation. HUVECs were used for function study. Cell proliferation, migration, apoptosis, release of inflammatory cytokines, and adhesion factors were detected. Student's t test and one-way ANOVA were applied for data comparison between two or among three or more groups. Correlation analysis of indicators was completed via Pearson's correlation analysis. Bioinformatics analysis predicted the target miRNAs and genes of SNHG12, with GO and KEGG for the function enrichment. It was found that SNHG12 was at low expression in DVT patients, and negatively correlated with D-dimer concentration (r = -0.535). SNHG12 and D-dimer were independent influence factors related to the development of DVT. SNHG12 and D-dimer combination had the best performance in DVT diagnosis. In HUVECs, SNHG12 promoted cell proliferation and migration and restricted the release of inflammatory cytokines and adhesion factors, but these influences were counteracted by miR-424-5p. A total of 208 overlapping target genes of miR-424-5p were identified, and their function was enriched in cellular cycle and senescence. PI3K-Akt signaling pathway was the most significant pathway based on KEGG results. In conclusion, SNHG12 had good diagnostic potential for DVT combined with D-dimer. SNHG12 maintains vascular endothelial cell function by acting as a competitive endogenous RNA (ceRNA) for miR-424-5p.

Associations between genetically predicted TIMP-3 levels and risk of venous thromboembolism: A two sample Mendelian randomization study

TIMP metallopeptidase inhibitor 3 (TIMP-3) may contribute to the pathogenesis of venous thromboembolism (VTE). However, few studies have investigated the effect of TIMP-3 on VTE. Therefore, a two-sample Mendelian randomization (MR) analysis was conducted to investigate the association between TIMP-3 levels and VTE. Seven independent single-nucleotide polymorphisms (SNPs) for TIMP-3 levels were obtained from a published genome-wide association study (the KORA Consortium, including 997 Europeans). We obtained outcome datasets for VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT) from the FinnGen Consortium. The primary analytical method used in the MR analysis was the inverse variance weighted (IVW) method. To enhance the robustness of the MR results, some other MR methods including weighted median, MR-Egger, and MR-PRESSO were conducted. Moreover, several sensitivity analyses were performed to identify potential horizontal pleiotropy and heterogeneity. In primary IVW MR analyses, per log increase in genetically predicted TIMP-3 levels were positively associated with the incidence of VTE (odds ratio [OR], 1.03; 95 % confidence interval (CI), 1.01, 1.06; P = 0.010), PE (OR, 1.04; 95 % CI, 1.01, 1.08; P = 0.009), and DVT (OR, 1.06; 95 % CI, 1.02, 1.10; P= 0.003). The results of the weighted median, MR-Egger, and MR-PRESSO were similar to the main findings. No unbalanced pleiotropy or heterogeneity was observed. The study suggests that genetically predicted high levels of TIMP-3 may be associated with an increased risk of VTE. These findings indicate that strategies targeting TIMP-3 may provide a basis for the prevention and treatment of VTE. Further investigation is required to clarify this potential mechanism.

Integrated landscape of plasma metabolism and proteome of patients with post-traumatic deep vein thrombosis

Deep vein thrombosis (DVT) is a leading cause of morbidity and mortality after trauma. Here, we integrate plasma metabolomics and proteomics to evaluate the metabolic alterations and their function in up to 680 individuals with and without DVT after trauma (pt-DVT). We identify 28 metabolites and 2 clinical parameter clusters associated with pt-DVT. Then, we develop a panel of 9 metabolites (hexadecanedioic acid, pyruvic acid, L-Carnitine, serotonin, PE(P-18:1(11Z)/18:2(9Z,12Z)), 3-Hydroxycapric acid, 5,6-DHET, 3-Methoxybenzenepropanoic acid and pentanenitrile) that can predict pt-DVT with high performance, which can be verified in an independent cohort. Furthermore, the integration analysis of metabolomics and proteomics data indicates that the upregulation of glycolysis/gluconeogenesis-TCA cycle may promote thrombosis by regulating ROS levels in red blood cells, suggesting that interfering with this process might be potential therapeutic strategies for pt-DVT. Together, our study comprehensively delineates the metabolic and hematological dysregulations for pt-DVT, and provides potential biomarkers for early detection.

miR-2467-3p/ABLIM1 Axis Mediates the Formation and Progression of Deep Vein Thrombosis by Regulating Inflammation and Oxidative Stress

Deep vein thrombosis (DVT) is a common postoperative complication of orthopaedic surgery with a complex pathogenesis mechanism. The effect of the miR-2467-3p/acting-binding LIM protein 1 (ABLIM1) axis on thrombus formation and human vascular endothelial cells (HUVECs) progression was evaluated aiming to identify a novel potential biomarker of DVT. DVT rat models were established by inferior vena cava stenosis. The expression of the miR-2467-3p/ABLIM1 axis was analyzed by PCR. HUVECs were induced with oxidative low-density lipoprotein (ox-LDL). Cell growth and motility were assessed by cell counting kit 8 (CCK8) and Transwell assay. The inflammation and oxidative stress were estimated by proinflammatory cytokines and generation of MDA and reactive oxygen species (ROS). ABLIM1 was downregulated in DVT rats. Overexpressing ABLIM1 could suppress the formation of thrombosis and alleviate inflammation and oxidative stress. In HUVECs, ox-LDL induced significantly increased miR-2467-3p and decreased ABLIM1, and miR-2467-3p could negatively regulate ABLIM1. The knockdown of miR-2467-3p could alleviate the inhibited cell growth and motility by ox-LDL, and the inflammation and oxidative stress were also attenuated. While silencing could reverse the effect of miR-2467-3p on ox-LDL-induced HUVECs. The miR-2467-3p/ABLIM1 axis regulates the occurrence and development of DVT through modulating HUVECs inflammation and oxidative stress.

e-Thrombosis: occupation-specific hazard in electronic information and technology professionals

There are many known risk factors for the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). However, a recently observed risk factor is prolonged sitting (or immobility) for occupational dispensation. Some occupations, especially electronic information technology (IT) professionals, computer gamers, programmers, etc., are amenable to prolonged sitting periods for their work. Such a trend significantly increased in the corporate world during the covid pandemic restrictions and work-from-home policy of the IT companies. We have reported a case of the sudden death of an IT professional due to DVT and PTE. There is a conspicuous indication of the association between prolonged sitting hours and the development of DVT and PTE. This is also known as e-thrombosis. The prolonged seated immobility thromboembolic syndrome is a recently observed phenomenon in professionals having prolonged seated working styles. This paper is a case-based review of all tenets, i.e., clinical presentation, autopsy pathology, and preventive measures of the prolonged seated immobility thromboembolism associated with a sedentary working style.

Vascular Complications in Extracorporeal Membrane Oxygenation-A Narrative Review

The establishment of a peripheral ECMO circuit can lead to significant arterial and venous complications in 10-30% of patients. Vascular complications, particularly acute limb ischemia, are associated with worsening overall outcomes. Limb ischemia occurs significantly more frequently in the early stages of VA ECMO than in VV ECMO. Mechanisms of limb ischemia include arterial obstruction, cannulation injury, loss of pulsatile flow, thromboembolism, venous stasis from compressive obstruction with large venous cannulas, and systemic vasoconstriction due to shock and pharmacologic vasoconstriction. The care team may use several mitigation strategies to prevent limb ischemia. Arterial and venous complications can be mitigated by careful access site selection, minimizing cannula size, placement of distal perfusion and/or outflow catheter(s), and continuous NIRS monitoring. Rapid intervention, when ischemia or compartment syndrome occurs, can reduce limb loss but may not affect the mortality and morbidity of the ECMO patient in the long term due to their underlying conditions and the etiology of the ECMO need.

Distribution characteristics of perioperative deep vein thrombosis (DVT) and risk factors of postoperative DVT exacerbation in patients with thoracolumbar fractures caused by high-energy injuries

OBJECTIVE

To investigate the distribution characteristics of perioperative deep venous thrombosis (DVT) in patients with thoracolumbar fractures caused by high-energy injuries and analyze the risk factors of postoperative DVT exacerbation.

METHODS

From October 2016 to July 2021, a total of 550 patients with thoracolumbar fractures due to high-energy injuries in our hospital were retrospectively analyzed. Both lower limbs were examined by ultrasound before and after operation. Depending on whether the postoperative DVT was exacerbating, the group was divided into a DVT exacerbation group and a non-DVT exacerbation group. Clinical data were used to study the characteristics of perioperative DVT. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to explore the risk factors of postoperative DVT exacerbation.

RESULTS

DVT was found in 97 patients before operation, including 78 cases of distal thrombus, 6 cases of proximal thrombus, and 13 cases of mixed thrombus. Postoperative DVT increased to 116, including 87 distal thrombus, 10 proximal thrombus, and 19 mixed thrombus. The intermuscular vein was the most easily involved vein. Compared with lumbar fractures, thoracic fractures were more likely to have postoperative proximal thrombus (P=0.014). There were 48 cases of thrombus exacerbation after operation. Logistic regression analysis revealed that age, lower extremity muscle strength, time from injury to operation, and blood loss were risk factors for postoperative DVT exacerbation.

CONCLUSIONS

The intermuscular vein is the most easily involved vein. The anatomical distribution of DVT at different fracture sites is different, and patients with thoracic fractures are more likely to have proximal DVT after operation. Age, lower extremity muscle strength, time from injury to operation, and blood loss were risk factors for postoperative DVT exacerbation.

Advancements in the interventional therapy and nursing care on deep vein thrombosis in the lower extremities

This review examines recent advancements in interventional treatments and nursing care for lower extremity deep vein thrombosis (DVT), highlighting significant innovations and their clinical applications. It discusses the transition to novel anticoagulants such as Direct Oral Anticoagulants, which offer a safer profile and simplified management compared to traditional therapies. Mechanical interventions, including balloon angioplasty and venous stenting, are detailed for their roles in improving immediate and long-term vascular function in acute DVT cases. Furthermore, the use of image-guided techniques is presented as essential for enhancing the accuracy and safety of DVT interventions. Additionally, this study outlines advances in nursing care strategies, emphasizing comprehensive preoperative and postoperative evaluations to optimize patient outcomes. These evaluations facilitate tailored treatment plans, crucial for managing the complex needs of DVT patients. Long-term care strategies are also discussed, with a focus on patient education to ensure adherence to treatment protocols and to prevent recurrence. The synthesis aims to inform healthcare professionals about cutting-edge practices in DVT management, promoting a deeper understanding of how these advancements can be integrated into clinical practice. It also underscores the necessity for ongoing research to address challenges such as cost-effectiveness and patient compliance, ensuring that future treatments are both accessible and effective.

Circ-USP9X accelerates deep vein thrombosis after fracture by acting as a miR-148b-3p sponge and upregulates SRC kinase signaling inhibitor 1

OBJECTIVES

This study aims to elucidate the role of circUSP9X (Circular RNA Ubiquitin Specific Peptidase 9 X-Linked) in the development of venous thrombosis in the lower extremities.

METHODS

An animal model of Deep Vein Thrombosis (DVT) and a hypoxic model of Human Umbilical Vein Endothelial Cells (HUVECs) treated with Cobalt (II) Chloride (CoCl2) were developed. The expression levels of circUSP9X, microRNA-148b-3p (miR-148b-3p), and SRC Kinase Signaling Inhibitor 1 (SRCIN1) were quantified using quantitative reverse transcription Polymerase Chain Reaction and Western blot analysis. Cell cytotoxicity, viability, apoptosis, and inflammation in HUVECs were assessed via Lactate Dehydrogenase (LDH) assay, MTT assay, flow cytometry, Enzyme-Linked Immunosorbent Assay, and Western blot, respectively. Hematoxylin and Eosin staining were employed for histopathological examination of the venous tissues in the animal model. The interaction between circUSP9X, miR-148b-3p, and SRCIN1 was further explored through dual-luciferase reporter assays and RNA Immunoprecipitation experiments.

RESULTS

The present findings reveal a significant upregulation of circUSP9X and SRCIN1 and a concurrent downregulation of miR-148b-3p in DVT cases. Knockdown of circUSP9X or overexpression of miR-148b-3p ameliorated CoCl2-induced apoptosis in HUVECs, reduced LDH release, enhanced cellular viability, and mitigated inflammation. Conversely, overexpression of circUSP9X intensified CoCl2's cytotoxic effects. The effects of manipulating circUSP9X expression were counteracted by the corresponding modulation of miR-148b-3p and SRCIN1 levels. Additionally, circUSP9X knockdown effectively inhibited the formation of DVT in the mouse model. A competitive binding mechanism of circUSP9X for miR-148b-3p, modulating SRCIN1 expression, was identified.

CONCLUSION

circUSP9X promotes the formation of DVT through the regulation of the miR-148b-3p/SRCIN1 axis.

Preliminary clinical analysis and pathway study of S100A8 as a biomarker for the diagnosis of acute deep vein thrombosis

Herein, we aimed to identify blood biomarkers that compensate for the poor specificity of D-dimer in the diagnosis of deep vein thrombosis (DVT). S100A8 was identified by conducting protein microarray analysis of blood samples from patients with and without DVT. We used ELISA to detect S100A8, VCAM-1, and ICAM-1 expression levels in human blood and evaluated their correlations. Additionally, we employed human recombinant protein S100A8 to induce human umbilical vein endothelial cells and examined the role of the TLR4/MAPK/VCAM-1 and ICAM-1 signaling axes in the pathogenic mechanism of S100A8. Simultaneously, we constructed a rat model of thrombosis induced by inferior vena cava stenosis and detected levels of S100A8, VCAM-1, and ICAM-1 in the blood of DVT rats using ELISA. The associations of thrombus tissue, neutrophils, and CD68-positive cells with S100A8 and p38MAPK, TLR4, and VCAM-1 expression levels in vein walls were explored. The results revealed that blood S100A8 was significantly upregulated during the acute phase of DVT and activated p38MAPK expression by combining with TLR4 to enhance the expression and secretion of VCAM-1 and ICAM-1, thereby affecting the occurrence and development of DVT. Therefore, S100A8 could be a potential biomarker for early diagnosis and screening of DVT.

Revolutionizing Neurocare: Biomimetic Nanodelivery Via Cell Membranes

Brain disorders represent a significant challenge in medical science due to the formidable blood-brain barrier (BBB), which severely limits the penetration of conventional therapeutics, hindering effective treatment strategies. This review delves into the innovative realm of biomimetic nanodelivery systems, including stem cell-derived nanoghosts, tumor cell membrane-coated nanoparticles, and erythrocyte membrane-based carriers, highlighting their potential to circumvent the BBB's restrictions. By mimicking native cell properties, these nanocarriers emerge as a promising solution for enhancing drug delivery to the brain, offering a strategic advantage in overcoming the barrier's selective permeability. The unique benefits of leveraging cell membranes from various sources is evaluated and advanced technologies for fabricating cell membrane-encapsulated nanoparticles capable of masquerading as endogenous cells are examined. This enables the targeted delivery of a broad spectrum of therapeutic agents, ranging from small molecule drugs to proteins, thereby providing an innovative approach to neurocare. Further, the review contrasts the capabilities and limitations of these biomimetic nanocarriers with traditional delivery methods, underlining their potential to enable targeted, sustained, and minimally invasive treatment modalities. This review is concluded with a perspective on the clinical translation of these biomimetic systems, underscoring their transformative impact on the therapeutic landscape for intractable brain diseases.

Haemostatic gene variations in cervical cancer-associated venous thrombosis: considerations for clinical strategies

Venous thromboembolism (VTE) is a life-threatening haemostatic disease frequently diagnosed among the cancer population. The Khorana Score is currently the primal risk assessment model to stratify oncological patients according to their susceptibility to VTE, however, it displays a limited performance. Meanwhile, intensive research on VTE pathophysiology in the general population has uncovered a range of single-nucleotide polymorphisms (SNPs) associated with the condition. Nonetheless, their predictive ability concerning cancer-associated thrombosis (CAT) is controversial. Cervical cancer (CC) patients undergoing chemoradiotherapy often experience VTE, which negatively affects their survival. Thus, aiming for an improvement in thromboprophylaxis, new thrombotic biomarkers, including SNPs, are currently under investigation. In this study, the predictive capability of haemostatic gene SNPs on CC-related VTE and their prognostic value regardless of VTE were explored. Six SNPs in haemostatic genes were evaluated. A total of 401 CC patients undergoing chemoradiotherapy were enrolled in a retrospective cohort study. The implications for the time to VTE occurrence and overall survival (OS) were assessed. CAT considerably impacted the CC patients' OS (log-rank test, P < 0.001). SERPINE1 rs2070682 (T > C) showed a significant association with the risk of CC-related VTE (CC/CT vs. TT, log-rank test, P = 0.002; C allele, Cox model, hazard ratio (HR) = 6.99 and P = 0.009), while F2 rs1799963 (G > A) demonstrated an important prognostic value regardless of VTE (AA/AG vs. GG, log-rank test, P = 0.020; A allele, Cox model, HR = 2.76 and P = 0.026). For the remaining SNPs, no significant associations were detected. The polymorphisms SERPINE1 rs2070682 and F2 rs1799963 could be valuable tools in clinical decision-making, aiding in thromboprophylaxis and CC management, respectively.

Comparison of different machine learning classification models for predicting deep vein thrombosis in lower extremity fractures

Deep vein thrombosis (DVT) is a common complication in patients with lower extremity fractures. Once it occurs, it will seriously affect the quality of life and postoperative recovery of patients. Therefore, early prediction and prevention of DVT can effectively improve the prognosis of patients. This study constructed different machine learning models to explore their effectiveness in predicting DVT. Five prediction models were applied to the study, including Extreme Gradient Boosting (XGBoost) model, Logistic Regression (LR) model, RandomForest (RF) model, Multilayer Perceptron (MLP) model, and Support Vector Machine (SVM) model. Afterwards, the performance of the obtained prediction models was evaluated by area under the curve (AUC), accuracy, sensitivity, specificity, F1 score, and Kappa. The prediction performances of the models based on machine learning are as follows: XGBoost model (AUC = 0.979, accuracy = 0.931), LR model (AUC = 0.821, accuracy = 0.758), RF model (AUC = 0.970, accuracy = 0.921), MLP model (AUC = 0.830, accuracy = 0.756), SVM model (AUC = 0.713, accuracy = 0.661). On our data set, the XGBoost model has the best performance. However, the model still needs external verification research before clinical application.

A Review About the Assessment of the Bleeding and Thrombosis Risk for Patients With Myeloproliferative Neoplasms Scheduled for Surgery

Myeloproliferative neoplasms (MPNs) present a unique challenge in surgical management due to their inherent predisposition to both bleeding and thrombosis. MPNs are a heterogenous group of acquired clonal conditions. The three classic MPNs are essential thrombocythemia (ET), myelofibrosis (PMF), and polycythemia vera (PV). All subtypes of MPN are associated with both thrombotic and bleeding complications. There are four risk categories for thrombosis in MPN patients: age, thrombosis history, and JAK-2 mutation. They are further classified as very low, low, intermediate, and high risk. The genetic landscape of MPN is fascinating and complex like all myeloid disorders. Bleeding risk can be assessed through leukocytosis, thrombocytosis, acquired von Willebrand syndrome (AVWS), and a previous history of bleeding in a patient. Risk assessment and perioperative management are important aspects of improving the quality of life and preventing complications in surgeries. Preoperative management includes a risk assessment of venous thromboembolism, use of appropriate pharmacological treatment, platelet count control, and correction and cardiovascular risk factors. This review summarizes the assessment of bleeding and thrombosis risk for patients with MPNs scheduled for surgery. Furthermore, this review discusses various tools that can be used to identify MPN patients at risk of thrombosis prior to surgery.

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

Cardiac troponin serum concentration is the primary marker used for the diagnosis of acute coronary syndrome. Moreover, the measurement of cardiac troponin concentration is important for risk stratification in patients with pulmonary embolism. The cardiac troponin level is also a general marker of myocardial damage, regardless of etiology. The purpose of this study is to conduct a literature review and present the most important information regarding the current state of knowledge on the cardiac troponin serum concentration in patients with chronic cardiovascular disease (CVD), as well as on the relationships between cardiac troponin serum concentration and features of subclinical cardiovascular dysfunction. According to research conducted to date, patients with CVDs, such as chronic coronary syndrome, chronic lower extremities' ischemia, and cerebrovascular disease, are characterized by higher cardiac troponin concentrations than people without a CVD. Moreover, the literature data indicate that the concentration of cardiac troponin is correlated with markers of subclinical dysfunction of the cardiovascular system, such as the intima-media thickness, pulse wave velocity, ankle-brachial index, coronary artery calcium index (the Agatston score), and flow-mediated dilation. However, further research is needed in various patient subpopulations and in different clinical contexts.

Endovascular management of acute and subacute venous thoracic outlet syndrome

Approximately 3% of all patients presenting with Thoracic Outlet Syndrome have a venous etiology (vTOS), which is considered "effort thrombosis". These patients will present with symptomatic deep venous thrombosis or focal subclavian vein (SCV) stenosis. Endovascular management of vTOS occurs in several phases: diagnostic, preoperative therapeutic intervention before decompression, postoperative interventions after decompression, and delayed interventions in the follow-up after decompression. In the diagnostic phase, dynamic SCV venography can establish functional vTOS. Approximately 4,000 patients have been treated for vTOS and reported in the literature since 1970. Declotting of the SCV was followed by surgical decompression in 53% of patients, while in the remainder, surgical decompression alone (18%), endovascular intervention alone (15%), or conservative therapy with anticoagulation (15%) was performed. The initial intervention was predominantly catheter-directed thrombolysis, with <10% of cases undergoing concomitant balloon angioplasty. 93% of cases were successful. In the postoperative phase, balloon angioplasty was performed to correct residual intrinsic SCV disease after vTOS decompression in under 15% of cases. Stents were rarely deployed. Symptom relief was reported as 94 ± 12% (mean ± SD) and 90 ± 23%, respectively for declotting with decompression and declotting alone. In the delayed phase, balloon angioplasty was performed in under 15% of cases to re-establish patency.

Analysis of Risk Factors for Postoperative Deep Vein Thrombosis in Traumatic Spinal Fracture Complicated with Spinal Cord Injury

The purpose of this study is to investigate the risk factors for postoperative deep vein thrombosis (DVT) in patients with traumatic spinal fractures complicated with Spinal Cord Injury(SCI). We conducted a retrospective analysis of 110 patients with traumatic spinal fractures and SCI admitted to our hospital from March 2021 to April 2024. DVT was diagnosed using ultrasound. Patient history, general data, surgical data, laboratory tests, and thromboelastogram (TEG) results were collected. The patients were divided into a DVT group and a non-DVT group according to the results of ultrasound one week after surgery. The risk factors and diagnostic value were analyzed using binary logistic regression and receiver operating characteristic (ROC) curves in both univariate and multivariate analyses. Multivariate and ROC analysis results showed that D-dimer, lower extremity, duration of bedrest, and MA values of TEG were independent risk factors for DVT in SCI, with D-dimer having the highest diagnostic value (AUC = 0.883). The AUC values for lower extremity, duration of bedrest, and MA were 0.731, 0.750, and 0.625. In conclusion, Postoperative D-dimer > 5.065 mg/l, lower extremity < 3, duration of bedrest, and MA value of TEG are independent risk factors for postoperative DVT in SCI patients, D-dimer having the highest diagnostic value. When the above risk factors occur, clinicians need to be vigilant and take appropriate prevention and treatment measures.

Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin - propensity score matching study

BACKGROUND

Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE.

METHODS

A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test.

RESULTS

Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61).

CONCLUSION

In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.