The epidemiology of venous thromboembolism

Scoring systems to predict thrombotic complications in solid tumor patients

PURPOSE OF REVIEW

To explore the use of large datasets in predicting and managing cancer-associated venous thromboembolism (CAT) by stratifying patients into risk groups. This includes evaluating current predictive models and identifying potential improvements to enhance clinical decision-making.

RECENT FINDINGS

Cancer patients are at an elevated risk of developing venous thromboembolism (VTE), which significantly impacts mortality and quality of life. Traditional approaches to risk assessment fail to account for the procoagulant changes associated with cancer, making individualized risk prediction a challenge. Current clinical guidelines as per ASCO recommend risk assessment before chemotherapy and endorse thromboprophylaxis as a standard preventive measure. Since any cancer population is highly heterogeneous in terms of VTE risk, predicting the risk of CAT is an oncological challenge. To address this, different predictive models have been developed to stratify patients by risk, enabling targeted thromboprophylaxis. However, these models vary in accuracy and utility. The present review discusses the pros and cons of these different models.

SUMMARY

The review examines existing CAT risk prediction models, highlighting their strengths, limitations, and diagnostic performance. It also identifies additional variables that could enhance these models to improve their effectiveness in guiding clinicians toward better risk stratification and treatment decisions for cancer patients.

Sedentary behaviors and venous thromboembolism risk among older women: the Objective Physical Activity and Cardiovascular Health study

BACKGROUND

Venous stasis, which can occur with prolonged sedentary behavior (SB), is associated with venous thromboembolism (VTE) risk, but VTE risk associated with accelerometer-measured SB has not been quantified.

OBJECTIVES

To evaluate accelerometer-based measures of SB in relation to incident VTE.

METHODS

We included 5591 participants, aged 63 to 99 years, of the Women's Health Initiative Objective Physical Activity and Cardiovascular Health cohort study without prior VTE. Between May 2012 and April 2014, participants wore the ActiGraph GT3X+ accelerometer at the hip for 7 days. Three SB measures were classified using the Convolutional Neural Network Hip Accelerometer Posture algorithm: total sitting time, mean sitting bout duration, and total time spent in prolonged (≥30 minutes) sitting bouts. VTE events were centrally adjudicated. Multivariable-adjusted Cox models estimated hazard ratios for each SB and VTE risk. Women were censored at first VTE, death, loss to follow-up, or February 2023. Mediation by body mass index (BMI) was evaluated.

RESULTS

Over a mean follow-up of 8.2 years, 229 women experienced a VTE. In adjusted models, longer mean sitting bout duration was associated with greater incident VTE risk (hazard ratio per 5-minute increase, 1.15; 95% CI, 1.04-1.28). BMI mediated approximately 30% of this association (P < .01). We found no significant evidence that total sitting time or total time spent in prolonged sitting bouts were associated with VTE.

CONCLUSION

Longer mean sitting bout duration was associated with greater VTE risk, with substantial mediation by BMI. Behavioral efforts to reduce sedentary bout length in older women may reduce their VTE risk.

Adult-onset inflammatory bowel disease and the risk of venous thromboembolism - a Swedish nationwide cohort study 2007-2021

BACKGROUND

Earlier studies, mainly prior to the widespread use of advanced therapy and implementation of guidelines for thromboprophylaxis indicate a doubled risk of venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD).

METHODS

Using Swedish healthcare registers, we identified a population-based cohort of patients with incident IBD 2007-2021. Patients were matched by age, sex, calendar year of birth and place of residence with up to 10 reference individuals. The primary outcome was VTE, i.e., pulmonary embolism (PE) and deep vein thrombosis (DVT). Incidence rates (IRs) per 1000 person-years, cumulative incidence and hazard ratios (HRs) were calculated for IBD overall and according to clinical characteristics. The temporal trend of the incidence of VTE by calendar year was presented.

RESULTS

We followed 55,252 IBD patients and 536,067 reference individuals, for a median of 6.5 years. The incidence of VTE in IBD was 5.03 vs. 2.35 per 1000 person-years among reference individuals, corresponding to a doubled risk of VTE (HR = 2.12; 95% confidence interval [CI] 2.02-2.23). Particularly high risks were seen in the first year of follow-up, and among patients with extensive ulcerative colitis (UC), primary sclerosing cholangitis (PSC), extraintestinal manifestations, perianal disease and hospitalization at diagnosis. The occurrence of VTE in IBD did not decrease across calendar years.

CONCLUSIONS

IBD remains linked to an elevated risk of VTE, particularly with disease characteristics associated with a higher inflammatory burden and higher age. Our findings underscore the importance of continuous vigilance and individual assessment of VTE risk in patients with IBD.

Risk of Venous Thromboembolism in Pediatric Patients with Surgically Treated Lower-Extremity Fractures: A Propensity-Matched Cohort Study

BACKGROUND

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a substantial cause of morbidity and mortality among hospitalized patients. Although rare in the general pediatric population, VTE remains a potential concern in hospitalized children, particularly those with lower-extremity (LE) fractures. With this study, we aimed to determine the risk of VTE in pediatric patients with surgically treated LE fractures through a retrospective, propensity-matched, cohort analysis.

METHODS

The TriNetX Research Network, encompassing data from >80 health-care organizations and >120 million patient records, was utilized for this retrospective cohort study comparing 3 age-based cohorts (children [age of <14 years], adolescents [age of 14 to 17 years], and adults [age of ≥18 years]) who underwent surgical treatment of LE fractures between January 1, 2003, and January 1, 2023.

RESULTS

A total of 634,880 patients with surgically treated LE fractures were included; 13.3% were children, 5.6% were adolescents, and 81.1% were adults. Propensity-score matching was used to compare VTE incidence across cohorts, resulting in 3 independent matched comparisons. Overall, the incidence of VTE (either DVT or PE) was 0.2% in children, 1.0% in adolescents, and 4.1% in adults. Adults had a significantly higher risk of developing DVT (risk ratio [RR]: 17.0; 95% confidence interval [CI]: 14.5 to 20.0) and PE (RR: 21.8; 95% CI: 17.0 to 28.1) compared with children. Similarly, adolescents had a higher risk of DVT (RR: 3.5; 95% CI: 2.7 to 4.4) and PE (RR: 3.1; 95% CI: 2.2 to 4.4) compared with children. The incidence of VTE varied by fracture location, with femoral and knee joint (incidence: 0.5% in children, 2.5% in adolescents) and pelvic and hip joint (incidence: 1.2% in children, 2.8% in adolescents) fractures presenting the highest risk across all age groups.

CONCLUSIONS

The incidence of VTE in a large cohort of pediatric patients undergoing surgical treatment of LE fractures was higher in adolescents than in children. These findings may warrant prophylactic VTE measures in adolescents undergoing surgical treatment of femoral or pelvic fractures.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

How Do Venous Thromboembolism Rates in Adolescents and Adults Compare After Arthroscopic Knee Surgery? A Propensity-Matched Study

BACKGROUND

Arthroscopic knee procedures such as meniscus and ACL repairs are cornerstone interventions in pediatric and sports orthopaedics. While venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a rare yet devastating complication in major joint surgeries, its association with minimally invasive procedures remains relatively unexplored. Emerging evidence shows rates of VTE in adolescent orthopaedic patients approaching that of adults, highlighting the need to further characterize the unique risk profile of this population. Therefore, this study aims to compare VTE rates, risk factors, and chemoprophylaxis use in adolescents versus adults undergoing arthroscopic knee procedures.

METHODS

A retrospective cohort study using the TriNetX Research Network identified 301,585 patients who underwent knee arthroscopy from January 2003 to January 2023, including 29,984 adolescents (aged 14 to 17) and 271,601 adults (aged 18 years or older). Propensity score matching based on sex and relevant comorbidities, including diabetes mellitus, tobacco use, oral contraceptive (OCP) use, and obesity yielded balanced cohorts of 29,984 each. Univariate logistic regression analysis was performed for preliminary assessment of the risk factors associated with VTE. P<0.01 was considered significant.

RESULTS

Adults had a higher 90-day incidence of DVT (1.3% vs. 0.8%) and PE (0.3% vs. 0.2%) than adolescents. Combined DVT/PE incidence was 1.5% in adults and 0.8% in adolescents (RR: 1.782). Univariate analysis showed OCP use (OR: 3.167), obesity (OR: 3.445), tobacco use (OR: 23.975), and diabetes (OR: 34.064) were significant VTE risk factors in adolescents; sex was not. Adults more frequently received postoperative chemoprophylaxis (24% vs. 20%, P<0.001), with aspirin being the most common agent (23% in adults vs. 19% in adolescents, P<0.001).

CONCLUSION

Adolescents undergoing knee arthroscopy have a lower risk of VTE compared with adults, with an incidence below 1%. Routine VTE prophylaxis may not be necessary for all adolescents but should be considered for those with significant risk factors, including diabetes, tobacco use, and obesity. Further research is warranted to refine prophylaxis guidelines in this population.

LEVEL OF EVIDENCE

Level III-retrospective cohort study.

Assessing Venous Thromboembolism Risk in Hip Arthroscopy: A Propensity-matched Comparison of Adolescents and Adults

BACKGROUND

Hip arthroscopy is a commonly performed procedure in adolescents with hip pathology. However, there is limited data on venous thromboembolism (VTE) events in this population, resulting in minimal guidance on appropriate VTE prophylaxis, with the bulk of current guidance extrapolated from the adult population. Therefore, this study aims to assess overall rates of VTE in the adolescent population as well as compare these rates to a matched cohort of adult patients undergoing hip arthroscopy.

METHODS

This retrospective cohort study drew data from the TriNetX platform between January 1, 2003 and March 1, 2024. Adolescent patients, ages 13 to 18, were matched to adult patients (19 and older) undergoing hip arthroscopy, accounting for sex, tobacco use, oral contraceptive use, diabetes mellitus, and overweight/obesity. Outcomes of interest were deep vein thrombosis (DVT) or pulmonary embolism (PE) within 90 days after the procedure. Overall rates were calculated and compared between cohorts. Statistical significance was set at P<0.01.

RESULTS

A total of 3655 patients were successfully matched with a mean age of 16 in the adolescent cohort and 35 in the adult cohort. The overall rates of DVT were similar between cohorts, at 1% for adolescent patients and 0.9% for adults (RR: 0.892; 95% CI: 0.559-1.423; P=0.63). All VTE events (combined DVT and PE) were also similar at 1.1% for adolescent patients and 1.0% in adults (RR: 0.925; 95% CI: 0.593-1.443; P=0.73).

CONCLUSION

This study found no significant difference in VTE between adolescent and adult patients undergoing hip arthroscopy. The overall rate of VTE was relatively high in adolescent patients, at 1.1%, suggesting additional attention to VTE and potential chemoprophylaxis may be warranted in select patients.

LEVEL OF EVIDENCE

Level III-case-control study or retrospective cohort study.

Micro/nanomotors in targeted drug delivery: Advances, challenges, and future directions

The therapeutic efficacy of drugs is highly dependent on their successful delivery to the target site. However, achieving targeted drug delivery to diseased areas remains a significant challenge. Current drug delivery systems based on nanocarriers often suffer from inefficiencies due to their lack of intrinsic propulsion and active targeting capabilities. Micro/nanomotors (MNMs), which are miniature machines capable of converting chemical or external energy into mechanical energy, offer a promising solution. Unlike traditional nanoparticles (NPs) that rely on passive diffusion through blood circulation, MNMs exhibit active locomotion, providing a significant advantage in future drug delivery applications. This review primarily focuses on the progress in research of MNMs in the realm of drug delivery. We present a succinct overview of MNMs and subsequently classify them based on their modes of mobility. Then we comprehensively summarize the applications of micro/nanomotor-based drug delivery systems in the treatment of various diseases, including cancer, bacterial infections, cardiovascular diseases, and others. Based on the current research status, we summarize the potential challenges, possible solutions, and prospect several key directions for future studies in active-targeted drug delivery using MNMs. Future research should focus on improving motor delivery efficiency, biosafety measures, productivity, and maneuverability.

Prediction of Recurrent Venous Thromboembolism and Arterial Cardiovascular Events after Discontinuation of Anticoagulation: The R-VTE-predict and MACE-predict Risk Scores

Patients who had venous thromboembolism (VTE) are not only at increased risk of recurrent VTE but also of major adverse cardiovascular events (MACEs) than the general population. Therefore, the prediction of the risk of these events is important for a tailored prevention and mitigation strategy. We aimed to develop simple scores to estimate recurrent VTE and MACE risks after the discontinuation of anticoagulation in a large cohort of individuals who suffered VTE (EDITH cohort). The primary endpoints were recurrent symptomatic VTE and MACE (composite of non-fatal acute coronary syndrome, stroke and cardiovascular death). Arterial thrombotic event (ATE) exclusively was also considered. Independent predictors of main outcomes were derived from multivariable Cox regression models. Weighted integer points based on the effect estimate of identified predictors were used to derive the final risk scores. A total of 1,999 participants (mean age: 54.78 years, 46.4% male, 43.6% unprovoked VTE) were included in the derivation cohort and 10,000 in the validation cohort (built using bootstrapping). During a median post-anticoagulation follow-up of 6.9 years, recurrent VTE occurred in 29.5% of participants and MACE in 14.8%. Independent predictors of recurrent VTE were male sex, age >65 years, cancer-associated VTE, and unprovoked VTE (vs. transient risk factor-associated VTE). Independent predictors of MACE were age >65 years, cancer-associated VTE, hypertension, renal insufficiency, and atrial fibrillation. The risk of recurrent VTE (moderate vs. low: hazard ratio [HR]: 2.62, 95% confidence interval [CI]: 2.06-3.34; high vs. low: HR: 3.78, 95% CI: 2.91-4.89), MACE (moderate vs. low: HR: 6.37, 95% CI: 3.19-12.69; high vs. low: HR: 12.32, 95% CI: 6.09-24.89), and ATE (based on MACE-predict risk score) increased gradually from the lowest to highest of the respective prediction risk score groups. These results were confirmed in the validation cohort with overall reasonable models' discrimination performance (recurrent VTE C-statistic: 0.62-0.63, MACE and ATE C-statistic: 0.72-0.77). Contemporary simple risk scores based on readily available clinical characteristics can reasonably predict the risk of recurrent VTE and MACE after the discontinuation of anticoagulation. These findings may influence the choice of anticoagulation strategy after the acute phase of VTE and, therefore, need confirmation by further studies.

The effect of combined oral contraceptives on thrombin generation assessed on ST Genesia- a paired clinical study

BACKGROUND

Treatment with combined oral contraceptives (COC) is associated with an increased risk of venous thromboembolism. Several changes of coagulant and anticoagulant factors induced by ethinyloestradiol during treatment with COC, have been demonstrated. Thrombin generation is a global test measuring both coagulant and anticoagulant factors, but the effect of COC on individuals starting COC, has not been examined before on the new equipment, ST Genesia. The aim of this project was to examine the effect of COC on thrombin generation on ST Genesia, in individuals before and after starting COC.

METHODS

Twenty-four female participants between 15 and 34 years of age, who were about to start treatment with ethinylestradiol/levonorgestrel-containing COC, were included in the study. Two blood samples were drawn from each of the study subjects, a baseline sample immediately before first COC dose, and a follow-up blood sample approximately 3-4 months after COC start. Standard biochemical analyses as well as standard and special coagulation analyses including thrombin generation on ST Genesia, were performed in all samples.

RESULTS

Thrombin generation, i.e., endogenous thrombin generation (ETP) and peak increased considerably after COC start, whereas time-to-peak was shortened. Thrombin-antithrombin complexes (TAT), prothrombin fragments (F1 + 2) and sex hormone binding globulin (SHBG) increased, and the coagulation inhibitors tissue factor pathway inhibitor (TFPI), protein S activity and antithrombin decreased slightly after COC start.

CONCLUSION

Although the coagulation factors only changed modestly, the global test thrombin generation performed on ST Genesia showed a considerable change after start of COC.

Pathophysiology and Management of Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) is a less common type of stroke that can occur across all age groups but predominantly affects children and young adults. Diagnosis is often challenging due to the nonspecific and variable clinical presentation. The disease course is heterogeneous, with CVT-related parenchymal lesions developing in approximately 50 to 60% of cases. Despite some advancements, significant gaps persist in understanding the pathophysiology of CVT, including the mechanisms underlying brain injury. Anticoagulation is the cornerstone of CVT treatment, but strategies targeting secondary mechanisms of parenchymal damage are still lacking. Here, the current state of the field is briefly reviewed, with the aim to introduce a wide audience (neuroscientists and clinicians alike) to the disease and inform clinical practice and future research.

Syringe-assisted test-aspiration with mechanical aspiration thrombectomy results in good safety and short-term outcomes in the treatment of patients with deep venous thrombosis

ObjectiveTo evaluate the short-term outcomes and safety of syringe-assisted test-aspiration with mechanical aspiration thrombectomy in the treatment of deep venous thrombosis.MethodsThis was a single-center, retrospective study of hospitalized patients with iliofemoral and/or inferior vena caval deep venous thrombosis, excluding those with pulmonary embolism. We collected the following patient data from the electronic medical records: age, sex, provoked/unprovoked deep venous thrombosis, symptom duration, thrombosed segments, and the presence of a tumor, thrombophilia, diabetes, and/or iliac vein compression syndrome. Venography and computed tomographic venography were performed in all patients before the procedure. All patients underwent syringe-assisted test-aspiration with mechanical aspiration thrombectomy under local anesthesia and sedation, and all received low-molecular-weight heparin peri-operatively. All patients underwent implantation of an inferior vena caval filter. Rivaroxaban was administered post-procedure, instead of heparin, for 3-6 months, with lower extremity compression.ResultsOverall, 29 patients with deep venous thrombosis underwent syringe-assisted test-aspiration with mechanical aspiration thrombectomy from January 2022 to October 2022 in our institution. Technical success (>70% thrombus resolution) was achieved in all patients, and using a single procedure in 25/29 patients (86%). Concomitant stenting was performed in 18/29 (62%) of the patients, and 21/29 (69%) underwent angioplasty. The median (interquartile range) procedure time was 110 min (100-122), the median intra-operative bleeding volume was 150 mL (120-180), and the median decrease in the hemoglobin concentration from pre- to post-operative was 7 g/L (4-14). The median follow-up duration was 7 months (5-9). All patients obtained symptomatic relief, and 27/29 achieved near-remission or full remission (combined total). No patients experienced peri-operative bleeding complications, or symptom recurrence or post-thrombectomy syndrome during follow-up.ConclusionThe short-term outcomes following syringe-assisted test-aspiration with mechanical aspiration thrombectomy in the treatment of deep venous thrombosis were excellent, and the procedure was safe.

Predicting a failure of postoperative thromboprophylaxis in non-small cell lung cancer: A stacking machine learning approach

BACKGROUND

Non-small-cell lung cancer (NSCLC) and its surgery significantly increase the venous thromboembolism (VTE) risk. This study explored the VTE risk factors and established a machine-learning model to predict a failure of postoperative thromboprophylaxis.

METHODS

This retrospective study included patients with NSCLC who underwent surgery between January 2018 and November 2022. The patients were randomized 7:3 to the training and test sets. Nine machine learning models were constructed. The three most predictive machine-learning classifiers were chosen as the first layer of the stacking machine-learning model, and logistic regression was the second layer of the meta-learning model.

RESULTS

This study included 362 patients, including 58 (16.0%) with VTE. Based on the multivariable logistic regression analysis, age, platelets, D-dimers, albumin, smoking history, and epidermal growth factor receptor (EGFR) exon 21 mutation were used to develop the nine machine-learning models. LGBM Classifier, RandomForest Classifier, and GNB were chosen for the first layer of the stacking machine learning model. The area under the received operating characteristics curve (ROC-AUC), accuracy, sensitivity, and specificity of the stacking machine learning model in the training/test set were 0.984/0.979, 0.949/0.954, 0.935/1.000, and 0.958/0.887, respectively. In the validation set, the final stacking machine learning model demonstrated an ROC AUC of 0.983, accuracy of 0.937, sensitivity of 0.978, and specificity of 0.947. The decision curve analyses revealed high benefits.

CONCLUSION

The stacking machine learning model based on EGFR mutation and clinical characteristics had a predictive value for postoperative VTE in patients with NSCLC.

Development and validation of a nomogram for predicting pulmonary embolism in patients with pulmonary tuberculosis

Background

The coexistence of pulmonary tuberculosis (PTB) and pulmonary embolism (PE) is an uncommon clinical condition, and its rarity is associated with a high mortality rate, underscoring the critical importance of early diagnosis. The purpose of this study is to develop and validate a nomogram model for predicting risk of PE in patients with PTB.

Methods

We included 694 patients with PTB in the development cohort and 236 patients in the validation cohort from another center. A prediction model was established based on independent risk factors. The nomogram's performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, and decision curve analysis (DCA).

Results

D-dimer, age, tumor, chest pain, dyspnea, and surgery were independent risk factors for PTB with PE, and a nomogram model was established to predict PTB with PE. The AUC of the development and validation cohort model was 0.903 and 0.821. The calibration curves for both cohorts showed that the probabilities predicted by the model were very close to the actual probabilities. The DCA also demonstrated that the nomogram model showed significant clinical application value.

Conclusions

The risk factor-related nomogram model identified in this study has a high predictive accuracy and provides a clinical application for assessing the risk of PE in patients with tuberculosis.

Circulating CD34+ Cells: A New Biomarker of Residual Pulmonary Vascular Obstruction after Pulmonary Embolism

Pulmonary embolism (PE) is a life-threatening condition with long-term complications, including residual pulmonary vascular obstruction (RPVO). RPVO is associated with an increased risk of venous thromboembolism recurrence, chronic symptoms, and reduced quality of life. We hypothesize that an endothelial activation and vascular injury play a central role in the pathophysiology of RPVO. This prospective monocentric study investigates the potential of circulating biomarkers, including CD34⁺ cells, circulating endothelial cells (CECs), and platelet-derived growth factor BB (PDGF-BB), as indicators of vascular sequelae and predictors of RPVO. We included 56 patients with a first episode of PE. Biomarker levels were measured at PE diagnosis and six months later, coinciding with RPVO assessment using ventilation-perfusion lung scans. This defined groups of patients with (RPVO ≥ 10%) and without (RPVO < 10%) perfusion defects. Associations between biomarker levels, presence of perfusion defects, and clinical parameters were analyzed. At PE diagnosis, CEC and PDGF-BB levels were significantly elevated in patients compared to healthy controls, while CD34⁺ levels showed no difference. At the six-month follow-up, patients with perfusion defects exhibited significantly lower CD34⁺ cell levels compared to those without (median 1440 cells/mL vs. 2960 cells/mL). No significant differences in CEC or PDGF-BB levels were observed at follow-up. In conclusion, low CD34⁺ cell levels at RPVO assessment suggest a decreased regenerative potential contributing to thrombus persistence. CD34⁺ cells may serve as biomarkers for perfusion defects and warrant further study for their potential role in guiding clinical management of PE complications.

A review of venous thromboembolism for the hospitalist

Venous thromboembolism (VTE), consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an extremely common condition both in the United States and worldwide. Not only is the diagnosis associated with significant morbidity and mortality for patients but it also imposes a deleterious financial burden on the US healthcare system. Diagnosis may be challenging due to variability in clinical presentation and requires a sequential workup including assessment of clinical pretest probability for VTE, D-dimer testing, and imaging. Following diagnosis, proper risk stratification is necessary to determine the appropriate treatment as well as the need for inpatient care. Elucidation of underlying major or minor risk factors at the time of diagnosis is essential as the presence of which may influence the duration of therapy. First-line treatment for most patients is anticoagulation with a direct oral anticoagulant (DOAC) for a minimum of 3-6 months. In multiple clinical trials, DOACs have proven to be non-inferior to vitamin K antagonists for the treatment of VTE with a lower risk of bleeding. Special consideration should be taken in the choice of agent and duration of treatment for patients who have underlying thrombophilias or malignancy and who are pregnant.

Development and Validation of a Modified Khorana Score for Predicting Venous Thromboembolism in Newly Diagnosed Stage IV Lung Cancer

We aimed to establish an effective model to identify metastatic lung cancer patients at high risk of venous thromboembolism (VTE). Patients diagnosed with stage IV lung cancer from January 2011 to June 2019 were included in the development cohort; those recruited from July 2019 to June 2021 were included in the validation cohort. Univariable and multivariable analyses determined the risk factors for VTE. Then we assessed the value for predicting VTE of the Khorana score and modified Khorana score in these two cohorts; 575 patients were included in the development cohort, and 202 patients in the validation cohort. Adenocarcinoma, D-dimer, and the Khorana score were independent risk factors for VTE. In the development cohort, the area under the receiver operating characteristic curve (AUC) of the Khorana score in patients with newly diagnosed stage IV lung cancer was 0.598 (95% CI, 0.512-0.684). The AUC of the modified Khorana score was 0.747 (95% CI, 0.689-0.805). The difference was statistically significant (P <.001). The AUC of the modified Khorana score in the validation cohort was 0.763 (95% CI, 0.661-0.865). The modified Khorana score is more able to accurately predict VTE in patients with newly diagnosed stage IV lung cancer than the Khorana score.

The age, sex, and provoked factors of acute symptomatic deep vein thrombosis on the left and right lower extremities

PURPOSE

Deep vein thrombosis (DVT) of the left and right lower extremities was treated in the same way, but the left and right extremities received different levels of attention. This study aimed to investigate the differences between the right and left lower extremity deep vein thrombosis (LEDVT).

METHODS

Clinical characteristics of LEDVT patients from July 2020 to June 2022 were retrospectively analyzed to compare the incidence of LEDVT on different limbs, demographics, predisposing factors, and anatomical characteristics. The exclusion criteria were bilateral LEDVT and recurrent thrombosis. Measured data was analyzed using independent samples t-test or Mann-Whitney test. Count data were analyzed by Chi-square test. A p < 0.05 was considered a statistically significant difference.

RESULTS

There were 478 patients included in this study and the ratio of left to right LEDVT on the left and right limbs was 3.16:1 (363:115). Left LEDVT predominantly affected female, with the major aged > 50 years (50 - 60 years: 16.80%; > 60 years: 57.30%). The primary predisposing factor was iliac vein compression syndrome, with iliofemoral thrombosis being the main type. Male patients with LEDVT on the right limb were predominant and the age of onset was usually ≤ 60 years (52.17%). The main predisposing factor was recent surgery or trauma (< 30 days) and femoropopliteal thrombosis was the main type. In more detail, the left iliac vein was compressed mainly in the proximal segment, and the right iliac vein was compressed mainly in the intermediate and distal segments. Recent surgery or trauma to the locomotor system and genitourinary system often induced LEDVT.

CONCLUSION

The incidence of LEDVT on the left is significantly higher than that on the right. LEDVT on different sides has different characteristics, which is crucial for prevention and diagnosis in the relevant population so there are also differences in treatment of the affected limbs.

Emerging Elastic Micro-Nano Materials for Diagnosis and Treatment of Thrombosis

Thrombus is a blood clot that forms in a blood vessel at the point of flaking. Thrombosis is closely associated with cardiovascular diseases caused by different sources and factors. However, the current clinical methods of thrombus diagnosis and treatment still have problems with targeting, permeability, stability, and biosafety. Therefore, in recent years, based on the development of micro/nano technology, researchers have tried to develop some new strategies for the diagnosis and treatment of thrombosis. Due to the unique structural characteristics, the micro-nano materials in physiological environments show excellent transport and delivery properties such as better in vivo circulation, longer life span, better targeting ability, and controllable cellular internalization. Especially, elasticity and stiffness are inherent mechanical properties of some well-designed micro-nano materials, which can make them better adapted to the needs of thrombosis diagnosis and treatment. Herein, this review first introduces the thrombotic microenvironment to characterize the thrombus development process. Then, to fine-tune the pathological occurrence and development of thrombosis, the role of elastic micro-nano materials for thrombus diagnosis and treatment is summarized. The properties, preparation methods, and biological fate of these materials have been discussed in detail. Following, the applications of elastic micro-nano materials in biomedical imaging, drug delivery, and therapy of thrombosis are highlighted. Last, the shortcomings and future design strategies of elastic micro-nano materials in diagnosis and treatment of clinical thrombosis are discussed. This review will provide new ideas for the use of nanotechnology in clinical diagnosis and treatment of thrombus in the future.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Systemic immune-inflammation index as a novel hematological marker for predicting the recurrence of deep venous thrombosis

OBJECTIVE

To determine whether there was a possible predictive relationship between systemic immune-inflammation index (SII) and recurrence of deep venous thrombosis (DVT).

METHODS

A total of 231 patients with DVT who met the study criteria and whose data could be accessed were enrolled to this retrospective single-centered cross-sectional study. Of them 26 patients with DVT recurrence consisted of the study group (Group 1) while remaining 205 cases without recurrence were considered as the control population (Group 2). The patients' basic clinical features and laboratory results from the complete blood count (CBC) test were recorded and compared between groups. Following univariate analyses, a multivariate logistic regression analysis was performed to identify the independent predictors of the recurrence of DVT. Additionally, a receiver-operating characteristic (ROC) curve analysis was performed to detect the cut-off values of the predictors with sensitivity and specificity rates.

RESULTS

There were no significant differences between the groups for basic clinical features, except for diabetes mellitus, pulmonary embolism, and atrial fibrillation. Although the univariate analysis revealed that the median values of NLR, PLR, and SII were significantly higher in the DVT recurrence group, only SII was determined to be a significant and independent predictor of DVT recurrence in the multivariate logistic regression analysis. According to ROC curve analysis, SII of 1685 × 103/mm3 constituted the cut-off value for predicting DVT recurrence with 61.5% sensitivity and 76.6% specificity (AUC = 0.686, p = .001).

CONCLUSION

The present study demonstrated for the first time in the literature that SII significantly predicted the recurrence of DVT.

Anticoagulants utilization in eight hospitals within the Luzhou region from 2019 to 2023

BACKGROUND

With the increasing utilization of anticoagulants, the selection of appropriate anticoagulants has emerged as a significant quandary. The objective of this study was to evaluate recent trend in the utilization and expenditure of anticoagulants within a specific region, aiming to provide valuable insights into the optimal choice of anticoagulants across other healthcare facilities.

METHODS

The utilization of anticoagulants was retrospectively analyzed. The data on anticoagulant utilizations in tertiary-care hospitals within a district were collected from January 2019 to December 2023. The expenditure, defined daily doses (DDDs), and defined daily cost (DDC) were calculated. The trends in the utilization and expenditure of anticoagulants were examined using linear regression analysis.

RESULTS

From 2019 to 2023, the DDDs of rivaroxaban demonstrated a significant annual increase in most hospitals (p < 0.05). Only a few hospitals exhibited a gradual rise in the consumption of low molecular weight heparin (LMWH) over the same period (p < 0.05). The trend of heparin sodium and warfarin varied across different hospitals. The implementation of the centralized procurement policy, however, resulted in a decline in the consumption of rivaroxaban and LMWH in 2021 and 2022 respectively. The DDC value of rivaroxaban experienced a substantial decrease over the past five years (p = 0.020), declining from 55.20 Chinese Yuan (CNY) in 2019 to 4.28 CNY in 2023. Conversely, there was a slight increase noted in the DDC of heparin sodium during this time frame (p = 0.042).

CONCLUSION

Over the past five years (2019-2023), there has been an increase in the utilization of rivaroxaban and LMWH. However, their expenditure has decreased. In addition, the utilization and expenditure of warfarin and heparin sodium remained relatively stable. The application prospects of rivaroxaban and LMWH are promising.

Effect of furmonertinib on the pharmacokinetics of rivaroxaban or apixaban in vivo

Furmonertinib, a third generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), is used for non-small cell lung cancer (NSCLC). Rivaroxaban and apixaban are direct oral anticoagulants (DOACs) used for venous thromboembolism (VTE), which is a frequent comorbid with NSCLC. They are substrates of CYP3A4, P-gp and BCRP, whereas furmonertinib is an inhibitor of P-gp and BCRP. This study aimed to disclose the extent of effect of furmonertinib on the pharmacokinetics of rivaroxaban or apixaban. Rats were divided into four groups (n = 6) that received rivaroxaban (group 1), furmonertinib and rivaroxaban (group 2), apixaban (group 3), furmonertinib and apixaban (group 4). The concentrations of drugs were measured by an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Furmonertinib increased the Cmax and AUC0-t of rivaroxaban by 1.66 and 2.07-fold, whereas decreased the CLz/F by 1.70-fold and Vz/F 1.27-fold. Furthermore, furmonertinib caused similar changes in apixaban pharmacokinetics. The pharmacokinetic results suggest that it is essential to alert the effect of furmonertinib on the pharmacokinetics of rivaroxaban or apixaban in clinical practice.

The Prevalence of the Thrombotic SNPs rs6025, rs1799963, rs2066865, rs2289252 and rs8176719 in Patients with Venous Thromboembolism in the Czech Population

IntroductionStudy aimed to determine the occurrence of 5 thrombosis-related single-nucleotide polymorphisms (SNPs) in patients with venous thromboembolism (VTE) (n = 2630) and a control group (n = 2637) in the Czech population.MethodsThe following gene SNPs were detected in both groups: F5 Leiden (rs6025), F2 (rs1799963), FGG, fibrinogen gamma' (rs2066865), F11 (rs2289252) and ABO (rs8176719). Statistical analysis was performed using SAS statistical software with population genetics tools.ResultsHeterozygotes for F5 Leiden were associated with a 5.58-fold and homozygotes F5 Leiden with a 33.46-fold increased risk of VTE. At SNP rs1799963 (F2, prothrombin), only heterozygotes had a significant 3.9-fold increased risk of VTE. The findings at SNP rs2066865 (fibrinogen gamma', FGG) showed a 1.37-fold increased risk of VTE for FGG heterozygotes and a 1.77-fold increased risk of VTE for FGG homozygotes. There is also a significant 1.42-fold increase risk of VTE in the heterozygotes and a 1.80-fold increase risk of VTE in the homozygotes of the SNP rs 2289252 (F11). Further higher increases in the risk of VTE in both variants were found in patients with VTE at rs8176719 (ABO, non-O). It corresponds to a 2.2-fold increase in the risk of VTE in heterozygotes and a 3.5-fold increase in the risk of VTE in homozygotes.ConclusionBesides F5 Leiden and prothrombin mutation, the study suggests that the gene polymorphisms of FGG (rs2066865), F11 (rs2289252) and ABO (rs8176719) play a role as an independent heritable risk factor for VTE in the Czech population.

Recent Updates and Advances in the Association Between Vitamin D Deficiency and Risk of Thrombotic Disease

Vitamin D (VD) is a vital lipophilic secosteroid hormone known for its essential role in maintaining skeletal health and regulating calcium and phosphate metabolism. Recent evidence has begun to illuminate its significance beyond bone health, particularly in relation to thrombosis-a condition characterized by blood clot formation within the vascular system that can lead to serious cardiovascular events such as myocardial infarction and stroke. VD deficiency, defined as a plasma 25-hydroxyVD level below 25 nmol/L, affects a substantial portion of the global population, with prevalence rates ranging from 8% to 18%. This study systematically explores the relationships between VD levels and the risk of thrombosis, investigating the underlying mechanisms including VD's anticoagulant properties, influence on inflammatory pathways, and interactions with endothelial cells. Epidemiological data suggest that low serum levels of VD correlate with an increased risk of venous thromboembolism (VTE), although the reported findings remain inconsistent. Mechanisms that potentially link VD to thrombotic risk include modulation of thrombomodulin and tissue factor expression, as well as enhancement of anti-inflammatory cytokines. Given the prevalence of VD insufficiency, particularly among populations with limited exposure to sunlight, this research highlights the urgent need for strategies to increase VD levels through dietary modifications and supplementation in order to prevent thrombotic events.

Predicting the risk of pulmonary embolism in patients with tuberculosis using machine learning algorithms

BACKGROUND

This study aimed to develop predictive models with robust generalization capabilities for assessing the risk of pulmonary embolism in patients with tuberculosis using machine learning algorithms.

METHODS

Data were collected from two centers and categorized into development and validation cohorts. Using the development cohort, candidate variables were selected via the Recursive Feature Elimination (RFE) method. Five machine learning algorithms, logistic regression (LR), random forest (RF), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and support vector machine (SVM), were utilized to construct the predictive models. Model performance was evaluated through nested cross-validation and area under the curve (AUC) metrics, supplemented by interpretations using Shapley Additive explanations (SHAP) and line charts of AUC values. Models were subjected to external validation using an independent validation group, facilitating the early identification and management of pulmonary embolism risks in tuberculosis patients.

RESULTS

Data from 694 patients were used for model development, and 236 patients from the validation group met the enrollment criteria. The optimal subset of variables identified included D-dimer, smoking status, dyspnea, age, sex, diabetes, platelet count, cough, fibrinogen, hemoglobin, hemoptysis, hypertension, chronic obstructive pulmonary disease (COPD), and chest pain. The RF model outperformed others, achieving an AUC of 0.839 (95% CI 0.780-0.899) and maintaining the highest average performance in external fivefold cross-validation (AUC: 0.906 ± 0.041).

CONCLUSIONS

The RF model demonstrates high and consistent effectiveness in predicting pulmonary embolism risk in tuberculosis patients.

Risk stratification and contributing factors of deep vein thrombosis among patients admitted at Debre Markos comprehensive specialized hospital, Ethiopia in 2024

Introduction

Deep vein thrombosis is a serious condition and a leading cause of morbidity and mortality in hospitalized patients. Studies conducted in various hospitals in Ethiopia have reported that the prevalence rates of deep vein thrombosis range from approximately 5-10% among hospitalized patients. The risk stratification of deep vein thrombosis and the identification of associated risk factors are critical for assessing deep vein thrombosis in hospital settings. Wells scoring provides a valuable framework for assessing individual risk. This study aims to assess the risk stratification of deep vein thrombosis and to identify the risk factors among patients admitted at Debre Markos Comprehensive Specialized Hospital.

Method

A facility-based cross-sectional study was conducted from December 2023 to February 2024. The study included 423 adult patients, and the data were collected using a structured questionnaire and chart review. Ordinal logistic regression analysis was conducted after performing the model test.

Result

The prevalence of deep vein thrombosis was found to be 7.9%, with 44.2% categorized as having no risk, 8.1% as moderate risk, and 47.7% as high risk for deep vein thrombosis stratification. Various risk factors, such as regular alcohol consumption (odd ratio 4.59, p = 0.032), a previous history of deep vein thrombosis (odd ratio 28.32, p = 0.000), the presence of a central catheter (odd ratio 12.92, p = 0.000), a severe lipid profile (odd ratio 3.8, p = 0.001), and a longer duration of stay in the ward (odd ratio 1.28, p = 0.000), were significantly associated with high risk for deep vein thrombosis stratification.

Conclusion

The prevalence of high-risk deep vein thrombosis stratification was found to be high, and the occurrence of deep vein thrombosis was also high within this risk group. Regular alcohol consumption, a previous history of deep vein thrombosis, the presence of a central catheter, a severe lipid profile, and a longer duration of stay in the ward were statistically significant for high-risk deep vein thrombosis stratification. This study highlights the importance of identifying patients who are at high risk for deep vein thrombosis stratification and addressing the risk factors for deep vein thrombosis stratification.

The time-dependent expression of FPR2 and ANXA1 in murine deep vein thrombosis model and its relation to thrombus age

Thrombus age determination in fatal venous thromboembolism cases is an important task for forensic pathologists. In this study, we investigated the time-dependent expressions of formyl peptide receptor 2 (FPR2) and Annexin A1 (ANXA1) in a stasis-induced deep vein thrombosis (DVT) murine model, with the aim of obtaining useful information for thrombus age timing. A total of 75 ICR mice were randomly classified into thrombosis group and control group. In thrombosis group, a DVT model was established by ligating the inferior vena cava (IVC) of mice, and thrombosed IVCs were harvested at 1, 3, 5, 7, 10, 14, and 21 days after modeling. In control group, IVCs without thrombosis were taken as control samples. The expressions of FPR2 and ANXA1 during thrombosis were detected using immunohistochemistry and double immunofluorescence staining. Their protein and mRNA levels in the samples were determined by Western blotting and quantitative real-time PCR. The results reveal that FPR2 was predominantly expressed by intrathrombotic neutrophils and macrophages. ANXA1 expression in the thrombi was mainly distributed in neutrophils, endothelial cells of neovessels, and fibroblastic cells. After thrombosis, the expressions of FPR2 and ANXA1 were time-dependently up-regulated. The percentage of FPR2-positive cells and the level of FPR2 protein significantly elevated at 1, 3, 5 and 7 days after IVC ligation as compared to those at 10, 14 and 21 days after ligation (p < 0.05). Moreover, the mRNA level of FPR2 were significantly higher at 5 days than that at the other post-ligation intervals (p < 0.05). Besides, the levels of ANXA1 mRNA and protein peaked at 10 and 14 days after ligation, respectively. A significant increase in the mRNA level of ANXA1 was found at 10 and 14 days as compared with that at the other post-ligation intervals (p < 0.01). Our findings suggest that FPR2 and ANXA1 are promising as useful markers for age estimation of venous thrombi.

Incidence and risk factors of VTE in lung cancer: a meta-analysis

BACKGROUND

Lung cancer has maintained a high prevalence and mortality. Besides, venous thromboembolism (VTE) is the third most common disease of cardiovascular disease. Lung cancer with VTE usually influenced the overall survival in the follow-up. In the development of lung cancer, vigilance against and early diagnosis of VTE is of significance.

METHODS

We searched the databases of PubMed, Web of Science, Embase and Cochrane for related research up to 30 November 2023 and extracted information of incidence, odds ratio (OR), hazard ratio (HR) and their 95% confidence intervals (CIs), for evaluating the incidence of VTE and its risk factors.

RESULTS

A total of 54 articles and 873,292 records were included in our study. The pooled incidences of VTE and PE were 6% and 3%, respectively. Subgroup analysis revealed that the tumour, node and metastasis (TNM) stage (HR= 5.43, 95% CI: 2.42, 12.22), metastasis (HR= 2.67, 95% CI: 1.35, 5.29) and chemotherapy (HR= 2.27, 95% CI: 1.11, 4.65) had major influence on VTE occurrence.

CONCLUSIONS

Lung cancer complicated with VTE is unignorable, and its occurrence varies widely by tumour staging, tissue type and treatment. The results may aid in clinical decision-making about lung cancer in higher risk with VTE and weather receiving anticoagulant prophylaxis.

High Rate of Thromboembolic Events in the Last Year of Life of Cancer Patients: A Registry Study

BACKGROUND/OBJECTIVES

Venous thromboembolism (VTE) is associated with cancer, but we wanted to show VTE data for the last year of life, adjusting for age, sex, socioeconomic status and comorbidities. We also wanted to study the possible increase in VTE month by month, as well as time trends from 2015 to 2023.

METHODS

A cohort of 27,423 deceased people with cancer were analyzed with t-tests, chi-square tests and binary logistic regression models.

RESULTS

In total, 13.6% had at least one VTE episode during the last year of life and the VTE rate increased month by month (p < 0.0001). In adjusted models, higher VTE rates were associated with younger age and being a woman (p < 0.0001), both for all VTE as well as separately for pulmonary embolism (PE). The VTE rate increased by 47% from 11.1% in 2015 to 16.3% in 2023, and with significant differences for the pre-COVID-19 and COVID-19 years (i.e., 2015-2019 compared to 2020-2023, p < 0.0001).

CONCLUSIONS

VTE is common in the last year of life and increases month by month. Higher frequencies are associated with female sex but especially with being younger, or having certain cancer forms such as pancreatic, gynecologic or lung cancer. The rate of VTE increased from 2015 to 2023. This is of interest as VTE has been associated with higher treatment intensity and with poorer prognosis and should be considered in the decision-making process.

Sex Differences in Testing for Pulmonary Embolism Among Emergency Department Patients Aged 18-49 by Chief Complaint

BACKGROUND

Women undergo diagnostic testing for pulmonary embolism (PE) in greater numbers than men, despite the disease incidence being higher in men overall. It is unknown if testing for PE varies based on patient chief complaint.

METHODS

This retrospective cohort study was conducted at two academic tertiary care hospitals. Nonpregnant adult patients (aged 18-49 years) were included if they presented to the ED between 1/1/2016 and 12/31/2018 with nontraumatic mechanisms and any of the following chief complaints: chest pain, shortness of breath, hemoptysis, or syncope AND had objective testing for PE. Data were obtained from the electronic medical record and analyzed descriptively. Four outcome variables were assessed: receipt of D-dimer testing, D-dimer positivity, receipt of pulmonary vascular imaging, and diagnosis of PE.

RESULTS

We studied 1,991 unique patient encounters, most of whom (63%; 1,256/1,991) were female. Overall, female patients had higher odds of receiving D-dimer testing than male patients (OR 1.30, CI 1.06-1.59, P = 0.015), while they had lower odds of being diagnosed with PE (OR 0.57, CI 0.36-0.90, P = 0.019). However, this trend varied by chief complaint. Among patients with chest pain, females had higher odds of having a D-dimer performed (OR 1.35, CI 1.01-1.80, P = 0.049) and lower odds of being diagnosed with PE (OR 0.36, CI 0.18-0.70, P = 0.003) than males.

CONCLUSIONS

Both patient sex and chief complaint were associated with trends in diagnostic testing for PE. Among patients with chest pain, females are significantly more likely to be tested with a D-dimer and less likely to be diagnosed with PE.

Factors associated with venous thromboembolism pharmacoprophylaxis initiation in hospitalized medical patients: the Medical Inpatients Thrombosis and Hemostasis study

BACKGROUND

Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown.

OBJECTIVES

To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services.

METHODS

We performed a cohort study using electronic health record data from adult patients hospitalized on medical services at 4 academic medical centers between 2016 and 2019. Main measures were candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission.

RESULTS

Among 111 550 admissions not on intermediate or full-dose anticoagulation, 48 520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission. After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest 2 tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (first) tertile (OR, 0.84; 95% CI, 0.81-0.86 for the second tertile; OR, 0.95; 95% CI, 0.92-0.98 for the third tertile).

CONCLUSION

Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first 2 hospital days was lower in patients with a higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with a higher predicted HA-VTE risk could not be assessed.

Evaluation of AT in acute pulmonary embolism with pleural effusion

Aim: We aimed to investigate whether there is a correlation between AT and pleural effusion in PE patients.Materials & methods: We retrospectively enrolled 325 patients aged 66.26 ± 14.86 years with acute PE in 256-computed tomography pulmonary angiography (CTPA) from 2015 to 2022 and recorded radiographic, clinical and biomarker data, the patients were divided into two groups, PE with pleural effusion group (178 patients) and PE without pleural effusion group (147 patients), odds ratios (OR) were estimated for AT of pleural effusion in PE.Results: A lower AT had a significantly increased risk of pleural effusion (adjusted OR: 2.009, 95% CI: 1.225-3.295).Conclusion: AT are reduced in PE patients with pleural effusion and are associated with the risk of pleural effusion.

Ancestry-independent risk of venous thromboembolism in individuals with sickle cell trait vs factor V Leiden

ABSTRACT

Sickle cell trait (SCT) is a risk factor for venous thromboembolism (VTE). Prior studies investigating the association between SCT and VTE have been performed nearly exclusively in Black populations. However, race-based research can contribute to systemic racism in medicine. We leveraged data from the 23andMe research cohort (4 184 082 participants) to calculate the ancestry-independent risk of VTE associated with SCT as well as comparative risk estimates for heterozygous factor V Leiden (FVL). Odds ratios (ORs) were calculated using a meta-analysis of 3 genetic ancestry groups (European [n = 3 183 142], Latine [n = 597 539], and African [n = 202 281]) and a secondary full-cohort analysis including 2 additional groups (East Asian [n = 159 863] and South Asian [n = 41 257]). Among the full cohort, 94 323 participants (2.25%) reported a history of VTE. On meta-analysis, individuals with SCT had a 1.45-fold (confidence interval [CI], 1.32-1.60) increased risk of VTE compared with SCT noncarriers, which was similar to the full-cohort estimate. The risk of pulmonary embolism (PE) in SCT (OR, 1.95; CI, 1.72-2.20) was higher than that of isolated deep venous thrombosis (DVT; OR, 1.04; CI, 0.90-1.21). FVL carriers had 3.30-fold (CI, 3.24-3.37) increased risk of VTE compared with FVL noncarriers, with a higher risk of isolated DVT (OR, 3.59; CI, 3.51-3.68) than PE (OR, 2.72; CI, 2.64-2.81). In this large, diverse cohort, the risk of VTE was increased among individuals with SCT compared with those without, independent of race or genetic ancestry. The risk of VTE with SCT was lower than that observed in FVL; however, the pattern of VTE in SCT was PE predominant, which is the opposite to that observed in FVL.

Statins for the primary prevention of venous thromboembolism

BACKGROUND

Venous thromboembolism (VTE) involves the formation of a blood clot in a vein, and includes deep venous thrombosis (DVT) or pulmonary embolism (PE). The annual incidence for VTE varies from 0.75 to 2.69 per 1000 individuals, with about 40 million people worldwide impacted by VTE. Statins, 3-hydroxy-3-methylglutaryl (HMG)-coenzyme A (CoA) reductase inhibitors, inhibit cholesterol biosynthesis and display several vascular-protective effects, including antithrombotic properties. However, the potential role of statins in the primary prevention of VTE is still not clear.

OBJECTIVES

To evaluate the benefits and risks of statins in preventing venous thromboembolism (VTE) in individuals with no prior history of VTE.

SEARCH METHODS

We used standard Cochrane search methods. The search was last updated on 13 March 2023.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) comparing statins with any control intervention (including placebo and usual care) in healthy individuals or participants with conditions other than VTE. There were no restrictions on the dose, duration, route, or timing of statins.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were VTE, DVT, and PE. Our secondary outcomes were serious adverse events, adverse events, and mortality. We used the trial sequential analysis (TSA) method to judge whether the evidence was sufficient, and we used the GRADE approach to assess the certainty of the evidence for each outcome.

MAIN RESULTS

We included 27 RCTs involving 122,601 adults (aged 18 years and above) who were healthy, had various medical conditions (e.g. hypercholesterolemia), or were at risk for cardiovascular disease. Both males and females were included in all studies. Two studies focused solely on participants over 60 years of age. We deemed four studies to have a low risk of bias overall, while 19 were at high risk of bias, and four were unclear. The 27 studies compared use of statins versus placebo or usual care in individuals who had never experienced VTE. The statins used in the studies were atorvastatin, rosuvastatin, pravastatin, lovastatin, fluvastatin, and simvastatin. Twenty-three studies followed up participants for over a year, with six of those extending follow-ups for over five years. Twenty-five studies were based in hospitals, and 24 studies were funded by industry. Only one study used VTE as a primary endpoint. The median incidence of VTE in the statins group was 0.72% (ranging from 0% to 10.53%), and in the control group it was 0.89% (ranging from 0% to 6.83%). Our pooled analysis of the 27 studies showed that, relative to control groups, statins may slightly reduce the overall incidence of VTE (odds ratio (OR) 0.86, 95% confidence intervals (CI) 0.76 to 0.98; 27 studies, 122,601 participants; low-certainty evidence). Of the statins we evaluated, only rosuvastatin seemed to be associated with a reduced incidence of VTE, albeit the reduction in incidence was very small. The evidence did not clearly indicate a difference between groups in the incidence of DVT (OR 0.70, 95% CI 0.41 to 1.18; six studies, 40,305 participants; low-certainty evidence), PE (OR 0.83, 95% CI 0.46 to 1.52; five studies, 28,427 participants; low-certainty evidence), or myopathy (OR 1.10, 95% CI 0.83 to 1.45; 10 studies, 75,551 participants; low-certainty evidence). Nonetheless, statin use might slightly decrease the incidence of any serious adverse event (OR 0.95, 95% CI 0.91 to 0.99; 13 studies, 67,020 participants; low-certainty evidence) and any death (OR 0.90, 95% CI 0.86 to 0.95; 24 studies, 116,761 participants; low-certainty evidence), compared to control.

AUTHORS' CONCLUSIONS

Using statins for the primary prevention of VTE may slightly reduce the incidence of VTE and all-cause mortality. However, this effect is likely too weak to be considered significant. Statin use may not decrease the occurrence of DVT and PE. The current evidence is insufficient to draw strong conclusions because of the risk of bias in the studies, imprecision in the effect estimates, and potential publication bias. More evidence from well conducted and fully reported RCTs is needed to assess the preventive effects of different types of statins, as well as the effects of different dosages and treatment durations in various populations.

Incidence of venous thromboembolism and adequacy of thromboprophylaxis in 2380 acutely-ill hospitalized patients: Results from the PROFMiG cohort study

INTRODUCTION

Hospital-acquired venous thromboembolism (VTE) is a major cause of preventable deaths. Incidence of VTE and adequacy of thromboprophylaxis have rarely been reported in low-resourced countries. The aim of this study was to estimate the incidence of VTE and to evaluate the adequacy of thromboprophylaxis in acutely-ill medical hospitalized patients.

METHODS

The PROFMiG is a prospective cohort study conducted in Brazil. We consecutively enrolled adult (> 18 years) acutely-ill hospitalized medical patients at admission. Risk assessment for VTE was evaluated by the IMPROVE7 (International Medical Prevention Registry on Venous Thromboembolism). Outcomes were death and VTE events during hospital stay up to 90 days after discharge. All VTE and death events were adjudicated. We also evaluated pulmonary embolism-related death and adequacy of thromboprophylaxis. VTE incidence was estimated by competing risk methods.

RESULTS

A total of 2380 participants was included. Median age was 70 years, 56.1 % women, median length of hospital stay was 10 days. A total of 2052 (86.3 %) patients were classified as low-risk for VTE, 30 (1.3 %) patients had objectively confirmed VTE, and 1449 (60.8 %) received inadequate thromboprophylaxis. The overall mortality rate was 14.0 %. Cumulative incidence of VTE was 2.0 % (95 % confidence interval 0.9 %-3.8 %) at 130 days after admission when considering death as competing risk.

CONCLUSION

The cumulative incidence of VTE in this cohort corroborates with that reported in high-resourced countries. Despite recommendation, thromboprophylaxis was mostly inadequate. We suggest the adoption of competing risk analysis to estimate the cumulative incidence of VTE in hospitalized patients.

TO INFORM OR NOT TO INFORM about venous thromboembolisms - A qualitative study on communication between healthcare professionals and patients with lung cancer

BACKGROUND

Venous thromboembolism (VTE) is a leading cause of death among cancer patients. Despite this, studies show that patients with cancer feel inadequately informed about the VTE risk and symptoms, which may impede their ability to recognise symptoms and react promptly. Patients with lung cancer are especially vulnerable due to a high relative risk of developing VTE combined with a high prevalence of low health literacy. This study aimed to explore the VTE information needs of lung cancer patients and how patients and healthcare professionals (HCPs) communicate about VTE.

MATERIAL AND METHODS

Data was collected via semi-structured interviews with patients with lung cancer and HCPs. All participants (n = 20) were recruited from an oncological department. The analysis was performed in an inductive manner using a Ricoeur inspired strategy.

FINDINGS

Patients had varying information needs regarding VTE, but HCPs did not routinely communicate about VTE, as the topic tended to be lowly prioritised. HCPs communicated about VTE when patients expressed a need or presented symptoms of VTE. HCPs expressed concerns about adding to patient's emotional burden by informing about VTE, while some patients emphasised the importance of being mentally prepared for potential complications.

CONCLUSION

The study demonstrates the challenging balance HCPs must maintain between adequately communicating about VTE and not causing undue psychological distress. However, given patient's often limited awareness of VTE, the responsibility to initiate communication about VTE must fall on the HCPs.

Prevention and management of postoperative deep vein thrombosis in lower extremities of patients with gastrointestinal tumor

BACKGROUND

Deep vein thrombosis (DVT) is a significant postoperative concern, particularly in patients undergoing surgery for gastrointestinal (GI) cancers. These patients often present multiple risk factors, including advanced age and elevated body mass index (BMI), which can increase the likelihood of thromboembolic events. Effective prophylaxis is crucial in this high-risk population to minimize complications such as DVT and pulmonary embolism (PE). This study investigates a comprehensive DVT prevention protocol, combining mechanical and pharmacological strategies alongside early mobilization, to evaluate its effectiveness and safety in reducing postoperative thrombosis rates among GI cancer surgery patients.

AIM

To evaluate the effectiveness and safety of postoperative DVT prevention strategies in patients with GI cancer.

METHODS

A prospective cohort study was conducted involving 100 patients who underwent surgery for GI tumors between January and December 2022. All patients received a standardized DVT prevention protocol, which included risk assessment, mechanical prophylaxis, pharmacological prophylaxis, and early mobilization. The primary endpoint was the incidence of DVT within 30 days postoperatively. Secondary outcomes included the occurrence of PE, bleeding complications, and adherence to the protocol.

RESULTS

The overall incidence of DVT was 7% (7/100 patients). One patient (1%) developed PE. The adherence rate to the prevention protocol was 92%. Bleeding complications were observed in 3% of patients. Significant risk factors for DVT development included advanced age [odds ratio (OR): 1.05; 95% confidence interval (95%CI): 1.01-1.09], higher BMI (OR: 1.11; 95%CI: 1.03-1.19), and longer operative time (OR: 1.007; 95%CI: 1.001-1.013).

CONCLUSION

Implementing a comprehensive DVT prevention and management protocol for patients undergoing GI tumor surgery resulted in a lower incidence. Strict adherence and individualized risk assessment are crucial for optimizing outcomes.

Overview of Venous Thromboembolism and Emerging Therapeutic Technologies Based on Nanocarriers-Mediated Drug Delivery Systems

Venous thromboembolism (VTE) is a serious health condition and represents an important cause of morbidity and, in some cases, mortality due to the lack of effective treatment options. According to the Centers for Disease Control and Prevention, 3 out of 10 people with VTE will have recurrence of a clotting event within ten years, presenting a significant unmet medical need. For some VTE patients, symptoms can last longer and have a higher than average risk of serious complications; in contrast, others may experience complications arising from insufficient therapies. People with VTE are initially treated with anticoagulants to prevent conditions such as stroke and to reduce the recurrence of VTE. However, thrombolytic therapy is used for people with pulmonary embolism (PE) experiencing low blood pressure or in severe cases of DVT. New drugs are under development, with the aim to ensure they are safe and effective, and may provide an additional option for the treatment of VTE. In this review, we summarize all ongoing trials evaluating anticoagulant interventions in VTE listed in clinicaltrials.gov, clarifying their underlying mechanisms and evaluating whether they prevent the progression of DVT to PE and recurrence of thrombosis. Moreover, this review summarizes the available evidence that supports the use of antiplatelet therapy for VTE. Since thrombolytic agents would cause off-target effects, targeted drug delivery platforms are used to develop various therapeutics for thrombotic diseases. We discuss the recent advances achieved with thrombus-targeting nanocarriers as well as the major challenges associated with the use of nanoparticle-based therapeutics.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Evaluation of Inflammation and Platelet Apoptosis Parameters in Obese Patients in Various Types of Anticoagulant Prophylaxis of Venous Thromboembolic Complications in Context of COVID-19

INTRODUCTION: The physical inactivity, hypoventilation, as well as chronic inflammation in obese patients aggravates their condition in various diseases. These features have become important with the advent of the COVID-19 pandemic, in which inflammation and platelet-activated coagulopathy are closely linked. AIM: To study laboratory parameters of inflammation and platelet apoptosis in obese patients using various types of anticoagulant prophylaxis of venous thromboembolic complications with the underlying COVID-19. MATERIALS AND METHODS: The study included 370 patients with COVID-19. Depending on the presence or absence of obesity and the type of parenteral anticoagulant, patients in our study were divided into groups: group 1 — non-obese + low molecular weight heparin (LMWH) (n = 114), group 2 — non-obese + unfractionated heparin (UFH) (n = 58), group 3 — obesity + LMWH (n = 76), group 4 — obesity + UFH (n = 66). The incidence of venous thromboembolic complications (VTEC), bleeding, general markers of the acute phase of inflammation, and specific markers of platelet apoptosis (phosphatidylserine and calreticulin) have been analyzed. RESULTS: At the end of hospital treatment, a decrease in ferritin levels was noted in patients both with and without obesity receiving LMWH. The concentration of calreticulin was higher in patients taking LMWH (groups 1 and 3). Phosphatidylserine levels were high in patients receiving LMWH only if they were obese. In patients taking UFH compared to LMWH, a high incidence of pulmonary embolism (PE) without a source (13.6% of cases versus 2.6%, respectively, p = 0.029) and PE with a source in the lower extremities (9.1% of cases versus 0%, respectively, p = 0.018) was found. When using LMWH, a lower incidence of bleeding was observed compared to using UFH (5.3% of cases versus 16.7%, respectively, p = 0.056). CONCLUSION: The levels of phosphatidylserine and calreticulin are higher in obese patients receiving LMWH. At the same time, patients in this group have a low incidence of VTEC and hemorrhagic complications compared to the group of patients taking UFH.

Management and Outcomes of Pulmonary Embolism in the Oldest-Old

Background

Treatment for pulmonary embolism has expanded to include Direct Oral Anticoagulants (DOACs). The incidence of pulmonary-embolism (PE) in "oldest-old" age group (≥85 years) is rapidly increasing, but there is limited research on its management and clinical outcomes.

Aim

To examine the differences in management and outcomes in those aged ≥85 years compared to other age groups.

Methods

We performed a retrospective cohort-study of 373 consecutive patients with pulmonary embolism confirmed on imaging by Computed Tomography Pulmonary Angiogram (CTPA) or Ventilation Perfusion (VQ) Scan at a principal referral hospital in Sydney, Australia. Data collected include clinical and demographic data, Charlson comorbidity index, treatment type and outcomes including complications, recurrent venous thromboembolism, and mortality.

Results

Across the age groups, DOACS were prescribed to 53.4% (n=199) of patients. In oldest-old patients with PE, LMWH bridging to warfarin was the most frequently prescribed treatment, used in 46.2% (n=18, 95% CI: 30.8%-61.5%, p=0.003) of these patients. The mortality rate for patients on LMWH was 13.9% (n=5, 95% CI: 4.2%-37.5%, p=0.553). Overall, major bleeding incidents were rare, occurring in just 1.7% (n=4, 95% CI: 0.4%-3.3%) of patients, with no significant differences in outcomes across age groups.

Conclusion

DOACs are increasingly used as the treatment modality of choice in atrial fibrillation but are less well studied in pulmonary embolism, particularly in oldest-old patients. We found that the safety and efficacy profile of DOACs in pulmonary embolism treatment is similar across the age groups. Our study does not support any change in treatment protocols of PE in the oldest old, but further studies are required to confirm our findings.

Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report From the Pulmonary Embolism Research Collaborative

Recent advances in therapy and the promulgation of multidisciplinary pulmonary embolism teams show great promise to improve management and outcomes of acute pulmonary embolism (PE). However, the absence of randomized evidence and lack of consensus leads to tremendous variations in treatment and compromises the wide implementation of new innovations. Moreover, the changing landscape of health care, where quality, cost, and accountability are increasingly relevant, dictates that a broad spectrum of outcomes of care must be routinely monitored to fully capture the impact of modern PE treatment. We set out to standardize data collection in patients with PE undergoing evaluation and treatment, and thus establish the foundation for an expanding evidence base that will address gaps in evidence and inform future care for acute PE. To do so, >100 international PE thought leaders convened in Washington, DC, in April 2022 to form the Pulmonary Embolism Research Collaborative. Participants included physician experts, key members of the US Food and Drug Administration, patient representatives, and industry leaders. Recognizing the multidisciplinary nature of PE care, the Pulmonary Embolism Research Collaborative was created with representative experts from stakeholder medical subspecialties, including cardiology, pulmonology, vascular medicine, critical care, hematology, cardiac surgery, emergency medicine, hospital medicine, and pharmacology. A list of critical evidence gaps was composed with a matching comprehensive set of standardized data elements; these data points will provide a foundation for productive research, knowledge enhancement, and advancement of clinical care within the field of acute PE, and contribute to answering urgent unmet needs in PE management. Evidence produced through the Pulmonary Embolism Research Collaborative, as it is applied to data collection, promises to provide crucial knowledge that will ultimately produce a robust evidence base that will lead to standardization and harmonization of PE management and improved outcomes.

Increasing the Rate of Venous Thromboembolism Chemoprophylaxis Administration Using the Electronic Medical Record

Introduction: Venous thromboembolism (VTE) remains a leading cause of preventable harm among hospitalized patients. Pharmacologic VTE prophylaxis reduces the rate of in-hospital VTE by 60%, but medication administration is often missed for various reasons. Electronic medical record (EMR) prompts may be a useful tool to decrease withholding of critical VTE chemoprophylaxis medications. Methods: In August 2021, an EMR prompt was implemented at a tertiary referral academic medical center mandating nursing staff to contact a provider for approval before withholding VTE chemoprophylaxis. A pre-intervention group from August 2020 to August 2021 was compared to a post-intervention group from August 2021 to August 2022. Rates of VTE chemoprophylaxis withholding were compared between the groups with a P < .01 considered significant. Results: A total of 16,395 patients prescribed VTE chemoprophylaxis were reviewed, with 13,395 (81.7%) receiving low molecular weight heparin. Of the 16,395 patients included, 10,701 (65.3%) were medical and 5694 (34.7%) were surgical. Patients in the pre-intervention cohort (n = 8803) and post-intervention cohort (n = 7592) were similar in hospital length of stay and duration of DVT prophylaxis. In the post-intervention group, the frequency of surgical patients with at least one missed dose had increased by 4.2% (P = .002), with the trauma and acute care surgery (TACS) show an increase of 6.6% (P < .001). However, the frequency of medical patients and non-TACS patients with missed doses decreased by 3.1% (P = .002) and 1.0% (<.001), respectively. Conclusions: EMR prompts appear to be a low-cost intervention that increases the rate of VTE prophylaxis administration among medical and elective surgery patients.

Venous Thromboembolism Prevention in Rehabilitation: A Review and Practice Suggestions

ABSTRACT

Venous thromboembolism is a frequent complication of acute hospital care, and this extends to inpatient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important venous thromboembolism, associated mortality and costs of care. While there has been extensive research on optimal approaches to venous thromboembolism prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of venous thromboembolism and its prevention related to inpatient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of venous thromboembolism after another thrombotic insult. Low molecular weight heparins and direct oral anticoagulants are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for venous thromboembolism prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.

The association of triglyceride-glucose index and combined obesity indicators with chest pain and risk of cardiovascular disease in American population with pre-diabetes or diabetes

Aim

To investigate the correlation of the triglyceride-glucose (TyG) index and its combined obesity indicators with chest pain and cardiovascular disease (CVD) in the pre-diabetes and diabetes population.

Methods

This cross-sectional investigation encompassed 6488 participants with diabetes and pre-diabetes who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. The association of the TyG and combined obesity index with chest pain and CVD was investigated using weighted logistic regression models and restricted cubic spline (RCS) analysis. The receiver operating characteristic (ROC) curve analysis was performed to compare different indicators.

Results

In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between TyG, TyG-BMI, TyG-WC, and TyG-WHtR and chest pain, with adjusted ORs (95% CI) of 1.21 (1.05, 1.39), 1.06 (1.01, 1.11), 1.08 (1.04, 1.14), and 1.27 (1.08, 1.48), respectively. For total-CVD, the adjusted ORs (95% CI) were 1.32 (1.08, 1.61), 1.10 (1.03, 1.17), 1.13 (1.06, 1.19), and 1.63 (1.35, 1.97), respectively, among which TyG, TyG-WC, and TyG-WHtR present curvilinear associations in RCS analysis (all P-nonlinear < 0.05). Furthermore, the ROC curve showed that TyG-WC had the most robust predictive efficacy for total-CVD, coronary heart disease (CHD), and myocardial infarction (MI), while TyG-WHtR had the best predictive ability for angina and heart failure.

Conclusion

There are significant associations of TyG and its related indicators with chest pain and total-CVD among the pathoglycemia population. TyG-WC and TyG-WHtR demonstrated superior predictive capability for the incidence of cardiovascular events.

A Cross-Sectional Study of the A1 Phenotype in the Colombian Caribbean: A Shadow Behind Pulmonary Embolism

INTRODUCTION

Venous thromboembolic disease (VTE) is an episodic condition of multifactorial origin, commonly manifesting as deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is a major cause of morbidity and mortality. As an acute condition, it has the potential for recurrence and is associated with major consequences; this disease poses significant challenges to the healthcare system. VTE is a widespread concern in developed and developing countries; therefore, it is not limited to specific regions or populations.

OBJECTIVES

To evaluate the risk factors associated with unprovoked PE in patients in a hospital center in Sincelejo, Colombia.

METHODS

This is an observational, analytical cross-sectional study utilizing retrospective data. From 2010 to 2023, we reviewed 126 medical records of patients who experienced their first unprovoked VTE events and met the inclusion criteria. We performed data analysis using R software version 3.5.1.

RESULTS

Of the patients, 36.5% (n = 46) were women; 63.5% (n = 80) were men, with a mean age of 62.22 years (SD = 10.62). About 53% of women presented with PE, compared to 47% of men. The coagulation factor VIII acted as a PE risk factor (p = 0.098). The best model to predict PE development obtained an Akaike information criterion (AIC) of 176.67, indicating that the A1 positive phenotype is the risk factor with the highest prediction for PE occurrence.

CONCLUSIONS

High levels of coagulation factor VIII and an A1-positive phenotype are risk factors that may increase PE development. These findings suggest the need for preventive strategies in this risk setting to reduce the incidence and recurrence of PE.

Dynamic Peripheral Hemoperfusion Distribution Monitoring Based on Janus Flexible Sensor System

OBJECTIVE

Peripheral vascular disease is a worldwide leading health concern. Real-time peripheral hemoperfusion monitoring during treatment is essential to plan treatment strategies to improve circulatory enhancement effects.

METHODS

The present work establishes a Janus flexible perfusion (JFP) sensor system for dynamic peripheral hemoperfusion monitoring. We develop a Janus structure with different Young's modulus to improve the mechanical properties for motion artifacts suppression. Besides, we propose a peripheral perfusion index (PPI) based on an optical perfusion model that is experimentally verified using an in-vitro model. The effectiveness of the system is assessed in three experimental scenarios, including motion artifact-robust test, induced vascular occlusion, and peripheral hemoperfusion monitoring with the intermittent pneumatic compression treatment.

RESULTS

The noise level of the traditional rigid sensor is five times that of the JFP sensor within the effective signal frequency domain when there is movement. The PPI can effectively discriminate between different peripheral hemoperfusion states and has a correlation coefficient of 0.92 with the Laser Doppler flowmetry (LDF) mean values. The kappa statistic between the JFP sensor and LDF is 0.78, indicating substantial agreement to estimate the peripheral hemoperfusion improvements.

CONCLUSION

The sensor system we proposed can monitor peripheral hemoperfusion variation in real-time and is insensitive to motion artifacts.

SIGNIFICANCE

The proposed sensing system provides a functional module for real-time estimation of peripheral hemoperfusion during clinical interventions.

Epidemiology of deep vein thrombosis

Deep vein thrombosis (DVT) is a cause of considerable morbidity worldwide. It is a common clinical disease in the daily practice of several medical disciplines including general medicine, angiology, and internal medicine, as well as of interest to public health because of its preventability and its sensitivity to secular changes in the distribution of population risk factors. In this review we present a comprehensive overview of the epidemiological features of DVT, including incidence and risk factors. Additionally, we give an overview of the burden that DVT poses on modern health care systems.

Derivation and external validation of a portable method to identify patients with pulmonary embolism from radiology reports: The READ-PE algorithm

BACKGROUND

Identification of pulmonary embolism (PE) across a cohort currently requires burdensome manual review. Previous approaches to automate capture of PE diagnosis have either been too complex for widespread use or have lacked external validation. We sought to develop and validate the Regular Expression Aided Determination of PE (READ-PE) algorithm, which uses a portable text-matching approach to identify PE in reports from computed tomography with angiography (CTA).

METHODS

We identified derivation and validation cohorts of final radiology reports for CTAs obtained on adults (≥ 18 years) at two independent, quaternary academic emergency departments (EDs) in the United States. All reports were in the English language. We manually reviewed CTA reports for PE as a reference standard. In the derivation cohort, we developed the READ-PE algorithm by iteratively combining regular expressions to identify PE. We validated the READ-PE algorithm in an independent cohort, and compared performance against three prior algorithms with sensitivity, specificity, positive-predictive-value (PPV), negative-predictive-value (NPV), and the F1 score.

RESULTS

Among 2948 CTAs in the derivation cohort 10.8 % had PE and the READ-PE algorithm reached 93 % sensitivity, 99 % specificity, 94 % PPV, 99 % NPV, and 0.93 F1 score, compared to F1 scores ranging from 0.50 to 0.85 for three prior algorithms. Among 1206 CTAs in the validation cohort 9.2 % had PE and the algorithm had 98 % sensitivity, 98 % specificity, 85 % PPV, 100 % NPV, and 0.91 F1 score.

CONCLUSIONS

The externally validated READ-PE algorithm identifies PE in English-language reports from CTAs obtained in the ED with high accuracy. This algorithm may be used in the electronic health record to accurately identify PE for research or surveillance. If implemented at other EDs, it should first undergo local validation and may require maintenance over time.