Pulmonary embolism and deep vein thrombosis

Optimal Cutoff Values and Utility of High-Sensitivity Troponin T and NT-proBNP for the Risk Stratification of Patients with Acute Pulmonary Embolism

BACKGROUND

Guidelines recommend using high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to risk stratify hemodynamically stable patients with acute pulmonary embolism (PE). However, there are no evidence-based cutoff values defined for this clinical application.

METHODS

We performed a single-center, retrospective cohort study of patients with imaging-confirmed PE and hsTnT and/or NT-proBNP (ElecsysTM, Roche) measured 12 h before or 24 h after PE Response Team (PERT) activation. We excluded hypotensive patients. Our primary outcome was a composite of adverse outcomes or critical interventions within 7 days. We calculated the area under the receiver operating curve (AUC, ROC) for hsTnT and NT-proBNP and determined the optimal cutoffs using the distance from (0,1). We performed a subgroup analysis on patients with PE and right ventricular dysfunction on imaging.

RESULTS

Two hundred thirty-four patients were included in the hsTnT analysis, and 727 in the NT-proBNP analysis. Mean age was 62 years (SD = 17) and 47% were female. The AUC for hsTnT was 0.64 (95% CI, 0.56-0.71) with an optimal cutoff of 46 ng/L, corresponding to a sensitivity of 59% (95% CI, 49-69) and a specificity of 61% (95% CI, 53-69). The AUC for NT-proBNP was 0.56 (95% CI, 0.51-0.61) with an optimal cutoff of 1092 pg/mL, corresponding to a sensitivity of 53% (95% CI, 45-61) and a specificity of 59% (95% CI, 55-63).

CONCLUSION

We identified an optimal cutoff of 46 ng/L for hsTnT and 1092 pg/mL for NT-proBNP, though the AUC for both markers suggests low to moderate performance for the risk stratification of initially hemodynamically stable PERT patients. Use of these biomarkers to risk stratify PE may require reconsideration.

The Type of Preoperative Oral Antithrombotics as a Risk Factor for Venous Thromboembolism After Hip Surgery: A Retrospective Study

Background and Objectives: Hip surgery is increasingly performed among elderly patients. Oral antithrombotics, which are taken for patients' underlying diseases, are a main concern regarding perioperative bleeding. Postoperative venous thromboembolism (VTE) is a leading cause of mortality after hip surgery. Therefore, administration of preoperative oral antithrombotics is a double-edged sword in hip surgery. In this study, we examined the correlation between the occurrence of postoperative VTE and the type of oral antithrombotics administered preoperatively. Materials and Methods: We analyzed the medical records of 601 patients aged 19 and over who underwent hip surgery from January 2021 to June 2023. The patients were assigned to two groups as follows: Groups VTE+ (patients who developed postoperative VTE) and VTE- (patients who did not develop postoperative VTE), respectively. Results: Of the 139 patients who had been taking oral antithrombotics for 6 months or more, 24 were allocated to group VTE+ and 115 to group VTE-, respectively. The number of patients who took clopidogrel and cilostazol was significantly higher in groups VTE- and VTE+, respectively (12.5 vs. 33.9%, p = 0.038, odds ratio (OR) = 0.278, 95% confidence interval (CI) = 0.078-0.991; 20.8 vs. 5.2%, p = 0.010, 95% CI = 1.325-17.245; group VTE+ vs. group VTE-). Preoperative albumin levels were significantly lower in group VTE+ (3.4 ± 0.6 g/dL vs. 3.7 ± 0.4 g/dL, p = 0.004, OR = 0.285, 95% CI = 0.115-0.702). In multivariate regression analysis, the results were statistically significant for clopidogrel, cilostazol, and preoperative albumin levels (p = 0.035, OR = 0.237, 95% CI = 0.062-0.901; p = 0.011, OR = 6.479, 95% CI = 1.542-27.226; p = 0.002, OR = 0.211, 95% CI = 0.080-0.558). Conclusions: Among the patients who had been taking oral antithrombotics for ≥6 months, clopidogrel had a prophylactic effect, but cilostazol showed an aggravating effect on postoperative VTE in hip surgery. Preoperative hypoalbuminemia increases the risk of postoperative VTE in hip surgery.

Predictive value of miR-24-3p and miR-1277-5p in hemodialysis patients with vascular access thrombosis

One of the complications of chronic kidney disease (CKD) is venous thromboembolism (VTE). Currently, the D-dimer test is used for the diagnosis of VTE. This test has low diagnostic value and specificity. Circulating microRNAs are present in plasma, serum, and other body fluids and have recently been shown to be valuable biomarkers in numerous illnesses. Therefore, this study aimed to evaluate the diagnostic potential of serum microRNAs as noninvasive biomarkers for VTE diagnosis in hemodialysis patients. Serum samples were collected from 42 hemodialysis patients with thrombosis, 42 hemodialysis patients without thrombosis, and 42 healthy individuals. After the synthesis of cDNA from serum, the expression of miR-24-3P and miR-1277-5P was measured by qRT-PCR. The data were analyzed using SPSS 20 and GraphPad Prism7 software. The expression level of miR-24-3P in the thrombotic and nonthrombotic hemodialysis groups was significantly greater than that in the healthy groups after adjustment for hyperglycemia (P = 0.003, P = 0.04). Receiver-operating characteristic (ROC) analysis revealed that the area under the curve (AUC) values were 0.769 and 0.649, respectively. However, in the thrombotic group compared with the nonthrombotic group after adjustment for hyperglycemia, no significant difference was detected (P = 0.063), and the AUC was 0.62. After adjustment for age, sex, and BMI, there was a significant difference between the thrombotic group and the nonthrombotic group (P = 0.002), and the AUC was 0.71. Compared with that in the control group, the odds ratio (OR) of increased miR-1277-5P expression was greater in the thrombotic group (P = 0.05, OR = 1.618). There was no significant difference between the nonthrombotic group and the control group (P = 0.73, OR = 0.914). Our results indicated that miR-24-3P is not a reliable marker for examining thrombosis in the studied samples, while miR-1277-5P has a positive association with VAT and could be considered a diagnostic and therapeutic marker.

Pulmonary Embolism Survival Prediction Using Multimodal Learning Based on Computed Tomography Angiography and Clinical Data

PURPOSE

Pulmonary embolism (PE) is a significant cause of mortality in the United States. The objective of this study is to implement deep learning (DL) models using computed tomography pulmonary angiography (CTPA), clinical data, and PE Severity Index (PESI) scores to predict PE survival.

MATERIALS AND METHODS

In total, 918 patients (median age 64 y, range 13 to 99 y, 48% male) with 3978 CTPAs were identified via retrospective review across 3 institutions. To predict survival, an AI model was used to extract disease-related imaging features from CTPAs. Imaging features and clinical variables were then incorporated into independent DL models to predict survival outcomes. Cross-modal fusion CoxPH models were used to develop multimodal models from combinations of DL models and calculated PESI scores. Five multimodal models were developed as follows: (1) using CTPA imaging features only, (2) using clinical variables only, (3) using both CTPA and clinical variables, (4) using CTPA and PESI score, and (5) using CTPA, clinical variables, and PESI score. Performance was evaluated using the concordance index (c-index). Kaplan-Meier analysis was performed to stratify patients into high-risk and low-risk groups. Additional factor-risk analysis was conducted to account for right ventricular (RV) dysfunction.

RESULTS

For both data sets, the multimodal models incorporating CTPA features, clinical variables, and PESI score achieved higher c-indices than PESI alone. Following the stratification of patients into high-risk and low-risk groups by models, survival outcomes differed significantly (both P<0.001). A strong correlation was found between high-risk grouping and RV dysfunction.

CONCLUSIONS

Multiomic DL models incorporating CTPA features, clinical data, and PESI achieved higher c-indices than PESI alone for PE survival prediction.

Iodine concentration in the lung parenchyma in relation to different inspiratory depths during CT pulmonary angiography

OBJECTIVES

This study aimed to investigate the impact of changing inspiratory depth from end- to mid-inspiratory level on the iodine concentration in the lung parenchyma and main pulmonary artery in dual-energy CT pulmonary angiography.

METHODS

This retrospective study included patients who underwent dual-energy CT pulmonary angiography from July 2020 to June 2023. Patients were instructed to hold their breath at end- and mid-inspiratory levels before and after January 2022, respectively. By placing regions of interest on the lung lobes and main pulmonary artery in the iodine map, their iodine concentration was recorded.

RESULTS

In end- and mid-inspiratory command, 173 (mean age: 63.4 ± 17.0 years; 68 males) and 179 (mean age: 65.1 ± 15.4 years; 62 males) patients, respectively, were included. The mean iodine concentrations of the right upper, right middle, right lower, left upper, and left lower lobes were 0.81/0.91, 0.67/0.74, 1.06/1.07, 0.85/0.95, and 1.07/1.11 mgI/mL, respectively, for the end-/mid-inspiratory level. The multivariable regression analysis revealed inspiratory depth as a significant factor for iodine concentration of the right upper, right middle, and left upper lobes. Main pulmonary artery iodine concentration in mid-inspiratory depth (13.21 mgI/mL) was higher than that in end-inspiratory depth (12.51 mgI/mL) (P = .129), and a statistically significant difference was observed in the patient group with a body weight of ≥70 kg (P = .015).

CONCLUSIONS

Changing inspiratory depth from end- to mid-inspiratory level has a significant impact on the iodine concentration in the upper and right middle lobes in dual-energy CT pulmonary angiography.

ADVANCES IN KNOWLEDGE

Changing inspiratory depth from end- to mid-inspiratory level has significantly increased the iodine concentration in the right upper, right middle, and left upper lobes.

Role of Virtual Monoenergetic Images in the Assessment of Vessel Enhancement in Segmental Level in Third-Generation Dual-Source Dual-Energy CT Pulmonary Angiography-A Prospective Study

Introduction  Pulmonary embolism is the third most common cause of cardiovascular death worldwide and imaging plays a pivotal role in establishing the diagnosis. Computed tomography pulmonary angiography (CTPA) scores over other modalities and is the current diagnostic investigation of choice. In this study, we assessed the main pulmonary artery and its corresponding segmental artery attenuation in reconstructed virtual monoenergetic (mono plus) images (VMI-MP) and linear blended images (spectral post processing, SPP) obtained from dual-energy CTPA. The values were compared using contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Materials and Methods  Forty patients (mean age group, 53.6 years; 26 females and 14 males) with segmental pulmonary thromboembolism were included in this prospective study. The patients underwent CTPA study using bolus tracking in the dual-source CT-SOMATOM Force, Siemens. Postcontrast datasets (90 kV, 150 kV, and SPP) were used to reconstruct the monoenergetic images using syngo.via software virtually. Comparison was done between bivariate samples using the paired sample t -test. Results  The mean Hounsfield unit (HU) artery in the left lung for VMI-MP and SPP images were 886.9 ± 242 and 356.8 ± 121.3 HU, respectively. Similarly, for the right lung, it was 868.3 ± 243.5 and 336.1 ± 105.5 HU, respectively. The mean attenuation of the arteries in MP images was higher and statistically significant ( p -value <0.005). Likewise, the CNR) and SNR were found to have a statistically significant p -value (<0.005). An acceptable increase in image noise was seen in VMI as compared with SPP images. Conclusion  Low-keV VMIs perform more effectively than the conventional polyenergetic spectrum to evaluate vessel attenuation, which in turn increases thrombus detectability. The increased CNR in VMI enables improved lesion conspicuity.

Cardiovascular Biomarkers: Tools for Precision Diagnosis and Prognosis

The present study provides a detailed review of cardiovascular biomarkers critical for the diagnosis, prognosis, and pathophysiology of cardiovascular diseases, the leading cause of global morbidity and mortality. These biomarkers aid in detecting disease onset, progression, and therapeutic responses, providing insights into molecular mechanisms. Enzyme markers like AST, CK-MB, LDH, CA-III, and HBDH are pivotal for detecting myocardial injury during acute events. Protein markers such as CRP, H-FABP, and MPO shed light on inflammation and oxidative stress. Cardiac Troponins, the gold standard for myocardial infarction diagnosis, exhibit high specificity and sensitivity, while IMA and GPBB indicate ischemia and early myocardial damage. Peptide markers, including BNP and NT-proBNP, are crucial for heart failure diagnosis and management, reflecting ventricular stress and remodeling. Novel peptides like MR-proANP and MR-proADM aid in assessing disease severity. Lipid markers such as lipoprotein-associated phospholipase A2 and oxylipins provide insights into lipid metabolism and atherosclerosis. Inflammatory and stress-related biomarkers, including TNFα, IL-6, GDF-15, and Pentraxin 3, illuminate chronic inflammation in CVDs. Hormonal markers like copeptin and endothelin-1 highlight neurohormonal activation, while emerging markers such as ST2, galectin-3, PAPP-A, and TMAO elucidate fibrosis, remodeling, and metabolic dysregulation. The inclusion of microRNAs and long non-coding RNAs represents a breakthrough in biomarker research, offering sensitive tools for early detection, risk stratification, and therapeutic targeting. This review emphasizes the diagnostic and prognostic utility of these biomarkers, advancing cardiovascular care through personalized medicine.

Mechanical Thrombectomy vs Catheter-Directed Thrombolysis for High-Risk Pulmonary Embolism: A Target Trial Emulation

BACKGROUND

Evidence is limited regarding the comparative effectiveness and safety of mechanical thrombectomy (MT) vs catheter-directed thrombolysis (CDT) for high-risk pulmonary embolism (PE).

OBJECTIVES

This observational study aimed to compare the outcomes of older adults with high-risk PE treated with MT vs CDT using a target trial emulation framework.

METHODS

We included Medicare fee-for-service beneficiaries aged 65 to 99 years admitted with high-risk PE (defined by cardiac arrest, shock, and vasopressor use) who underwent MT/CDT from 2017 to 2020. We evaluated 1-year mortality using an inverse probability of treatment weighting approach, controlling for 62 baseline covariates. We also evaluated readmissions and in-hospital outcomes, including intracranial hemorrhage. Patients were followed from the date of the index procedure to the outcomes of interest, 1 year, or December 2020.

RESULTS

We included 235 and 484 patients in the MT and CDT groups, respectively. The absolute risk of 1-year mortality was 48.4% (95% CI: 34.1%-63.3%) in the MT group and 45.4% (95% CI: 37.8%-55.8%) in the CDT group, with an adjusted HR of 1.16 (95% CI: 0.84-1.59). We found no evidence that all-cause readmission (MT vs CDT; subdistribution HR: 0.89; 95% CI: 0.56-1.40), intracranial hemorrhage (adjusted OR: 0.36; 95% CI: 0.07-1.77), or transfusions (adjusted OR: 0.96; 95% CI: 0.52-1.76) differed significantly between the 2 groups.

CONCLUSIONS

Among older adults with high-risk PE treated with catheter-based therapies, the clinical outcomes were similar between the patients treated with MT vs CDT. Randomized trials are needed to confirm our findings.

Hampton's Hump-A Rare Radiological Feature in Patients with Pulmonary Embolism in a Single-Center Study

Background: Pulmonary embolism is a potentially life-threatening condition caused by the sudden occlusion of pulmonary arteries. Its non-specific and highly variable clinical presentation often leads to undiagnosed cases, making computed tomography pulmonary angiography (CTPA) essential for diagnosis. Hampton's hump is a rare radiological finding associated with pulmonary embolism, characterized by a wedge-shaped, pleural-based opacification due to pulmonary infarction. Methods: This study examines the correlation between pulmonary embolism severity and the presence of Hampton's hump in CTPA based on a database of 428 patients. Results: We observed a correlation between the presence of Hampton's hump and an increased likelihood of rider-type embolism, pleural effusion, and dilation of the pulmonary trunk and left pulmonary artery. The data indicate that patients with at least one risk factor for severe pulmonary embolism are more likely to present with Hampton's hump. Furthermore, the presence of this sign in patients diagnosed with pulmonary embolism and pleural effusion substantially increases the risk of in-hospital death. Conclusions: This study underscores the significance of Hampton's hump as a rare but clinically relevant radiological finding in patients with pulmonary embolism. Given the limited number of studies on this topic, our findings provide valuable insights into the role of Hampton's hump in the context of pulmonary embolism.

VTE Prevention Ability Among Community Nurses in the Medical Consortium Based on the Kirkpatrick Mode Evaluation of the Effects of Training

PURPOSE

To explore the application of the Kirkpatrick model in VTE prevention training among community nurses in the medical consortium.

METHOD

A team of experts was established to formulate a VTE prevention ability training program for community nurses in the medical consortium. According to a literature review, the results of a questionnaire survey and the results of on-site supervision surveys of nurses in five community health service centers in the medical consortium. The Kirkpatrick model was applied to train 117 nurses in five community service centers, and the effects on the four dimensions (i.e., the reaction layer, learning layer, behavior layer, and results layer) were observed.

RESULTS

A total of 100% of nurses' reported satisfaction with the training, and the attendance rate was ≥98%. After the training, the theoretical knowledge of VTE prevention and the results of the skills assessment of community nurses in the medical consortium were significantly greater than the pretraining levels (p < 0.001). Three months after training, the nurses' VTE prevention execution score significantly improved compared with the pretraining scores (p < 0.001). The compliance rate and standard rate of ankle pump movement significantly improved compared with those before training (p < 0.001).

CONCLUSION

Training based on the offset model can effectively improve VTE prevention knowledge among community nurses in the medical consortium, thereby enhancing VTE prevention among patients and at improving the compliance and standardization of patients' self-prevention. These findings provide a reference for future in-service training programs targeting VTE prevention among nurses in community hospitals.

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

BACKGROUND

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

METHODS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Development and validation of a prediction model for VTE risk in gastric and esophageal cancer patients

Objective

This study focuses on the risk of venous thromboembolism (VTE) in patients with gastric or esophageal cancer (GC/EC), investigating the risk factors for VTE in this population. Utilizing machine learning techniques, the research aims to develop an interpretable VTE risk prediction model. The goal is to identify patients with gastric or esophageal cancer who are at high risk of VTE at an early stage in clinical practice, thereby enabling precise anticoagulant prophylaxis and thrombus management.

Methods

This study is a real-world investigation aimed at predicting VTE in patients with GC/EC. Data were collected from inpatients diagnosed with GC/EC at Sichuan Provincial People's Hospital between 1 January 2018, and 31 June 2023. Using nine supervised learning algorithms, 576 prediction models were developed based on 56 available variables. Subsequently, a simplified modeling approach was employed using the top 12 feature variables from the best-performing model. The primary metric for assessing the predictive performance of the models was the area under the ROC curve (AUC). Additionally, the training data used to construct the best model in this study were employed to externally validate several existing assessment models, including the Padua, Caprini, Khorana, and COMPASS-CAT scores.

Results

A total of 3,742 cases of GC/EC patients were collected after excluding duplicate visit information. The study included 861 (23.0%) patients, of which 124 (14.4%) developed VTE. The top five models based on AUC for full-variable modeling are as follows: GBoost (0.9646), Logic Regression (0.9443), AdaBoost (0.9382), CatBoost (0.9354), XGBoost (0.8097). For simplified modeling, the models are: Simp-CatBoost (0.8811), Simp-GBoost (0.8771), Simp-Random Forest (0.8736), Simp-AdaBoost (0.8263), Simp-Logistic Regression (0.8090). After evaluating predictive performance and practicality, the Simp-GBoost model was determined as the best model for this study. External validation of the Padua score, Caprini score, Khorana score, and COMPASS-CAT score based on the training set of the Simp-GBoost model yielded AUCs of 0.4367, 0.2900, 0.5000, and 0.3633, respectively.

Conclusion

In this study, we analyzed the risk factors of VTE in GC/EC patients, and constructed a well-performing VTE risk prediction model capable of accurately identifying the extent of VTE risk in patients. Four VTE prediction scoring systems were introduced to externally validate the dataset of this study. The results demonstrated that the VTE risk prediction model established in this study held greater clinical utility for patients with GC/EC. The Simp-GB model can provide intelligent assistance in the early clinical assessment of VTE risk in these patients.

MDM2 interacts with PTEN to inhibit endothelial cell development and promote deep vein thrombosis via the JAK/STAT signaling pathway

Deep vein thrombosis (DVT) is a prevalent clinical condition, which markedly affects patients' quality of life, commonly leading to post‑thrombotic syndrome. The present study aimed to elucidate the intricate interplay between murine double minute‑2 (MDM2) and phosphatase and tensin homolog (PTEN), thus shedding new light on their role in the pathogenesis of DVT. The results showed that both MDM2 and PTEN were upregulated in venous blood samples obtained from patients with DVT. However, MDM2 or PTEN knockdown markedly increased the proliferation, migration, invasion, apoptosis and angiogenesis of oxidized low‑density lipoprotein‑treated human umbilical vein endothelial cells (HUVECs). Furthermore, MDM2 silencing downregulated PTEN. The association between MDM2 and PTEN was verified through comprehensive analyses, including Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) analysis and co‑immunoprecipitation assays. The effect of PTEN on DVT was evaluated by Kyoto Encyclopedia of Genes and Genomes and STRING analysis, which demonstrated that PTEN displayed an inhibitory role in the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling pathway. Notably, treatment with AG‑490, an inhibitor of JAK/STAT signaling, reversed the protective effect of PTEN knockdown on the behavior of HUVECs. In summary, the results of the current study indicated that both MDM2 and PTEN were upregulated in patients with DVT. The interaction between MDM2 and PTEN was also verified, thus providing novel insights into their potential collaborative role in the development of DVT. Overall, MDM2 and PTEN may interact to inhibit endothelial cell development and promote the occurrence of DVT via inhibiting the JAK/STAT signaling pathway.

Analysis of clinical characteristics in 1940 patients with acute pulmonary embolism

BACKGROUND

The clinical characteristics of acute pulmonary embolism (APE) according to mortality risk has been partly explored. Further research is required in light of the latest guide update on risk stratification for APE.

METHODS

We collected the data from hospitalized patients with APE. Patients were classified according to the 2019 European Society of Cardiology's (ESC) guidelines. The clinical traits between different risk stratification of APE was investigated.

RESULTS

A total of 1940 patients had APE. Patients who were stratified as high risk showed the highest frequency of both syncope (4.5 % vs 6.6 % vs 12.7 %; P = 0.002) and dyspnea (61.9 % vs 73.0 % vs 73.8 %, P = 0.007) when compared to the other two groups. The rates of deep venous thrombosis (DVT) were: 49.4 % in low-risk stratification, 63.2 % in intermediate-risk stratification, and 68.1 % in high-risk stratification, (Pfor trend = 0.001), while the proportion of low-risk stratification patients increased (2.5 %-13.3 %, Pfor trend<0.001).

CONCLUSION

In conclusion, clinical characteristics differ among pulmonary embolism patients with different risk stratification. Furthermore, the percentage of low-risk patients increased progressively while overall in-hospital death rates among APE patients gradually decreased.

Economic Analysis of Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism

BACKGROUND

Pulmonary embolism is associated with a significant burden of morbidity, mortality, and health care costs. Catheter-directed thrombolysis has emerged as a promising option for patients with intermediate-risk pulmonary embolism which aims to improve outcomes over standard anticoagulation.

METHODS

We constructed a decision-analytic model comparing the cost-effectiveness of catheter-directed thrombolysis to anticoagulation alone for the management of intermediate-risk pulmonary embolism. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. The main outcome was ICER (US dollars/deaths averted).

RESULTS

In the base case analysis, derived using systemic lysis data, the cost associated with catheter-directed thrombolysis was estimated at $22,353 with a probability of survival at 1 month of 0.984. For the anticoagulation alone strategy, the cost was $25,060, and the probability of survival at 1 month was 0.958. Overall, catheter-directed thrombolysis resulted in savings of $104,089 per death averted (ICER,-$104,089 per death averted). Sensitivity analysis revealed that catheter-directed thrombolysis would no longer be cost-effective when its associated mortality is greater than 0.042. In the probabilistic analysis, at a willingness-to-pay of $100,000, catheter-directed thrombolysis had a 63% chance of being cost-effective, and in cost-effectiveness acceptability curves, it was cost-effective in 63%-78% of simulations for a willingness to pay ranging from $0 to $100,000.

CONCLUSIONS

If the assumptions made in our model are shown to be accurate then CDT would be cost-effective and may lead to considerable cost savings if used where clinically appropriate.

Is CT pulmonary angiography overutilized in the evaluation of patients with suspected pulmonary embolism? A retrospective study

Introduction

Despite the high mortality rate of acute untreated pulmonary embolism (PE) at 30%, diagnosing PE is challenging. While the prevalence of PE has decreased in recent years, the overuse of computed tomography pulmonary angiography (CTPA) remains a concern. The National Institute for Health and Care Excellence (NICE) provides guidelines using the Wells score for PE assessment. The Royal College of Radiologists (RCR) recommends a positive yield of 15.4% - 37% for CTPA tests. This study assesses the positive yield of CTPA for suspected PE patients and evaluates the potential reduction through Wells score/D-dimer assessment as recommended by NICE.

Methods

All patients who underwent CTPA between September 1, 2019, and January 31, 2020, at Salmaniya Medical Complex were included. Data on patient demographics and pre-CTPA workup were collected from electronic patient records (EPR) and stored in MS Excel 2019 for analysis.

Results

Of 188 suspected PE patients (mean age 50 ±12.3 years; 62.8% female), 12.2% were diagnosed with PE. None had documented Wells scores. A low-risk Wells score (≤4) was assigned to 68.6% of patients, with only 26.1% undergoing D-dimer testing. PE was confirmed in 4 patients with low-risk Wells scores and elevated D-dimers. All 10 patients with low-risk Wells scores and negative D-dimers were PE-negative.

Conclusion

In total, 5.3% - 47.9% of the CTPAs conducted could have been avoided by following NICE guidelines. We propose integrating an algorithm-based checklist with validated tools like the Wells and Geneva scores into the ePMA system to guide appropriate CTPA referrals, promote evidence-based decision-making, reduce unnecessary imaging, and optimize patient care and resource use.

Peripheral Venous Ultrasound

After clinical evaluation, especially clinical prediction rules, appropriately ordered venous duplex has become the standard test for evaluating and excluding deep vein thrombosis (DVT). Ultrasound is useful for lower- and upper-extremity veins. Protocols include grayscale, color Doppler, and spectral Doppler. Recommended lower-extremity protocols include central leg and calf veins. Duplex Doppler is widely used to evaluate patients with chronic venous disease, especially with suspected venous reflux. Mapping to identify adequate veins before surgery is another widely used indication for venous ultrasound. Ultrasound for thrombosis can be characterized as normal, acute DVT, superficial thrombosis, or chronic postthrombotic changes in most patients.

Clinical Characteristics and Risk Factors of Patients with Lung Cancer Complicated with Pulmonary Embolism: A Case Control Study

PURPOSE

The purpose of this study was to investigate the clinical characteristics and risk factors for patients with lung cancer complicated by pulmonary embolism and to provide a reference for the early clinical identification of these patients.

METHODS

Eighty patients with lung cancer complicated with pulmonary embolism who were treated at Bethune Hospital of Shanxi from October 2018 to October 2025 were compared with 80 patients with lung cancer without pulmonary embolism. The clinical data of the two groups of patients were collected and analysed.

RESULTS

Compared with that in patients in the LC group, the proportion of patients with pulmonary interstitial fibrosis in the LP group was significantly greater (p < 0.05). The incidence of dyspnoea in the LP group was significantly greater than that in the LC group (p < 0.05). Compared with that in the LC group, the proportion of pulmonary artery compression in the LP group was significantly greater, and the difference was statistically significant (p < 0.05). In terms of pathological type, the proportion of adenocarcinoma patients in the LP group was significantly greater than that in the LC group (p < 0.05). In terms of tumor stage, the proportion of patients with stage III/IV disease in the LP group was significantly greater than that in the LC group, while the proportion of patients with stage I/II disease was significantly lower than that in the LC group, and the difference was statistically significant (p < 0.05). The neutrophil [NEUT (%)], prothrombin time (PT), white blood cell (WBC), carcinoma embryonic antigen (CEA) and D-dimer (DD) levels were significantly greater in the LP group than in the LC group (p < 0.05). In terms of treatment, the proportion of patients receiving systemic chemotherapy in the LP group was significantly greater than that in the LC group (p < 0.05). Logistic regression analysis revealed that adenocarcinoma, systemic chemotherapy and tumor stage III-IV were independent risk factors for lung cancer complicated with pulmonary embolism.

CONCLUSION

(1) Tumor stage (III/IV), systemic chemotherapy, and adenocarcinoma were independent risk factors for pulmonary thromboembolism in patients with lung cancer. (2) In addition, patients with LP were more likely to have pulmonary interstitial fibrosis, dyspnoea, compression of the pulmonary artery by the tumor location, biological targeted therapy, and abnormal increases in D-dimer, WBC, NEUT (%), CEA and PT levels as laboratory indicators. (3) Pulmonary thromboembolism should be considered in lung cancer patients with a combination of the factors described above.

Association of Fibrinogen Aα Thr312Ala (rs6050) Polymorphism with Venous Thrombosis and Chronic Thromboembolic Pulmonary Hypertension: A Meta-Analysis

BACKGROUND

Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Chronic thromboembolic pulmonary hypertension (CTEPH) typically arises from acute pulmonary embolism. The pathogenesis of them involves multiple risk factors such as genetic predisposition. However, the findings from these studies are not entirely consistent. This study aims to investigate the association between FGA rs6050 polymorphism and susceptibility to thrombotic diseases.

METHODS

We searched PubMed, OVID, Web of Science, Academic Search Ultimate, CNKI, and Wan Fang database. To assess the strength of associations, we calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) in different genetic models. Additionally, subgroup analyses, sensitivity analysis, and assessment of publication bias were also carried out.

RESULTS

A total of 11 studies, including 9 reported results on VTE (3856 individuals [1545 cases]) and 3 on CTEPH (761 participants [350 cases]), revealed a significant association between the rs6050 polymorphism and susceptibility to both VTE and CTEPH. The A allele was consistently linked to an elevated risk of VTE across all genetic models (allele, homozygote, heterozygote, recessive, and dominant model), while it was also associated with an increased risk of CTEPH under all genetic models excluding the recessive model. Furthermore, subgroup analysis among ethnic groups revealed a significant association between rs6050 polymorphisms and VTE in both Caucasians and Asians under all genetic models. In Africans, the association with VTE was only observed for rs6050 polymorphisms in dominant and heterozygous models.

CONCLUSIONS

The FGA rs6050 polymorphism is positively associated with susceptibility to VTE and CTEPH.

Biological Aging and Venous Thromboembolism: A Review of Telomeres and Beyond

Although venous thromboembolism (VTE) is the third most common cardiovascular disease, and the risk of VTE increases sharply with advancing age, approximately 40% of VTE cases are currently classified as unprovoked, highlighting the importance of risk factor research. While chronological aging is associated with the risk of VTE, the association with biological aging remains unclear. Biological aging is highly complex, influenced by several dysregulated cellular and biochemical mechanisms. In the last decade, advancements in omics methodologies provided insights into the molecular complexity of biological aging. Techniques such as high-throughput genomics, epigenomics, transcriptomics, proteomics, and metabolomics analyses identified and quantified numerous epigenetic markers, transcripts, proteins, and metabolites. These methods have also revealed the molecular alterations organisms undergo as they age. Despite the progress, there is still a lack of consensus regarding the methods for assessing and validating these biomarkers, and their application lacks standardization. This review gives an overview of biomarkers of biological aging, including telomere length, and their potential role for VTE. Furthermore, we critically examine the advantages and disadvantages of the proposed methods and discuss possible future directions for investigating biological aging in VTE.

Integrating biomarkers for hemostatic disorders into computational models of blood clot formation: A systematic review

In the pursuit of personalized medicine, there is a growing demand for computational models with parameters that are easily obtainable to accelerate the development of potential solutions. Blood tests, owing to their affordability, accessibility, and routine use in healthcare, offer valuable biomarkers for assessing hemostatic balance in thrombotic and bleeding disorders. Incorporating these biomarkers into computational models of blood coagulation is crucial for creating patient-specific models, which allow for the analysis of the influence of these biomarkers on clot formation. This systematic review aims to examine how clinically relevant biomarkers are integrated into computational models of blood clot formation, thereby advancing discussions on integration methodologies, identifying current gaps, and recommending future research directions. A systematic review was conducted following the PRISMA protocol, focusing on ten clinically significant biomarkers associated with hemostatic disorders: D-dimer, fibrinogen, Von Willebrand factor, factor Ⅷ, P-selectin, prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin Ⅲ, protein C, and protein S. By utilizing this set of biomarkers, this review underscores their integration into computational models and emphasizes their integration in the context of venous thromboembolism and hemophilia. Eligibility criteria included mathematical models of thrombin generation, blood clotting, or fibrin formation under flow, incorporating at least one of these biomarkers. A total of 53 articles were included in this review. Results indicate that commonly used biomarkers such as D-dimer, PT, and APTT are rarely and superficially integrated into computational blood coagulation models. Additionally, the kinetic parameters governing the dynamics of blood clot formation demonstrated significant variability across studies, with discrepancies of up to 1, 000-fold. This review highlights a critical gap in the availability of computational models based on phenomenological or first-principles approaches that effectively incorporate affordable and routinely used clinical test results for predicting blood coagulation. This hinders the development of practical tools for clinical application, as current mathematical models often fail to consider precise, patient-specific values. This limitation is especially pronounced in patients with conditions such as hemophilia, protein C and S deficiencies, or antithrombin deficiency. Addressing these challenges by developing patient-specific models that account for kinetic variability is crucial for advancing personalized medicine in the field of hemostasis.

Diagnostic accuracy and added value of dynamic chest radiography in detecting pulmonary embolism: A retrospective study

Purpose

This study aimed to assess the diagnostic performance of dynamic chest radiography (DCR) and investigate its added value to chest radiography (CR) in detecting pulmonary embolism (PE).

Methods

Of 775 patients who underwent CR and DCR in our hospital between June 2020 and August 2022, individuals who also underwent contrast-enhanced CT (CECT) of the chest within 72 h were included in this study. PE or non-PE diagnosis was confirmed by CECT and the subsequent clinical course. The enrolled patients were randomized into two groups. Six observers, including two thoracic radiologists, two cardiologists, and two radiology residents, interpreted each chest radiograph with and without DCR using a crossover design with a washout period. Diagnostic performance was compared between CR with and without DCR in the standing and supine positions.

Results

Sixty patients (15 PE, 45 non-PE) were retrospectively enrolled. The addition of DCR to CR significantly improved the sensitivity, specificity, accuracy, and area under the curve (AUC) in the standing (35.6-70.0 % [P < 0.0001], 84.8-93.3 % [P = 0.0010], 72.5-87.5 % [P < 0.0001], and 0.66-0.85 [P < 0.0001], respectively) and supine (33.3-65.6 % [P < 0.0001], 78.5-92.2 % [P < 0.0001], 67.2-85.6 % [P < 0.0001], and 0.62-0.80 [P = 0.0002], respectively) positions for PE detection. No significant differences were found between the AUC values of DCR with CR in the standing and supine positions (P = 0.11) or among radiologists, cardiologists, and radiology residents (P = 0.14-0.68).

Conclusions

Incorporating DCR with CR demonstrated moderate sensitivity, high specificity, and high accuracy in detecting PE, all of which were significantly higher than those achieved with CR alone, regardless of scan position, observer expertise, or experience.

A prognostic prediction model for acute pulmonary embolism

Acute pulmonary embolism (APE) is a very common and important medical emergency in intensive care units with an unfavorable prognosis. This study aims to explore the prognostic factors of APE and to construct a prognostic prediction model. A retrospective analysis was conducted on 252 APE patients in the emergency department of our hospital from January 2020 to March 2024. The initial observation endpoint was set as the mortality status of patients within 30 days of admission. Cox multivariate regression analysis was used to identify independent risk factors for prognosis. Based on these factors, a nomogram predictive model was constructed and evaluated using R software. Within 30 days of admission, 42 patients died with an overall mortality rate of 16.6% (42/252). Binary Cox multivariate regression analysis indicated that age ≥ 62.5 (HR: 2.64, 95% CI: 1.23-5.63, p = 0.012), right ventricular dysfunction (RVD) (HR: 4.58, 95% CI: 1.76-11.96, p = 0.002), white blood cell count (WBC) ≥ 13.1 (HR: 2.35, 95% CI: 1.20-4.60, p = 0.013), albumin/fibrinogen ratio (AFR) < 9.15 (HR: 3.36, 95% CI: 1.76-6.42, p < 0.001), Prognostic Nutritional Index (PNI) < 50.3 (HR: 4.35, 95% CI: 1.62-11.71, p = 0.004), and Systemic Inflammation Response Index (SIRI) ≥ 1.05 (HR: 7.21, 95% CI: 3.38-15.37,p < 0.001) were independent risk factors for mortality. The nomogram model based on these factors demonstrated a good predictive value for 30-day mortality, with an AUC of 0.908. The nomogram model based on age, RVD, WBC, AFR, PNI, and SIRI has a well prognostic value for APE patients.

Metabolic landscape in venous thrombosis: insights into molecular biology and therapeutic implications

The findings of the last decade suggest a complex link between inflammatory cells, coagulation, and the activation of platelets and their synergistic interaction to promote venous thrombosis. Inflammation is present throughout the process of venous thrombosis, and various metabolic pathways of erythrocytes, endothelial cells, and immune cells involved in venous thrombosis, including glucose metabolism, lipid metabolism, homocysteine metabolism, and oxidative stress, are associated with inflammation. While the metabolic microenvironment has been identified as a marker of malignancy, recent studies have revealed that for cancer thrombosis, alterations in the metabolic microenvironment appear to also be a potential risk. In this review, we discuss how the synergy between metabolism and thrombosis drives thrombotic disease. We also explore the great potential of anti-inflammatory strategies targeting venous thrombosis and the complex link between anti-inflammation and metabolism. Furthermore, we suggest how we can use our existing knowledge to reduce the risk of venous thrombosis.

Massive Pulmonary Embolism With Negative D-dimer: A Case Report

Pulmonary embolism (PE) is a critical condition that arises when clots migrate to the lungs, obstructing pulmonary circulation and posing a significant risk to the patient's health. While the D-dimer test is useful for excluding PE, it is not infallible. This report describes a case where extensive PE was present despite the patient having a normal D-dimer level, emphasizing the importance of a thorough clinical evaluation. Our case is that of a 36-year-old male patient with a known history of acromegaly. He presented to the emergency department with a cough, shortness of breath, and high-grade fever and was ultimately diagnosed with a massive bilateral PE. Despite a negative D-dimer result and a low probability based on the Wells score, the diagnosis was confirmed by a CT pulmonary angiogram. This case report raises questions about the sensitivity and safety of a negative D-dimer result in ruling out acute PE. Clinical judgment, combined with imaging, is essential for an accurate diagnosis in high-risk cases to avoid missing life-threatening conditions like PE.

Bariatric surgery in patients with preoperative therapeutic anticoagulation: a 2015-2021 MBSAQIP database study

BACKGROUND

The link between obesity and adverse cardiovascular events is well-established. With the rising prevalence of metabolic and bariatric surgery (MBS), a greater number of patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) may present with preoperative therapeutic anticoagulation (AC).

OBJECTIVES

This study evaluated perioperative outcomes of SG and RYGB in patients on preoperative AC.

SETTING

Patients reported to the 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

METHODS

Adults undergoing primary SG or RYGB with and without preoperative anticoagulation (SG-AC or RYGB-AC and non-SG-AC or non-RYGB-AC, respectively) were analyzed from the 2015-2021 MBSAQIP database. Differences in baseline characteristics by AC status for each MBS were adjusted using entropy-balanced weights. Multivariable logistic and linear regressions were developed to analyze the independent association between AC and outcomes of interest.

RESULTS

Of 1,178,090 patients included, 72.0% (n = 850,682) had SG and 28.0% (n = 327,408) had RYGB, of which 1.8% (n = 15,021) and 1.9% (n = 6201) had AC, respectively. Compared to non-SG-AC and non-RYGB-AC, both SG-AC and RYGB-AC encountered higher absolute 30-day rates of anastomotic leak, deep vein thrombosis and gastrointestinal bleeding. Following multivariable adjustment, SG-AC was associated with significantly greater odds of adverse cardiovascular events, anastomotic leak, gastrointestinal bleeding, and greater operative length and length of stay. RYGB-AC was associated with higher odds of readmission, unplanned ICU admission, and ED visit.

CONCLUSIONS

While preoperative AC may confer distinct outcomes between SG and RYGB, this 7-year study of MBSAQIP demonstrated an overall association with greater postoperative morbidity. Management of MBS patients with preoperative AC requires consideration of thrombohemorrhagic risks.

Kallikrein inhibitor derived from immunoglobulin heavy chain junction region possesses anti-thromboinflammation potential

Influenza vaccination is associated with a reduced incidence of cardiovascular events, cardiovascular death, and all-cause mortality. However, the functional role of the associated immunoglobulin remains unclear. This study identified a specific influenza-related immunoglobulin heavy chain junction region sequence (Ser-Leu-Gly-Ala-Ser-Asp, SD6) that inhibited plasma kallikrein (PKa) activity to resist thromboinflammatory responses and stroke injury. PKa is considered an attractive therapeutic target for alleviating the complications of thrombophilia-induced inflammation. In vitro, SD6 prolonged plasma recalcification and activated partial thromboplastin time, with no effects on bleeding risk-related prothrombin time, indicating selective inhibition of the intrinsic coagulation pathway. Correspondingly, at doses ranging from 0.25 to 4 mg/kg, SD6 attenuated arterial and cortical venous thrombosis in FeCl3-induced and photochemically induced mice, without impacting hemorrhage risk, and further mitigated cerebral inflammatory injury in a mouse model of transient middle cerebral artery occlusion ischemic stroke. These findings suggest that SD6 may serve as a potential therapeutic agent for the treatment of thromboinflammatory conditions.

Reporting of Incidental Thrombotic Arteriopathy in Lung Resection Specimens: Examination of Clinical Impact

Pulmonary thrombotic arteriopathy (PTA) can be an incidental finding in lung resections performed for various indications. Historic studies largely examined PTA in autopsies. Thus, the prevalence in surgical samples, particularly in the modern era of lung cancer screening, is poorly defined. Detection of PTA in surgical samples may provide an opportunity for therapeutic intervention, but the impact of this finding on clinical management is unknown. We retrospectively examined consecutive lung surgical resections containing a report of incidental PTA between 2019 and 2022 in our institution. A retrospective chart review was performed to determine the history of systemic thromboembolism and clinical and radiographic follow-up. All slides were reviewed to morphologically characterize the vascular changes. Among 2930 pulmonary resections, 66 (2.3%) reportedly contained PTA. Twenty-four (36.4%) patients had a clinically recognized thromboembolic event either before or after surgical resection. Patients with clinically recognized thromboembolic disease were significantly more likely to have both acute and organized thrombi affecting large arteries. The presence of infarct, chronic hypertensive vasculopathy, or number of vessels with thrombi were not significantly associated with a clinically detected event. Reporting of incidental PTA led to clinical intervention in six patients and confirmed systemic thromboembolic disease in 2. Moreover, 2 patients with no further workup based on the incidental pathology findings subsequently developed pulmonary embolism. PTA is incidentally detected in 2.3% of surgical lung resections, and in two-thirds of cases, there is no clinical suspicion of thromboembolic disease. Pathologic reporting of PTA rarely led to clinical intervention, suggesting a need for improved communication of incidental pathology findings.

Bismuth Chelate-Mediated Digital Subtraction Angiography

Digital subtraction angiography (DSA) is considered the "gold standard" for the diagnosis of vascular diseases. However, the contrast agents used in DSA are limited to iodine (I)-based small molecules, which are unsuitable for patients with contraindications. Here, iodine-free DSA utilizing a bismuth (Bi) chelate, Bi-DTPA Dimeglumine, is proposed for vascular visualization for the first time. Bi-DTPA Dimeglumine possesses a simple synthesis process without the need for purification, large-scale production ability (over 200 g in the lab), superior X-ray imaging capability, renal clearance capacity, and good biocompatibility. Bi-DTPA-enhanced DSA can clearly display the arteries of the rabbit's head and lower limbs, with a minimum vascular resolution of 0.5 mm. The displayed integrity of terminal vessels by Bi-DTPA-enhanced DSA is superior to that of iopromide-enhanced DSA. In a rabbit model of thrombotic disease, Bi-DTPA Dimeglumine-enhanced DSA enables the detection of embolism and subsequent reevaluation of vascular conditions after recanalization therapy. This proposed iodine-free DSA provides a promising and universal approach for diagnosing vascular diseases.

Machine Learning-Based Predictive Models for Patients with Venous Thromboembolism: A Systematic Review

BACKGROUND

 Venous thromboembolism (VTE) is a chronic disorder with a significant health and economic burden. Several VTE-specific clinical prediction models (CPMs) have been used to assist physicians in decision-making but have several limitations. This systematic review explores if machine learning (ML) can enhance CPMs by analyzing extensive patient data derived from electronic health records. We aimed to explore ML-CPMs' applications in VTE for risk stratification, outcome prediction, diagnosis, and treatment.

METHODS

 Three databases were searched: PubMed, Google Scholar, and IEEE electronic library. Inclusion criteria focused on studies using structured data, excluding non-English publications, studies on non-humans, and certain data types such as natural language processing and image processing. Studies involving pregnant women, cancer patients, and children were also excluded. After excluding irrelevant studies, a total of 77 studies were included.

RESULTS

 Most studies report that ML-CPMs outperformed traditional CPMs in terms of receiver operating area under the curve in the four clinical domains that were explored. However, the majority of the studies were retrospective, monocentric, and lacked detailed model architecture description and external validation, which are essential for quality audit. This review identified research gaps and highlighted challenges related to standardized reporting, reproducibility, and model comparison.

CONCLUSION

 ML-CPMs show promise in improving risk assessment and individualized treatment recommendations in VTE. Apparently, there is an urgent need for standardized reporting and methodology for ML models, external validation, prospective and real-world data studies, as well as interventional studies to evaluate the impact of artificial intelligence in VTE.

Quantitative texture analysis using machine learning for predicting interpretable pulmonary perfusion from non-contrast computed tomography in pulmonary embolism patients

BACKGROUND

Pulmonary embolism (PE) is life-threatening and requires timely and accurate diagnosis, yet current imaging methods, like computed tomography pulmonary angiography, present limitations, particularly for patients with contraindications to iodinated contrast agents. We aimed to develop a quantitative texture analysis pipeline using machine learning (ML) based on non-contrast thoracic computed tomography (CT) scans to discover intensity and textural features correlated with regional lung perfusion (Q) physiology and pathology and synthesize voxel-wise Q surrogates to assist in PE diagnosis.

METHODS

We retrospectively collected 99mTc-labeled macroaggregated albumin Q-SPECT/CT scans from patients suspected of PE, including an internal dataset of 76 patients (64 for training, 12 for testing) and an external testing dataset of 49 patients. Quantitative CT features were extracted from segmented lung subregions and underwent a two-stage feature selection pipeline. The prior-knowledge-driven preselection stage screened for robust and non-redundant perfusion-correlated features, while the data-driven selection stage further filtered features by fitting ML models for classification. The final classification model, trained with the highest-performing PE-associated feature combination, was evaluated in the testing cohorts based on the Area Under the Curve (AUC) for subregion-level predictability. The voxel-wise Q surrogate was then synthesized using the final selected feature maps (FMs) and model score maps (MSMs) to investigate spatial distributions. The Spearman correlation coefficient (SCC) and Dice similarity coefficient (DSC) were used to assess the spatial consistency between FMs or MSMs and Q-SPECT scans.

RESULTS

The optimal model performance achieved an AUC of 0.863 during internal testing and 0.828 on the external testing cohort. The model identified a combination containing 14 intensity and textural features that were non-redundant, robust, and capable of distinguishing between high- and low-functional lung regions. Spatial consistency assessment in the internal testing cohort showed moderate-to-high agreement between MSMs and reference Q-SPECT scans, with median SCC of 0.66, median DSCs of 0.86 and 0.64 for high- and low-functional regions, respectively.

CONCLUSIONS

This study validated the feasibility of using quantitative texture analysis and a data-driven ML pipeline to generate voxel-wise lung perfusion surrogates, providing a radiation-free, widely accessible alternative to functional lung imaging in managing pulmonary vascular diseases.

CLINICAL TRIAL NUMBER

Not applicable.

Sex, Racial/Ethnic, and Regional Disparities in Pulmonary Embolism Mortality Trends in the USA, 1999-2020

BACKGROUND

While the National Institutes of Health emphasize integrating sex as a biological variable into research, specific considerations of sex-related differences in pulmonary embolism (PE) mortality trends remain scarce. This study examines sex-based PE mortality trends across regional and demographic groups in the USA from 1999 to 2020.

METHODS

A retrospective analysis of National Center for Health Statistics mortality data from 1999 to 2020 was conducted. Using ICD-10 code I26, PE decedents were identified. Piecewise linear regression assessed sex-based temporal trends in PE mortality by age, race/ethnicity, and census region. Annual percentage changes and average annual percentage changes were derived using Weighted Bayesian Information Criteria. The 95% confidence intervals were estimated using the empirical quantile method.

RESULTS

From 1999 to 2020, a total of 179,273 individuals died in the USA due to PE, resulting in an age-adjusted mortality rate of 2.5 per 100,000 persons (95% CI, 2.5-2.5). While men and women exhibited comparable rates in recent time segments and across most subcategories, a higher mortality trend among males compared to females was observed among non-Hispanic White and Hispanic individuals and residents of the Western US census region. These results remained robust even after excluding data from 2020, accounting for the potential impact of the COVID-19 pandemic.

CONCLUSIONS

Our study highlights sex-based disparities in PE mortality trends in the USA from 1999 to 2020. Despite overall stable mortality rates, higher trends among males were evident in specific demographic groups and regions. These findings emphasize the importance of targeted interventions to mitigate PE-related mortality discrepancies across diverse populations.

Incidence, Risk Factors, and Correlation with Caprini Score of Deep Vein Thrombosis After Colpocleisis with/without Concomitant Hysterectomy for Pelvic Organ Prolapse in Elderly Women

INTRODUCTION AND HYPOTHESIS

The objective was to investigate the incidence and risk factors of lower extremity deep vein thrombosis (DVT) in elderly women undergoing colpocleisis for pelvic organ prolapse and to evaluate the predictive efficacy of the Caprini scores.

METHODS

Data from patients who underwent colpocleisis from August 2019 to April 2024 were retrospectively analyzed. The primary endpoint was DVT detected by ultrasonography within 7 days of surgery. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors. Efficacy parameters of the Caprini scores were analyzed and optimal cut-off values were selected.

RESULTS

A total of 262 patients were enrolled in the study, of whom 8.4% (22 out of 262) developed DVT postoperatively. After statistical analysis, the duration of menopause, history of inflammatory bowel disease, as well as higher levels of preoperative cholesterol and preoperative D-dimer, were identified as independent risk factors. There was a significant difference in the Caprini scores between the DVT and non-DVT groups (7.27 ± 1.28 vs 6.15 ± 0.80, p < 0.001), and the risk of DVT tended to increase with higher Caprini scores. The best performance was achieved when the threshold for the Caprini score was set to 7, at which point the area under the receiver operating characteristic curve was 0.758, the sensitivity was 0.773, and the specificity was 0.662.

CONCLUSION

There was a strong correlation between the occurrence of DVT after colpocleisis and the Caprini score, with higher Caprini scores indicating a higher risk of postoperative DVT. A significantly increased risk was suggested when this score was ≥ 7.

Reviewing the Rare Association Between Progestogen-only Implant and Pulmonary Embolism in a Woman with Multiple Cardiovascular Risk Factors: A Case Report

Pulmonary embolism (PE) is a recognized complication of hormonal contraceptive use, but the risk associated with progestogen-only implants in women with multiple cardiovascular (CV) risk factors remains uncertain. We present the case of a woman in her early forties with multiple CV risk factors, including obesity, obstructive sleep apnoea, and hypertension, who developed bilateral PE while using a progestogen-only implant. This case highlights the potential increased risk of PE in women with multiple CV risk factors using progestogen-only implants, warranting further investigation and cautious clinical decision-making.

The Predictive Value of Qanadli and Miller Index Scores in Patients with Intermediate-High-Risk and High-Risk Pulmonary Emboli Undergoing Aspiration Thrombectomy

PURPOSE

To evaluate the correlation between clot burden and pulmonary artery pressures in patients undergoing suction thromboembolectomy for high-risk and intermediate-high-risk pulmonary embolism with secondary outcomes of 30-day mortality and intensive care unit (ICU) length of stay.

MATERIALS AND METHODS

Institutional review board (IRB) exemption was granted for this retrospective study. The charts of 120 consecutive patients who underwent mechanical thromboembolectomy using the Flowtriever system (Inari Medical, Irvine, California) between February 2020 and August 2022 were retrospectively reviewed, and the following data were collected: (a) preprocedural B-type natriuretic peptide and creatinine levels, (b) echocardiographic findings, (c) preprocedural and postprocedural pulmonary artery pressures, (d) ICU length of stay, and (e) 30-day mortality. Clot burden was scored using Qanadli and Miller indices and correlated with the clinical outcomes.

RESULTS

Of the 120 patients who underwent thromboembolectomy, pulmonary artery pressures and diagnostic-quality angiograms were available in 109 patients. In the 109 patients with adequate data, Qanadli, preprocedural Miller, and postprocedural Miller scores correlated with pulmonary artery pressures. Neither was independently associated with ICU length of stay. Freedom from 30-day mortality was 91%, and embolism-specific mortality was 92%. All-risk and high-risk patients who survived demonstrated a significantly lower preprocedural and postprocedural Miller score, respectively.

CONCLUSIONS

Thrombus burden as measured by the Qanadli and Miller scores appeared to be correlated with pulmonary artery pressures. Furthermore, catheter-directed thromboembolectomy led to a reduction in Miller scores, which appeared to be correlated with a reduction in pulmonary pressures. In high-risk patients, a reduced postprocedural Miller score and pulmonary pressure demonstrated improved 30-day survival. Further investigation into the association between Miller scores and patient mortality is warranted to stratify patients who would benefit from emergency intervention.

Lipid lowering for prevention of venous thromboembolism: a network meta-analysis

BACKGROUND AND AIMS

Studies have suggested that statins may be associated with reduced risk of venous thromboembolism (VTE). The aim of the current study was to assess the evidence regarding the comparative effect of all lipid-lowering therapies (LLT) in primary VTE prevention.

METHODS

After a systematic search of PubMed, CENTRAL, and Web of Science up until 2 November 2022, randomized controlled trials (RCT) of statins (high- or low-/moderate-intensity), ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were selected. An additive component network meta-analysis to compare VTE risk during long-term follow-up across different combinations of LLT was performed.

RESULTS

Forty-five RCTs (n = 254 933 patients) were identified, reporting a total of 2084 VTE events. Compared with placebo, the combination of PCSK9i with high-intensity statin was associated with the largest reduction in VTE risk (risk ratio [RR] 0.59; 95% confidence interval [CI] 0.43-0.80), while there was a trend towards reduction for high-intensity (0.84; 0.70-1.02) and low-/moderate-intensity (0.89; 0.79-1.00) statin monotherapy. Ezetimibe monotherapy did not affect the VTE risk (1.04; 0.83-1.30). There was a gradual increase in the summary effect of VTE reduction with increasing intensity of the LLT. When compared with low-/moderate-intensity statin monotherapy, the combination of PCSK9i and high-intensity statin was significantly more likely to reduce VTE risk (0.66; 0.49-0.89).

CONCLUSIONS

The present meta-analysis of RCTs suggests that LLT may have a potential for VTE prevention, particularly in high-intensity dosing and in combination therapy.

Novel Strategy for Human Deep Vein Thrombosis Diagnosis Based on Metabolomics and Stacking Machine Learning

Deep vein thrombosis (DVT) is a serious health issue that often leads to considerable morbidity and mortality. Diagnosis of DVT in a clinical setting, however, presents considerable challenges. The fusion of metabolomics techniques and machine learning methods has led to high diagnostic and prognostic accuracy for various pathological conditions. This study explored the synergistic potential of dual-platform metabolomics (specifically, gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS)) to expand the detection of metabolites and improve the precision of DVT diagnosis. Sixty-one differential metabolites were identified in serum from DVT patients: 22 from GC-MS and 39 from LC-MS. Among these, five key metabolites were highlighted by SHapley Additive exPlanations (SHAP)-guided feature engineering and then used to develop a stacking diagnostic model. Additionally, a user-friendly interface application system was developed to streamline and automate the application of the diagnostic model, enhancing its practicality and accessibility for clinical use. This work showed that the integration of dual-platform metabolomics with a stacking machine learning model enables faster and more accurate diagnosis of DVT in clinical environments.

Racial, biological sex, and geographic disparities of venous thromboembolism in the United States, 2016 to 2019

BACKGROUND

Venous thromboembolism (VTE) stands as the leading cause of preventable death within hospitals in the United States. Although there have been some studies investigating the incidence rates of VTE, there has yet to be a large-scale study elucidating disparities in sex, race, income, region, and seasons in patients with VTE. The goal of this study was to report the disparities in race, sex, income, region, and seasons in patients with VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT), in hospitalized patients from 2016 to 2019.

METHODS

We used the United States National Inpatients Sample database to identify inpatients diagnosed with PE, DVT, and PE and DVT from 2016 to 2019. The inpatient incidence per thousand was calculated for sex and race using the weighted sample model. The regional and monthly incidence of DVT and PE per thousand inpatients and risk of incidence were calculated. Patients' characteristics including hospital type, bed size, median length of stay, median total charges, and mortality were also collected.

RESULTS

We examined 455,111 cases of VTE, 177,410 cases of DVT, 189,271 cases of PE, and 88,430 cases of both DVT and PE combined. Over the study period, we observed a statistically significant trend among PE hospitalization incidences. There was a strong and positive correlation between DVT and PE inpatients. Black inpatients had the highest cumulative incidence of hospitalizations in all cohorts with 10.36 per 1000 in PE and 9.1 per 1000 in DVT. Asian and Pacific Islander inpatients had the lowest cumulative incidence with 4.42 per 1000 in PE and 4.28 per 1000 in DVT. Females showed the lowest cumulative incidence with 7.47 per 1000 in PE and 6.53 per 1000 in DVT. The Mountain region was the highest among PE hospitalizations with 9.62 per 1000. For DVT, the Middle Atlantic region was the highest at 8.65 per 1000. The in-hospital mortality rate was the highest among the PE hospitalizations at 7.3%. Also, the trend analysis showed significant increases among all groups.

CONCLUSIONS

Over the study period (2016-2019), we report the racial, biological sex, and geographical disparities from the National Inpatient Sample database, highlighting that Black inpatients had the highest incidence of PE and DVT, whereas Asian/Pacific Islander inpatients had the lowest incidences of PE and DVT. Moreover, women had a lower incidence compared with men. The observed regional variations indicated that the incidence of PE was highest in the Mountain region, whereas the incidence of DVT was lowest in the Middle Atlantic region. There was an increase in the mortality of inpatients diagnosed with VTE reflecting the growing burden of this condition in the US health care system.

Post-operative Saddle Pulmonary Embolism: A Case Report

Pulmonary embolisms are serious complications that can arise from surgical procedures involving the extremities due to the risk of deep vein thrombosis (DVT) and subsequent embolism. This life-threatening condition occurs when an embolus lodges at the bifurcation of the main pulmonary arteries, compromising blood flow to the lungs. Treatment options for pulmonary embolism primarily include anticoagulation therapy, thrombolysis, thrombectomy, and inferior vena cava (IVC) filter placement. Given that cases of saddle pulmonary embolism are rare but potentially fatal, healthcare providers must maintain a high index of suspicion and implement rigorous preventive measures to mitigate the risk in surgical patients.

Relationship of the Novel Scoring System for Lower Extremity Venous Thrombosis with Pulmonary Embolism

RATIONALE AND OBJECTIVE

To develop a new scoring system, the "Lower extremity venous Doppler ultrasound scoring system" (LEVDUS), to predict the diagnosis of pulmonary embolism (PE) localization in patients with deep vein thrombosis (DVT).

METHODS

This single-center retrospective study included 182 patients aged ≥ 18 years. We used scoring according to thrombosis localization and stage in Doppler US. Patients with PE were divided into three categories based on the pulmonary artery (PA) location on CT pulmonary angiography. LEVDUS values were compared according to the PE classification. The threshold value was determined for the diagnosis of PE in the receiver operating characteristics analysis. Factors affecting the diagnosis of PE were evaluated by logistic regression analysis.

RESULTS

A total of 182 patients were included (female patients: 55.5% [101/182]). The median age of the patients was 68 (IQR, 56-77). The rates of DVT and PE were 35.2% (64/182) and 52.7% (96/182), respectively. Although the median LEVDUS and d-dimer values in the subsegmental PE group were higher, LEVDUS was statistically significant but d-dimer was not (p = 0.005 and p = 0.022, respectively). In addition, both LEVDUS and d-dimer median values in the other PE groups were statistically significantly higher than the non-PE group (p < 0.001). The cut-off value for the diagnosis of PE was LEVDUS≥ 2.5. LEVDUS was 1.2-fold higher for the presence of PE.

CONCLUSION

LEVDUS provides useful information in predicting the presence of PE in patients and provides a common diagnostic language between radiologists and emergency or clinic physicians.

Decoding Pulmonary Embolism: Pathophysiology, Diagnosis, and Treatment

Pulmonary Embolism (PE) is a life-threatening condition initiated by the presence of blood clots in the pulmonary arteries, leading to severe morbidity and mortality. Underlying mechanisms involve endothelial dysfunction, including impaired blood flow regulation, a pro-thrombotic state, inflammation, heightened oxidative stress, and altered vascular remodeling. These mechanisms contribute to vascular diseases stemming from PE, such as recurrent thromboembolism, chronic thromboembolic pulmonary hypertension, post-thrombotic syndrome, right heart failure, and cardiogenic shock. Detailing key risk factors and utilizing hemodynamic stability-based categorization, the review aims for precise risk stratification by applying established diagnostic tools and scoring systems. This article explores both conventional and emerging biomarkers as potential diagnostic tools. Additionally, by synthesizing existing knowledge, it provides a comprehensive outlook of the current enhanced PE management and preventive strategies. The conclusion underscores the need for future research to improve diagnostic accuracy and therapeutic effectiveness in PE.

Artificial intelligence-based pulmonary embolism classification: Development and validation using real-world data

This paper presents an artificial intelligence-based classification model for the detection of pulmonary embolism in computed tomography angiography. The proposed model, developed from public data and validated on a large dataset from a tertiary hospital, uses a two-dimensional approach that integrates temporal series to classify each slice of the examination and make predictions at both slice and examination levels. The training process consists of two stages: first using a convolutional neural network InceptionResNet V2 and then a recurrent neural network long short-term memory model. This approach achieved an accuracy of 93% at the slice level and 77% at the examination level. External validation using a hospital dataset resulted in a precision of 86% for positive pulmonary embolism cases and 69% for negative pulmonary embolism cases. Notably, the model excels in excluding pulmonary embolism, achieving a precision of 73% and a recall of 82%, emphasizing its clinical value in reducing unnecessary interventions. In addition, the diverse demographic distribution in the validation dataset strengthens the model's generalizability. Overall, this model offers promising potential for accurate detection and exclusion of pulmonary embolism, potentially streamlining diagnosis and improving patient outcomes.

Effects of physical training on coagulation parameters, interleukin-6, and angiotensin-converting enzyme-2 in COVID-19 survivors

COVID-19 is a highly contagious virus that uses Angiotensin-converting enzyme 2 (ACE2) as a receptor to enter human cells. The virus leads to an increase in inflammatory cytokines (i.e. IL-6) and an impaired coagulation system, which can cause serious complications during and after the disease. Physical exercise has been shown to improve COVID-19 complications through various mechanisms, such as modulation of the immune and coagulation systems. Therefore, this study investigated the effects of 8 weeks of training on inflammatory, coagulation, and physical factors in patients with COVID-19 during the recovery phase. Twenty-seven male and female volunteers (age 20-45 years) who recently recovered from COVID-19 were assigned to the control (n = 13) or the training group (n = 14). Blood samples, aerobic capacity and muscle endurance were collected 24 h before the start of the interventions and 24 h after the final training session in week 4 and 48 h after the final training session in week 8. IL-6, ACE2, fibrinogen, and D-dimer were measured using ELISA. The training group showed a significant increase in muscle endurance (p = 0.004) and aerobic capacity (p = 0.009) compared to the control group. Serum levels of IL-6 and fibrinogen decreased in the training group but this decrease was not statistically significant (p > 0.05). Despite a slight increase in the quality of life and sleep in the training group, no statistically significant difference was observed between the training and the control group. It appears that physical training has beneficial effects on the coagulation system, inflammatory factors, and sleep quality and can facilitate the recovery of COVID-19 patients.

Resveratrol as an adjuvant prebiotic therapy in the management of pulmonary thromboembolism

Pulmonary thromboembolism (PTE) presents a grave threat to patient lives, often marked by arterial occlusion in the pulmonary vasculature, frequently stemming from deep vein thrombosis (DVT). While current anticoagulant therapies offer temporary relief, they fall short of addressing the long-term management of PTE. Notably, PTE-associated mortality rates continue to rise annually, positioning it as a crucial concern within the cardiovascular landscape. An intriguing suspect underlying compromised prognoses is the intricate interplay between the gut microbiome and PTE outcomes. The gut-derived metabolite, trimethylamine N-oxide (TMAO), has emerged as a direct contributor to accelerated thrombogenesis, thereby heightening PTE susceptibility. In pursuit of remedies, research has delved into diverse prebiotic and probiotic interventions, with Resveratrol (RSV) emerging as a promising candidate. This paper explores the potential of RSV, a polyphenolic compound, as an adjuvant prebiotic therapy. The proposed therapeutic approach not only augments anticoagulant potency through strategic pharmacokinetic interactions but also introduces a novel avenue for attenuating future PTE incidents through deliberate gut microbiome modulation. RSV's multifaceted attributes extend beyond its role in PTE prevention. Recognized for its anti-inflammatory, antioxidant, and cardioprotective properties, RSV stands as a versatile therapeutic candidate. It exhibits the ability to curtail platelet aggregation, augment warfarin bioavailability, and mitigate pulmonary arterial wall thickening - an ensemble of effects that substantiate its potential as an adjunct prebiotic for PTE patients. This literature review weaves together the latest insights, culminating in a compelling proposition: RSV is an instrumental player in the trajectory of PTE management.

Early Detection of Pulmonary Embolism in a General Patient Population Immediately Upon Hospital Admission Using Machine Learning to Identify New, Unidentified Risk Factors: Model Development Study

BACKGROUND

Under- or late identification of pulmonary embolism (PE)-a thrombosis of 1 or more pulmonary arteries that seriously threatens patients' lives-is a major challenge confronting modern medicine.

OBJECTIVE

We aimed to establish accurate and informative machine learning (ML) models to identify patients at high risk for PE as they are admitted to the hospital, before their initial clinical checkup, by using only the information in their medical records.

METHODS

We collected demographics, comorbidities, and medications data for 2568 patients with PE and 52,598 control patients. We focused on data available prior to emergency department admission, as these are the most universally accessible data. We trained an ML random forest algorithm to detect PE at the earliest possible time during a patient's hospitalization-at the time of his or her admission. We developed and applied 2 ML-based methods specifically to address the data imbalance between PE and non-PE patients, which causes misdiagnosis of PE.

RESULTS

The resulting models predicted PE based on age, sex, BMI, past clinical PE events, chronic lung disease, past thrombotic events, and usage of anticoagulants, obtaining an 80% geometric mean value for the PE and non-PE classification accuracies. Although on hospital admission only 4% (1942/46,639) of the patients had a diagnosis of PE, we identified 2 clustering schemes comprising subgroups with more than 61% (705/1120 in clustering scheme 1; 427/701 and 340/549 in clustering scheme 2) positive patients for PE. One subgroup in the first clustering scheme included 36% (705/1942) of all patients with PE who were characterized by a definite past PE diagnosis, a 6-fold higher prevalence of deep vein thrombosis, and a 3-fold higher prevalence of pneumonia, compared with patients of the other subgroups in this scheme. In the second clustering scheme, 2 subgroups (1 of only men and 1 of only women) included patients who all had a past PE diagnosis and a relatively high prevalence of pneumonia, and a third subgroup included only those patients with a past diagnosis of pneumonia.

CONCLUSIONS

This study established an ML tool for early diagnosis of PE almost immediately upon hospital admission. Despite the highly imbalanced scenario undermining accurate PE prediction and using information available only from the patient's medical history, our models were both accurate and informative, enabling the identification of patients already at high risk for PE upon hospital admission, even before the initial clinical checkup was performed. The fact that we did not restrict our patients to those at high risk for PE according to previously published scales (eg, Wells or revised Genova scores) enabled us to accurately assess the application of ML on raw medical data and identify new, previously unidentified risk factors for PE, such as previous pulmonary disease, in general populations.

Integrated proteomic and metabolomic profiling of lymph after trauma-induced hypercoagulopathy and antithrombotic therapy

BACKGROUND

Routine coagulation tests are not widely accepted diagnostic criteria of trauma-induced hypercoagulopathy (TIH) due to insensitivity. Lymphatic vessels drain approximately 10% of the interstitial fluid into the lymphatic system and form lymph.

SUBJECTIVE

The purpose of this study was to identify the potential lymph biomarkers for TIH.

METHODS

Eighteen male Sprague-Dawley rats were randomly assigned to the sham (non-fractured rats with sham surgery and vehicle treatment), the VEH (fractured rats with vehicle treatment) and the CLO (fractured rats with clopidogrel treatment) group. Thoracic duct lymph was obtained to perform proteomics and untargeted metabolomics.

RESULTS

A total of 1207 proteins and 16,695 metabolites were identified. The top 5 GO terms of lymph proteomics indicated that oxidative stress and innate immunity were closely associated with TIH and antithrombotic therapy. The top 5 GO terms of lymph metabolomics showed that homocystine and lysophosphatidylcholine were the differential expressed metabolites (DEMs) between the sham and VEH groups, while cholic acid, docosahexaenoic acid, N1-Methyl-2-pyridone-5-carboxamide, isoleucine and testosterone are the DEMs between the VEH and CLO group.

CONCLUSIONS

This study presents the first proteomic and metabolomic profiling of lymph after TIH and antithrombotic therapy, and predicts the possible lymph biomarkers for TIH.

Which one is the best in treating deep venous thrombosis -- percutaneous mechanical thrombectomy, catheter-directed thrombolysis or combination of them?

OBJECTIVE

To compare the treatment outcomes among percutaneous mechanical thrombectomy (PMT) with AngioJet, Catheter-directed thrombolysis (CDT), and a combination of both.

METHODS

One hundred forty nine patients with acute or sub-acute iliac-femoral vein thrombosis accepting CDT and/or PMT were divided into three groups respectively: PMT group, CDT group, PMT + CDT group (PMT followed by CDT). The severity of thrombosis was evaluated by venographic scoring system. Technical success was defined as restored patent deep venous blood flow after CDT and/or PMT. Clinical follow-up were assessed by ultrasound or venography imaging. The primary endpoints were recurrence of DVT, and severity level of post-thrombotic syndrome (PTS) during the follow-up.

RESULTS

Technical success and immediate clinical improvements were achieved on all patients. The proportion of sub-acute DVT and the venographic scoring in PMT + CDT group were significantly higher than that in CDT group and PMT group (proportion of sub-acute DVT: p = 0.032 and p = 0.005, respectively; venographic scoring: p < 0.001, respectively). The proportion of May-Thurner Syndrome was lower in PMT group than that in CDT and PMT + CDT group (p = 0.026 and p = 0.005, respectively). The proportion of DVT recurrence/stent thrombosis was significantly higher in CDT group than that in PMT + CDT group (p = 0.04). The severity of PTS was the highest in CDT group ( χ2 = 14.459, p = 0.006) compared to PMT group (p = 0.029) and PMT + CDT group (p = 0.006).

CONCLUSION

Patients with sub-acute DVT, high SVS scoring and combined May-Thurner Syndrome were recommended to take PMT + CDT treatment and might have lower rate of DVT recurrence/stent thrombosis and severe PTS. Our study provided evidence detailing of PMT + CDT therapy.