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Ouwerkerk JJ, Argandykov D, Gerban A, Proaño-Zamudio JA, Dorken-Gallastegi A, Hwabejire JO, Kaafarani HM, Velmahos GC, Parks J. Delayed hemothorax readmissions after rib fracture in blunt trauma patients. J Clin Orthop Trauma 2023; 45:102259. [PMID: 37872975 PMCID: PMC10589369 DOI: 10.1016/j.jcot.2023.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Background Rib fractures are the most common traumatic injury. Hemothorax is one of the widespread complications associated with a rib fracture and occurs in 10-37 % of all rib fractures. Delayed hemothorax (DHTX) is defined as an accumulation of blood within the pleural cavity. Although there is extensive literature on hemothorax, there is limited literature on rib fractures and DHTX readmissions. The objective of this study was to identify potential risk factors for DHTX readmission and examine descriptive information on readmission. Methods Using the 2016-2019 National Readmission Database (NRD), patients that experienced an admission with a blunt traumatic rib fracture were included. It was determined if the patients experienced DHTX by screening for an admission containing an ICD-10 code for hemothorax within 30 days after an admission containing a ICD-10 code for rib fracture. Univariable and multivariable analysis was performed to determine independent risk factors associated with DHTX readmission. Additionally, information on the clinical and financial characteristics of DHTX readmissions were examined. Results A total of 242,071 patients were included, of whom 635 experienced DHTX readmission ≤30 days after discharge. Diagnosed with hemothorax on the index admission had the largest odds ratio for DHTX readmission (7.43 [6.14-8.99], P < 0.001). Complications found during DHTX readmission included acute respiratory failure (16.9 %), sepsis (6.9 %), and empyema (4.3 %). Treatment mainly consisted of pleural drainage (62.2 %) and video-assisted thoracoscopic surgery (VATS) evacuation of hemothorax (10.1 %). Conclusion Patients admitted for a rib fracture have a low incidence for DHTX readmission within 30 days. However, multivariable analysis has demonstrated some risk and protective factors associated with DHTX readmission. Further studies should focus on exploring these risk factors to screen for potential DHTX readmission and/or protective factors to decrease the change for DHTX readmission.
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Affiliation(s)
- Joep J.J. Ouwerkerk
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Trauma Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dias Argandykov
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony Gerban
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jefferson A. Proaño-Zamudio
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ander Dorken-Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John O. Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M.A. Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George C. Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Flot C, Oliver I, Caron P, Savagner F, Tauber M, Claeyssens S, Edouard T. Acquired von Willebrand's syndrome caused by primary hypothyroidism in a 5-year-old girl. J Pediatr Endocrinol Metab 2019; 32:1295-1298. [PMID: 31472063 DOI: 10.1515/jpem-2019-0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022]
Abstract
Background Acquired von Willebrand's syndrome (aVWS) associated with hypothyroidism is rare in children and more often diagnosed during the peripubertal period in the context of Hashimoto's thyroiditis. Case presentation A 5-year-old girl was referred to the paediatric haematology unit for rectal bleeding, anaemia and prolonged activated partial thromboplastin time (aPTT). Her developmental and learning skills were normal. The physical examination revealed severe short stature (height SDS: -3.6) with overweight (body mass index SDS: 1.8) and clinical sign of hypothyroidism. Laboratory investigation revealed aVWS type 1 associated with severe primary hypothyroidism. Anti-thyroid antibodies were negative and thyroid ultrasound found thyroid hypoplasia in favour of congenital hypothyroidism. Restoration of euthyroidism was associated with increased growth velocity and normalisation of coagulation parameters. Conclusion This report highlights the importance of excluding an underlying pathology (including hypothyroidism) in children with suspected VWS, even in young age.
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Affiliation(s)
- Claire Flot
- Paediatric Endocrine Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
| | - Isabelle Oliver
- Paediatric Endocrine Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Larrey University Hospital, Toulouse, France
| | - Frédérique Savagner
- Biochemistry and Genetic Laboratory, Federative Institute of Biology, Purpan University Hospital, Toulouse, France
| | - Maithé Tauber
- Paediatric Endocrine Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
| | - Ségolène Claeyssens
- Haemophilia Care Center, Medical Department, Purpan University Hospital, Toulouse, France
| | - Thomas Edouard
- Paediatric Endocrine Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
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3
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Assessment of the Impact of l-Thyroxine Therapy on Bleeding Risk in Patients Receiving Vitamin K Antagonists. Clin Drug Investig 2017; 37:929-936. [DOI: 10.1007/s40261-017-0545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krysiak R, Szkróbka W, Okopień B. The effect of l-thyroxine treatment on sexual function and depressive symptoms in men with autoimmune hypothyroidism. Pharmacol Rep 2017; 69:432-437. [DOI: 10.1016/j.pharep.2017.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 12/31/2016] [Accepted: 01/11/2017] [Indexed: 11/25/2022]
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Rodilla Fiz AM, Garví López M, Gómez Garrido M, Girón la Casa M. Changes in haemostasis and thrombosis associated with thyroid disease: Presentation of 2 cases. ACTA ACUST UNITED AC 2015; 63:357-60. [PMID: 26626435 DOI: 10.1016/j.redar.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022]
Abstract
There is a relationship between thyroid diseases and primary and secondary changes in haemostasis. The most frequent association between them are hypocoagulability states with clinical hypothyroidism and vascular thrombophilia (hypercoagulability and/or hypofibrinolysis) with hyperparathyroidism. However, there are recent studies that have detected changes in haemostasis -primary and secondary- associated with thyroid diseases with normal hormone levels, suggesting other pathogenic mechanisms not yet known. The cases are presented of 2 patients with thyroid disease that required surgery: one multinodular goitre and one papillary carcinoma of the thyroid, both with normal hormone levels. They were shown to have haemostasis disorders during the preoperative work up. These showed a Factor VII deficiency and a Factor XI deficiency along with a thrombotic disease of unknown origin, respectively.
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Affiliation(s)
- A M Rodilla Fiz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - M Garví López
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Gómez Garrido
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Girón la Casa
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Krysiak R, Gilowski W, Szkrobka W, Okopien B. Different effects of fenofibrate on metabolic and cardiovascular risk factors in mixed dyslipidemic women with normal thyroid function and subclinical hypothyroidism. Cardiovasc Ther 2014; 32:264-9. [PMID: 25290818 DOI: 10.1111/1755-5922.12095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS Subclinical hypothyroidism is suggested to increase cardiovascular risk. No previous study compared the effect of any fibrate on plasma levels of lipids and other cardiovascular risk factors in patients with different thyroid function status. METHODS The study included three age-, weight- and lipid-matched groups of women with mixed dyslipidemia in different thyroid function status: patients with untreated subclinical hypothyroidism (group 1, n = 18), women with treated hypothyroidism (group 2, n = 15), and subjects without thyroid disorders (group 3, n = 19). Plasma lipids, glucose homeostasis markers, as well as plasma levels of uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine, and fibrinogen were determined before and after 12 weeks of fenofibrate therapy. RESULTS Despite similar plasma lipid levels, mixed dyslipidemic patients with untreated hypothyroidism had decreased insulin sensitivity, as well as higher circulating levels of uric acid, hsCRP, homocysteine, and fibrinogen in comparison with the other groups. The effect of fenofibrate on plasma lipids and, with the exception of homocysteine, on circulating levels of all investigated risk factors was stronger in patients from groups 2 and 3 than in patients from group 1. CONCLUSIONS The obtained results indicate that the effect of fenofibrate on plasma lipids and circulating levels of cardiovascular risk factors is partially related to thyroid function. They also suggest that to improve the strength of fibrate action in dyslipidemic patients with subclinical hypothyroidism, they should be administered together with L-thyroxine.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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Abstract
When preparing for oral surgery, patients taking anticoagulants usually should not discontinue their medication because of the risk of a thromboembolic event. The therapeutic effect of many anticoagulants is not readily measured, so preoperatively, the surgeon cannot know the true risk for postoperative hemorrhage. The risk of a thromboembolic event usually outweighs the concerns of controlling postoperative hemorrhage. Hemophilia patients are also at risk for postoperative bleeding. Single extractions probably do not pose a serious risk for postoperative hemorrhage. However, when a mucogingival flap is raised in these patients, there may be prolonged bleeding. Surgical sponges saturated with aqueous tranexamic acid solution and compressed onto the bleeding site with biting pressure may stop bleeding. Bleeding was stopped in the case example presented here after three 10-minute compressions over 30 minutes in a patient taking aspirin and clopidogrel for a previous thromboembolic event and a metal coronary stent. The clot formed is very fragile and is prone to bleeding, so it should not be disturbed. This technique needs to be studied for efficacy.
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Stuijver DJF, Piantanida E, van Zaane B, Galli L, Romualdi E, Tanda ML, Meijers JCM, Büller HR, Gerdes VEA, Squizzato A. Acquired von Willebrand syndrome in patients with overt hypothyroidism: a prospective cohort study. Haemophilia 2013; 20:326-32. [DOI: 10.1111/hae.12275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
Affiliation(s)
- D. J. F. Stuijver
- Department of Internal Medicine; Slotervaart Hospital; Amsterdam The Netherlands
- Department of Vascular Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - E. Piantanida
- Endocrinology Unit; Department of Clinical and Experimental Medicine; University of Insubria; Varese Italy
| | - B. van Zaane
- Department of Internal Medicine; Slotervaart Hospital; Amsterdam The Netherlands
- Department of Vascular Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - L. Galli
- Department of Clinical and Experimental Medicine; Research Center on Thromboembolic Disorders and Antithrombotic Therapies; University of Insubria; Varese Italy
| | - E. Romualdi
- Department of Clinical and Experimental Medicine; Research Center on Thromboembolic Disorders and Antithrombotic Therapies; University of Insubria; Varese Italy
| | - M. L. Tanda
- Endocrinology Unit; Department of Clinical and Experimental Medicine; University of Insubria; Varese Italy
| | - J. C. M. Meijers
- Department of Vascular Medicine; Academic Medical Centre; Amsterdam The Netherlands
- Department of Experimental Vascular Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - H. R. Büller
- Department of Vascular Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - V. E. A. Gerdes
- Department of Internal Medicine; Slotervaart Hospital; Amsterdam The Netherlands
- Department of Vascular Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - A. Squizzato
- Department of Clinical and Experimental Medicine; Research Center on Thromboembolic Disorders and Antithrombotic Therapies; University of Insubria; Varese Italy
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Franchini M. The even closer link between the thyroid and haemostasis. Thromb Haemost 2012; 109:175-6. [PMID: 23224147 DOI: 10.1160/th12-11-0804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/21/2012] [Indexed: 11/05/2022]
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Hassan S, Qureshi W, Donthireddy V, Kuriakose P. Congenital von Willebrand's disease and clinical hypothyroidism. Haemophilia 2012; 19:242-5. [PMID: 23171382 DOI: 10.1111/hae.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 01/10/2023]
Abstract
Data from case reports and systematic reviews suggest an association of Hypothyroidism and Acquired von Willebrand's syndrome. It is not known if congenital von Willebrand's disease is associated with hypothyroidism in a similar way. The aim of this study was to identify the association of congenital von Willebrand's disease (VWD) with clinical hypothyroidism. A total of 350 cases of congenital VWD were initially screened from our institution database from 1985 to 2010. A careful review of patient records was carried out to see if patients truly had congenital VWD and coexisting clinical hypothyroidism. Patients with uncertain diagnoses or other bleeding disorders were excluded, leading to 197 patients remaining in the final sample. A random age- and sex-matched parallel control group was also obtained from the hospital database. Of 197 patients (mean age 43.8 ± 17.5 years, women 72%) of congenital VWD, 32/197 (16%) were diagnosed with clinical hypothyroidism, while only 11/197 (5.6%) of the matched controls were clinically hypothyroid. Univariate and multivariate analysis demonstrated that VWD was an independent predictor of developing clinical hypothyroidism (OR 3.45; 95% CI 1.65-7.22, P = 0.001). The proportion of patients diagnosed with clinical hypothyroidism was more in the VWD group (P < 0.0001). Our analysis shows a strong association of clinical hypothyroidism in patients with congenital VWD, but future studies will be required to delineate a pathological mechanism. In our opinion, clinicians should consider checking thyroid function in the newly diagnosed and established cases of congenital VWD.
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Affiliation(s)
- S Hassan
- Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
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