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Tafur AJ, Caprini JA. Dissecting the rationale for thromboprophylaxis in challenging surgical cases. J Thromb Haemost 2024; 22:613-619. [PMID: 38184204 DOI: 10.1016/j.jtha.2023.12.033] [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: 08/26/2023] [Revised: 12/02/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Pulmonary embolism (PE) is a leading preventable cause of death in surgical patients, and rates of fatal PE are increasing. Individual assessment, to balance the risks of thrombosis and bleeding, is the key to providing appropriate prophylaxis. The risk assessment process includes use of evidence-based guidelines, literature published since the latest guidelines, large registries, and risk scoring systems together with clinical experience and judgment. Risk assessment is a dynamic process and needs to be updated both during the hospital stay and just prior to discharge since clinical events may change the level of risk. The final assessment may identify patients who require ongoing anticoagulant prophylaxis after discharge. The Caprini risk score is widely used in surgical patients and is a composite of the number of risk factors and their relative weights. The Caprini risk score set point for risk levels requiring anticoagulant prophylaxis varies depending on the type of surgical procedure, surgical population, and number of risk factors. Mandatory implementation of evidence-based care pathways is helpful in lowering PE-related mortality. This review presents several challenging cases, emphasizing the importance of employing all available assessment tools, including dynamic assessment of risk during hospitalization. Finally, the limitations of evidence-based guidelines in complex scenarios and the need to employ all available tools to properly protect very high-risk patients are emphasized.
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Affiliation(s)
- Alfonso J Tafur
- NorthShore University HealthSystem, Cardiovascular Institute, Evanston, Illinois, USA; University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
| | - Joseph A Caprini
- Emeritus NorthShore University HealthSystem, Evanston, Illinois, USA
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Bordeanu-Diaconescu EM, Grosu-Bularda A, Frunza A, Grama S, Andrei MC, Neagu TP, Hariga CS, Lascar I. Venous Thromboembolism in Burn Patients: A 5-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:258. [PMID: 38399545 PMCID: PMC10889946 DOI: 10.3390/medicina60020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Burn patients manifest all components of Virchow's triad, amplifying the concern for venous thromboembolism (VTE). Routine prophylaxis for VTE remains a subject of debate, with the central concern being the occurrence of associated adverse events. Materials and Methods: We conducted a five-year retrospective study on burn patients admitted to our burn center. Demographic data, comorbidities, burn lesions characteristics, surgical interventions, anticoagulant medication, the need for transfusions, the presence of a central venous catheter, length of stay, complications, and mortality were recorded. Results: Of the overall number of patients (494), 2.63% (13 patients) developed venous thromboembolic complications documented through paraclinical investigations. In 70% of cases, thrombosis occurred in a limb with central venous catether (CVC). Every patient with VTE had a Caprini score above 8, with a mean score of 12 points in our study group. Conclusions: Considering each patient's particularities and burn injury characteristics, individualized approaches may be necessary to optimize thromboprophylaxis effectiveness. We suggest routinely using the Caprini Risk Assessment Model in burn patients. We recommend the administration of pharmacologic thromboprophylaxis in all patients and careful monitoring of patients with Caprini scores above 8, due to the increased risk of VTE. Additionally, ongoing research in this field may provide insights into new strategies for managing thrombotic risk in burn patients.
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Affiliation(s)
- Eliza-Maria Bordeanu-Diaconescu
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Andreea Grosu-Bularda
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Adrian Frunza
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Sabina Grama
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
| | - Mihaela-Cristina Andrei
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Tiberiu Paul Neagu
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.)
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
| | - Ioan Lascar
- Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania (I.L.)
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Mlaver E, Lynde GC, Sweeney JF, Sharma J. Generalizability of COBRA: A Parsimonious Perioperative Venous Thromboembolism Risk Assessment Model. J Surg Res 2024; 293:8-13. [PMID: 37690384 PMCID: PMC10843055 DOI: 10.1016/j.jss.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/30/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Standardized use of venous thromboembolism (VTE) risk assessment models (RAMs) in surgical patients has been limited, in part due to the cumbersome workflow addition required to use available models. The COBRA score-capturing cancer diagnosis, (old) age, body mass index, race, and American Society of Anesthesiologists Physical Status score-has been reported as a potentially automatable VTE RAM that circumvents the cumbersome workflow addition that most RAMs represent. We aimed to test the ability of the COBRA model to effectively risk-stratify patients across various populations. METHODS Patients were included from the 2014-2019 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Participant Use Data File for two hospitals, representing colorectal, endocrine, breast, transplant, plastic, and general surgery services. COBRA score was calculated for each patient using preoperative characteristics. We calculated negative predictive value (NPV) for VTE outcomes and compared the COBRA score to NSQIP's expected VTE rate for all patients, between the two hospitals, and between subspecialty service lines. RESULTS Of the 10,711 patients included, those with COBRA <4 (31%) had projected median VTE rate of 0.21% (interquartile range, 0.09-0.68%; mean, 0.54%). Patients with higher scores (69%) had median rate of 0.88% (0.26-2.07%; 1.46%); relative rate 2.7. The median projected VTE rates for patients identified as low risk were 0.21% and 0.16% and as high risk were 0.87% and 0.89% at hospitals one and 2, respectively. The median projected VTE rates for patients identified as low risk were 0.17%, 0.61%, and 0.08% and as high risk were 0.52%, 1.43%, and 0.18% among general, colorectal, and endocrine surgery patients, respectively. COBRA had NPV of 0.995 and sensitivity of 0.871 as compared to NPV 0.997 and sensitivity 0.857 of the NSQIP model. CONCLUSIONS The COBRA score is concordant with the traditional gold standard NSQIP VTE RAM and demonstrates interhospital and service-specific generalizability, although performance was limited in especially low-risk patients. The model adequately risk-stratifies surgical patients preoperatively, potentially providing clinical decision support for perioperative workflows.
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Affiliation(s)
- Eli Mlaver
- Department of Surgery, Emory University Hospital, Atlanta, Georgia.
| | - Grant C Lynde
- Department of Anesthesiology, Emory University Hospital, Atlanta, Georgia
| | - John F Sweeney
- Department of Surgery, Emory University Hospital, Atlanta, Georgia
| | - Jyotirmay Sharma
- Department of Surgery, Emory University Hospital, Atlanta, Georgia
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Sheng W, Wang X, Xu W, Hao Z, Ma H, Zhang S. Development and validation of machine learning models for venous thromboembolism risk assessment at admission: a retrospective study. Front Cardiovasc Med 2023; 10:1198526. [PMID: 37705687 PMCID: PMC10497101 DOI: 10.3389/fcvm.2023.1198526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Venous thromboembolism (VTE) risk assessment at admission is of great importance for early screening and timely prophylaxis and management during hospitalization. The purpose of this study is to develop and validate novel risk assessment models at admission based on machine learning (ML) methods. Methods In this retrospective study, a total of 3078 individuals were included with their Caprini variables within 24 hours at admission. Then several ML models were built, including logistic regression (LR), random forest (RF), and extreme gradient boosting (XGB). The prediction performance of ML models and the Caprini risk score (CRS) was then validated and compared through a series of evaluation metrics. Results The values of AUROC and AUPRC were 0.798 and 0.303 for LR, 0.804 and 0.360 for RF, and 0.796 and 0.352 for XGB, respectively, which outperformed CRS significantly (0.714 and 0.180, P < 0.001). When prediction scores were stratified into three risk levels for application, RF could obtain more reasonable results than CRS, including smaller false positive alerts and larger lower-risk proportions. The boosting results of stratification were further verified by the net-reclassification-improvement (NRI) analysis. Discussion This study indicated that machine learning models could improve VTE risk prediction at admission compared with CRS. Among the ML models, RF was found to have superior performance and great potential in clinical practice.
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Affiliation(s)
- Wenbo Sheng
- Research and Development Department, Shanghai Synyi Medical Technology Co., Ltd., Shanghai, China
| | - Xiaoli Wang
- Pudong Institute for Health Development, Shanghai, China
| | - Wenxiang Xu
- Research and Development Department, Shanghai Synyi Medical Technology Co., Ltd., Shanghai, China
| | - Zedong Hao
- Research and Development Department, Shanghai Synyi Medical Technology Co., Ltd., Shanghai, China
| | - Handong Ma
- Research and Development Department, Shanghai Synyi Medical Technology Co., Ltd., Shanghai, China
| | - Shaodian Zhang
- Research and Development Department, Shanghai Synyi Medical Technology Co., Ltd., Shanghai, China
- Division of Medical Affairs, Shanghai Tenth People's Hospital, Shanghai, China
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Giannopoulos S, Kalantar Motamedi SM, Athanasiadis DI, Clapp B, Lyo V, Ghanem O, Edwards M, Puzziferri N, Stefanidis D. Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices. Surg Obes Relat Dis 2023; 19:799-807. [PMID: 36717309 DOI: 10.1016/j.soard.2022.12.038] [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: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is the most common cause of death following metabolic/bariatric surgery (MBS), with most events occurring after discharge. The available evidence on ideal prophylaxis type, dosage, and duration after discharge is limited. OBJECTIVES Assess metabolic/bariatric surgeon VTE prophylaxis practices and define existing variability. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers. METHODS The members of the ASMBS Research Committee developed and administered a web-based survey to MBSAQIP medical directors and ASMBS members to examine the differences in clinical practice regarding the administration of VTE prophylaxis after MBS. RESULTS Overall, 264 metabolic/bariatric surgeons (136 medical directors and 128 ASMBS members) participated in the survey. Both mechanical and chemical VTE prophylaxis was used by 97.1% of the participants, knee-high compression devices by 84.7%, enoxaparin (32.4% 40 mg every 24 hours, 22.7% 40 mg every 12 hours, 24.4% adjusted the dose based on body mass index) by 56.5%, and heparin (46.1% 5000 units every 8 hours, 22.6% 5000 units every 12 hours, 20.9% 5000 units once preoperatively) by 38.1%. Most surgeons (81.6%) administered the first dose preoperatively, while the first postoperative dose was given on the evening of surgery by 44% or the next morning by 42.2%. Extended VTE prophylaxis was prescribed for 2 weeks by 38.7% and 4 weeks by 28.9%. CONCLUSIONS VTE prophylaxis practices vary widely among metabolic/bariatric surgeons. Variability may be related to limited available comparative evidence. Large prospective clinical trials are needed to define optimal practices for VTE risk stratification and prophylaxis in bariatric surgery patients.
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Affiliation(s)
| | | | | | - Benjamin Clapp
- Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas
| | - Victoria Lyo
- Department of Surgery, University of California Davis, Sacramento, California
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Nancy Puzziferri
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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Turner BRH, Machin M, Jasionowska S, Salim S, Onida S, Shalhoub J, Davies AH. Systematic Review and Meta-analysis of the Additional Benefit of Pharmacological Thromboprophylaxis for Endovenous Varicose Vein Interventions. Ann Surg 2023; 278:166-171. [PMID: 36205129 PMCID: PMC10321513 DOI: 10.1097/sla.0000000000005709] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) after endovenous interventions for varicose veins in the presence of pharmacological and mechanical thromboprophylaxis versus mechanical thromboprophylaxis alone. BACKGROUND The VTE rate after endovenous procedures for varicose veins is higher than other day-case procedures and could be reduced with pharmacological thromboprophylaxis. METHODS The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines with a registered protocol (PROSPERO: CRD42021274963). Studies of endovenous intervention for superficial venous incompetence reporting the predefined outcomes with at least 30 patients were eligible. Data were pooled with a fixed effects model. RESULTS There were 221 trials included in the review (47 randomized trial arms, 105 prospective cohort studies, and 69 retrospective studies). In randomized trial arms, the rate of deep venous thrombosis with additional pharmacological thromboprophylaxis was 0.52% (95% CI, 0.23%-1.19%) (9 studies, 1095 patients, 2 events) versus 2.26% (95% CI, 1.81%-2.82%) (38 studies, 6951 patients, 69 events) with mechanical thromboprophylaxis alone. The rate of pulmonary embolism in randomized trial arms with additional pharmacological thromboprophylaxis was 0.45% (95% CI, 0.09-2.35) (5 studies, 460 participants, 1 event) versus 0.23% (95% CI, 0.1%-0.52%) (28 studies, 4834 participants, 3 events) for mechanical measures alone. The rate of EHIT grade III to IV was 0.35% (95% CI, 0.09-1.40) versus 0.88% (95% CI, 0.28%-2.70%). There was 1 VTE-related mortality and 1 instance of major bleeding, with low rates of minor bleeding. CONCLUSIONS There is a significant reduction in the rate of DVT with additional pharmacological thromboprophylaxis and routine prescription of anticoagulation after endovenous varicose vein intervention should be considered. VTE risk for individual study participants is heterogeneous and risk stratification in future randomized interventional studies is critical to establish the clinical effectiveness and safety of additional pharmacological thromboprophylaxis.
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Croke L. Guideline for Prevention of Venous Thromboembolism. AORN J 2022; 116:P4-P6. [DOI: 10.1002/aorn.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
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Ivankovic V, McAlpine K, Delic E, Carrier M, Stacey D, Auer RC. Extended‐duration thromboprophylaxis for abdominopelvic surgery: Development and evaluation of a risk‐stratified patient decision aid to facilitate shared decision making. Res Pract Thromb Haemost 2022; 6:e12831. [PMID: 36397933 PMCID: PMC9663316 DOI: 10.1002/rth2.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/02/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Extended-duration thromboprophylaxis is used to decrease risk of venous thromboembolism (VTE) after surgery but may increase the risk of bleeding. The decision to complete a course of extended-duration thromboprophylaxis can be challenging. Objective The objective of this study was to develop an acceptable patient decision aid (PtDA) to facilitate shared decision making for the use of extended-duration thromboprophylaxis following major abdominal surgery. Methods An evidence-based, risk-stratified PtDA was created. The evidence on benefits and harms of a 28-day postoperative course of low-molecular-weight heparin (LMWH) versus in-hospital prophylaxis only were synthesized. Outcomes included minor bleeding, major bleeding, clinically significant VTE, and fatal VTE. Risks were calculated and reported by Caprini score. Alpha testing of the PtDA draft with various stakeholders was performed using a 10-question survey to assess acceptability of the PtDA with patients, thrombosis experts, and surgeons. The primary outcome was the acceptability of the PtDA. Results Acceptability testing was performed with 11 patients, 11 thrombosis experts, and 11 surgeons. Most responders felt the language on the PtDA was easy to follow (28/33, 85%), and that the information was well balanced between management options (9/11 [82%] patients; 17/21 [80%] clinicians). Most patients (9/11, 82%) and clinicians (18/22, 82%) believed it would be a useful clinical tool, and were satisfied with the overall quality of the PtDA (27/33, 82%). Conclusions A risk-stratified, evidence-based PtDA was created to facilitate shared decision making for the use of extended-duration LMWH following major abdominal surgery. This clinical tool was acceptable with patients and physicians and is available at https://decisionaid.ohri.ca/decaids.html.
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Affiliation(s)
| | - Kristen McAlpine
- Division of Urology, Department of Surgery University of Toronto Toronto Ontario Canada
| | - Edita Delic
- Department of Surgery, University of Ottawa The Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Marc Carrier
- Department of Medicine University of Ottawa The Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Rebecca C. Auer
- Department of Surgery, University of Ottawa The Ottawa Hospital Research Institute Ottawa Ontario Canada
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Wilson S, Chen X, Cronin M, Dengler N, Enker P, Krauss ES, Laberko L, Lobastov K, Obi AT, Powell CA, Schastlivtsev I, Segal A, Simonson B, Siracuse J, Wakefield TW, McAneny D, Caprini JA, Caprini JA. Thrombosis prophylaxis in surgical patients using the Caprini Risk Score. Curr Probl Surg 2022; 59:101221. [PMID: 36372452 DOI: 10.1016/j.cpsurg.2022.101221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Xialan Chen
- Beijing Shijitan Hospital, Capital Medical University, Beijing, P.R. China
| | - MaryAnne Cronin
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Nancy Dengler
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Paul Enker
- Zucker School of Medicine, Hofstra University, Uniondale, NY
| | - Eugene S Krauss
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Leonid Laberko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Andrea T Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Chloé A Powell
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Ayal Segal
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Barry Simonson
- Zucker School of Medicine, Hofstra University, Uniondale, NY
| | | | | | - David McAneny
- Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Joseph A Caprini
- Emeritus, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Chicago, IL
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Hillegass E, Lukaszewicz K, Puthoff M. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022. Phys Ther 2022; 102:6585463. [PMID: 35567347 DOI: 10.1093/ptj/pzac057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key action statements (KAS), including guidance on upper extremity DVT, pulmonary embolism, and special populations. This document will guide physical therapist practice in the prevention of and screening for VTE and in the management of patients who are at risk for or who have been diagnosed with VTE. Through a systematic review of published studies and a structured appraisal process, KAS were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms based on the KAS were developed that can assist with clinical decision-making. Physical therapists, along with other members of the health care team, should implement these KAS to decrease the incidence of VTE, improve the diagnosis and acute management of VTE, and reduce the long-term complications of VTE.
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Affiliation(s)
- Ellen Hillegass
- Department of Physical Therapy, Mercer University, Atlanta, Georgia, USA
| | | | - Michael Puthoff
- Physical Therapy Department, St Ambrose University, Davenport, Iowa, USA
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Triccas LT, Camilleri KP, Tracey C, Mansoureh FH, Benjamin W, Francesca M, Leonardo B, Dante M, Geert V. Reliability of Upper Limb Pin-Prick Stimulation With Electroencephalography: Evoked Potentials, Spectra and Source Localization. Front Hum Neurosci 2022; 16:881291. [PMID: 35937675 PMCID: PMC9351050 DOI: 10.3389/fnhum.2022.881291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
In order for electroencephalography (EEG) with sensory stimuli measures to be used in research and neurological clinical practice, demonstration of reliability is needed. However, this is rarely examined. Here we studied the test-retest reliability of the EEG latency and amplitude of evoked potentials and spectra as well as identifying the sources during pin-prick stimulation. We recorded EEG in 23 healthy older adults who underwent a protocol of pin-prick stimulation on the dominant and non-dominant hand. EEG was recorded in a second session with rest intervals of 1 week. For EEG electrodes Fz, Cz, and Pz peak amplitude, latency and frequency spectra for pin-prick evoked potentials was determined and test-retest reliability was assessed. Substantial reliability ICC scores (0.76-0.79) were identified for evoked potential negative-positive amplitude from the left hand at C4 channel and positive peak latency when stimulating the right hand at Cz channel. Frequency spectra showed consistent increase of low-frequency band activity (< 5 Hz) and also in theta and alpha bands in first 0.25 s. Almost perfect reliability scores were found for activity at both low-frequency and theta bands (ICC scores: 0.81-0.98). Sources were identified in the primary somatosensory and motor cortices in relation to the positive peak using s-LORETA analysis. Measuring the frequency response from the pin-prick evoked potentials may allow the reliable assessment of central somatosensory impairment in the clinical setting.
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Affiliation(s)
- Lisa Tedesco Triccas
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Kenneth P. Camilleri
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Camilleri Tracey
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Fahimi Hnazaee Mansoureh
- Laboratory for Neuro- and Psychophysiology, KU Leuven, Leuven, Belgium
- The Wellcome Trust Centre for Neuroimaging, University College London Institute of Neurology, London, United Kingdom
| | | | - Muscat Francesca
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | - Boccuni Leonardo
- Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Mantini Dante
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Verheyden Geert
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Zhang Z, Wu Y, Liu Q, Dong F, Pang W, Zhe K, Wan J, Xie W, Wang W, Yang P, Sun A, Zhai Z. Patient-Completed Caprini Risk Score for Venous Thromboembolism Risk Assessment: Developed and Validated from 1,017 Medical and Surgical Patients. TH OPEN 2022; 6:e184-e193. [PMID: 36046202 PMCID: PMC9303073 DOI: 10.1055/s-0042-1749170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/11/2022] [Indexed: 10/26/2022] Open
Abstract
Abstract
Background The Caprini Risk Score (CRS) is one of the most widely used risk assessment models for venous thromboembolism (VTE). A well-validated patient-completed CRS form may allow patients to self-report and simplify the evaluation by health care workers.
Methods The Chinese version of the CRS was optimized for easy understanding in a pilot study. The amended CRS form was completed by prospectively recruited patients and blinded nurses. The agreement levels of the individual questions and the total scores of patient and nurse-completed forms were compared using the Kappa value. The total scores were used for risk stratification of patients. Correlation and differences between patient and nurse-completed forms were analyzed using the Spearman correlation and Bland–Altman method, respectively.
Results We recruited 504 medical patients and 513 surgical patients, aged 52.7 ± 16.3 years, of which 443 (43.6%) were men, and 91.6% of the patients were educated beyond junior high school. The patients spent less time to complete the form compared with trained nurses. There was good question-to-question agreement between patient and nurse-completed CRS (k >0.6 for most questions, p < 0.0001). The total scores also showed good agreement (k = 0.6097, p < 0.0001), and enabled the classification of patients into different risk groups. The patient and nurse-derived scores were highly correlated (Spearman's r = 0.84), and without extreme values (p < 0.0001).
Conclusion We have created and verified a Chinese version of the patient-completed CRS, which showed good agreement and correlation with nurse-completed CRS. CRS represents a suitable tool for VTE risk assessment of hospitalized patients in China.
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Affiliation(s)
- Zhu Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Yifan Wu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Qingxia Liu
- Department of Nursing, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Fen Dong
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Wenyi Pang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Kaiyuan Zhe
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Wanmu Xie
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Wei Wang
- Department of Nursing, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Peiran Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Aihua Sun
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Department of Nursing, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
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13
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Grill MH, Caffaro RA, Grill TA, Júnior VC, Kikuchi R, Ribeiro CM, da Silva VS, Tafur AJ, Caprini JA, Ramacciotti E. A Prospective Study Evaluating Patterns of Responses to the Caprini Score to Prevent Venous Thromboembolism After Interventional Treatment for Varicose Veins. Clin Appl Thromb Hemost 2022; 28:10760296221112081. [PMID: 35850592 PMCID: PMC9309759 DOI: 10.1177/10760296221112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a critical complication of varicose vein
treatments. The Caprini Score (CS) is an established tool to assess
patients’ VTE risks. One disadvantage is the number of questions required,
some of them referring to a low incidence of disease, even lower in patients
seeking an elective procedure. These elements take time and may result in
filling errors if the CS is not filled out by a properly trained health
professional. Objective To establish a response pattern in CS, with emphasis on questions that
usually have a negative answer and propose a simpler adaptative digital
version without changing the original structure of the tool. Methods two hundred and twenty-seven patients in the pre-surgical treatment of
varicose veins were enrolled prospectively and submitted to the CS
evaluation. Results The pattern of dichotomous responses could be divided arbitrarily into four
subgroups considering the percentage of positive responses: none (11 items),
less than 3% (13 items), between 3% and 20% (5 items), and more than 20% (8
items). Of the 12 CS questions related to illnesses that occurred in the
last month, ten had had no responses, and 2 were less than 3%. Conclusion There is a pattern in the CS responses of patients with an indication of
surgical treatment of varicose veins. Many of the CS questions are not
helpful in this scenario and may result in filling errors performed by
untrained providers. An adaptative version of the CS might benefit varicose
veins surgery VTE risk stratification
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Affiliation(s)
| | | | | | | | - Roberto Kikuchi
- Santa Casa de São Paulo School of Medical Science, São Paulo, Brazil
| | | | | | - Alfonso J Tafur
- 3271NorthShore University Health System, Evanston, Illinois, USA
| | - Joseph A Caprini
- 3271NorthShore University Health System, Evanston, Illinois, USA
| | - Eduardo Ramacciotti
- Santa Casa de São Paulo School of Medical Science, São Paulo, Brazil.,600818Science Valley Research Institute, São Paulo, Brazil.,23356Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
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14
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Saadaldin H, Shetye P, Gavankar S, Laddu AR, Tafur A, Caprini JA. Using the Caprini Risk Score to Increase VTE Awareness in the Community: The Know Your Score Project. Clin Appl Thromb Hemost 2022; 28:10760296221107020. [PMID: 35791574 PMCID: PMC9272049 DOI: 10.1177/10760296221107020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract presented during the ISTH congress 2021 Shetye, P., Gavankar, S, Saadaldin, H, et al, Using the Caprini Risk Score to Increase VTE Awareness in the Community. The Know Your Score Project. AS-ISTH-2021-02054, 2021
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Affiliation(s)
- Hassan Saadaldin
- Department of Medicine, October 6 University, Cairo, Egypt, Mississuago, Ontario, Canada
| | | | | | | | - Alfonso Tafur
- 3271Northshore University Health System, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Joseph A Caprini
- 3271Northshore University Health System, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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15
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Ferreira CR, de Bastos M, Diniz ML, Mancini RA, Raposo YS, Alves SM, Rezende SM. Inter-observer reliability of a risk assessment model for venous thromboembolism in acutely-ill medical hospitalized patients: Results from a prospective cohort study. Phlebology 2021; 36:827-834. [PMID: 34192948 DOI: 10.1177/02683555211021226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. METHODS In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. RESULTS We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for "immobilization", to almost perfect (0.98; 95% CI 0.97-0.99) for "thrombophilia"; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. CONCLUSION Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.
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Affiliation(s)
- Cassia Rl Ferreira
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Hospital Governador Israel Pinheiro, Belo Horizonte, Minas Gerais, Brazil
| | - Marcos de Bastos
- Hospital Governador Israel Pinheiro, Belo Horizonte, Minas Gerais, Brazil.,Faculdade da Saúde e Ecologia Humana (FASEH), Vespasiano, Minas Gerais, Brazil
| | - Mirella L Diniz
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renan A Mancini
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Yan S Raposo
- Faculdade da Saúde e Ecologia Humana (FASEH), Vespasiano, Minas Gerais, Brazil
| | - Samara Mpg Alves
- Hospital Governador Israel Pinheiro, Belo Horizonte, Minas Gerais, Brazil
| | - Suely M Rezende
- University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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16
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Chen X, Deng H, Tong X, Gu B, Liu J, Huang H, Ye L, Pan L, Caprini JA, Wang Y. Clinical Validation of the Chinese Version of Patient Completed Caprini Risk Assessment Form. Clin Appl Thromb Hemost 2021; 26:1076029620945038. [PMID: 32816523 PMCID: PMC7444100 DOI: 10.1177/1076029620945038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To create and validate patient-completed Caprini risk score (CRS) tools for Chinese people. We revised Chinese patient-completed CRS form according to previously published studies. We prospectively recruited 70 internal medical patients and 70 surgical patients. The average age of these patients was 54.26 ± 15.29 years, 54.29% of them were male and 80% of them had education beyond high school. The study compared: (1) patient-completed CRS and physician-completed CRS; (2) the final value of physician-completed CRS (physician-completed CRS + body mass index) and CRS in the electronic medical record (EMR) system. Patient-completed CRS was 3.71 ± 3.63, patients spent 3.60 ± 1.24 minutes, 57.14% patients were at high-highest risk; physician-completed CRS was 3.84 ± 3.63, physicians spent 2.11 ± 1.13 minutes, 59.28% patients were at high-highest risk; the final value of physician-completed CRS was 4.12 ± 3.62, 63.58% patients were at high-highest risk; CRS value in the EMR system was 4.07 ± 3.58, 65% patients were at high-highest risk. There were strong positive correlations (P < .0001) between patient-completed CRS and physician-completed CRS (r = 0.978, κ = 0.76) and between the final value of physician-completed CRS and CRS in EMR (r = 0.994, κ = 0.97). This study successfully developed and validated a Chinese patient-completed CRS that we found can replace physician-completed CRS. This results in considerable time saving for physicians and this process should increase the percentage of patients having complete risk assessment when they are admitted to the hospital.
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Affiliation(s)
- Xiaolan Chen
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hui Deng
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xinjie Tong
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bei Gu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jingxuan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - He Huang
- Department of Hospital Affairs, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liwei Ye
- Department of Hospital Affairs, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Joseph A Caprini
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA.,NorthShore University HealthSystem, Evanston, IL, USA
| | - Yong Wang
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Emergency Medical Center, Beijing, People's Republic of China
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17
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Paz Rios LH, Minga I, Kwak E, Najib A, Aller A, Lees E, Macrinici V, Rezaei Bookani K, Pursnani A, Caprini J, Spyropoulos AC, Tafur A. Prognostic Value of Venous Thromboembolism Risk Assessment Models in Patients with Severe COVID-19. TH OPEN 2021; 5:e211-e219. [PMID: 34179684 PMCID: PMC8219405 DOI: 10.1055/s-0041-1730293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Severe novel corona virus disease 2019 (COVID-19) causes dysregulation of the coagulation system with arterial and venous thromboembolism (VTE). We hypothesize that validated VTE risk scores would have prognostic ability in this population. Methods Retrospective observational cohort with severe COVID-19 performed in NorthShore University Health System. Patients were >18 years of age and met criteria for inpatient or intensive care unit (ICU) care. The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) and Caprini scores were calculated and patients were stratified. Results This study includes 184 patients, mostly men (63.6%), Caucasian (54.3%), 63 years old (interquartile range [IQR]: 24-101), and 57.1% of them required ICU care. Twenty-seven (14.7%) thrombotic events occurred: 12 (6.5%) cases of disseminated intravascular coagulation (DIC), 9 (4.9%) of pulmonary embolism, 5 (2.7%) of deep vein thrombosis, and 1 (0.5%) stroke. Among them, 86 patients (46.7%) died, 95 (51.6%) were discharged, and 3 (1.6%) were still hospitalized. "Moderate risk for VTE" and "High risk for VTE" by IMPROVE score had significant mortality association: (hazard ratio [HR]: 5.68; 95% confidence interval [CI]: 2.93-11.03; p < 0.001) and (HR = 6.22; 95% CI: 3.04-12.71; p < 0.001), respectively, with 87% sensitivity and 63% specificity (area under the curve [AUC] = 0.752, p < 0.001). "High Risk for VTE" by Caprini score had significant mortality association (HR = 17.6; 95% CI: 5.56-55.96; p < 0.001) with 96% sensitivity and 55% specificity (AUC = 0.843, p < 0.001). Both scores were associated with thrombotic events when classified as "High risk for VTE" by IMPROVE (HR = 6.50; 95% CI: 2.72-15.53; p < 0.001) and Caprini scores (HR = 11.507; 95% CI: 2.697-49.104; p = 0.001). Conclusion The IMPROVE and Caprini risk scores were independent predictors of mortality and thrombotic events in severe COVID-19. With larger validation, this can be useful prognostic information.
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Affiliation(s)
- Luis H. Paz Rios
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Iva Minga
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Esther Kwak
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Ayman Najib
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Ashley Aller
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Elizabeth Lees
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Victor Macrinici
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Kaveh Rezaei Bookani
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Amit Pursnani
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
| | - Joseph Caprini
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States
| | - Alex C. Spyropoulos
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, NY, NY, United States
| | - Alfonso Tafur
- Cardiovascular Division, Department of Medicine, NorthShore University Health System, Evanston, Illinois, United States
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18
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Gong C, Yu K, Zhang N, Huang J. Predictive value of thromboelastography for postoperative lower extremity deep venous thrombosis in gastric cancer complicated with portal hypertension patients. Clin Exp Hypertens 2020; 43:196-202. [PMID: 33092424 DOI: 10.1080/10641963.2020.1836194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To explore the predictive value of thromboelastography (TEG) for the occurrence of lower extremity deep venous thrombosis (LDVT) in gastric cancer combined with portal hypertension patients after operation. METHODS 172 gastric cancer patients combined with portal hypertension were randomly divided into laparoscopic surgery or laparotomy groups. All patients were taken venous blood on an empty stomach 1 day before operation, 1 day, 3 days, and 5 days after operation. RESULTS There was no significant difference in R value, K value, α angle, and MA before and after operation (P > .05). Compared with the same group before operation, the R value and K value were decreased at 1, 3, and 5 days after operation, while the α angle and MA were increased (P < .05). Compared with the non-LDVT group, the postoperative R value and K value in the LDVT group were significantly lower, while the α angle and MA were significantly higher (P < .05). The AUC of R value, K value, α angle, and MA levels at 3 days after surgery to identify patients with LDVT was 0.778, 0.718, 0.881, and 0.781, respectively. The estimated probability of the final model for LDVT was 0.622. Compared with the estimated probability ≥0.622 group, the LDVT rate in the estimated probability <0.622 group was significantly increased (χ2 = 60.128, P < .001). CONCLUSIONS The combination of R value, K value, α angle, and MA at 3 days after surgery has a moderately effective predictive effect for the occurrence of LDVT in gastric cancer patients combined with portal hypertension.
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Affiliation(s)
- Chunhong Gong
- Department of Blood Transfusion, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology , Xianning, P.R. China
| | - Kaihu Yu
- Department of Radiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology , Xianning, P.R. China
| | - Nianrong Zhang
- Department of Radiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology , Xianning, P.R. China
| | - Juan Huang
- Department of Pediatrics, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology , Xianning, P.R. China
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19
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Mlaver E, Lynde GC, Gallion C, Sweeney JF, Sharma J. Development of a Novel Preoperative Venous Thromboembolism Risk Assessment Model. Am Surg 2020; 86:1098-1105. [PMID: 32967431 DOI: 10.1177/0003134820943556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Standardization of preoperative venous thromboembolism (VTE) risk assessment remains challenging due to variation in risk assessment models (RAMs) and the cumbersome workflow addition that most RAMs represent. We aimed to develop a parsimonious RAM that is automatable and actionable within the preoperative workflow. METHODS We performed a case-controlled review of all 18 VTE cases reported over a 12-month period and 171 matched controls included in an institutional National Surgical Quality Improvement Project (NSQIP) data set. We examined the predictive value of the Caprini, Padua, and NSQIP RAMs. We identified the 5 most impactful risk factors in VTE development by contribution to the known RAMs. We compared the predictive ability of cancer, age, body mass index, black race, and American Society of Anesthesiologists Physical Status (ASA-PS) score, to the Caprini, Padua, and NSQIP RAMs for VTE outcomes. Finally, we evaluated concordance between each of the models. RESULTS The Caprini Score was found to be 88.9% sensitive and 32.7% specific using a threshold of 5. The Padua score was found to be 61.1% sensitive and 47.4% specific using a threshold of 4. The novel 5-factor RAM was found to be 94.4% sensitive and 38.0% specific using a threshold of 4. The Caprini and Padua models were discordant in 26% of patients. DISCUSSION Cumbersome manual data entry contributes to the ongoing challenge of standardized VTE risk assessment and prophylaxis. Universally documented information and patient demographics can be utilized to create clinical decision support tools that can improve the efficiency of perioperative workflow and improve the quality of care.
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Affiliation(s)
- Eli Mlaver
- 1371 Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Grant C Lynde
- 1371 Department of Anesthesiology, Emory University, Atlanta, GA, USA
| | | | - John F Sweeney
- 1371 Department of Surgery, Emory University, Atlanta, GA, USA
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20
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Plancher KD, Chan JJ, Bishai SK, Silane M, Ibrahim TF, Petterson SC. DVT and Pulmonary Embolism Following Knee Arthroscopy: The Role of Genetic Predisposition and Autoimmune Antibodies: A Report of 3 Cases. JBJS Case Connect 2020; 10:e0514. [PMID: 32649112 DOI: 10.2106/jbjs.cc.19.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deep vein thrombosis (DVT) after arthroscopy has been considered a rare event; however, recent studies using ultrasound and venography have shown that the incidence of DVTs is underestimated. CASES:: This report describes 3 patients with DVT and/or PE after knee arthroscopy who were attributed to a genetic predisposition of hypercoagulability unknown to the patient and surgeon. CONCLUSIONS:: Genetic predisposition and autoimmune antibodies may play a role in the development of DVT after knee arthroscopy. We recommend focused questions regarding family history be added to the standard DVT/PE preoperative questionnaire.
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Affiliation(s)
- Kevin D Plancher
- 1Albert Einstein College of Medicine, Department of Orthopaedic Surgery, Bronx, New York 2Plancher Orthopaedics and Sports Medicine, New York, New York 3Orthopaedic Foundation, Stamford, Connecticut 4Michigan State University College of Osteopathic Medicine, East Lansing, Michigan 5Weill-Cornell Medical School, Department of Orthopaedic Surgery, New York, New York
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21
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Caprini JA. Thrombosis Risk Assessment In The COVID-19 Era. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i3.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The appearance of the coronavirus pandemic has prompted a renewed interest in thrombosis risk assessment, particularly since this disease is associated with a high risk of thrombotic events. It is known that the number one preventable cause of death in hospitalized patients including those having surgical procedures is fatal pulmonary emboli. There is also high-quality data that the use of anticoagulant drugs in the proper dose, and for the period of time shown to be efficacious, will prevent most fatal events. It is true that even with the use of the best anticoagulant regimes venous thromboembolic events (VTE) can still occur but are rarely fatal. We also realize that providing adequate anticoagulant prophylaxis for the entire period of risk is the key to preventing these deaths. Thrombosis risk scoring identifies who's at risk for these emboli and guides physician choices for appropriate preventive measures.
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22
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Tafur A, Fareed J. The Risk of Venous Thromboembolism is Not Equal for all Patients Who Undergo Total Joint Replacement. Clin Appl Thromb Hemost 2019; 25:1076029619838062. [PMID: 30939893 PMCID: PMC6715001 DOI: 10.1177/1076029619838062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Alfonso Tafur
- 1 Department of Vascular Medicine, Northshore University Health System, Evanston, IL, USA
| | - Jawed Fareed
- 2 Health Sciences Division, Cardiovascular Institute, Loyola University Chicago, Maywood, IL, USA
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23
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Direct Comparison of Patient-completed and Physician-completed Caprini Scores for Plastic Surgery Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2363. [PMID: 31592033 PMCID: PMC6756651 DOI: 10.1097/gox.0000000000002363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text. We examined the ability of plastic surgery patients to perform their own venous thromboembolism (VTE) risk stratification using a previously validated patient-completed Caprini risk scoring sheet.
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24
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Krauss ES, Segal A, Cronin M, Dengler N, Lesser ML, Ahn S, Caprini JA. Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis. Clin Appl Thromb Hemost 2019; 25:1076029619838066. [PMID: 30939898 PMCID: PMC6714918 DOI: 10.1177/1076029619838066] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Appropriate chemoprophylaxis choice following arthroplasty requires accurate patient risk
assessment. We compared the results of our prospective department protocol to the Caprini
risk assessment model (RAM) retrospectively in this study group. Our goal was to determine
whether the department protocol or the Caprini score would identify venous thromboembolism
(VTE) events after total joint replacement. A secondary purpose was to validate the 2013
Caprini RAM in joint arthroplasty and determine whether patients with VTE would be
accurately identified using the Caprini score. A total of 1078 patients met inclusion
criteria. A Caprini score of 10 or greater is considered high risk and a score of 9 or
less is considered low risk. The 2013 version of the Caprini RAM retrospectively
stratified 7 of the 8 VTE events correctly, while only 1 VTE was identified with the
prospective department protocol. This tool provided a consistent, accurate, and
efficacious method for risk stratification and selection of chemoprophylaxis.
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Affiliation(s)
- Eugene S Krauss
- 1 Department of Orthopaedic Surgery, Northwell Health, Syosset Hospital, Syosset, NY, USA
| | - Ayal Segal
- 1 Department of Orthopaedic Surgery, Northwell Health, Syosset Hospital, Syosset, NY, USA
| | - MaryAnne Cronin
- 3 Emeritus, NorthShore University Health System, Evanston, IL, USA
| | - Nancy Dengler
- 1 Department of Orthopaedic Surgery, Northwell Health, Syosset Hospital, Syosset, NY, USA
| | - Martin L Lesser
- 2 Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Seungjun Ahn
- 2 Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Joseph A Caprini
- 3 Emeritus, NorthShore University Health System, Evanston, IL, USA.,4 University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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25
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Cronin M, Dengler N, Krauss ES, Segal A, Wei N, Daly M, Mota F, Caprini JA. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost 2019; 25:1076029619838052. [PMID: 30939900 PMCID: PMC6714938 DOI: 10.1177/1076029619838052] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The Caprini risk assessment model (RAM) has been validated in over 250 000 patients in
more than 100 clinical trials worldwide. Ultimately, appropriate treatment options are
dependent on precise completion of the Caprini RAM. As the numerical score increases, the
clinical venous thromboembolism rate rises exponentially in every patient group where it
has been properly tested. The 2013 Caprini RAM was completed by specially trained medical
students via review of the presurgical assessment history, medical clearances, and medical
consults. The Caprini RAM was completed for every participant both preoperatively and
predischarge to ensure that any changes in the patient’s postoperative course were
captured by the tool. This process led to the development of completion guidelines to
ensure consistency and accuracy of scoring. The 2013 Caprini scoring system provides a
consistent, thorough, and efficacious method for risk stratification and selection of
prophylaxis for the prevention of venous thrombosis.
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Affiliation(s)
- MaryAnne Cronin
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Nancy Dengler
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Eugene S Krauss
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Ayal Segal
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Nicole Wei
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Madison Daly
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Frank Mota
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Joseph A Caprini
- 2 Emeritus, NorthShore University HealthSystem, Evanston, IL, USA.,3 University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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26
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Al-Ogaili A, Quintero LD, Adum JPS, Fuentes HE, Caprini J. Venous Thromboembolism Risk Stratification: The Missing Link in Hospitalized Patients. J Atheroscler Thromb 2018; 25:1087-1088. [PMID: 29731505 PMCID: PMC6224207 DOI: 10.5551/jat.ed096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/06/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ahmed Al-Ogaili
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Luis Diaz Quintero
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Juan Pablo Salazar Adum
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Harry E. Fuentes
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Joseph Caprini
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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27
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Diaz Quintero LA, Fuentes HE, Salazar Adum JP, Tafur AJ, Kudrna JC, Caprini JA. Letter to the Editor on "Correlation of the Caprini Score and Venous Thromboembolism Incidence Following Primary Total Joint Arthroplasty-Results of a Single-Institution Protocol". J Arthroplasty 2018; 33:2697-2698. [PMID: 29716770 DOI: 10.1016/j.arth.2018.03.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Luis A Diaz Quintero
- Division of Internal Medicine, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Harry E Fuentes
- Division of Internal Medicine, Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Juan P Salazar Adum
- Division of Internal Medicine, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Alfonso J Tafur
- Division of Vascular Medicine, Department of Medicine, NorthShore University HealthSystem, Skokie, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - James C Kudrna
- Department of Orthopedic Surgery, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Glenview, Illinois
| | - Joseph A Caprini
- NorthShore University HealthSystem-Emeritus, Skokie, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois
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