جستجوی مقالات مرتبط با کلیدواژه « venous thromboembolism » در نشریات گروه « پزشکی »

Mortality from cardiovascular causes, including pulmonary embolism (PE), is the second most common cause of mortality in psychiatric patients. Signs and symptoms that are specific to PE include tachycardia and dyspnea. It rarely manifests as acute psychosis and other unspecific signs and symptoms. Many common treatment modalities for psychiatric disorders increase the risk of coagulopathies and conditions, such as catatonia are associated with an increased incidence of venous thromboembolism (VTE). PE is a preventable cause of death for psychiatric patients. Therefore, we present this case to emphasize the importance of VTE complications in psychiatric patients.

A 56-year-old woman was hospitalized a week before admission due to aggression, restlessness, and disturbance. She was hospitalized more than 6 times with the diagnosis of “bipolar spectrum”. Based on available information, a diagnosis of “unspecified and related bipolar disorder” with akathisia (possibly doxepin and selective serotonin reuptake inhibitor [SSRI] induced) was considered. Doxepin, citalopram, and olanzapine were tapered. Also, sodium valproate tablet 200 mg/qid and propranolol tablet 20 mg/bid were added to her drugs. After two weeks, with no progress in relieving symptoms, tachycardia was detected. Therefore, consultation with an internal medicine specialist and more evaluation was requested. With a high level of D-dimer, and low saturation, we considered thromboembolism, the patient was sent to a general hospital, and then the diagnosis of VTE was confirmed.

One of the vital causes of death in psychiatric wards is VTE. It is difficult to diagnose VTE in a psychiatric patient; therefore, it can increase the risk of mortality. Therefore, psychiatrists must perform essential assessments for patients with clinical suspicion. We publish this case to raise awareness of thromboembolic complications in psychiatric patients, especially hospitalized patients.

 Many studies have evaluated thromboembolic events in COVID-19 patients, and most of them have reported a high estimation of the prevalence of such events. The present study sought to evaluate the prevalence of thromboembolic events in patients with COVID-19.

 This study is a systematic review with meta-analysis that investigated thromboembolic events in patients with COVID-19 from the start of the pandemic to August 31, 2021. The 4 main databases for collecting articles were Medline, Scopus, Google Scholar, and Web of Science. Deep vein thrombosis, pulmonary embolism, arterial thrombosis, and the overall rate of thromboembolic events were considered primary outcomes.

 In a total of 63 studies (104 920 patients with COVID-19), the overall thrombosis rate was 21% (95% CI, 18% to 25%), the rate of deep vein thrombosis was 20% (95% Cl, 16% to 25%), the rate of pulmonary embolism was 8% (95% Cl, 6% to 10%), and the rate of arterial thrombosis was 5% (95% Cl, 3% to 7%). The prevalence of all primary outcomes in critically ill patients admitted to the intensive care unit (ICU) was significantly higher (P<0.05). In older patients, the prevalence of overall thrombosis, pulmonary embolism, or deep vein thrombosis was significantly higher (P<0.05).

 This study showed that COVID-19 increases the risk of thromboembolic events, especially in elderly and critically ill patients admitted to the ICU. Therefore, more strategies are needed to prevent thromboembolic events in patients with COVID-19, especially in ICU-admitted and elderly patients.

The highest risk of developing venous thromboembolism (VTE) is seen in patients who have undergone orthopedic surgery. One of the most common methods to reduce the risk of thromboembolism in these patients is anticoagulant prophylaxis. Rivaroxaban is one of the anticoagulants that has a lower cost than other anticoagulants and has a significant effect on people’s quality of life as it is edible. The study aimed to determine the cost-effectiveness of rivaroxaban as compared with enoxaparin for venous thromboembolism prophylaxis in knee replacement   patients in Iran.  

It was a quantitative and economic evaluation study with a cost-effectiveness approach and an applied study because its results could be used directly for policy-making and decision-making in the health system. The study was conducted in 2019 and 2020. This study considered the health system perspective. The study population included all knee replacement patients. The sample included 203 patients referred to Shafa Yahyaeian Hospital and 300 patients referred to Rasoul Hospital in Tehran. The study was conducted in two steps. A systematic review of studies was conducted in the first step. The CHEERS checklist was used to evaluate the quality of the studies in the systematic review. The EQ-5D questionnaire was used in the second step to calculate the QALY, and the cost collection form was used to calculate the direct medical cost. The data were analyzed through a decision tree, and Stata and Tree age pro softwares were the analysis tools. Also, according to the per capita GDP index for Iran in 2018, the incremental cost-effectiveness threshold was considered to be $10,000.  

The results of this study showed that during the prophylaxis period, rivaroxaban was one and a half times less costly than enoxaparin. Quality of life in uncomplicated conditions were 0.85 QALY for rivaroxaban and 0.69 QALY for enoxaparin. Based on the results of this study, the cost of rivaroxaban during the prophylaxis was $ 160.97 and the quality of life was 0.85 QALY and the cost of enoxaparin was $ 276.07 and the quality of life was 0.69 QALY. The cost difference between the two interventions was $ 115.09 and the outcome difference was 0.16 QALY. The incremental cost-effectiveness ratio was $ 189.40 for rivaroxaban and $ 416.28 for enoxaparin. According to the results of this study, rivaroxaban reduced the duration of hospitalization by an average of 2 days in asymptomatic patients (prophylaxis period) compared to enoxaparin. 

Rivaroxaban, an oral medication, reduced costs and increased the quality of life in people undergoing knee replacement surgery compared with an enoxaparin injection vial. This drug was less costly for the patient and health systems and its use was cost-effective as a thromboprophylaxis drug following knee replacement surgery.

COVID-19 disease began to spread all around the world in December 2019 until now; and in the early stage it may be related to high D-dimer level that indicates coagulation pathways and thrombosis activation that can be affected by some underlying diseases including diabetes, stroke, cancer, and pregnancy and it also can be associated with Chronic obstructive pulmonary disease (COPD). The aim of this article was to analyze D-dimer levels in COVID-19 patients, as D-dimer level is one of the measures to detect the severity and outcomes of COVID-19. According to the results of this study, there is a higher level of D-dimer as well as concentrations of fibrinogen in the disease onset and it seems that the poor prognosis is linked to a 3 to 4-fold increase in D-dimer levels. It is also shown that 76% of the patients with ≥1 D-dimer measurement, had elevated D-dimer and were more likely to have critical illness than those with normal D-dimer. There was an increase in the rates of adverse outcomes with higher D-dimer of more than 2000 ng/mL and it is associated with the highest risk of death at 47%, thrombotic event at 37.8%, and critical illness at 66%. It also found that diabetes and COPD had the strongest association with death in COVID-19. So, it is necessary to measure the D-dimer levels and parameters of coagulation from the beginning as well as pay attention to comorbidities that can help control and management of COVID-19 disease.

Interaction between cancer cells and the coagulation system could have reciprocal effects on both groups. Coagulation-fibrinolytic cascade is a process that regulates the homeostasis of the body, and this process can be disrupted by several factors; one of the most important factor is cancer. In contrast, the coagulation-fibrinolytic system can also act as a factor in cancer growth and metastasis. Our aim in this study is to investigate this relationship.

The present study is based on Pubmed database information (2010- 2023) using the words “Cancer”, “Coagulation”, “Platelet “, “Tissue factor” and “ VTE “.

Cancer cells disrupt the coagulation process by activating prooncogenic factors or inhibiting tumor suppressors, thereby inducing changes in platelets and coagulation factors, and increasing proteins involved in coagulation. These aberrations in the coagulation system result in coagulation abnormalities such as venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC). In various cancers, the activity of the coagulation and fibrinolytic systems increases, leading to an increase in coagulation and fibrinolysis factors. These factors are closely related to tumor size, tumor stage, cancer progression and metastasis.

The coagulation-fibrinolytic system is closely related to cancers.Cancer cells can disrupt the coagulation-fibrinolysis process. Also, coagulation-fibrinolytic agents can both lead to cancer progression and can be used as a marker for the prognosis of some cancers.

Studies have shown that patients with inflammatory bowel disease (IBD) have an increased risk for venous thromboembolism (VTE). VTEs causes significant morbidity and mortality.

We carried out a comprehensive search through different online databases including PubMed, Google Scholar, Scopus, and Medline. We focused on some of patients-related factors that may affect the risk of VTE incidence among IBD patients and also reviewed current guidelines on the prophylactic regimen of the IBD patients.

Based on the previous studies, the hypercoagulable nature of the disease results from a complex interaction between the systems participating in the coagulation cascade, including endothelial cells, platelets, and coagulation factors. There are a number of clinical factors that increase the probability of VTE development which include disease activity, age, pregnancy, surgery, and medical treatment.

Taken together, these data suggest to initiate prophylactic regimen in IBD patients and to adjust it regarding to the patient’s condition and the presence of other predisposing factors.

To study the incidence, risk factors for developing asymptomatic venous thromboembolism and the compliance of patients on anticoagulants for asymptomatic venous thromboembolism (VTE) in nononcological urological medium-high risk inpatients, and build a risk assessment model (RAM) for early screening for asymptomatic VTE.

We conducted a retrospective analysis of 573 inpatients admitted to a nononcological urological ward of a tertiary hospital in China from January 1, 2017, to June 30, 2019. Data were collected using the electronic medical record system, and patients underwent a follow-up by phone 6 months after discharge.

Among the 573 medium-high risk inpatients, 73 (15.4%) were diagnosed with VTE, including 20 (4.2%) symptomatic and 53 (11.2%) asymptomatic. Prior history of VTE, a history of anticoagulants or antiplatelet agents before admission, and D-dimer ≥ 1 were the potential risk factors identified for asymptomatic VTE. Patients with poor awareness of VTE and its dangers, and patients who lived more than 1 hour away from the hospital had a high probability of poor compliance with anticoagulation therapy after discharge. Using D-dimer (1.785 μg/ml), we built a RAM for the early diagnosis of asymptomatic VTE.

We found that patients with urinary nontumor VTE had low compliance with anticoagulation therapy after discharge. The key factors for determining asymptomatic VTE in nononcological urological inpatients included prior history of VTE, a history of taking anticoagulants or anti-platelet agents before admission, and D-dimer ≥ 1. Furthermore, we found that the threshold of D-dimer should be elevated to 1.785 μg/ml to predict asymptomatic VTE.

Venousthrombosis has a great impact on patients' quality of life after relapse. The present study summarizes the prediction model of recurrent venous thrombosis published in recent years regarding the applicable population, evaluation index, and predictive performance. It aims to provide a reference for the construction of a more reasonable predictive model and application of venous thrombosis recurrence. A query was conducted on EBSCO, Ovid, PubMed, Wanfang, and CNKI databases using the keywords "Venous Thromboembolism", "Recurrence", and "PredictionModels" to assess the prediction model of recurrent venous thrombosis. A total of five major models related to the recurrence of venous thrombosis were included. The models differed in reliability, validity, scoringmethod, evaluation method, and scope of application.

Stroke-related atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary thromboembolism (PE) are among the most common thromboembolic events. recently, direct oral anticoagulants (DOACs) have been slowly replacing warfarin. Rivaroxaban is a DOAC frequently prescribes to control thrombotic events. The safety and efficacy of Rivaroxaban are dependent on appropriate prescription, dosage, and other factors. This study is aimed to evaluate the Rivaroxaban utilization based on the standard protocol in both inpatient and outpatient settings. This cross-sectional/observational study was conducted for six months from 1st August 2018 to 1st February 2019 at a private hospital and also an outpatient clinic in Shiraz, Iran. First, a clinical pharmacist defined a standard protocol for Rivaroxaban utilization and several indexes (9 indexes for Non-valvular AF (NVAF) patients and 10 indexes for DVT/PE patients). Second, participants were classified into three groups (NVAF inpatients, NVAF outpatients, and DVT/PE patients). Finally, the adherence of Rivaroxaban utilization indexes in each group to was evaluated accordingly. Two hundred and forty one eligible patients were recruited into this study. Most patients (N=208), were NVAF. Rivaroxaban utilization was appropriate in 71.9%, 65.8%, and 50.6% of patients within groups 1, 2, and 3, respectively. Although medication interaction, administration regarding time/meal, and dose adjustment based on renal function showed the lowest compliance, the monitoring laboratory data and considering the underlying disorders were completely matched with the protocol. This study showed some critical errors in both settings, especially in DVT/PE patients (49.4% no match). Hence, the most productive collaboration must be developed between clinical pharmacists and clinical practitioners.

Incidental pulmonary embolisms (iPE) are common in cancer patients. Studies addressing iPE in oncology are increasing; however, few of these investigations have been conducted in a Latin-American population. This study aims to describe the incidence and characteristics of iPE in cancer patients in a comprehensive cancer center from Panama.

A single-center, retrospective study was conducted at the National Institute of Oncology during a period of 7 months. Every contrast-enhanced CT scan was reviewed. Electronic records and CT reports were reviewed for demographic, clinical, and radiological information.

We reported 46 iPEs in 4065 scans (incidence=1.13%). The mean±SD age was 6413± years. Most patients were female (63.0%) and were outpatients (73.9%) when the CT scan was performed. Central iPEs were found in thirty-one patients (67.4%). Thirty patients were receiving chemotherapy (54.3%) or hormone therapy (10.9%); two-thirds had metastatic disease. The most frequently reported tumors were gastrointestinal, breast, and gynecologic cancers. More than 70% were reported as asymptomatic, and 78% were initially managed with anticoagulation.

Our study reported a low incidence of iPE in oncologic patients (1.13%) which is consistent with what has been observed in previous studies (0.34%-7.3%). The true incidence is still uncertain, and it might be underestimated; especially the rate of subsegmental embolism.

Recently, a few studies based on anti-factor Xa activity levels have propounded doubtful and sub-prophylactic levels by the usual dose of enoxaparin in surgical and critically ill patients. In this study, we assessed two doses of enoxaparin in adult non-critically ill patients.

Patients were randomly assigned into two groups of intervention and control. While the intervention group received enoxaparin with a daily dose of 60 mg, the control group received enoxaparin 40 mg. Anti-factor Xa activity was measured based on the peak steady-state levels. The level of 0.2 to 0.4 IU/mL was considered as a prophylactic goal. All individuals were followed for bleeding or thromboembolic events during admission.

The mean levels of anti-factor Xa were 0.29 ± 0.13 IU/mL in the control group (n = 31) and 0.44 ± 0.19 IU/mL in the intervention group (n = 29). More patients in the control group had an optimal level of anti-factor Xa compared to the patients in the intervention group (62.1% vs. 29%). No adverse outcomes were detected in any of the groups.

Enoxaparin dose of 60 mg daily provided anti-factor Xa level higher than desired in most patients. In non-critically ill patients, the dose of 40 mg is the proper dose for thromboprophylaxis.

This is a novel observation report on patients undergoing spine surgery with a history of bariatric procedures. Acknowledgment of aggregated complications in such patients can prevent catastrophic outcomes.

We report three patients with spinal disorders and a history of bariatric surgery who developed pulmonary embolism following spine surgery. None of the patients had a history of venous thromboembolism or deep vein thrombosis (DVT) before this event. All patients were given thromboprophylaxis after both bariatric and spine surgery, including intra-and post-operative mechanical and pharmacological thromboprophylaxis upon discharge.

Patients undergoing spine surgery with a history of bariatric procedures are at increased risk of developing venous thromboembolic complications, including pulmonary embolism. We recommend extensive venous thromboembolic evaluation and treating these patients as high-risk individuals even in the absence of active thromboembolic disease.

Acute pulmonary thromboembolism (PTE) is the most common manifestation of venous thromboembolism (VTE). Due to the physiological response of circulating leukocytes to stress, circulation neutrophils increase and lymphocytes decrease. Therefore, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) can be important measures to assess the severity of systemic inflammation. We sought to study NLR and PLR and their relationships with the severity of VTE and mortality.

The study enrolled 331 patients with VTE from 2014 through 2018. Based on the complete blood count obtained from the peripheral blood samples of the patients on admission, NLR and PLR were calculated. The incidence of VTE with or without PTE, as well as its severity, was determined based on computed tomography angiography findings and the patients’ clinical status.

A positive relationship was observed between PTE and NLR (P=0.01). There was a significant relationship between the NLR and PLR values and PTE based on computed tomography angiography findings (NLR: P=0.001, PLR: P=0.012), but no relationship was detected between the ratios and the patients’ PTE severity based on clinical status. A significant relationship was also observed between NLR and the main pulmonary artery and segmental involvement (P=0.009), while no such association was seen with PLR. Additionally, the results revealed a significant relationship between NLR and mortality (P=0.030).

Our results demonstrated a significant relationship between the NLR and PLR values and PTE severity based on computed tomography angiography results and also mortality in patients with PTE. (Iranian Heart Journal 2022; 23(1): 65-73)

Pulmonary thromboembolism following spine surgery, although rare, could end into devastating outcome. Gold standard for it diagnosis is pulmonary CT angiography but in operating theatre, clinical suspicion is the key to diagnose. Here we report a case of pulmonary embolism with classic clinical findings which approved using pulmonary CT angiography and echocardiography.

Venous thromboembolic disease (VTD) is a very common and severe pathological condition in which there aremany predisposing factors. Olanzapine is a drug frequently used in psychiatric practises; it is thought to increasethe risk of VTD. Here, we report two cases, a young man and a woman, with a medical history of schizophreniatreated by olanzapine who developed pulmonary embolism and we did not find any aetiologies of VTD in them.Due to the link between olanzapine and pulmonary embolism, which has been previously described, olanzapineis considered responsible for this problem. Two mechanisms have been reported in the literature in this regard;significant weight gain and lethargy, which are very common side effects of olanzapine. So far, no direct effectof olanzapine on platelet aggregation or coagulation has been found. In patients developing VTD while beingtreated with olanzapine, discontinuation of olanzapine as a treatment option must be done with an adjustmentof antipsychotic treatment and regular monitoring of psychic symptoms. Since the diagnosis of pulmonaryembolism is not easy to make in a schizophrenic patient, clinicians should take that in consideration whenprescribing these drugs and when facing clinical situations where VTD is suspected.