Screening for thromboembolic risk factors on IBD patients

Aim. To analyze thromboembolic risk factors and identify additional predictors of left atrial appendage (LAA) thrombosis, which are not included in the CHA2DS2VASc scale, in long-term Far North residents with nonvalvular atrial fibrillation (AF).Material and methods. The study included 162 patients (men, 108; women, 54; mean age, 55,3±8,7 years) with non-valvular AF, living in the Far North, and 684 patients (men, 408; women, 276; mean age, 56,9±9,3 years), living in the temperate latitudes, hospitalized for catheter ablation. All patients underwent transthoracic and transesophageal echocardiography. According to transesophageal echocardiography, Far North patients were divided into two groups: group 1 — 21 patients with LAA thrombosis, group 2 — 141 patients without LAA thrombosis.Results. Compared to patients living in the temperate latitudes, Far North patients were younger (p=0,021) and were more likely to have type 2 diabetes (14,2% vs 8,3%, p=0,022), class ³II obesity (29,6% vs 21,1%, p=0,019), persistent AF(47,5% vs 33,2%, p=0,0019), LAA thrombosis (13% vs 6,6%, p=0,006), and severe structural and functional cardiac abnormalities (biatrial and right ventricular enlargement, lower left ventricular ejection fraction). In Far North patients, using logistic regression, independent predictors of LAA thrombosis were identified: an increase in left ventricular mass index (odds ratio (OR), 1,029; 95% confidence interval (CI), 1,011-1,048; p=0,001), persistent AF (OR, 3,521; 95% CI, 1,050-11,800; p=0,041).Conclusion. In Far North patients with nonvalvular AF, scheduled for catheter ablation, compared with patients from temperate latitudes, with a similar profile of cardiovascular diseases at a younger age, type 2 diabetes, grade ³II obesity, persistent AF, and LAA thrombosis were more common. The presence of persistent AF and an increase in left ventricular mass index are independent predictors of LAA thrombosis in Far North patients with nonvalvular AF.

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Venous thromboembolic risk and thromboprophylaxis in acutely ill medical outpatients

Phlebologie ◽

10.1055/s-0037-1622155 ◽

2006 ◽

Vol 35 (06) ◽

pp. 286-288

Author(s):

V. Hach-Wunderle ◽

F. H. Mader ◽

W. D. Paar ◽

S. K. Haas

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Family Physicians ◽

Medical Illness ◽

Thromboembolic Risk ◽

Objective Risk ◽

Subjective Risk ◽

Venous Thromboembolic ◽

Objective Score ◽

Medical Outpatients

Summary215 German family physicians participated in a prospective registry to assess the venous thromboembolic risk in acutely ill medical outpatients. In 1247 patients who were visited at home due to an acute medical illness, the risk factors were documented using a standardised questionnaire. The doctors subjectively rated the patient’s risk on a scale ranging from 1 to 10 and the result was compared with an objective risk-score which had been previously developed for hospitalized patients and has been successfully used in these patients. The results showed a wide agreement of the subjective risk assessment and the objective score. The resulting consequence of an adequate thromboprophylaxis reflects a high awareness of venous thromboembolic risk among the physicians treating acutely ill medical outpatients.

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The Importance of a Standardized Screening Tool to Identify Thromboembolic Risk Factors in Pediatric Lower Extremity Arthroscopy Patients

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-18-00390 ◽

2019 ◽

Vol 27 (9) ◽

pp. 335-343 ◽

Cited By ~ 1

Author(s):

Henry Bone Ellis ◽

Meagan J. Sabatino ◽

Zachary Clarke ◽

Garrett Dennis ◽

Amanda L. Fletcher ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Screening Tool ◽

Thromboembolic Risk ◽

Standardized Screening

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The personalized antithrombotic management of atrial fibrillation with intermediate thromboembolic risk: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa176 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-4

Author(s):

Andreas Hammer ◽

Sebastian Schnaubelt ◽

Alexander Niessner ◽

Patrick Sulzgruber

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Antithrombotic Therapy ◽

Additional Patient ◽

Individual Risk ◽

First Episode ◽

Antithrombotic Treatment ◽

Thromboembolic Risk

Abstract Background So far there has been little evidence on the antithrombotic treatment of patients presenting with atrial fibrillation (AF) and a CHA2DS2-VASc score of 1 in men (2 in women). However, a recently published position paper suggests a personalized approach in weighing individual risk factors and considering additional patient characteristics and biomarkers for the decision for or against antithrombotic treatment in this intermediate-risk AF population. Case summary A 63-year-old male patient with a CHA2DS2-VASc score of 1 due to hypertension presents with a first episode of paroxysmal AF. The European Society of Cardiology (ESC) guidelines on the management of AF do not recommend a general antithrombotic therapy in those patients. Therefore, the decision for or against the initiation of oral anticoagulation (OAC) in the presented case is based on recent treatment recommendations of the ESC, that aim to guide clinicals through the question whether to anticoagulate or not. Discussion Oral anticoagulation in patients presenting with a CHA2DS2-VASc of 1 remains a challenging approach in clinical practice and physicians need to carefully balance the individual benefit of reducing thromboembolic risk with OAC against the potential harm due to an increase in bleeding risk in this patient population. The ESC provided an easily applicable approach for decision-making in patients with AF and a CHA2DS2-VASc score of 1 via consideration of additional risk factors, scoring tools, and established biomarkers. Of note, if an antithrombotic therapy is offered, non-vitamin K antagonist oral anticoagulants should be preferred over vitamin K antagonists based on the beneficial net clinical benefit.

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Abstract 13478: Pulmonary Embolism in Covid-19 Patients:A French Multicentre Cohort Study

Circulation ◽

10.1161/circ.142.suppl_3.13478 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Charles Fauvel ◽

Orianne Weizman ◽

Antonin Trimaille ◽

Delphine Mika ◽

Nathalie Pace ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Therapeutic Dose ◽

Multivariable Analysis ◽

Pulmonary Angiography ◽

Univariable Analysis ◽

Thromboembolic Risk ◽

Reactive Protein ◽

Hospitalised Patients ◽

Venous Thromboembolic

Introduction: While pulmonary embolism(PE) appears to be a major issue in Covid-19, data remain sparse. Hypothesis: We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of Covid-19 patients. Methods: In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit(ICU) were excluded. Results: Among 1,240 patients (58.1% men, mean age 64±17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both p<0.001). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (p>0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); p=0.04 and OR 0.11, 95%CI(0.06-0.18); p<0.001, respectively). In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); p=0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), p<0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), p<0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), p=0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), p=0.002). Conclusions: Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

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