Thermally Injured Patients Are at Significant Risk for Thromboembolic Complications

Background and Objectives: The CRASH-2 trial is the largest randomised control trial examining tranexamic acid (TXA) for injured patients. Since its publication, debate has arisen around whether results could be applied to mature trauma systems in developed nations, with global opinion divided. The aim of this study was to determine if, among trauma patients in or at significant risk of major haemorrhages, there is an association of geographic region with the proportion of patients that received tranexamic acid. Materials and Methods: We conducted a systematic review of the literature. Potentially eligible papers were first screened via title and abstract screening. A full copy of the remaining papers was then obtained and screened for final inclusion. The Newcastle–Ottawa Scale for non-randomised control trials was used for quality assessment of the final studies included. A meta-analysis was conducted using a random-effects model, reporting variation in use sub-grouped by geographical location. Results: There were 727 papers identified through database searching and 23 manuscripts met the criteria for final inclusion in this review. There was a statistically significant variation in the use of TXA for included patients. Europe and Oceania had higher usage rates of TXA compared to other continents. Use of TXA in Asia and Africa was significantly less than other continents and varied use was observed in North America. Conclusions: A large geographical variance in the use of TXA for trauma patients in or at significant risk of major haemorrhage currently exists. The populations in Asia and Africa, where the results of CRASH-2 could be most readily generalised to, reported low rates of use. The reason why remains unclear and further research is required to standardise the use of TXA for trauma resuscitation.

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Risk stratification of thromboembolic complications development in surgical patients

Innovative medicine of Kuban ◽

10.35401/2500-0268-2020-17-1-46-51 ◽

2020 ◽

pp. 46-51

Author(s):

K. I. Popandopulo ◽

V. A. Porhanov ◽

G. K. Karipidi ◽

I. V. Vagin ◽

S. B. Bazlov ◽

...

Keyword(s):

Specific Gravity ◽

Risk Stratification ◽

Case Reports ◽

Significant Risk ◽

Thromboembolic Complications ◽

Abdominal Organs ◽

Ratio Criterion ◽

Venous Thromboembolic ◽

Sequential Probability ◽

Clinical Records

Aim. Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment.Material and methods. This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data.Results and discussion. Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%.Conclusion. The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs.

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HOW TO TREAT VTEC IN CANCER PATIENTS IN THE ACUTE PERIOD? EXTENDED TREATMENT. THE ROLE OF DIRECT ORAL ANTICOAGULANTS. THE RESULTS OF HOKUSAI VTE CANCER STUDY

Atherothrombosis Journal ◽

10.21518/2307-1109-2018-2-28-35 ◽

2018 ◽

pp. 28-35 ◽

Cited By ~ 1

Author(s):

Yulia A. Fedotkina

Keyword(s):

Cancer Patients ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Significant Risk ◽

Low Molecular Weight ◽

Efficacy And Safety ◽

Thromboembolic Complications ◽

Cancer Study ◽

Venous Thromboembolic

Cancer is one of the most significant risk factors for venous thromboembolic complications (VTEC). The article discusses the features of the treatment of cancer patients with VTEC. The issues of alternative anticoagulant therapy are considered. The article presents the results of HOKUSAI VTE Cancer study, the first completed study to compare the efficacy and safety of a direct oral anticoagulant endoxaban with a low molecular weight heparin dalterapin for the treatment of VTEC in cancer patients.

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Thromboembolic Complications in Patients with Sickle Cell Disease

Blood ◽

10.1182/blood-2018-99-118388 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4913-4913

Author(s):

Salam Alkindi ◽

Anwaar Al-Ghadani ◽

Samah Al-zeheimi ◽

Anil Pathare

Keyword(s):

Risk Factors ◽

Sickle Cell Disease ◽

Venous Thrombosis ◽

Sickle Cell ◽

Significant Risk ◽

Central Venous Catheters ◽

Morbidity And Mortality ◽

Thromboembolic Complications ◽

Cell Disease ◽

Central Venous

Abstract Background and Purpose: Venous thromboembolism (VTE) is common in patients with sickle cell disease (SCD). Traditional risk factors such as central venous catheters, frequent hospitalization, orthopedic surgeries for avascular necrosis, and pregnancy often leads to an increased incidence of VTE in the SCD. In addition, SCD itself appears to be a hypercoagulable state with many SCD-specific factors such as genotype, splenectomy and thrombophilia modifying the risk of VTE. This study aims to assess the clinical and pathological characteristics of VTE amongst a cohort of patients with SCD at the Sultan Qaboos University Hospital and determine its relation to morbidity and mortality. Methodology: In this retrospective case control study, medical details of all patients with SCD who developed thromboembolic complications over the past decade were retrieved from the hospital information system. SCD patients matched for age and gender (2:1 ratio) who did not have thromboembolic complications but had a thrombophilia screen performed served as controls. The study was approved by the local Medical Research and Ethics Committee. Results & Discussion: A total of 53 SCD patients were enrolled [34 cases, 19 controls] in this study. Amongst the 34 cases (mean age-30 yrs.), 18 had pulmonary embolism, eight had deep venous thrombosis, whereas, three each had cerebral venous thrombosis and portal venous thrombosis and one each had cerebral arterial thrombosis and VTE. A higher incidence of autosplenectomy(69.7% v/s 52.6%) and central venous catheters(42.4% v/s 5.3%) were significantly associated with thrombosis (p<0.05, Chi Square test). High LDH levels, WBC and Platelet counts were significant risk factors(p<0.05) for VTE. 21 patients [63.6%] amongst the cases developed acute chest syndrome, where 3[9%] had cerebrovascular accident. Mortality was seen in seven cases [21%]. Conclusions: The study shows that thromboembolic complications in SCD has a high impact on the morbidity and mortality. It confirms PE as the leading cause for VTE in SCD with asplenia, central venous catheter, high LDH, WBC and Platelet counts being significant risk factors. Disclosures No relevant conflicts of interest to declare.

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Thromboembolic complications in thermally injured patients

World Journal of Surgery ◽

10.1007/bf02067085 ◽

1992 ◽

Vol 16 (6) ◽

pp. 1151-1154 ◽

Cited By ~ 39

Author(s):

Loring W. Rue ◽

William G. Cioffi ◽

Robert Rush ◽

William F. McManus ◽

Basil A. Pruitt

Keyword(s):

Thromboembolic Complications ◽

Injured Patients

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Homozygous Cystathionine β-Synthase Deficiency, Combined With Factor V Leiden or Thermolabile Methylenetetrahydrofolate Reductase in the Risk of Venous Thrombosis

Blood ◽

10.1182/blood.v91.6.2015 ◽

1998 ◽

Vol 91 (6) ◽

pp. 2015-2018 ◽

Cited By ~ 41

Author(s):

Leo A.J. Kluijtmans ◽

Godfried H.J. Boers ◽

Bert Verbruggen ◽

Frans J.M. Trijbels ◽

Irena R.O. Nováková ◽

...

Keyword(s):

Venous Thrombosis ◽

Methylenetetrahydrofolate Reductase ◽

Significant Risk ◽

Factor V Leiden ◽

Major Complication ◽

Significant Risk Factor ◽

Mthfr Gene ◽

Factor V ◽

Thromboembolic Complications ◽

Thrombotic Complications

Abstract Severe hyperhomocysteinemia in its most frequent form, is caused by a homozygous enzymatic deficiency of cystathionine β-synthase (CBS). A major complication in CBS deficiency is deep venous thrombosis or pulmonary embolism. A recent report by Mandel et al (N Engl J Med 334:763, 1996) postulated factor V Leiden (FVL) to be an absolute prerequisite for the development of thromboembolism in patients with severe hyperhomocysteinemia. We studied 24 patients with homocystinuria caused by homozygous CBS deficiency from 18 unrelated kindreds for FVL and for the 677C→T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and investigated their possible interaction in the risk of venous thrombosis. Thrombotic complications were diagnosed in six patients, of whom only one was a carrier of FVL. On the contrary, thermolabile MTHFR caused by the 677C→T mutation, was frequently observed among homocystinuria patients, especially among those with thromboembolic complications: three of six homocystinuria patients who had suffered from a thromboembolic event had thermolabile MTHFR. These data indicate that FVL is not an absolute prerequisite and probably not even a major determinant of venous thrombosis in homocystinuria, but, interestingly, thermolabile MTHFR may constitute a significant risk factor for thromboembolic complications in this inborn error of methionine metabolism.

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Homozygous Cystathionine β-Synthase Deficiency, Combined With Factor V Leiden or Thermolabile Methylenetetrahydrofolate Reductase in the Risk of Venous Thrombosis

Blood ◽

10.1182/blood.v91.6.2015.2015_2015_2018 ◽

1998 ◽

Vol 91 (6) ◽

pp. 2015-2018

Author(s):

Leo A.J. Kluijtmans ◽

Godfried H.J. Boers ◽

Bert Verbruggen ◽

Frans J.M. Trijbels ◽

Irena R.O. Nováková ◽

...

Keyword(s):

Venous Thrombosis ◽

Methylenetetrahydrofolate Reductase ◽

Significant Risk ◽

Factor V Leiden ◽

Major Complication ◽

Significant Risk Factor ◽

Mthfr Gene ◽

Factor V ◽

Thromboembolic Complications ◽

Thrombotic Complications

Severe hyperhomocysteinemia in its most frequent form, is caused by a homozygous enzymatic deficiency of cystathionine β-synthase (CBS). A major complication in CBS deficiency is deep venous thrombosis or pulmonary embolism. A recent report by Mandel et al (N Engl J Med 334:763, 1996) postulated factor V Leiden (FVL) to be an absolute prerequisite for the development of thromboembolism in patients with severe hyperhomocysteinemia. We studied 24 patients with homocystinuria caused by homozygous CBS deficiency from 18 unrelated kindreds for FVL and for the 677C→T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and investigated their possible interaction in the risk of venous thrombosis. Thrombotic complications were diagnosed in six patients, of whom only one was a carrier of FVL. On the contrary, thermolabile MTHFR caused by the 677C→T mutation, was frequently observed among homocystinuria patients, especially among those with thromboembolic complications: three of six homocystinuria patients who had suffered from a thromboembolic event had thermolabile MTHFR. These data indicate that FVL is not an absolute prerequisite and probably not even a major determinant of venous thrombosis in homocystinuria, but, interestingly, thermolabile MTHFR may constitute a significant risk factor for thromboembolic complications in this inborn error of methionine metabolism.

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