scholarly journals Increased D-Dimer Levels and Residual Venous Thrombosis Are Associated with Late Recurrence of Deep Venous Thrombosis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3554-3554
Author(s):  
Bruna Moraes Mazetto ◽  
Fernanda Andrade Orsi ◽  
Mariane Flores-Nascimento ◽  
Sandra Silveira ◽  
Luis Fernando Bittar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Recurrence Risk ◽  
Late Recurrence ◽  
Long Time ◽  
Risk Patients ◽  
D Dimer

Abstract Background: Many patients present new thrombotic events even long-time after the first thrombotic episode and risk factors for recurrence in these cases are not fully elucidated. Aim: To evaluate the risk of late recurrence of thrombosis after a first DVT episode. Methods: This is a prospective observational study. We evaluated the association of D-dimer (DD) levels and persistent residual venous thrombosis (RVT), by Doppler ultrasound, with the occurrence of new thrombotic events long-time after the acute DVT episode. Results: Fifty-six patients were enrolled for the study. For all patients, DVT episode occurred more than 12 months apart from the enrollment day. Median follow-up was 28 months. During the follow-up time, 10 patients presented thrombosis recurrence. Patients who suffered DVT recurrence had higher DD levels than those who did not had recurrence (median= 0.99 vs 0.40, respectively). The best cut-off value to discriminate those at risk for recurrence was DD > 0.63mg/L (area= 0.7380 95%CI= 0.5800 to 0.8961, P=0.01). Recurrence occurred in 27.7% of patients with previous DD>0.63mg/L and in 5.9% of patients with previous DD< 0.63mg/L (relative risk = 6.46; 95%CI 1.36- 30.52, P=0.007). New thrombosis events occurred only in patients with previously documented RVT, mainly in patients with hypoechoic RVT. During follow-up, new thrombotic events were diagnosed in 75% of patients with hypoechoic RVT. The relative risk for recurrence according to the presence of RVT was 9.129 (95% CI= 2.60-32.02, P<0.001). The presence of RVT also modified the effect of DD on the recurrence risk. Patients with DD > 0,63mg/L but without RVT had similar risk of recurrence than those with DD< 0.63mg/L, whereas the risk for recurrence increased in 14-15 times in patients with RVT. Conclusion: These results suggests that the persistence of residual thrombosis combined with high levels of DD, long-time after the acute DVT, are risk factors associated with late thrombosis recurrence. Disclosures No relevant conflicts of interest to declare.

Risk of Thromboembolic Events in ET and Early/Prefibrotic PMF: The Relevance of an Accurate Histological Diagnosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1735-1735
Author(s):  
Serena Rupoli ◽  
Gaia Goteri ◽  
Picardi Picardi ◽  
Lucia Canafoglia ◽  
Giorgia Micucci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conflicts Of Interest ◽  
Myeloproliferative Neoplasm ◽  
Primary Myelofibrosis ◽  
Vascular Events ◽  
Bone Marrow Trephine Biopsy ◽  
Increased Risk ◽  
Risk Patients ◽  
Early Primary

Abstract Abstract 1735 Background: Essential Thrombocytemia (ET) is a myeloproliferative neoplasm characterized by increased risk of vascular events. Established thrombosis risk factors are age and previous vascular events. The clinical and prognostic relevance of WHO histologic criteria for ET and prefibrotic/early Primary Myelofibrosis (PMF) has been well recognized. Our aim was to evaluate the correlation between histologic interpretation and vascular events in our series of thrombocytemias. Material and methods: From our files, we retrieved all patients consecutively diagnosed as having ET with complete clinical data (N = 283) who had undergone to a bone marrow trephine biopsy before any treatment at or within 1 year of diagnosis (N= 133). The histologic slides were reviewed in order to separate true ET cases from early/prefibrotic PMF; vaso-occlusive events at diagnosis and in the follow-up were than compared in the two groups. Results: Histologic review reclassified 61 cases as ET and 72 cases as prefibrotic/early PMF. Prefibrotic/early PMF showed a significant higher prevalence of thrombosis history and thrombotic events at diagnosis, and an increased leukocyte count than ET (22% vs 8%, 15.2% vs 1.6%, 8389/mmc vs 7500/mmc, respectively); furthermore, venous thromboses (mainly atypical) were relatively common in PMF, as opposed to WHO-defined ET. During follow-up, patients with prefibrotic PMF, although younger, showed a significant higher risk of developing thrombosis: the 15-year risk of thrombosis was 48% in prefibrotic PMF (grade 0), 16% in early PMF (grade 1, 2) and 17% in ET. Multivariate analysis confirmed that age and histopathology are independent risk factors for thrombosis during follow-up. Patients older than 60 or with prefibrotic PMF are high risk patients whereas those younger and with non prefibrotic PMF or ET should be considered at low risk (20-year risk of thrombosis 47% vs 4%, p=0.005). Conclusion: The results of present study indicate prefibrotic PMF as a myloproliferative neoplasm with the highest tendency to develop vascular events compared to early PMF and ET. Therefore we suggest to include histopathology interpretation in the risk stratification of so-called ET patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals D-Dimer Levels and Risk of Recurrence Following Provoked Venous Thromboembolism: Findings from the Riete Registry

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3810-3810
Author(s):  
Martin Ellis ◽  
Martin Mar ◽  
Monreal Manuel ◽  
Orly Hamburger-Avnery ◽  
Alessandra Bura-Riviere ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Conflicts Of Interest ◽  
Hazard Ratio ◽  
Increased Risk ◽  
Risk Patients ◽  
Recurrent Vte ◽  
D Dimer

Abstract Background. Patients with venous thromboembolism (VTE) secondary to transient risk factors or cancer may develop VTE recurrences after discontinuing anticoagulant therapy. Identifying at-risk patients could help to guide the ideal duration of anticoagulant therapy in these patients. Methods. We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. The proportion of patients with raised d-dimer levels was determined and the hazard ratio (HR) for VTE recurrences compared to those with normal levels was calculated. Univariate and multivariate analyses of factors associated with VTE recurrence were performed. Results. 3 606 patients were identified in the database in April 2018: 2 590 had VTE after a transient risk factor and 1016 had a cancer. D-dimer levels were measured after discontinuing anticoagulation in 1 732 (67%) patients with transient risk factors and 732 (72%) patients with cancer-associated VTE and these patients formed the cohort in which recurrent VTE rate was calculated. D-dimers and were elevated in 551 (31.8%) of patients with a transient risk factor and were normal in 1181 (68.2%). In the cancer-associated group, d-dimers were elevated in 398 (54.3%) and normal in 334 (45.7%) patients. The adjusted hazard ratio for recurrent VTE was: 2.32 (95%CI: 1.55-3.49) in patients with transient risk factors and 2.23 (95%CI: 1.50-3.39) in those with cancer. Conclusions. Patients with raised d-dimer levels after discontinuing anticoagulant therapy for provoked or cancer-associated VTE are at increased risk for recurrent VTE and death. Future studies could target these patients for extended anticoagulation. Disclosures No relevant conflicts of interest to declare.

scholarly journals Lower Echogenicity of the Residual Venous Thrombosis at Ultrasound Examination Is Associated to Recurrent Thrombosis Events

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4251-4251
Author(s):  
Bruna M Mazetto ◽  
Fernanda Loureiro de Andrade Orsi ◽  
Sandra A.F Silveira ◽  
Kiara Cristina Senger Zapponi ◽  
Marina P Colella ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Recurrence Risk ◽  
Computer Assisted ◽  
Tnf Α ◽  
Residual Thrombus ◽  
The Individual ◽  
Risk For Thrombosis ◽  
Risk Factor For Recurrence ◽  
D Dimer

Abstract Introduction: After the first thrombotic event, up to 30% of deep venous thrombosis (DVT) cases may recur within 10 years. Unprovoked first DVT episode, male gender and persistently elevated D-dimer are important risk factors for DVT recurrence. However, additional elements may still contribute to evaluate the individual recurrence risk. The role of residual venous thrombosis (RVT) as a risk factor for recurrence is controversial. The lack of a standardized methodology for RVT evaluation by conventional ultrasonography (US) may explain, in part, why the results are divergent among different studies. Several clinical studies in arterial thrombosis have evaluated the echogenicity of atherosclerotic plaques by grayscale median (GSM) computer-assisted ultrasound (US) analysis, and carotid plaques showing lower US-generated GSM values (<25) were identified as high risk lesions since they more prone to embolization. In this context, we hypothesized that the assessment of RVT echogenicities, by US-generated GSM, could be a new tool for the evaluation of the individual recurrence risk for DVT and possibly guide further antithrombotic treatments. Aim: In patients with history of previous DVT, we evaluated whether the US-generated GSM values for RVT may predict the recurrence of thrombotic events. Material and Methods: This is a prospective study that included 52 patients with at least one episode of unprovoked DVT, or DVT provoked by hormones, attended at the Hematology Center in the University of Campinas, Brazil. Only patients with DVT in the lower limbs and diagnosed in the previous 5 years were selected. Patients with antiphospholipids antibodies and neoplasia were excluded. At the time of enrollment for the study, patients were submitted to a duplex examination and blood samples collection. Medical evaluation was performed twice a year and a new US image was achieved when DVT recurrence was suspected or by the end of the follow-up. The primary endpoint of the study was thrombosis recurrence, and was made 2 years after enrollment for the study. Laboratory analysis: IL-8, IL-6 and TNF-α levels were performed by ELISA, D-dimer by turbidimetry and CRP by nephelometry. US-generated GSM : The region containing only the residual thrombus was depicted point by point to trace a surrounding line. GSM was then calculated by specific software. Results: From 52 consecutive patients with previous DVT, 30 patients presented RVT. During the two years of follow-up, 10 patients had a new venous thrombosis event; in all cases of thrombosis recurrence, patients had a previous diagnosis of RVT. Among patients with RVT, those with lower GSM values presented more recurrent events; the GSM < 24 was the optimal cut-off value to determine the risk of thrombosis recurrence (specificity of 95%; 95% CI = 75.13 to 99.87%). The relative risk for recurrence was 2.8 (95%CI= 1.2 to 6.5; P=0.09) greater in patients with GSM <24, comparing to patients with GSM >24. The risk for recurrence was five times greater in patients with GSM < 24 (RR=5.1, 95% CI = 2.115 -12.50; P = 0.0194) if compared to patients with GSM>24 grouped with patients without RVT. We further dichotomized all patients according to the presence of RVT and GSM values; the first group was composed by individuals with thrombus GSM<24, and the second one by either patients with thrombus GSM > 24 and patients without RVT. Serum levels of TNF-α and IL-8 were significantly higher in patients with GSM <24 (6.8 vs. 2.2 pg/mL, P=0.03 and 59.1 vs. 19.0 pg/mL, P=0.001; respectively). Levels of PCR (0.37mg/dL), IL-6 (3.13pg/mL) and D-dimer (0.66mg/L) were increased in patients with GSM<24 compared to the other group (0.19 pg/mL, 1.19 pg/m and 0.46 mg/L; respectively), the differences were not statistically significant. Conclusion: Our findings suggest that RVT may be a risk factor for recurrence, particularly the recurrence risk seems to be higher among patients with very hypoechoic residual thrombus (GSM<24). Patients with thrombus GSM < 24 also presented higher levels of inflammatory markers, which may also be consistent with higher risk for thrombosis recurrence. GSM values are objectively achieved by computer-assisted US equipments and can be performed in patients taking anticoagulants. Therefore US-generated GSM value of the residual thrombus rises as a promising marker for assessment of individual risk for thrombosis recurrence. Disclosures No relevant conflicts of interest to declare.

Coagulation Factors, Postmenopausal Hormone Replacement Therapy and the Risk of Venous Thrombosis: The WHI Clinical Trials of Postmenopausal Hormone Therapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 127-127 ◽  
Author(s):  
Mary Cushman ◽  
Joseph Larson ◽  
Frits R. Rosendaal ◽  
Lawrence S. Phillips ◽  
Barbara V. Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Venous Thrombosis ◽  
Protein C ◽  
Coagulation Factor ◽  
Protein S ◽  
Postmenopausal Hormone ◽  
Free Protein ◽  
Coagulation Marker ◽  
D Dimer

Abstract Background. Postmenopausal estrogen (E) therapy, especially in combination with progestin (P) doubles the relative risk of venous thrombosis (VTE). Risk with hormones is higher with increasing age, obesity and with factor V Leiden. We studied coagulation markers as susceptibility factors for postmenopausal hormone-related VTE. Methods. The Women’s Health Initiative program included two placebo-controlled double-blind randomized trials of two E regimens, E (conjugated equine estrogens) or E+P (E + medroxyprogesterone acetate), in 16,608 postmenopausal women aged 50–79. We performed a nested case control study that measured baseline levels of coagulation markers in 215 women who developed VTE during follow up and 867 age-matched controls. The joint effects of treatment assignment to either E regimen vs placebo and prespecified abnormal levels of each coagulation factor on relative risk of VTE were estimated by logistic regression adjusting for age, race, body-mass index and type of E regimen. Results. Low levels of protein C and free protein S (<5th percentile), high D-dimer (top quartile), and high plasmin antiplasmin complex (PAP) and prothrombin fragment 1–2 (top decile) were all associated with risk of VTE with adjusted odds ratios (95% CI) of 2.0 (1.0–4.1), 2.9 (1.5–5.6), 2.8 (2.0–4.0), 2.5 (1.6–4.0) and 1.9 (1.2–3.1), respectively. Elevated factors II, VIII, IX and fibrinogen were not VTE risk factors. Compared to women with normal coagulation marker levels assigned to placebo, the joint odds of VTE with either E regimen plus an abnormal coagulation marker were more than additive compared to the separate effects of hormones and coagulation abnormalities for low protein C, low free protein S, and elevated D-dimer, PAP and F1–2. The odds ratios of VTE with the combination of an abnormal coagulation factor and assignment to hormones were (in order listed in prior sentence), 4.5 (95% CI 2.0–10.2), 6.7 (3.0–14.5), 6.1 (3.7–10), 5.8 (3.2–10.5) and 4.4 (2.4–7.7). Conclusions. We report new findings of elevated F1-2 and PAP as VTE risk factors in women in this prospective study nested in trials of E or E+P versus placebo. Protein C or S values below the 5th percentile were also clinically relevant even though they do not represent inherited deficiency. Lower protein C and free protein S, and higher D-dimer, F1-2 and PAP all identified women at increased risk of VTE with hormones. If our findings are confirmed in management studies, measurement of these factors might assist women with decision-making on safety of E or E+P.

Anatomical Distribution of First VTE Event and Risk of VTE Recurrence: Long Term Follow-up and Retrospective Analysis of 346 Patients. Experience From a Single Center

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1224-1224
Author(s):  
Emmanouil Papadakis ◽  
Dionysia Theocharidou ◽  
Anastasia Mpanti ◽  
Anastasia Spyrou ◽  
Konstantinos Loukidis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Statistical Analysis ◽  
High Risk ◽  
Conflicts Of Interest ◽  
Statistical Significance ◽  
Recurrence Risk ◽  
Published Data ◽  
Anatomical Distribution ◽  
Independent Risk Factors

Abstract Abstract 1224 Venous thromboembolism (VTE) is a chronic disease with recurrence risk that persists over the years. Predicting the chance of recurrence on an individual basis is of paramount importance for the appropriate tailoring of anticoagulant therapy. Recurrence risk is affected by thrombophilia and is lower in patients with provoked VTE than in patients with unprovoked thrombosis. Up to date there are no studies focused on the recurrence risk according to the anatomical distribution of the 1st VTE event. In order to evaluate the risk factors of VTE recurrence, after a review of relevant literature we set specific laboratory and clinical variables, which could be associated with VTE recurrence. Moreover, we evaluated retrospectively 346 patients of the Haemostasis Unit, who had already had an episode of VTE concerning the risk of VTE recurrence. Data statistical analysis was done with SPSS package 15.0. At first a monovariable statistical model was used with significance levels set at p= 0.05. For the multivariable statistical analysis model we used all variables with p< 0.1 from the previous model and those mentioned at recent medical literature as significantly related with VTE recurrence. The 346 patients enrolled had already suffered a first episode of VTE and are being followed up regarding VTE recurrence. The study population, 169 (48.7%) male and 178 (51.3%) female, had a mean age at first VTE of 41.54 years. The exclusion criteria of our study were: high risk patients for VTE recurrence who received indefinite anticoagulation (n=72), patients who have suffered VTE and had a follow up period after discontinuation of anticoagulation shorter than 2 years (n=73) and patients who were lost at follow up (n=15). Among 194 patients who were enrolled 108 (55.7%) were women and 86 (44.3%) men, with a mean age at 1st VTE of 40.10 years. 114 patients had only one VTE episode, 59 suffered two, 16 patients had tree episodes and 5 patients had >= 4 episodes. Based on previously published data we tried to define whether the following variables are high risk factors for VTE recurrence in our population: gender, age of diagnosis, thrombophilic factors (FVLeiden, FII, HCY, VIII, AT, PrC, PrS, PAI1, Lp(a), XII), the presence of unprovoked VTE episode and VTE location (DVT, PE, CNS Thrombosis). Male gender p=0,038, FVLeiden homozygous p=0.036, the presence of unprovoked VTE p=0.029, and VTE location p= 0.05 reached statistical significance on a monovariable analysis. Based on the previous analysis and on previously published data we applied gender, age at the time of diagnosis, presence of unprovoked VTE episode and VTE location on a multiple regression analysis in order to define independent risk factors concerning VTE recurrence (Table 1).Table 1Independent Risk factors concerning VTE recurrenceRisk FactorORCI 95%FVLeiden9.7931.07–89.62Unprovoked VTE9.7571.404–5.414Pulmonary embolism11.5321.419–93.746Deep Venus Thrombosis (DVT)17.7932.232–141.841 Concerning VTE location, CNS thrombosis has the lowest risk for VTE recurrence and Pulmonary embolism and DVT are independent risk factors compared to the first one. Among VTE events CNS thrombosis and DVT/PE share similarities regarding the transient risk factors and the presence of predisposing thrombophilias. As far as the recurrence risk after a first VTE our study demonstrates ( in agreement with current literature) that CNS thrombosis carries recurrence risk statistically lesser than PE and the highest recurrence risk carry the patients after a first DVT event. Our study is the first observational study regarding recurrence risk after VTE coming from Greece. Disclosures: No relevant conflicts of interest to declare.

JAK2 (V617F) Mutation and Cerebral Venous Thrombosis,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3339-3339
Author(s):  
Ida Martinelli ◽  
Serena Maria Passamonti ◽  
Eugenia Biguzzi ◽  
Franca Franchi ◽  
Francesca Gianniello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Whole Blood ◽  
Cerebral Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Myeloproliferative Neoplasm ◽  
Jak2 V617f ◽  
Jak2 V617f Mutation ◽  
V617f Mutation

Abstract Abstract 3339 Background. Whether or not cerebral venous thrombosis, such as splanchnic venous thrombosis, can be the first manifestation of an underlying myeloproliferative neoplasm is currently unclear. Methods. Patients with cerebral venous thrombosis were tested for the JAK2 (V617F) mutation within one year from the onset of thrombosis and were followed until the development of a myeloproliferative neoplasm or censored at the end of follow-up. Results. Ten of 152 patients (6.6%) carried the JAK2 (V617F) mutation. Three of them had known acquired risk factors for thrombosis and 5 had thrombophilia. The median duration of follow-up was 7.8 years (6 months to 21.3 years). Six patients met the diagnostic criteria for myeloproliferative neoplasm at the time of cerebral venous thrombosis, while three additional patients developed the disease during the follow-up, for an annual incidence of 0.26% patient-years (95% CI 0.05–0.64). The last patient has no evidence of disease after three years of follow-up. Patients without the JAK2 (V617F) mutation at the time of cerebral venous thrombosis were re-tested at the end of the follow-up and remained negative, with normal whole blood counts [log-rank test c2: 159 (p<0.0001)]. Hence, a myeloproliferative neoplasm was diagnosed in 90% of patients with the JAK2 (V617F) mutation and in none of those without (Fisher's exact test p<0.0001). Conclusions. Cerebral venous thrombosis can be the first symptom of a myeloproliferative neoplasm. Thus, patients with cerebral venous thrombosis should be tested for the JAK2 (V617F) mutation, irrespective of whole blood counts and the presence of other risk factors for thrombosis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Runzhen Chen ◽  
Chen Liu ◽  
Peng Zhou ◽  
Yu Tan ◽  
Zhaoxue Sheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Prognostic Value ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Risk Of Death ◽  
Clinical Risk ◽  
Percutaneous Coronary ◽  
D Dimer

Abstract Background Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. Results During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). Conclusions For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.

scholarly journals Risk Factors for Non-union in First MTPJ Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035 ◽  
Author(s):  
Andrew Molloy ◽  
Clifford Butcher ◽  
Lyndon Mason
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Univariate Analysis ◽  
Dorsal Plate ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Severe Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw. Methods: Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate Results: 71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate Conclusion: Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved

scholarly journals Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

2019 ◽  
Vol 30 (3) ◽  
pp. 402-407
Author(s):  
Daphne M Stol ◽  
Monika Hollander ◽  
Ilse F Badenbroek ◽  
Mark M J Nielen ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Newly Diagnosed ◽  
Additional Risk ◽  
High Risk Patients ◽  
Detection Program ◽  
Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

Recurrence risk factors in detachable balloon embolization of traumatic direct carotid cavernous fistulas in 188 patients

2017 ◽  
Vol 10 (7) ◽  
pp. 704-707 ◽  
Author(s):  
Bu-Lang Gao ◽  
Zi-Liang Wang ◽  
Tian-Xiao Li ◽  
Bin Xu
Keyword(s):  
Risk Factors ◽  
Recurrence Risk ◽  
Parent Artery ◽  
Nerve Paralysis ◽  
Factors Affecting ◽  
Risk Factors For Recurrence ◽  
Carotid Cavernous Fistulas ◽  
Abducent Nerve ◽  
Balloon Embolization

PurposeTo investigate the effects of detachable balloons in embolizing traumatic carotid cavernous fistulas (TCCFs) and the risk factors for recurrence after balloon embolization.Materials and methods188 patients with TCCFs were enrolled, and clinical, treatment, and follow-up data were analyzed for possible risk factors for recurrence after embolization.ResultsAmong 188 patients, 182 (96.8%) had successful balloon embolization; 6 patients failed. One balloon was used in 94 cases and multiple (two or more) balloons were used in 62 patients. 26 patients had occlusion of the parent artery whereas the remainder had parent artery preservation. Periprocedural complications occurred in 3 patients (1.6%) including cerebral embolism in 1 and abducent nerve paralysis in the other 2. Immediately following embolization, headache appeared in 92 patients and was relieved after 3–5 days with medications. A total of 165 patients (87.8%) had follow-up (6 months to 16 years, mean 5 years). 23 (13.9%) patients with internal carotid artery preservation had recurrence 1–33 days (mean 11 days) after the first embolization and were retreated to complete occlusion. Factors affecting recurrence were multiple balloons and residual fistula (p<0.05). Logistic regression confirmed the independent factors affecting recurrence were multiple balloons (≥2 balloons, OR 7.80, 95% CI 2.28 to 26.73; p=0.001) and residual fistula immediately following embolization (OR 10.46, 95% CI 2.99 to 36.5; p=0.000).ConclusionThe recurrence rate is high in the first month after embolization with detachable balloons, and multiple balloons and residual fistula are two independent factors affecting recurrence following balloon embolization.

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