scholarly journals Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin

Blood ◽  
1991 ◽  
Vol 78 (9) ◽  
pp. 2337-2343 ◽  
Author(s):  
HK Nieuwenhuis ◽  
J Albada ◽  
JD Banga ◽  
JJ Sixma
Keyword(s):  
Risk Factors ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Performance Status ◽  
Bleeding Tendency ◽  
Who Grade ◽  
Risk Of Bleeding ◽  
History Of ◽  
Acute Venous Thromboembolism

In a prospective double-blind trial, we treated 194 patients with acute venous thromboembolism with heparin or low molecular weight heparin (LMWH; Fragmin). To evaluate the most important prognostic factors for bleeding, the presenting clinical features of the patients, the patients' anticoagulant responses, and the doses of the drugs were analyzed using univariate and multivariate regression analyses. No significant differences in clinical risk factors associated with bleeding were observed between heparin and LMWH. The univariate analyses ranked the parameters in the following order of importance: World Health Organization (WHO) performance status, history of bleeding tendency, cardiopulmonary resuscitation, recent trauma or surgery, leukocyte counts, platelet counts, duration of symptoms, and body surface area. Patients with WHO grade 4 had an eightfold increase in risk of bleeding as compared with WHO grade 1. Assessment of the individual contribution of each variable using multivariate regression analysis showed that the WHO performance status was the most important independent factor predicting major bleeding. A history of a bleeding tendency, recent trauma or surgery, and body surface area were also independent risk factors. The risk of bleeding was influenced by two factors related to the treatment, the patient's anticoagulant response as measured with the anti-Xa assay and the dose of the drug expressed as U/24 h/m2. An increased risk of bleeding was only observed at mean anti-Xa levels greater than 0.8 U/mL for both drugs. Significantly more major bleedings occurred in patients treated with high doses of the drugs, an observation that was independent of the concomitant anti-Xa levels. It should be considered whether choosing an appropriate initial dose adapted to the patient's body surface area and clinical risk factors can improve the efficacy to safety ratio of heparin treatment.

scholarly journals Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin

Blood ◽  
1991 ◽  
Vol 78 (9) ◽  
pp. 2337-2343 ◽  
Author(s):  
HK Nieuwenhuis ◽  
J Albada ◽  
JD Banga ◽  
JJ Sixma
Keyword(s):  
Risk Factors ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Performance Status ◽  
Bleeding Tendency ◽  
Who Grade ◽  
Risk Of Bleeding ◽  
History Of ◽  
Acute Venous Thromboembolism

Abstract In a prospective double-blind trial, we treated 194 patients with acute venous thromboembolism with heparin or low molecular weight heparin (LMWH; Fragmin). To evaluate the most important prognostic factors for bleeding, the presenting clinical features of the patients, the patients' anticoagulant responses, and the doses of the drugs were analyzed using univariate and multivariate regression analyses. No significant differences in clinical risk factors associated with bleeding were observed between heparin and LMWH. The univariate analyses ranked the parameters in the following order of importance: World Health Organization (WHO) performance status, history of bleeding tendency, cardiopulmonary resuscitation, recent trauma or surgery, leukocyte counts, platelet counts, duration of symptoms, and body surface area. Patients with WHO grade 4 had an eightfold increase in risk of bleeding as compared with WHO grade 1. Assessment of the individual contribution of each variable using multivariate regression analysis showed that the WHO performance status was the most important independent factor predicting major bleeding. A history of a bleeding tendency, recent trauma or surgery, and body surface area were also independent risk factors. The risk of bleeding was influenced by two factors related to the treatment, the patient's anticoagulant response as measured with the anti-Xa assay and the dose of the drug expressed as U/24 h/m2. An increased risk of bleeding was only observed at mean anti-Xa levels greater than 0.8 U/mL for both drugs. Significantly more major bleedings occurred in patients treated with high doses of the drugs, an observation that was independent of the concomitant anti-Xa levels. It should be considered whether choosing an appropriate initial dose adapted to the patient's body surface area and clinical risk factors can improve the efficacy to safety ratio of heparin treatment.

Risk Factors for Bleeding during Treatment of Acute Venous Thromboembolism

1996 ◽  
Vol 76 (05) ◽  
pp. 682-688 ◽  
Author(s):  
Jos P J Wester ◽  
Harold W de Valk ◽  
Karel H Nieuwenhuis ◽  
Catherine B Brouwer ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Small Body ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Risk Of Bleeding ◽  
Acute Venous Thromboembolism

Summary Objective: Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism. Design: Secondary analysis of a prospective, randomized, assessor-blind, multicenter clinical trial. Setting: One university and 2 regional teaching hospitals. Patients: 188 patients treated with heparin or danaparoid for acute venous thromboembolism. Measurements: The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively. Results: Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area ≤2 m2 (odds ratio 2.3, 95% Cl 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% Cl 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders. Conclusions: A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.

Pulmonary valve replacement following repair of tetralogy of Fallot: comparison of outcomes between bio- and mechanical prostheses

2021 ◽  
Author(s):  
Dong-Hee Kim ◽  
Eun Seok Choi ◽  
Bo Sang Kwon ◽  
Tae-Jin Yun ◽  
Seul Gi Cha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surface Area ◽  
Body Surface Area ◽  
Valve Replacement ◽  
Body Surface ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Prosthesis Failure ◽  
Mechanical Prosthesis ◽  
Mechanical Prostheses

Abstract OBJECTIVES The aims of this study were to evaluate and compare the outcomes after pulmonary valve replacement (PVR) with a mechanical prosthesis (MP) and a bioprosthesis (BP). METHODS From 2004 through 2017, a total of 131 patients, who had already been repaired for tetralogy or Fallot or its variants, underwent their first PVR with an MP or a BP. Outcomes of interests were prosthesis failure (stenosis >3.5 m/s, regurgitation >mild or infective endocarditis) and reintervention. RESULTS The median age at PVR was 19 years. BP and MP were used in 88 (67.2%) and 43 (32.8%) patients, respectively. The median follow-up duration was 7.4 years, and the 10-year survival rate was 96.4%. Risk factors for prosthesis failure were smaller body surface area [hazard ratio (HR) 0.23 per 1 m2, P = 0.047] and smaller prosthesis size (HR 0.73 per 1 mm, P = 0.039). Risk factors for prosthesis reintervention were smaller body surface area (HR 0.11 per 1 m2, P = 0.011) and prosthesis size (HR 0.67 per 1 mm, P = 0.044). Probability of prosthesis failure and reintervention at 10 years were 24.6% (19.5% in BP vs 34.8% in MP, P = 0.34) and 7.8% (5.6% in BP vs 11.9% in MP, P = 0.079), respectively. Anticoagulation-related major thromboembolic events were observed in 4 patients receiving an MP. CONCLUSIONS MP might not be superior to BP in terms of prosthesis failure or reintervention. MP should be carefully considered for highly selected patients in the era of transcatheter PVR.

Abstract P026: Early Repolarization Pattern is Associated With Increased Left Ventricular Mass and Left Ventricular Hypertrophy: Results From the Dallas Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
David A McNamara ◽  
Ari Bennett ◽  
Jarett D Berry ◽  
Mark S Link
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Left Ventricular ◽  
Percent Body Fat ◽  
Early Repolarization ◽  
Heart Study ◽  
Dallas Heart Study

Introduction: Recent studies have shown an association between early repolarization pattern (ERP) ECG morphology and sudden cardiac death. The role of left ventricular mass (LVM) as a potential mediator of ERP has not been well explored. Methods: Participants in the Dallas Heart Study who underwent an ECG and cardiac MRI (CMR) were assessed for ERP, defined as J-point elevation ≥1 mm in any 2 contiguous leads. We compared participants with and without ERP by age, gender, race/ethnicity, established cardiovascular risk factors of diabetes, hypertension and hyperlipidemia, lean body mass and percent body fat, and CMR-derived LVM, LVM/body surface area, and LVH defined by standard criteria, using Student’s T-tests and chi-squared tests where appropriate. Results: Of the 3,015 participants in our study, 276 (9.2%) had ERP. Participants with ERP were younger (43±9 vs 44±10 yrs, p=0.04), more prevalent in blacks than non-blacks (14 vs 5.0%, p<0.00001), and in men than women (18 vs 2.0%, p<0.00001). Baseline cardiovascular risk factors were not significantly different. Participants with ERP demonstrated higher lean body mass (59±10 vs 52±11 kg, p<0.00001) and lower percent body fat (27±8 vs 36±9%, p<0.00001). The presence of ERP was associated with greater LVM, increased LVM/body surface area, and the presence of LVH in the overall population and in analyses stratified by sex (Table 1). Conclusion: In a large, multi-ethnic cohort, ERP is associated with increased total LVM, increased LVM/body surface area, and LVH. These novel associations may provide insight into the biology of ERP. Further studies investigating the relationship of LVM and LVH with ERP are warranted.

scholarly journals Body surface area, height, and body fat percentage as more sensitive risk factors of cancer and cardiovascular disease

2020 ◽  
Vol 9 (12) ◽  
pp. 4433-4446 ◽  
Author(s):  
Shucheng Si ◽  
Marlvin A. Tewara ◽  
Xiaokang Ji ◽  
Yongchao Wang ◽  
Yanxun Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Fat ◽  
Body Surface ◽  
Body Fat Percentage ◽  
Fat Percentage

scholarly journals POS1001 CLINICAL AND SURROGATE CARDIOVASCULAR RISK ASSESSMENT AND ITS RELATIONSHIP WITH PSORIATIC ARTHRITIS PATHOGENESIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 769.1-769
Author(s):  
N. Barbarroja Puerto ◽  
I. Arias de la Rosa ◽  
C. Román-Rodriguez ◽  
I. Gómez García ◽  
C. Perez-Sanchez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Peripheral Blood ◽  
Molecular Mechanisms ◽  
Mononuclear Cells ◽  
Cv Disease

Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with an increased prevalence of cardiovascular (CV) events. Traditional CV risk factors do not account for the increased CV disease mortality in PsA. Inflammation seems to have a key role in the development of this comorbidity, however the specific molecular mechanisms involved are not defined yet.Objectives:To evaluate clinical CV risk factors and surrogate markers and their relationship with inflammation, disease activity and metabolic comorbidities in PsA patientsMethods:This is a cross-sectional study including 100 PsA patients without CV disease recruited in the routine clinical practice at the Rheumatology Department, Reina Sofia Hospital of Cordoba and 100 age-matched healthy donors (HDs). Different parameters related to the cardiometabolic risk were analyzed. Clinical and analytical parameters were collected: lipid profile (cholesterol, HDL, LDL, TG, ApoA and ApoB), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAPSA, VAS, CRP and ESR. To measure the persistence of inflammation, CRP levels were recorded retrospectively once, twice, or three times during the 5 years prior to study and at the moment of the study. Increased levels of CRP in at least 50% of the determinations was considered as persistent inflammation. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of patients and HDs. A panel of 92 proteins involved in CV disease and an adipocytokine profile was measured in plasma and PBMCs. In addition, activation of 18 intracellular pathways involved in cell activation was also measured in PBMCs. In vitro experiments in adipocytes treated with serum from PsA patients were also carried out.Results:Traditional CV risk factors including atherogenic risk, insulin resistance (IR), metabolic syndrome, smoking, obesity, arterial hypertension, apolipoprotein B/A risk, type 2 diabetes mellitus and the levels of SCORE were significantly increased in PsA patients. The presence of IR was associated with disease activity markers (DAPSA, ESR and CRP). In fact, the HOMA-IR index was related to the CRP persistence. PsA patients with obesity had significantly increased the number of tender and swollen joints, the levels of DAPSA and CRP. Twenty-eight proteins involved in CV disease and six adipocytokines were significantly elevated in the plasma of PsA patients. Several of these cardiovascular molecules were associated with higher levels of DAPSA (CTSD, GAL3, CD163, FABP4, IL6 and IL1RT2), acute phase reactants (GAL3, TNFα, Adiponectin, TNFR1 and IL6), affected body surface area (IL2RA, GAL3, CCL15, TRAP, CSTB, CD163, OPG and CNTN1) and onychopaty (TRAP, VWF, MCP-1, GAL3, LTBR, TFPI, CHI3L1, CTSZ and JAM-A). In addition, the mRNA expression of most of those 28 CV molecules were significantly increased in PBMCs from PsA patients. At intracellular level, the activation of 11 kinases (ERK1/2, AKT, S6 Ribosomal, mTOR, HSP27, Bad, p70 S6 kinase, PRAS40, p53 and caspase-3) involved in insulin signaling, inflammation, cell survival and apoptosis were altered in PBMCs. Finally, serum from PsA patients was able to modify the expression of these molecules in adipocytes.Conclusion:1) Disease activity and inflammatory burden are closely associated with the presence of metabolic alterations, specifically obesity and IR in patients with PsA. 2) The development of IR is extremely related to the persistence of CRP levels in the previous 5 years. 3) Inflammation is closely associated to the adipose tissue dysfunction in PsA and 4) FABP4, CD163 and GAL3 are surrogate CV markers commonly associated with clinical features of PsA, suggesting the role of these molecules linking CVD and PsA pathogenesis.Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.Disclosure of Interests:None declared.

The Natural History of the Growth of the Hand: I. Hand Area as a Percentage of Body Surface Area

2001 ◽  
Vol 107 (3) ◽  
pp. 726-733 ◽  
Author(s):  
Hamid reza Amirsheybani ◽  
Gia M. Crecelius ◽  
Nigel H. Timothy ◽  
Margarit Pfeiffer ◽  
Gregory C. Saggers ◽  
...  
Keyword(s):  
Natural History ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
History Of ◽  
Hand Area

scholarly journals Core Body Temperatures in Collegiate Marching Band Artists During Rehearsals and Performances

2021 ◽  
Vol 56 (3) ◽  
pp. 302-310
Author(s):  
Dawn M. Emerson ◽  
Toni Marie Torres-McGehee ◽  
Susan W. Yeargin ◽  
Melani R. Kelly ◽  
Nancy Uriegas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
National Collegiate Athletic Association ◽  
Sweat Rate ◽  
Urine Specific Gravity ◽  
Marching Band ◽  
Wet Bulb Globe Temperature ◽  
Globe Temperature

Context To our knowledge, no researchers have investigated thermoregulatory responses and exertional heat illness (EHI) risk factors in marching band (MB) artists performing physical activity in high environmental temperatures. Objective To examine core temperature (Tc) and EHI risk factors in MB artists. Design Descriptive epidemiology study. Setting Three rehearsals and 2 football games for 2 National Collegiate Athletic Association Division I institution's MBs. Patients or Other Participants Nineteen volunteers (females = 13, males = 6; age = 20.5 ± 0.9 years, height = 165.1 ± 7.1 cm, mass = 75.0 ± 19.1 kg) completed the study. Main Outcome Measure(s) We measured Tc, wet bulb globe temperature, and relative humidity preactivity, during activity, and postactivity. Other variables were activity time and intensity, body surface area, hydration characteristics (fluid volume, sweat rate, urine specific gravity, percentage of body mass loss), and medical history (eg, previous EHI, medications). The statistical analysis consisted of descriptive information (mean ± standard deviation), comparative analyses that determined differences within days, and correlations that identified variables significantly associated with Tc. Results The mean time for rehearsals was 102.8 ± 19.8 minutes and for games was 260.5 ± 47.7 minutes. Mean maximum Tc was 39.1 ± 1.1°C for games and 38.4 ± 0.7°C for rehearsals; the highest Tc (41.2°C) occurred during a game. Fluid consumption did not match sweat rates (P &lt; .001). Participants reported to games in a hypohydrated state 63.6% of the time. The maximum Tc correlated with the maximum wet bulb globe temperature (r = 0.618, P &lt; .001) and was higher in individuals using mental health medications (rpb = −0.254, P = .022) and females (rpb = 0.330, P = .002). Body surface area (r = −0.449, P &lt; .001) and instrument mass (r = −0.479, P &lt; .001) were negatively correlated with Tc. Conclusions Marching band artists experienced high Tc during activity and should have access to athletic trainers who can implement EHI-prevention and -management strategies.

scholarly journals Impact of Seasonal Variation in Association with Other Factors on Vitamin D Status among Mangalorean Population

2021 ◽  
Vol 10 (9) ◽  
pp. 589-594
Author(s):  
Tirthal Rai ◽  
Mayur Rai ◽  
Janice Dsa ◽  
Srinidhi Rai ◽  
Sushith P ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Vitamin D ◽  
Seasonal Variation ◽  
Vitamin D Deficiency ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Mass ◽  
Body Surface ◽  
Endocrine Society

BACKGROUND India has plenty of sunshine, yet people here are deprived of vitamin D – ‘sunshine vitamin’. According to endocrine society of India, vitamin D levels of < 20 ng / mL is considered to be vitamin D deficiency. The objective of the study was to evaluate seasonal variation of vitamin D and give an insight on risk factors such as age, gender, diet, body mass index, occupation, skin complexion and body surface area exposure on vitamin D level. METHODS The study was conducted in a tertiary hospital in Mangalore on 109 apparently healthy individuals. The same cohort of subjects was followed for two seasons - summer and winter. Serum was collected and analysed for 25-OH vitamin D, calcium and phosphorous. Skin color was assessed according to the Fitzpatrick classification, questionnaire was given to assess the approximate time limit of sun exposure in a day along with the exposed areas to sunlight and anthropometric parameters such as height and weight were measured using standard guidelines. Body mass index (BMI) was calculated. Comparison of mean vitamin D along with the factors influencing them in both seasons was done using paired t test. Inferential statistical analysis was done using chi-square test. Pearson correlation test was also done. Statistical significance was considered at P < 0.05. RESULTS Mean vitamin D was higher in summer (15.14 ± 5.62) as compared to winter (14.42 ± 5.38) irrespective of the risk factors. Vitamin D deficiency was highest in older age group (83.9 %), females (84.6 %), overweight (100 %), vegetarians (92.3 %), office workers (91.2 %), both complexions and those exposed with < 1.5 hours of sunlight (97.2 %). Vitamin D deficiency was also more prevalent in those with lesser exposed body surface area. CONCLUSIONS Vitamin D deficiency was statistically most common in winter than summer. It was seen correlating with majority of the risk factors, except skin complexion and among the confounding factors. The key for vitamin D production in this population was maximum body surface area exposure (face, hand, leg and feet) to sunlight for more than 2.5 hours, yet these subjects were vitamin D deficient. However, they did not manifest with any skeletal or extra-skeletal morbidity. Thus, concluding that a reliable cut off value for reference range of vitamin D should be set in this population in order to abstain from excess vitamin D treatment. KEY WORDS Sunshine Vitamin, Vitamin D Deficiency, Mangalore, Skin Colour, Sunlight Exposure, Body Surface Area, Summer, Winter

scholarly journals Ungueal melanoma and a generalized vitiligo: Is this a rare association?

2021 ◽  
Vol 12 (e) ◽  
pp. 1-3
Author(s):  
Hanane Daflaoui ◽  
Loubab Omahsan ◽  
Adnane Lachkar ◽  
Abdelouahed Najib ◽  
Siham Dikhaye ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Cutaneous Melanoma ◽  
Good Prognosis ◽  
Rare Association ◽  
Skin Cancers ◽  
Histological Data ◽  
History Of ◽  
Melanoma Skin

We report an observation of a good prognosis ungual melanoma showed up 10 years after the onset of a generalized vitiligo. It’s a 66ans years old male, with a history of a rapidly progressing vulgar vitiligo showed up 10 years earlier. The patient has been referred to us for the management of a nail melanoma, retained on clinical and histological data, with a vitiligo extended to 70% Body Surface Area. The assessment of locoregional and distant extension was without abnormalities. Several authors have reported the association of vitiligo and other autoimmune disorders, non-melanoma skin cancers, or as part of a particular syndrome. The association of ungueal melanoma and generalized vitiligo was rarely reported in literature. Across this observation, we illustrate that The association of cutaneous melanoma and vitiligo is not rare and may be a factor of good prognosis.

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