High incidence of postoperative silent venous thromboembolism in ulcerative colitis: a retrospective observational study

Abstract Background The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease. We aimed to analyze the incidence and predictive factors of postoperative VTE in patients with ulcerative colitis. Methods Patients with ulcerative colitis who underwent colon and rectum surgery during 2010–2018 were included. We retrospectively investigated the incidence of postoperative VTE. Results A total of 140 colorectal surgery cases were included. Postoperative VTE was detected in 24 (17.1 %). Portal–mesenteric venous thrombosis was the most frequent VTE (18 cases; 75 %); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than in those refractory to medications (27.2 % vs. 12.5 %; p < 0.031). TPC with IPAA was more often associated with VTE development (28 %) than total colectomy (10.5 %) or proctectomy (5.9 %). On logistic regression analysis, TPC with IPAA, total colectomy, long operation time (> 4 h), and high serum D-dimer level (> 5.3 µg/mL) on the day following surgery were identified as predictive risk factors. Conclusions Postoperative VTE occurred frequently and asymptomatically, especially after TPC with IPAA. Serum D-dimer level on the day after surgery may be a useful predictor of VTE.

Download Full-text

High Incidence of Postoperative Silent Venous Thromboembolism in Ulcerative Colitis

10.21203/rs.3.rs-141629/v1 ◽

2021 ◽

Author(s):

Norimitsu Shimada ◽

Hiroki Ohge ◽

Hiroki Kitagawa ◽

Kosuke Yoshimura ◽

Norifumi Shigemoto ◽

...

Keyword(s):

Ulcerative Colitis ◽

Venous Thromboembolism ◽

Total Colectomy ◽

Univariate Analysis ◽

High Serum ◽

Total Proctocolectomy ◽

Bowel Diseases ◽

Colon And Rectum ◽

Predictive Risk ◽

D Dimer

Abstract Purpose: The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel diseases. We aimed to analyze the incidence and predictive factors of postoperative VTE.Methods: Patients with ulcerative colitis who underwent colon and rectum surgery during 2010–2018 were included. We retrospectively investigated the incidence of postoperative VTE.Results: A total 140 cases of colorectal surgery were included. Postoperative VTE was detected in 24 (17.1%). All patients with VTE had no specific symptoms related to thrombus, except one pulmonary embolism. Portal–mesenteric venous thrombosis was the most frequent (18, 75%); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than refractory to medications (27.2% vs. 12.5%; p<0.031). TPC with IPAA was more associated with developing VTE (28%) than total colectomy (10.5%) or proctectomy (5.9%). On logistic regression analysis of predictive risk factors, TPC with IPAA, total colectomy, longer operative time (>4 hours), and high serum D-dimer levels (>5.3 μg/mL) the day following surgery were identified. Conclusion: Postoperative VTE occurred frequently and asymptomatic, especially after TPC with IPAA. D-dimer the day after surgery may be useful predictor of VTE.

Download Full-text

High Pretreatment Plasma D-dimer Levels Are Associated With Poor Prognosis in Patients With Ovarian Cancer Independently of Venous Thromboembolism and Tumor Extension

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000415 ◽

2015 ◽

Vol 25 (4) ◽

pp. 593-598 ◽

Cited By ~ 20

Author(s):

Manabu Sakurai ◽

Toyomi Satoh ◽

Koji Matsumoto ◽

Hiroo Michikami ◽

Yuko Nakamura ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Venous Thromboembolism ◽

Univariate Analysis ◽

Prognostic Significance ◽

Distant Metastases ◽

Tumor Extension ◽

Poor Overall Survival ◽

Gynecology And Obstetrics ◽

D Dimer

ObjectiveElevated plasma D-dimer (DD) is associated with decreased survival among patients with breast, lung, and colon cancers. The present study clarifies the prognostic significance of pretreatment plasma DD levels in patients with epithelial ovarian cancer (EOC).MethodsWe investigated pretreatment DD levels and other variables for overall survival using univariate and multivariate analyses in 134 consecutive patients with EOC stages II to IV who were initially treated between November 2004 and December 2010.ResultsThe median follow-up period was 53 (7–106) months. Univariate analysis significantly associated elevated pretreatment DD (≥2.0 μg/mL) levels to poor 5-year overall survival rates irrespective of previously treated venous thromboembolism (72.2% vs 52.6%,P= 0.039). Cancer antigen 125 levels of 200 U/mL or higher (P= 0.011), distant metastases (P= 0.0004), residual tumors (P< 0.0001), and International Federation of Gynecology and Obstetrics stage III/IV (P= 0.0033) were also poor prognostic factors. Multivariate analysis independently associated DD levels of 2.0 μg/mL or higher (P= 0.041), distant metastases (P= 0.013), and residual tumors (P< 0.0001) with poor overall survival.ConclusionsHigh pretreatment DD levels are associated with poor overall survival in patients with EOC independently of venous thromboembolism and tumor extension and might comprise a promising prognostic biomarker for patients with EOC.

Download Full-text

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70277-x ◽

2006 ◽

Vol 2006 ◽

pp. 361-362

Author(s):

G.L. Moneta

Keyword(s):

Venous Thromboembolism ◽

Predictive Value ◽

Recurrent Venous Thromboembolism ◽

D Dimer

Download Full-text

COVID-19 infection: epidemiological, clinical, and radiological expression among adult population

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00341-9 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Eman Ragab ◽

Asrar Helal Mahrous ◽

Ghadeer Maher El Sheikh

Keyword(s):

Serum Ferritin ◽

Clinical Laboratory ◽

Adult Population ◽

Significant Risk ◽

High Serum ◽

Male Gender ◽

Lower Sensitivity ◽

Significant Difference ◽

D Dimer

Abstract Background High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases. Results Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature. Conclusion Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.

Download Full-text

State-of-the-art surgery for ulcerative colitis

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02295-6 ◽

2021 ◽

Author(s):

Shanglei Liu ◽

Samuel Eisenstein

Keyword(s):

Ulcerative Colitis ◽

Surgical Intervention ◽

State Of The Art ◽

Total Proctocolectomy ◽

First Line ◽

Anastomotic Complications ◽

Permanent Ileostomy ◽

Elective Setting ◽

Pouch Reconstruction ◽

Degrees Of Severity

AbstractUlcerative colitis (UC) is an autoimmune-mediated colitis which can present in varying degrees of severity and increases the individual’s risk of developing colon cancer. While first-line treatment for UC is medical management, surgical treatment may be necessary in up to 25–30% of patients. With an increasing armamentarium of biologic therapies, patients are presenting for surgery much later in their course, and careful understanding of the complex interplay of the disease, its management, and the patient’s overall health is necessary when considering he appropriate way in which to address their disease surgically. Surgery is generally a total proctocolectomy either with pelvic pouch reconstruction or permanent ileostomy; however, this may need to be spread across multiple procedures given the complexity of the surgery weighed against the overall state of the patient’s health. Minimally invasive surgery, employing either laparoscopic, robotic, or transanal laparoscopic approaches, is currently the preferred approach in the elective setting. There is also some emerging evidence that appendectomy may delay the progression of UC in some individuals. Those who treat these patients surgically must also be familiar with the numerous potential pitfalls of surgical intervention and have plans in place for managing problems such as pouchitis, cuffitis, and anastomotic complications.

Download Full-text

Serum lnc34a is a potential prediction biomarker for bone metastasis in hepatocellular carcinoma patients

BMC Cancer ◽

10.1186/s12885-021-07808-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Li Zhang ◽

Hao Niu ◽

Ping Yang ◽

Jie Ma ◽

Bao-Ying Yuan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Bone Metastasis ◽

Univariate Analysis ◽

High Serum ◽

Chain Reaction ◽

Serum Samples ◽

Early Screening ◽

Expression Levels ◽

Node Metastasis ◽

Polymerase Chain

Abstract Background Early screening and intervention therapies are crucial to improve the prognosis of hepatocellular carcinoma (HCC) patients with bone metastasis. We aimed to identify serum lncRNA as a prediction biomarker in HCC bone metastasis. Methods The expression levels of lnc34a in serum samples from 157 HCC patients were detected by quantitative real-time polymerase chain reaction (PCR). Univariate analysis and multivariate analysis were performed to determine statistically significant variables. Results Expression levels of lnc34a in serum from HCC patients with bone metastasis were significantly higher than those without bone metastasis. The high expressions of lnc34a, vascular invasion and Barcelona Clinic Liver Cancer (BCLC) stage were associated with bone metastasis by analysis. Moreover, lnc34a expression was specifically associated with bone metastasis rather than lung or lymph node metastasis in HCC. Conclusions High serum lnc34a expression was a independent risk factor for developing bone metastasis in HCC.

Download Full-text

Potential problems of partial resection for colitis-associated cancer in a patient with ulcerative colitis: case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab086 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Yuki Horio ◽

Motoi Uchino ◽

Takako Kihara ◽

Toshihiro Bando ◽

Ryuichi Kuwahara ◽

...

Keyword(s):

Ulcerative Colitis ◽

Endoscopic Resection ◽

Ileal Pouch ◽

Standard Procedure ◽

Partial Resection ◽

Total Proctocolectomy ◽

Potential Problems ◽

Partial Colectomy ◽

A Site ◽

Anal Site

Abstract Total proctocolectomy and an ileal pouch-anal anastomosis are recommended as the standard procedure for ulcerative colitis (UC)-colitis-associated cancer (CAC). However, several studies have reported the partial colectomy and endoscopic resection of UC-CAC in recent years. We present a surgical case of UC-CAC that was detected at a site that had not been diagnosed preoperatively, and we report potential problems of partial colectomy and endoscopic resection through this case. Considerations of synchronous and metachronous cancer/dysplasia are important before partial resection is planned for CAC in UC. Moreover, it should be noted that endoscopic resection at the anal site can be a risk factor for pouch surgery failure due to fibrosis after resection.

Download Full-text

Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa337 ◽

2021 ◽

Author(s):

Susanna Scharrer ◽

Christian Primas ◽

Sabine Eichinger ◽

Sebastian Tonko ◽

Maximilian Kutschera ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Venous Thromboembolism ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Fatal Bleeding ◽

Adjusted Incidence Rate ◽

Inflammatory Bowel ◽

Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

Download Full-text