Non-steroidal anti-inflammatory drugs have been associated with an increased risk of venous thromboembolism. We report for the first time, the case of a patient who developed massive pulmonary ...embolism after a long period of treatment with high doses of ibuprofen. A 65-year-old woman was admitted with severe dyspnea while on treatment with high doses of ibuprofen for diffuse spine pain due to arthrosis. A spiral computed tomography showed a massive pulmonary embolism. No other explanation for the thromboembolic disorder was found. She was successfully treated with therapeutic doses of low-molecular-weight heparin followed by rivaroxaban. Ibuprofen was discontinued and replaced by tramadol. High-dose ibuprofen is likely to have accounted for the life-threatening thromboembolic disorder.
Antithrombin, protein C and S defects are well-recognized inherited risk factors for venous thromboembolism (VTE). Although these defects have been reported to increase the risk of VTE in fertile ...women under combined oral contraceptives (COCs), the magnitude of this association is uncertain. In a sub-analysis of a prospective cohort study, we evaluated the incidence of VTE occurring during treatment with COCs in fertile women who were family members of a proband with an objectively diagnosed VTE event and a documented defect of antithrombin, protein C or S. Of the 197 women of child-bearing age from 88 families who qualified for this analysis in a 17-year period, 112 (57%) were carriers of an inherited defect (23 antithrombin, 41 protein C and 48 protein S), whereas the remaining 85 were free from these abnormalities. Estrogen-progestin therapy was used by 19 of the 112 (17%) carriers of inherited thrombophilia for an overall period of 276 months, and by 17 of the 85 (20%) non-carriers for an overall period of 992 months. VTE events developed in 12 of the 19 (63%) carriers, leading to a monthly event rate of 4.3% (95% CI: 2.2 to 7.6), and in 2 of the 17 (12%) non-carriers, leading to a monthly rate of 0.2% (95% CI: 0.02 to 0.7), for a relative risk of 21 (95% CI, 4.7 to 92). Among family members of probands with inherited defects of antithrombin, protein C or S defects, the use of estrogen-progestin therapy in carriers of these abnormalities results in a risk of VTE events that is more than 20 times as high as that expected in non-carriers. Accordingly, the systematic screening for thrombophilia in these families has the potential to identify those subjects in whom this kind of hormonal treatment should be strongly discouraged.
Isolated distal deep vein thrombosis (IDDVT) represents up to half of all lower limb DVT. This study investigated treatment patterns and outcomes in 2,145 patients with IDDVT in comparison with those ...with proximal DVT (PDVT;
= 3,846) and pulmonary embolism (PE;
= 4,097) enrolled in the GARFIELD-VTE registry. IDDVT patients were more likely to have recently undergone surgery (14.6%) or experienced leg trauma (13.2%) than PDVT patients (11.0 and 8.7%, respectively) and PE patients (12.7 and 4.5%, respectively). Compared with IDDVT, patients with PDVT or PE were more likely to have active cancer (7.2% vs. 9.9% and 10.3%). However, influence of provoking factors on risk of recurrence in IDDVT remains controversial. Nearly all patients (IDDVT, PDVT, and PE) were given anticoagulant therapy. In IDDVT, PDVT, and PE groups the proportion of patients receiving anticoagulant therapy was 61.4, 73.9, and 81.1% at 6 months and 45.8, 54.7, and 61.9% at 12 months. Over 12 months, the incidence of all-cause mortality, cancer, and recurrence was significantly lower in IDDVT patients than PDVT patients (hazard ratio HR, 0.61 95% confidence interval CI, 0.48-0.77; sub-HR sHR, 0.60 95% CI, 0.39-0.93; and sHR, 0.76 95% CI, 0.60-0.97). Likewise, risk of death and incident cancer was significantly (both
< 0.05) lower in patients with IDDVT compared with PE. This study reveals a global trend that most IDDVT patients as well as those with PDVT and PE are given anticoagulant therapy, in many cases for at least 12 months.
In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well ...documented.
To determine the clinical course of patients during the 8 years after their first episode of symptomatic deep venous thrombosis.
Prospective cohort study.
University outpatient thrombosis clinic.
355 consecutive patients with a first episode of symptomatic deep venous thrombosis.
Recurrent venous thromboembolism, the post-thrombotic syndrome, and death. Potential risk factors for these outcomes were also evaluated.
The cumulative incidence of recurrent venous thromboembolism was 17.5% after 2 years of follow-up (95% CI, 13.6% to 22.2%), 24.6% after 5 years (CI, 19.6% to 29.7%), and 30.3% after 8 years (CI, 23.6% to 37.0%). The presence of cancer and of impaired coagulation inhibition increased the risk for recurrent venous thromboembolism (hazard ratios, 1.72 CI, 1.31 to 2.25 and 1.44 CI, 1.02 to 2.01, respectively). In contrast, surgery and recent trauma or fracture were associated with a decreased risk for recurrent venous thromboembolism (hazard ratios, 0.36 CI, 0.21 to 0.62 and 0.51 CI, 0.32 to 0.87, respectively). The cumulative incidence of the post-thrombotic syndrome was 22.8% after 2 years (CI, 18.0% to 27.5%), 28.0% after 5 years (CI, 22.7% to 33.3%), and 29.1% after 8 years (CI, 23.4% to 34.7%). The development of ipsilateral recurrent deep venous thrombosis was strongly associated with the risk for the post-thrombotic syndrome (hazard ratio, 6.4; CI, 3.1 to 13.3). Survival after 8 years was 70.2% (CI, 64.7% to 75.6%). The presence of cancer increased the risk for death (hazard ratio, 8.1; CI, 3.6 to 18.1).
Patients with symptomatic deep venous thrombosis, especially those without transient risk factors for deep venous thrombosis, have a high risk for recurrent venous thromboembolism that persists for many years. The post-thrombotic syndrome occurs in almost one third of these patients and is strongly related to ipsilateral recurrent deep venous thrombosis. These findings challenge the widely adopted use of short-course anticoagulation therapy in patients with symptomatic deep venous thrombosis.
Objective
The excess of visceral adipose tissue might hinder and delay immune response. How people with abdominal obesity (AO) will respond to mRNA vaccines against SARS‐CoV‐2 is yet to be ...established. SARS‐CoV‐2‐specific antibody responses were evaluated after the first and second dose of the BNT162b2 mRNA vaccine, comparing the response of individuals with AO with the response of those without, and discerning between individuals with or without prior infection.
Methods
Immunoglobulin G (IgG)‐neutralizing antibodies against the Trimeric complex (IgG‐TrimericS) were measured at four time points: at baseline, at day 21 after vaccine dose 1, and at 1 and 3 months after dose 2. Nucleocapsid antibodies were assessed to detect prior SARS‐CoV‐2 infection. Waist circumference was measured to determine AO.
Results
Between the first and third month after vaccine dose 2, the drop in IgG‐TrimericS levels was more remarkable in individuals with AO compared with those without AO (2.44‐fold 95% CI: 2.22‐2.63 vs. 1.82‐fold 95% CI: 1.69‐1.92, respectively, p < 0.001). Multivariable linear regression confirmed this result after inclusion of assessed confounders (p < 0.001).
Conclusions
The waning antibody levels in individuals with AO may further support recent recommendations to offer booster vaccines to adults with high‐risk medical conditions, including obesity, and particularly to those with a more prevalent AO phenotype.
There is not enough clinical evidence to make a strong recommendation on the optimal duration of thromboprophylaxis using low-molecular weight heparins (LMWH) in patients undergoing major cancer ...surgery.
CANBESURE is a randomized, double-blind study which enrolled patients admitted for abdominal or pelvic surgery for cancer. They received 3500 IU of bemiparin subcutaneously once daily for 8 days and were then randomized to receive either bemiparin or placebo for 20 additional days. Bilateral venography was performed after 20 days and evaluated blinded. The primary efficacy outcome was the composite of deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE) and all-cause mortality at the end of double-blind period. Major venous thromboembolism (proximal deep-vein thrombosis, non-fatal pulmonary embolism and venous thromboembolism-related deaths) was also evaluated. The primary safety outcome was major bleeding.
Six hundred and twenty-five and 488 patients were included in the safety and main efficacy analyzes, respectively. The primary efficacy outcome occurred in 25 out of 248 patients (10.1%) in the bemiparin group and 32 out of 240 (13.3%) in the placebo group (relative risk reduction 24.4%; 95% CI: -23.7-53.8%; P = 0.26). At the end of double-blind period, major venous thromboembolism occurred in 2 (0.8%) and 11 (4.6%) patients, respectively (relative risk reduction 82.4%; 95% CI: 21.5-96.1%; P = 0.010). No significant difference was found in major bleedings.
Four weeks compared with 1 week of prophylaxis with bemiparin after abdominal or pelvic cancer surgery did not significantly reduce the primary efficacy outcome, but decreased major venous thromboembolism (VTE) without increasing hemorrhagic complications.
ABSTRACT
Using a sample of 67 galaxies from the MeerKAT International GigaHertz Tiered Extragalactic Exploration Survey Early Science data, we study the H i-based baryonic Tully–Fisher relation ...(bTFr), covering a period of ∼1 billion years (0 ≤ z ≤ 0.081). We consider the bTFr based on two different rotational velocity measures: the width of the global H i profile and Vout, measured as the outermost rotational velocity from the resolved H i rotation curves. Both relations exhibit very low intrinsic scatter orthogonal to the best-fitting relation (σ⊥ = 0.07 ± 0.01), comparable to the SPARC sample at z ≃ 0. The slopes of the relations are similar and consistent with the z ≃ 0 studies ($3.66^{+0.35}_{-0.29}$ for W50 and $3.47^{+0.37}_{-0.30}$ for Vout). We find no evidence that the bTFr has evolved over the last billion years, and all galaxies in our sample are consistent with the same relation independent of redshift and the rotational velocity measure. Our results set-up a reference for all future studies of the H i-based bTFr as a function of redshift that will be conducted with the ongoing deep SKA pathfinders surveys.
•Venous thromboembolism prophylaxis in obese hospitalized patients with a fixed-dosestrategy of heparin hasoftenbeenquestioned.•The efficacy and safety of standard dose vs weight-adjusted were ...compared.•Among different strategies of heparin regimen, none has been shown to be superior in term so freduction in VTE related-events nor in bleeding events.•Standard doses of heparin for thromboprophylaxis should be used in obesein patients.
Background: Fixed dose unfractionated or low molecular weight heparin is the recommended treatment for venous thromboembolism (VTE) prevention in hospitalized patients. However, its efficacy has been questioned in obese population. Results of previous studies on weight-adjusted doses of heparin for VTE prevention are contradictory. Different anticoagulant regimens are used in clinical practice, but their role remains to be elucidated.
Aims: To clarify the efficacy and safety of weight-adjusted dose heparin for VTE prevention in obese subjects hospitalized for medical and surgical conditions.
Methods: Twelve studies were identified as reporting VTE occurrence, major or minor bleeding and anti-Xa levels. A random-effect meta-analysis was conducted to derive odds ratios (OR) comparing fixed vs weight adjusted-doses heparins on VTE occurrence, bleeding, anti-Xa levels. Medical and surgical patients, prospective vs retrospective and quality of studies were extracted for moderators and meta-regression analysis.
Results: Weight-adjusted dose heparin administration was not associated with reduced VTE occurrence (6320/13317 patients, OR 1.03, 95% C.I. 0.79 to 1.35), nor increased bleeding (5840/10906 patients, OR 0.84, 95% C.I. 0.65 to 1.08), but it was associated with higher anti-Xa levels (284/294 patients, ES 2.04, 95% C.I. 1.16 to 2.92, p<0.0001). A significant heterogeneity was present for comparison of anti-Xa levels (I2=94%, p=0.0001) but not for VTE occurrence or bleeding (I2=7.6% and 12.8% respectivel). None of the moderators explained the heterogeneity of the results among primary studies.
Conclusion: Weight-adjusted dose as compared to fixed-dose of heparins in the prevention of VTE in obese patients was not associated with a lower risk of VTE nor a higher risk of bleeding.
In this article I analyse the evolution of Ramsey Nasr (Rotterdam 1974) from neo-romantic to committed “political” poet. I particularly focus on the way he positioned himself, poetically and ...mediatically, during the years 2009-2013 – a period of economic crisis and social and political unrest – in his capacity of Poet Laureate of The Netherlands, a highly symbolic function. Supposed to represent the “nation”, in public lectures/performances he fully engaged in the polarised debate around the boundaries of historical and contemporary Dutchness. Being self half-allochtonous (Dutch-Palestinian) with a transcultural background, in his poetry he performed a multiple, plural, instable personal and collective identity, questioning any essentialistic and seemingly stable definition of the Dutch cultural identity, as of any other identity construction: the Christian, the Calvinist, the European etc. Nasr did not hesitate to provoke the political establishment, by topicalizing and investigating traumas in Dutch history and in contemporary society (Holocaust, multiculturalism and integration of Muslim migrants, Israeli-Palestinian conflict etc). Instead of erasing these traumas from collective memory, or turning them into museum-pieces, he stated the necessity for everyone to meditate on them in new, daring, hybridized forms.
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