This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To assess the effects of pharmacological interventions for preventing venous thromboembolism in patients ...undergoing bariatric surgery.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To assess the efficacy and safety of statins in preventing primary venous thromboembolism (VTE) in people with ...no previous history of VTE.
BackgroundAtrial High-Rate Episodes (AHRE), as detected by implantable cardiac devices, increase stroke risk. Remote monitoring (RM) provides physicians with timely notification of such episodes ...through automatic downloads from home. The AHRE burden required to increase thromboembolic risk is unclear albeit the European Society of Cardiology (ESC) AF guidelines recommend initiating oral anticoagulation (OAC) in patients with at least a single episode of long duration (≥ 1 hour) and an overall ‘high’ daily burden of AHRE (total duration of all episodes), having considered the CHA2DS-VAS2C score. Moreover, device manufacturers are inconsistent with their nominal AHRE notification settings.AimIn light of the ESC AF guidelines (2020), this study reviewed the current practise of RM for AHRE detection to determine OAC in patients with AHRE and CHA2DS-Vas2c ≥ 2 (Male) or 3 (Female).MethodsWe retrospectively collected data from 50 patients with RM devices at a district hospital in the UK. Patients were selected to allow comparison between the 4 different manufacturers (Abbott, Biotronik, Boston Scientific, and Medtronic) used at the centre (figure 1). The latest AHRE notification alert settings and clinical data were obtained from electronic patient records. Table 1 shows the nominal settings.ResultsOf the 50 patients, 50% had dual chamber pacemaker (figure 2), mean age 74 (SD ± 9) years, 38 patients (76%) had no documented history of atrial fibrillation at device implantation: 37 of them had an elevated CHA2DS-Vas2c score or previous TIA/stroke. Of these 37 patients, 33 patients had nominal RM settings with 8 of these patients later anticoagulated for AF; 4 patients had AHRE burden settings reduced to 1 hour, with one of these patients later anticoagulated for AF. DiscussionAbbott can alert for single, prolonged AHRE episodes in accordance with ESC guidance. However, episode detection is nominally set at 3 hours. AHRE burden can be determined by all manufacturers and may be used solely (without supporting guidance) in the absence of single episode alerts, pending robust trial data to conclusively alter the current OAC recomendation. Also, it is apparent that RM nominal settings are not actively altered by device implanting physicians but this may change as a result of the recently revised ESC AF guidance.In our cohort, 37 patients without a history of AF at device implantation were at significant risk of thromboembolism in the event of developing AF. It is possible that the 9 patients on OAC may have initiated OAC sooner if significant AHRE been detected earlier. Similarly, limitations of AHRE detection and a failure by physicians to alter RM nominal settings potentially limited identification of other patients suitable for OAC.Abstract 102 Figure 1Abstract 102 Figure 2Abstract 102 Table 1RM nominal settings for AHRE alerts between different device manufacturers Single Episode (On/Off) Single Episode Duration Daily Burden (On/Off) Daily Burden Duration AbbottOn3hrOn6 hrBiotronikN/AN/AOn6 hrBoston ScientificN/AN/AOn0 hrMedtronicN/AN/AOff6 hrsConclusionsGuideline-directed AHRE detection settings are under-utilised even though most patients with implantable cardiac devices are at potentially high risk of developing thromboembolic events.Conflict of InterestNone
Background
Three months ago, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) broke out in Wuhan, China, and spread rapidly around the world. Severe novel coronavirus pneumonia (NCP) ...patients have abnormal blood coagulation function, but their venous thromboembolism (VTE) prevalence is still rarely mentioned.
Objectives
To determine the incidence of VTE in patients with severe NCP.
Methods
In this study, 81 severe NCP patients in the intensive care unit (ICU) of Union Hospital (Wuhan, China) were enrolled. The results of conventional coagulation parameters and lower limb vein ultrasonography of these patients were retrospectively collected and analyzed.
Results
The incidence of VTE in these patients was 25% (20/81), of which 8 patients with VTE events died. The VTE group was different from the non‐VTE group in age, lymphocyte counts, activated partial thromboplastin time (APTT), D‐dimer, etc. If 1.5 µg/mL was used as the D‐dimer cut‐off value to predicting VTE, the sensitivity was 85.0%, the specificity was 88.5%, and the negative predictive value (NPV) was 94.7%.
Conclusions
The incidence of VTE in patients with severe NCP is 25% (20/81), which may be related to poor prognosis. The significant increase of D‐dimer in severe NCP patients is a good index for identifying high‐risk groups of VTE.
Background
Coagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID‐19 patients.
...Objectives
Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID‐19 patients.
Patients and methods
We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID‐19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.
Results
From March 19 to April 11, 2020, 26 consecutive patients with severe COVID‐19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID‐19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.
Conclusion
Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID‐19 patients.
Coronavirus disease-2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the ...venous and arterial circulations, because of excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, the authors review the current understanding of the pathogenesis, epidemiology, management, and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, of those with pre-existing thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To assess the benefits and risks of standard‐ versus extended‐duration anticoagulation for primary VTE ...prophylaxis in acutely ill medical patients.
Coagulopathy in COVID-19 is a burning issue and strategies to prevent thromboembolic events are debated and highly heterogeneous. The objective was to determine incidence and risk factors of venous ...thromboembolism (VTE) in COVID-19 inpatients receiving thromboprophylaxis. In this retrospective French cohort study, patients hospitalized in medical wards non-ICU with confirmed COVID-19 and adequate thromboprophylaxis were included. A systematic low limb venous duplex ultrasonography was performed at hospital discharge or earlier if deep venous thrombosis (DVT) was clinically suspected. Chest angio-CT scan was performed when pulmonary embolism (PE) was suspected. Of 71 patients, 16 developed VTE (22.5%) and 7 PE (10%) despite adequate thromboprophylaxis. D-dimers at baseline were significantly higher in patients with DVT (p < 0.001). Demographics, comorbidities, disease manifestations, severity score, and other biological parameters, including inflammatory markers, were similar in patients with and without VTE. The negative predictive value of a baseline D-dimer level < 1.0 µg/ml was 90% for VTE and 98% for PE. The positive predictive value for VTE was 44% and 67% for D-dimer level ≥ 1.0 µg/ml and ≥ 3 µg/ml, respectively. The association between D-dimer level and VTE risk increased by taking into account the latest available D-dimer level prior to venous duplex ultrasonography for the patients with monitoring of D-dimer. Despite thromboprophylaxis, the risk of VTE is high in COVID-19 non-ICU inpatients. Increased D-dimer concentrations of more than 1.0 μg/ml predict the risk of venous thromboembolism. D-dimer level-guided aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies.
Background
Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. ...Unsuspected VTE are often referred as “asymptomatic,” “incidental,” or “clinically silent/occult” VTE.
Objective
To understand the epidemiology, management, and outcomes of uVTE in children.
Methods
A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years).
Results
Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval CI: 13%‐24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non‐CVL settings included post‐spinal surgery, post‐splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long‐term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor‐associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management.
Conclusion
Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and thromboprophylaxis. Prospective research is needed to clarify the optimal management of iVTE.
Background
Coronavirus disease 2019 (COVID‐19) can lead to systemic coagulation activation and thrombotic complications.
Objectives
To investigate the incidence of objectively confirmed venous ...thromboembolism (VTE) in hospitalized patients with COVID‐19.
Methods
Single‐center cohort study of 198 hospitalized patients with COVID‐19.
Results
Seventy‐five patients (38%) were admitted to the intensive care unit (ICU). At time of data collection, 16 (8%) were still hospitalized and 19% had died. During a median follow‐up of 7 days (IQR, 3‐13), 39 patients (20%) were diagnosed with VTE of whom 25 (13%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7, 14 and 21 days were 16% (95% CI, 10‐22), 33% (95% CI, 23‐43) and 42% (95% CI 30‐54) respectively. For symptomatic VTE, these were 10% (95% CI, 5.8‐16), 21% (95% CI, 14‐30) and 25% (95% CI 16‐36). VTE appeared to be associated with death (adjusted HR, 2.4; 95% CI, 1.02‐5.5). The cumulative incidence of VTE was higher in the ICU (26% (95% CI, 17‐37), 47% (95% CI, 34‐58), and 59% (95% CI, 42‐72) at 7, 14 and 21 days) than on the wards (any VTE and symptomatic VTE 5.8% (95% CI, 1.4‐15), 9.2% (95% CI, 2.6‐21), and 9.2% (2.6‐21) at 7, 14, and 21 days).
Conclusions
The observed risk for VTE in COVID‐19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival.
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