Travel-related thrombosis (TRT), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk associated with long-haul travel. Prolonged immobility, dehydration, and cabin pressure changes during flights contribute to venous stasis, hypoxia, and hypercoagulability, collectively increasing the risk of venous thromboembolism (VTE). While the absolute risk of TRT is relatively low in the population overall, it rises significantly among high-risk groups, including individuals with a history of VTE, thrombophilia, pregnancy, or recent surgery. This review explores the epidemiology, pathophysiology, clinical presentation, and diagnostic evaluation of TRT while highlighting the importance of early recognition and prevention. Risk assessment models can provide guidance for identifying at-risk travelers. Preventive strategies include pharmacological prophylaxis with low-molecular-weight heparin (LMWH) for high-risk individuals and nonpharmacological measures such as compression stockings, intermittent pneumatic compression, mobility exercises, and hydration. Guidelines from international societies recommend tailored interventions based on individual risk profiles, as randomized controlled trials are scarce. Given that long-haul travel dramatically expands, this review critically analyzes the available TRT management strategies in various clinical settings, aiming to increase awareness of this global health issue.

Total hip arthroplasty (THA) is a common surgical intervention for patients who have seronegative spondyloarthropathies (SpA). However, there is a paucity of literature addressing the outcomes of THA specifically in SpA patients. This study aimed to investigate both the short-term and long-term systemic and orthopaedic outcomes of THA in SpA patients as a whole, as well as within the individual subtypes of SpA.

This retrospective cohort study used a federated health research network, identifying 3,074 SpA patients who underwent THA between 2005 and 2022. Propensity score matching was used to compare SpA and non-SpA patients, balancing baseline characteristics. Short-term (30 days, 180 days, and 1 year) and long-term (5 years) postoperative complications were analyzed. The outcomes included systemic and joint complications. Chi-square analyses were done to compare outcomes across categorical data.

The SpA patients had increased rates of revision THA, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening at various postoperative intervals. Surgical site infections and myocardial infarctions were more frequent at 1 month, 6 months, and 1 year. Additionally, SpA patients exhibited a higher incidence of deep vein thrombosis at 6 months and 1 year. Subtype analysis revealed that ankylosing spondylitis patients were more likely to have revision surgery and prosthetic dislocation, while psoriatic arthritis patients had a lower risk of hip dislocation and femur fractures.

The SpA patients undergoing THA are at greater risk for systemic and orthopaedic complications compared to non-SpA patients. The increased incidence of infections, thromboembolic events, and prosthetic issues highlights the need for careful preoperative assessment and postoperative management.

To investigate the current status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery in Japan.

We reviewed data on eight gastroenterological procedures from the Japanese National Clinical Database (NCD), accrued between 2018 and 2020. Patient characteristics, prophylactic methods, postoperative bleeding, cardiac arrest, and postoperative mortality rate within 30 days were retrieved.

Despite recommendations, approximately 30% of patients did not receive VTE prophylaxis, suggesting a lack of awareness. Pharmacological prophylaxis was associated with a higher incidence of VTE than mechanical or no prophylaxis for all procedures. Combined prophylaxis resulted in a lower incidence of VTE than pharmacological prophylaxis alone. Pharmacological prophylaxis was also associated with an increased incidence of bleeding events. The risk of cardiac arrest and death was higher in patients with pulmonary embolism (PE), but there was a trend toward lower mortality in the group that received pharmacological prophylaxis.

Pharmacological prophylaxis for VTE was limited in reducing the incidence of VTE, but it may reduce the risk of death. Combining pharmacological and mechanical prophylaxis tended to be more effective for preventing VTE than either method alone. Conversely, pharmacological prophylaxis may increase the risk of bleeding.

Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol.

We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 - 2018 (early cohort) and 2019 - 2020 (late cohort) and stratified before and after the intervention.

Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p < 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03).

BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS.

Despite the broad utilization of aspirin (ASA) as a venous thromboembolism (VTE) chemoprophylactic agent following total knee arthroplasty (TKA) and total hip arthroplasty (THA), few studies have evaluated its safety and efficacy in patients who had a history of VTE. This study sought to evaluate the safety and efficacy of ASA relative to enoxaparin in high-risk total joint arthroplasty patients.

An all-payer claims database was queried for primary, elective THA, and TKA patients from January 2015 to December 2021. Patients who had a history of VTE were divided based on receipt of either ASA or enoxaparin as VTE prophylaxis. In a 1:1 ratio, 1,429 THA and 2,864 TKA high-risk ASA patients were matched to high-risk enoxaparin patients on age, sex, race, and presence of pertinent comorbidities. Multivariable regression analyses accounted for potential confounders.

After multivariable analyses, similar risk of pulmonary embolism (THA: adjusted odds ratio [aOR]: 0.85, 95% confidence interval [CI]: 0.26 to 2.76; TKA: aOR: 0.71, 95% CI: 0.38 to 1.32) and deep vein thrombosis (DVT) (THA: aOR: 1.12, 95% CI: 0.53 to 2.36) was observed in the ASA cohorts relative to the enoxaparin cohorts. TKA patients in the ASA cohort had a lower risk of DVT than those in the enoxaparin cohort (aOR: 0.57, 95% CI: 0.33 to 0.96). THA ASA patients demonstrated a reduced risk of stroke (aOR: 0.03, 95% CI: 0.00 to 0.73), while TKA ASA patients had a lower risk of acute blood loss anemia (aOR: 0.77, 95% CI: 0.66 to 0.88).

High-risk patients who received ASA demonstrated similar risk of pulmonary embolism and DVT, but decreased risk of bleeding-related and medical complications compared to patients who received enoxaparin. The utilization of ASA in high-risk patients was not associated with an increased risk of adverse outcomes.

This meta-analysis aims to evaluate the effect of prophylactic anticoagulation on incidence of venous thromboembolism (VTE), bleeding events, and mortality in hospitalized cirrhotic patients.

We utilized the following databases (EMBASE, PubMed, MedRxiv and google-scholar) to search for studies that satisfied the reviewers pre-specified inclusion criteria. The incidence of VTE, bleeding risks, and mortality were assessed using a quality effect meta-analytic model.

From screening of 539 studies, a total of 9 studies (n = 6275 patients) satisfied inclusion criteria. Our results suggested no significant difference in the primary outcome of VTE events in both groups of cirrhotic patients who received and did not receive anticoagulation for VTE prophylaxis, (OR:0.9, 95 % CI:0.50-1.62). Similarly, there was a non-significant reduced risk of bleeding events in hospitalized cirrhotic amongst patient cohorts receiving VTE prophylaxis compared to those who did not (OR:0.51, 95 % CI:0.22-1.14). Analysis of three studies showed no significant difference in mortality in both groups (OR 1.02, 95 % CI:0.8-1.31).

In a pooled examination of studies evaluating outcomes in patients exposed to VTE prophylactic anticoagulation, we found no significant difference in the burden of VTE or mortality between treated and untreated patients with chronic liver disease (CLD). The retrospective design of a plurality of studies enrolled in the review meant further prospective studies are needed to objectively ascertain the efficacy and safety of VTE prophylaxis amongst patient cohorts with CLD.

Managing anticoagulant and antiplatelet therapy in elderly patients with high cardiovascular risk undergoing degenerative lumbosacral spine surgery is a complex challenge. Balancing the reduction of thromboembolic events and minimizing bleeding risks requires tailored perioperative strategies. This study evaluates the outcomes of a standardized management approach for such therapies in this vulnerable population.

A retrospective analysis was conducted on 578 patients aged 60 years or older undergoing elective surgery for lumbar spinal stenosis, lumbar disc herniation, or spondylolisthesis. Patients were categorized into three groups based on their antithrombotic regimen: no therapy (Group A), primary prevention therapy (Group B), and secondary prevention therapy (Group C). Perioperative bridging with enoxaparin or low-dose aspirin was applied where indicated. Clinical outcomes, including surgical duration, blood loss, postoperative complications (Clavien-Dindo scale), and hospitalization length, were assessed.

No significant differences were observed in intraoperative blood loss or surgical duration across groups. Hospitalization duration was shorter in Group B compared with Group A for lumbar stenosis ( P = .01) and in Group C compared with Group A for disc herniation ( P < .01). Complications were predominantly Grade I or II, with no major bleeding or cardiovascular events recorded. The management demonstrated safety and efficacy in maintaining cardiovascular protection while controlling bleeding risks.

This study highlights the feasibility of individualized perioperative management of antithrombotic therapy in high-risk patients undergoing elective degenerative spine surgery. The findings support the development of standardized management strategies to optimize surgical outcomes without compromising patient safety. Further prospective studies are needed to refine these strategies.

To explore the use of large datasets in predicting and managing cancer-associated venous thromboembolism (CAT) by stratifying patients into risk groups. This includes evaluating current predictive models and identifying potential improvements to enhance clinical decision-making.

Cancer patients are at an elevated risk of developing venous thromboembolism (VTE), which significantly impacts mortality and quality of life. Traditional approaches to risk assessment fail to account for the procoagulant changes associated with cancer, making individualized risk prediction a challenge. Current clinical guidelines as per ASCO recommend risk assessment before chemotherapy and endorse thromboprophylaxis as a standard preventive measure. Since any cancer population is highly heterogeneous in terms of VTE risk, predicting the risk of CAT is an oncological challenge. To address this, different predictive models have been developed to stratify patients by risk, enabling targeted thromboprophylaxis. However, these models vary in accuracy and utility. The present review discusses the pros and cons of these different models.

The review examines existing CAT risk prediction models, highlighting their strengths, limitations, and diagnostic performance. It also identifies additional variables that could enhance these models to improve their effectiveness in guiding clinicians toward better risk stratification and treatment decisions for cancer patients.

This study aimed to evaluate the necessity of anticoagulant therapy with an Xa inhibitor for asymptomatic acute distal lower-limb deep vein thrombosis (DVT) detected on ultrasonography after total hip arthroplasty (THA).

After exclusions, patients who underwent primary cementless THA were divided into treatment and no-treatment groups based on whether they received anticoagulant therapy with an Xa inhibitor for asymptomatic acute distal lower-limb DVT. Residual distal lower-limb DVT at 3 months, incidence of proximal DVT, and symptomatic venous thromboembolism (VTE) after THA were compared between the groups.

A total of 574 patients met the inclusion criteria (treatment group, n = 287; no-treatment group, n = 287). Residual distal lower-limb DVT at 3 months was detected in 3 patients (1.0%) in the treatment group and in 10 patients (3.5%) in the no-treatment group. No symptomatic VTE was observed in either group. No significant difference was observed between the two groups, although the no-treatment group tended to have a higher residual rate of acute distal lower-limb DVT.

The necessity of anticoagulant therapy for asymptomatic acute distal lower-limb DVT was not confirmed.

Appropriate chemical prophylaxis can reduce the risk of venous thromboembolism (VTE) in trauma patients. A system-wide VTE clinical practice guideline (CPG) and electronic health record (EHR)-based VTE prophylaxis order set were implemented. The CPG provided guidelines based on bleeding risk, recommended earlier initiation of chemical prophylaxis, and favored low-molecular-weight heparin (LMWH). The purpose of this study was to evaluate the impact of VTE CPG and prophylaxis order set on the rate of VTE.

A retrospective review was performed on trauma patients 15 years or older admitted to three trauma centers between July 2018 and December 2021. Exclusion criteria included burn injury, readmission, length of stay <2 days, and withdrawal of care. The VTE CPG and EHR order set were implemented in November 2020, and a pre-implementation/postimplementation (POST) comparison was conducted.

A total of 12,479 patients were included. There were no differences in age, sex, and Injury Severity Score. The POST group had a higher usage of LMWH (64.0 vs. 67.5%, p < 0.01), a lower rate of no prophylaxis (17.2 vs. 12.5%, p < 0.01), and a shorter time to prophylaxis (29.4 vs. 25.9 hours, p < 0.01). The rates of VTE (1.6 vs. 1.0%, p < 0.01) and deep vein thrombosis (1.1 vs. 0.7%, p = 0.03) were lower in the POST group. There was no difference in the rate of pulmonary embolism (0.6 vs. 0.4%, p = 0.06). The POST group had a higher mortality (0.7 vs. 1.1%, p = 0.03) on univariable analysis, but there were no differences between groups on adjusted analysis. Independent predictors of VTE were longer time to VTE prophylaxis, higher Injury Severity Score, ventilator-associated pneumonia, and longer hospital length of stay. Use of LMWH and postintervention period were protective from VTE.

The implementation of a system-wide VTE CPG and EHR-based prophylaxis order set were associated with a reduced incidence of VTE in trauma patients without an associated mortality difference.

Prognostic and Epidemiological; Level IV.

Cryptogenic stroke (CS) in young adults may be associated with the presence of a patent foramen ovale (PFO). This case report presents a woman in her 40s admitted with sudden left hemiplegia. Imaging confirmed an ischaemic stroke in the right middle cerebral artery territory and occlusion of the right internal carotid artery. Further investigations identified a large PFO associated with an atrial septal aneurysm. An in-depth assessment revealed a distal deep vein thrombosis (DVT). Initial anticoagulation therapy was interrupted due to severe metrorrhagia, necessitating the placement of an inferior vena cava (IVC) filter. Subsequent extensive thrombosis of the IVC led to initiation of low molecular weight heparin followed by long-term direct oral anticoagulants. This case highlights the complexity of managing CS with PFO, emphasising the importance of thorough aetiological evaluation to distinguish pathogenic from incidental PFO, and the need for a personalised and multidisciplinary therapeutic strategy to balance thromboembolic and haemorrhagic risks effectively.

Patients who have atrial fibrillation frequently require long-term anticoagulation with warfarin or a direct-acting oral anticoagulant (DOAC), such as apixaban or rivaroxaban, to avoid vascular complications. However, the impact of anticoagulant use on postoperative complications following total knee arthroplasty (TKA) in an outpatient setting has not been thoroughly elucidated. The purpose of this study was to examine the impact of anticoagulant use on early postoperative complications among atrial fibrillation patients undergoing outpatient TKA.

An insurance claims database was queried to identify all patients who underwent outpatient TKA between January 2010 and April 2022. There were two cohorts of patients, with associated 1:1 matched controls, who had atrial fibrillation and filled a prescription of either warfarin (N = 4,396) or DOAC (N = 5,383) for at least 30 days. The mean age was 70 years (range, 51 to 84), and 47.9% were women in the warfarin cohort, while the mean age was 70 years and 49.2% were women in the DOAC cohort. Postoperative 30-day medical and 90-day surgical complications were subsequently compared.

Patients on warfarin had a higher incidence of pulmonary embolism (1.1 versus 0.2%, P < 0.001) and a lower incidence of TKA revision (0.1 versus 0.4%, P = 0.003) than matched controls. Similarly, patients on DOACs exhibited a higher incidence of pneumonia (1.4 versus 0.6%, P < 0.001) and myocardial infarction (3.2 versus 1.5%, P < 0.001) and a lower incidence of wound dehiscence (0.1 versus 0.5%, P < 0.001), joint infection (0.4 versus 0.9%, P = 0.002), and TKA revision (0.1 versus 0.4%, P = 0.002) than matched controls.

Atrial fibrillation patients on long-term anticoagulants undergoing outpatient TKA experience higher rates of medical complications and lower rates of surgical complications than matched controls. Thus, patients on long-term anticoagulants may be considered for outpatient TKA but should be counseled appropriately on associated medical risks.

During hospitalization, a significant number of patients at risk of thromboembolism do not receive prophylaxis, despite established standards and viable procedures for preventing deep vein thrombosis (DVT). This study aimed to assess the appropriateness of vein thrombosis prophylaxis use among patients admitted to the medical ward of Debre Tabor Comprehensive Specialized Hospital (DTCSH) in Northwest Ethiopia.

An observational follow-up study was conducted in the medical wards of Debre Tabor Comprehensive Specialized Hospital in Northwest Ethiopia to determine whether thromboprophylaxis was appropriately used, based on the Padua risk assessment tool. To identify factors associated with the occurrence of inappropriate thromboprophylaxis use, a binary logistic regression model was used. Statistical significance was considered when the p-value was <0.05, with a 95% confidence interval.

Among the 365 patients in the study, 21.37% received inappropriate thromboprophylaxis, while 78.63% received it correctly. Patients admitted to the ICU [AOR = 4.276, 95% CI: 1.878-16.134; p = 0.000], those who stayed for more than 6 days [AOR =6.192, 95% CI: 2.085-14.391; p = 0.000], and general practitioners [AOR = 1.816, 95% CI: 1.007-3.207; p = 0.048] were more likely to receive inappropriate thrombophylaxis.

The appropriateness of DVT prophylaxis use was suboptimal, especially among the patients treated by general practitioners, those hospitalized in the intensive care unit, and those who stayed for more than a few days in the ward. Using an integrated risk stratification checklist is an effective way to promote the more rational use of DVT prophylaxis.

Neurosurgery patients are at high risk of developing venous thromboembolism (VTE) which increases the risk of morbidity and mortality. This study is designed to investigate the effectiveness and safety of sulodexide in combination with routine VTE prophylaxis compared with routine VTE prophylaxis alone for VTE prevention in neurosurgical patients. This retrospective, cohort study included neurosurgical patients received routine VTE prophylaxis (control group) or routine VTE prophylaxis plus sulodexide (experimental group) during hospitalization. Predictors of VTE during hospitalization were determined using multivariable logistic regression. A total of 694 eligible patients were included in this study. The incidence of VTE in the experimental group (4.52%, 10/221) was lower compared with that in the control group (6.98%, 33/473) (P = 0.212). The change from baseline in serum creatinine and blood urea nitrogen of the experimental group was significantly higher compared with that in the control group (both P < 0.05). In elderly patients (>65 years), VTE incidence in the experimental group was 3.51% which was significantly lower than that in the control group (10.8%; P = 0.03) and odd ratio [OR] was 0.3 (95% confidence interval [CI]: 0.07, 0.92). Multivariate logistic regression analysis revealed that use of sulodexide plus routine VTE prophylaxis (OR = 0.172, 95% CI: 0.055, 0.535; P = 0.006) and baseline Glasgow Coma Scale (GCS) score (OR = 0.587, 95% CI: 0.521, 0.792; P < 0.001) were protective factors for VTE risk, and the length of hospital stay (OR = 1.134, 95% CI: 1.021, 1.199; P=0.007) was a risk factor for VTE. Sulodexide in combination with routine VTE prophylaxis effectively reduces the risk of VTE in neurosurgical patients. A high baseline GCS score is a protective factor for VTE, whereas length of hospital stay is a risk factor for VTE.

Taking a historical perspective, we review the discovery, pharmacology, and clinical evaluation of the old and new anticoagulants that have been approved for clinical use. The drugs are discussed chronologically, starting in the 1880s, and progressing through to 2024. The innovations in technology used to develop novel anticoagulants came in fits and starts and reflected the advances in science and technology over these decades, whereas the shift from anecdote to evidence-based use of anticoagulants was delayed until the principles of epidemiology and biostatistics were introduced into clinical trial design and to the approval process. Hirudin, heparin, and vitamin K antagonists were discovered by chance, and were used clinically before their mechanism of action was elucidated and before their net clinical benefits were evaluated in randomized clinical trials. Subsequent anticoagulants were designed based on a better understanding of the structure and function of coagulation proteins, including antithrombin, thrombin, and factor Xa, and underwent more rigorous preclinical and clinical evaluation before regulatory approval. By simplifying oral anticoagulation, the direct oral anticoagulants have revolutionized anticoagulation care and have enhanced the uptake of anticoagulation, but bleeding has not been eliminated and there is a need for more effective and convenient anticoagulants for thrombosis triggered by the contact pathway of coagulation. The newly developed factor XIa and XIIa inhibitors have the potential to address these unmet clinical needs and are undergoing clinical evaluation for several indications. SIGNIFICANCE STATEMENT: Anticoagulant therapy is the cornerstone of treatment and prevention of thrombosis, which remains a leading cause of morbidity and mortality worldwide. Elucidation of the structure and function of coagulation enzymes, their cofactors, and inhibitors, coupled with advances in structure-based design led to the discovery of more convenient, safer, and more effective anticoagulants that have revolutionized the management of thrombotic disorders.

The interpretation of plain hip radiographs can vary widely among physicians. This study aimed to develop and validate a deep learning-based screening model for distinguishing normal hips from severe hip diseases on plain radiographs.

Electronic medical records and plain radiograph from 2004 to 2012 were used to construct two patient groups: the hip disease group (those who underwent total hip arthroplasty) and normal group. A total of 1,726 radiographs (500 normal hip radiographs and 1,226 radiographs with hip diseases, respectively) were included and were allocated for training (320 and 783), validation (80 and 196), and test (100 and 247) groups. Four different models were designed-raw image for both training and test set, preprocessed image for training but raw image for the test set, preprocessed images for both sets, and change of backbone algorithm from DenseNet to EfficientNet. The deep learning models were compared in terms of accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1-score, and area under the receiver operating characteristic curve (AUROC).

The mean age of the patients was 54.0 ± 14.8 years in the hip disease group and 49.8 ± 14.9 years in the normal group. The final model showed highest performance in both the internal test set (accuracy 0.96, sensitivity 0.96, specificity 0.97, PPV 0.99, NPV 0.99, F1-score 0.97, and AUROC 0.99) and the external validation set (accuracy 0.94, sensitivity 0.93, specificity 0.96, PPV 0.95, NPV 0.93, F1-score 0.94, and AUROC 0.98). In the gradcam image, while the first model depended on unrelated marks of radiograph, the second and third model mainly focused on the femur shaft and sciatic notch, respectively.

The deep learning-based model showed high accuracy and reliability in screening hip diseases on plain radiographs, potentially aiding physicians in more accurately diagnosing hip conditions.

Venous thromboembolism (VTE) is an important global health problem and the third most prevalent cardiovascular disorder. It has been proven that computerized tools were helpful in the prevention and control of VTE. However, studies that focused on the acceptance of computerized tools for VTE prevention among healthcare workers were limited.

This study aims to explore what factors are influencing healthcare workers' acceptance of the Artificial Intelligence Clinical Assistant Decision Support System (AI-CDSS) for VTE prevention based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT).

We conducted a cross-sectional survey among healthcare workers in three grade-A tertiary hospitals in Shanxi, China. Statistically, the hypothesized model was evaluated by AMOS structural equation modeling.

510 (72.86%) valid surveys were collected in total. The results showed that performance expectancy (β = 0.45, P < 0.001), effort expectancy (β = 0.21, P < 0.001), and top management support (β = 0.30, P < 0.001) positively influenced healthcare workers' intention. Top management support was an antecedent of performance expectancy (β = 0.41 , P < 0.001), social influence (β = 0.57, P < 0.001), effort expectancy (β = 0.61, P < 0.001), and information quality (β = 0.59, P < 0.001). In addition, Social influence positively influenced performance expectancy (β = 0.52, P < 0.001), and information quality positively influenced system quality (β = 0.65, P < 0.001). Social influence did not influence nurses' behavioral intention (β = 0.06, p = 0.376), but negatively influenced clinicians' behavioral intention in the model (β = -0.19, P < 0.001). System quality positively influenced nurses' behavioral intention; (β = 0.16, P < 0.001), and information quality positively influenced clinicians' behavioral intention (β = 0.15, p = 0.025).

With this model explaining 76.3% variance of the behavioral intention variable, this study could be useful as a reference for hospital administrators to evaluate future developments and facilitate the implementation of AI-CDSS for VTE prevention.

Venous Thromboembolism (VTE) is a common, preventable complication in trauma. Low-molecular-weight heparin (LMWH) is recommended for VTE prophylaxis (VTEp). We investigated whether switching from fixed-dose dalteparin to anti-Xa-guided enoxaparin prophylaxis reduces VTE without increasing the risk of bleeding among hospitalized trauma patients.

This observational study compared injured patients admitted one year before (pre-P) and after (post-P) implementing a new VTEp protocol. The protocol was introduced as a performance improvement project (subcutaneous enoxaparin 30 mg twice daily), with dose calibration to peak plasma Anti-Xa level measured after the 3rd dose. The primary outcomes were the rate of VTE and bleeding.

After protocol implementation (post-P), 305 patients were compared to 350 pre-protocol patients (pre-P). Anti-Xa levels were measured in 83% of post-P and none in the pre-P. 40% had low levels of anti-Xa, suggesting inadequate prophylaxis, and enoxaparin doses were accordingly increased. 51% attained the desired anti-Xa levels, 9% had higher levels, and LMWH doses were subsequently reduced. VTE incidence after protocol implementation decreased from 4 to 1.3% (OR 0.31; 95% CI 0.1-0.9, P = 0.03) without increasing the bleeding rate. The time intervals between two consecutive PE events were significantly longer after protocol implementation. Among TBI patients, the rate of VTE was lower. However, it did not reach statistical significance. 75% of patients with VTE had low anti-Xa levels, while 20% of those with bleeding had high anti-Xa levels.

Among adult patients in the trauma ICU, compared to a fixed dose dalteparin, enoxaparin prophylaxis with dose calibration according to peak anti-Xa levels was associated with lower VTE rates without increasing the risk of bleeding. About 40% of patients who received initial enoxaparin doses of 30 mg twice daily had anti-Xa levels suggestive of inadequate prophylaxis. Calibrating LMWH dosing may improve VTEp following traumatic injury.

Background: The routine use of venous thromboembolism (VTE) prophylaxis in breast cancer surgery has caused substantial polarity among breast cancer surgeons across the globe. The aim of this study is to assess the use of VTE prophylaxis in breast cancer surgery outcomes. Methods: A comprehensive electronic search was undertaken of all comparative studies that described the role of VTE prophylaxis in breast cancer surgery. Studies that reported on postoperative outcomes between patients who received VTE prophylaxis (prophylaxis) and those who did not (no prophylaxis) were included in the review. A meta-analysis using random-effect model was used to analyse key outcomes, with data presented as odd ratio (OR). Results: A total of 2470 patients from 6 studies were included in this study. Among these patients, 60.9% (n: 1504) received prophylaxis. The haematoma rate in this study is 0.05% (n: 133). The incidence of haematoma was significantly associated with the use of prophylaxis (6.85% versus 3.11%, p : 0.001). Surgical intervention for haematomas was also significantly associated in this group (3.15% versus 0.83%, p : 0.004). However, there was no difference in VTE events between both groups (0.26% versus 0.36%, p : 0.88). Conclusions: The use of VTE prophylaxis in breast cancer surgery is associated with increased haematomas without any benefit in preventing VTE events. Future studies that examine the use of risk assessment tools for VTE prophylaxis in high risk patients may be beneficial.

Hemorrhagic complications associated with regional anesthesia are extremely rare. The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy reviews the published evidence since 2018 and provides guidance to help avoid this potentially catastrophic complication.The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy uses similar methodology as previous editions but is reorganized and significantly condensed. Therefore, the clinicians are encouraged to review the earlier texts for more detailed descriptions of methods, clinical trials, case series and pharmacology. It is impossible to perform large, randomized controlled trials evaluating a complication this rare; therefore, where the evidence is limited, the authors continue to maintain an 'antihemorrhagic' approach focused on patient safety and have proposed conservative times for the interruption of therapy prior to neural blockade. In previous versions, the anticoagulant doses were described as prophylactic and therapeutic. In this version, we will be using 'low dose' and 'high dose,' which will allow us to be consistent with other published guidelines and more accurately describe the dose in the setting of specific patient characteristics and indications. For example, the same 'high' dose may be used in one patient as a treatment for deep venous thrombosis (DVT) and in another patient as prophylaxis for recurrent DVT. Due to the increasing ability to obtain drug-specific assays, we have included suggestions for when ordering these tests may be helpful and guide practice. Like previous editions, at the end of each recommendation the authors have clearly noted how the recommendation has changed from previous editions.

Venous thromboembolism (VTE) is a significant preventable cause of postoperative morbidity and mortality after major abdominopelvic surgery that calls for extended VTE prophylaxis (eVTEp). Literature suggests that significant racial disparities may exist in post-operative care.

The study sought to examine if racial disparities exist in the administration of eVTEp after hysterectomy in a statewide collaborative.

We conducted a retrospective cohort study of post-hysterectomy patients across 69 hospitals in the Michigan Surgical Quality Collaborative from January 2016 to February 2020. The variable of interest was race (Black/African or White American). The primary outcome was administration or absence of eVTEp. Descriptive statistics and mixed effects logistic regression were performed for risk adjustment with covariates such as age, cancer occurrence, inflammatory bowel disease, American Society of Anesthesiologists physical status classification, perioperative VTE prophylaxis, postoperative VTE prophylaxis, surgical approach, and surgical duration, among other variables.

In total, 24,513 patients underwent hysterectomy. Of these patients, 1,107 (4.45%) received eVTEp, 153 (13.24%) of which were Black and 954 (82.53%) of which were White. Mixed effects logistic regression analysis suggested that Black patients were significantly less likely to receive eVTEp than White patients (odds ratio = 0.776; 95% CI: 0.615-0.979; P = 0.039). Additionally, tobacco use, coronary artery disease, bleeding disorder, cancer occurrence, functional status, perioperative VTE prophylaxis, surgical duration, length of stay, and surgical approach were associated with a higher likelihood of receiving eVTEp.

eVTEp is recommended for the prevention of post-discharge VTE in select patients after hysterectomy. Regression analysis showed that, compared to their White counterparts, Black females were significantly less likely to receive eVTEp. The underlying reasons for this disparity require further investigation into possible socioeconomic influences and inherent biases.

Aims/Background Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. Methods The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. Results Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention (p > 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups (p > 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group (p < 0.05). Conclusion The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile.

Tuberculosis (TB) induces a hypercoagulable state characterized by systemic inflammation, endothelial dysfunction, and alterations in the coagulation and fibrinolytic pathways. This review explores the pathophysiological mechanisms underlying hypercoagulability in TB, including increased pro-inflammatory cytokine release, endothelial damage, platelet activation, and reduced anticoagulant and fibrinolytic activity. These factors contribute to an elevated risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), which complicate TB prognosis and treatment. The potential role of adjunctive anti-inflammatory therapies, such as vitamin D, NSAIDs, corticosteroids, and anti-platelet agents, is highlighted as a strategy to mitigate systemic inflammation and reduce thrombotic risks in patients with TB. The challenges of anticoagulation therapy, particularly in managing the interactions between anti-TB medications and traditional anticoagulants, are discussed, along with the potential of novel oral anticoagulants (NOAs) as alternatives. We also address therapy of hypercoagulability in TB within resource-limited settings which requires low-cost diagnostics, accessible anticoagulation options, adjunctive therapies, and preventive strategies integrated into existing healthcare systems. Effective risk stratification and individualized management strategies are vital for reducing the morbidity and mortality associated with thrombotic complications in TB.

Cerebral venous thrombosis (CVT) is a rare but potentially life-threatening condition characterized by the formation of a blood clot in the dural venous sinuses or cerebral veins. CVT presents a diverse array of clinical symptoms, making its diagnosis challenging. Understanding regional variations and specific risk factors associated with CVT is crucial, especially in low-resource settings like Somalia, where epidemiological data is limited and healthcare resources are scarce.

This study aims to investigate the clinical and risk factors associated with CVT in patients presenting to Mogadishu Somali-Turkey Recep Tayyip Erdogan Research and Training Hospital, a tertiary hospital in Mogadishu, Somalia.

We conducted a retrospective observational study involving 68 patients diagnosed with CVT between January 2019 and December 2023. Data included demographic information, clinical presentations, risk factors, and anatomical thrombosis locations. Descriptive statistics and chi-square tests were used for analysis.

The majority of patients were female (86.76%) and aged 20-40 years (86.76%). Significant risk factors included the postpartum period (77.94%) and pregnancy, with statistical analysis showing strong associations between CVT and the postpartum period (χ² = 62.96, p < 0.0001) and pregnancy (χ² = 5.21, p = 0.022). Postpartum CVT was linked to thrombosis location (p = 0.025). Headache was the predominant symptom (98.53%), followed by altered mental status (83.82%), focal motor deficits (80.88%), and seizures (70.59%). The superior sagittal sinus was the most commonly involved site (57.35%).

This study emphasizes the postpartum period as a significant risk factor for CVT in Somalia and highlights the need for clinical vigilance and early intervention strategies. Larger, multicenter studies are needed to validate these findings.

This study aimed to assess the risk, incidence and predictors of venous thromboembolism (VTE) among patients admitted to the emergency department of tertiary hospitals in Addis Ababa city, Ethiopia.

A multicentre hospital-based prospective follow-up study was conducted.

The study was conducted in three tertiary care hospitals in Addis Ababa city, Ethiopia: Tikur Anbesa Specialized Hospital, Addis Ababa Burn Emergency and Trauma Hospital and St. Paulos Hospital Millennium Medical College.

A total of 422 patients admitted to the adult emergency wards of the selected hospitals during the study period were included.

The study assessed the level of VTE risk, incidence and independent risk factors for VTE.

Nearly half (51.7%) of the study participants were male, with a mean age of 49.36 (±17.12) years. Around one-third of patients (130, 30.8%) were unable to perform physical activity, and about two-thirds had comorbid illnesses. The most common admission diagnosis was trauma (23.7%), followed by infectious disease (19.2%). More than two-thirds (70.64%) of patients were at high risk of developing VTE according to the Padua Risk Prediction Score. Eighteen patients (4.3%) were diagnosed with VTE during their emergency stay. Multivariate Cox regression analysis revealed that patients who were physically active prior to admission (adjusted hazard ratio (AHR)=0.67, 95% CI 0.082 to 1.579, p=0.014) and those receiving pharmacological prophylaxis (AHR=0.167, 95% CI 0.037 to 0.768, p=0.021) were found to have a protective effect against the risk of developing VTE. Conversely, patients with acute infection (AHR=8.169, 95% CI 1.045 to 63.854, p=0.045) and active cancer (AHR=5.133, 95% CI 1.241 to 21.093, p=0.023) had a higher risk of VTE incidence.

The study found that the risk and incidence of VTE were high among patients in the emergency department. Absence of pharmacological prophylaxis, physical inactivity prior to admission, active cancer and acute infection were identified as independent predictors of VTE incidence during emergency ward stays.

Patients at high risk of deep vein thrombosis are recommended to undergo lower-extremity ultrasonography to screen for pulmonary embolism (PE); however, there are few reports on whether this can effectively reduce the occurrence of fatal pulmonary embolism (FPE). This study aimed to assess the risk factors associated with PE and to investigate whether perioperative ultrasound screening of lower extremity veins in orthopedic patients can effectively reduce the incidence of FPE. We enrolled 137 patients with PE who underwent orthopedic surgery between 2013 and 2020. Patients were divided into survival and non-survival groups based on whether FPE occurred during hospitalization. Demographic and clinical data were compared between groups. Ultrasound screening was effective in reducing the incidence of FPE in orthopedic patients. Thrombolytic therapy and computed tomography pulmonary angiography (CTPA) were highlighted factors that protect against FPE. Coronary heart disease was found to be independent risk factors for FPE. Proximal thrombus associated with an FPE. Ultrasound screening of the lower limb veins should be routinely performed in orthopedic patients during the perioperative period. Prophylactic inferior vena cava filter implantation, thrombolytic therapy, and CTPA can be performed in patients with suspected PE to reduce its incidence.

Advancements in the management of venous disease have been documented in scientific literature. We performed a bibliometric analysis using citations as an indication of impact to analyze the most influential articles on venous disease and treatment.

A retrospective search of the Web of Science database was conducted in May 2023. Key search terms were queried to generate relevant articles. Articles were ranked on total number of citations and average number of citations per year. Metrics analyzed included top journals, impact factor, journal discipline, institution and country of publication, author degree and gender, number of publications per year, level of evidence, and article topic area.

The top 100 articles on venous disease were published between 1994 and 2020, with a total of 102,856 citations, average 1,028 citations/article, and mean of 70 citations/year. The most popular article was "Incidence of thrombotic complications of in critically ill Intensive Care Unit patients with COVID-19" with 3,482 citations in total. The most popular journals were New England Journal of Medicine (22 articles), Lancet (14 articles), and CHEST (13 articles), pertaining to management of deep venous thrombosis (DVT). The Journal of Vascular surgery had 2 influential articles, focused on management of chronic venous disease. Many articles were published in the United States (52), Canada (38), and Netherlands (25). Prolific authors were predominantly male (96%) and 59% were MDs versus 29% combined MD/PhD and 12% PhDs. Popular venous articles included guidelines/standards for DVT management (12%), epidemiology of venous thromboembolism (12%), and anticoagulation for DVT (12%). Specific venous thromboembolism risk factors within popular literature included prothrombotic genes, malignancy, pregnancy, trauma, and COVID-19. Articles on surgical interventions included inferior vena cava filter placement, catheter-directed thrombolysis, and risks of femoral and subclavian vein catheterization. Venous stenting and mechanical thrombectomy were not within the top articles.

Top-cited articles on venous disease emphasized management of DVT, followed by chronic venous disease, through the collaboration of multiple medical and surgical specialties. The largest number of citations in recent DVT literature was driven by COVID-19 complications.

Venous thromboembolism (VTE) is a significant concern in vascular surgery due to its potentially severe consequences. Effective prophylactic measures are essential to minimize the risks associated with VTE. However, considerable controversy remains regarding the optimal strategies for VTE prevention in patients undergoing vascular procedures.

This review critically analyzes key clinical research, guidelines, and expert opinions to explore the advantages and limitations of various VTE prophylaxis approaches. The pharmacological and mechanical methods are explored, with a focus on balancing the risk of VTE against the potential for bleeding complications, particularly in high-risk patients.

The review addresses controversial issues such as the choice of anticoagulants, dosage, timing, and duration of prophylaxis. The lack of consensus in existing guidelines and the variability in clinical practice regarding VTE prevention in vascular surgery patients is highlighted. The role of patient-specific risk factors, including the use of intraoperative anticoagulation and bleeding risks, is also examined.

This review provides a comprehensive evaluation of VTE prophylaxis strategies in vascular surgery, emphasizing the need for individualized, evidence-based approaches. Clarifying these controversies is crucial for optimizing patient outcomes and minimizing both thrombotic and hemorrhagic complications.

To explore the relationship between the systemic immune-inflammation index (SII) and deep venous thrombosis (DVT) in patients with spinal cord injury (SCI).

This cross-sectional study included data from 382 participants with SCI. The SII was calculated for all participants. Logistic regression, smooth curve fitting, interaction effects were used to substantiate the research objectives.

The overall prevalence of DVT was 23.1% (22.4% among males, 25.6% among females). A positive association between SII and the risk for DVT was observed (odds ratio 1.39 [95% CI 1.03-1.87]; P=0.032), independent of confounders. Similar patterns of association were observed in the subgroup analysis (P values for interaction, all >0.05). Further sensitivity analyses provided confidence that the results were reliable and unlikely to be substantially altered by unmeasured confounding factors.

Results of the present suggest that higher SII may be associated with DVT in patients with SCI, highlighting a potential link between SII and DVT. These findings underscore the potential of SII as a valuable predictive biomarker for DVT, thus offering a promising avenue for early detection and intervention strategies in patients with SCI.

Randomized controlled trials suggest that prophylactic doses of anticoagulants effectively prevent venous thromboembolism (VTE) in hospitalized medical patients with high thromboembolic risk. However, no prospective studies exist regarding the real-world prevalence of prophylactic anticoagulant use. This prospective study aimed to determine the rate and predictors of thromboprophylaxis in an unselected population of patients hospitalized in medical departments.

We conducted a multicenter prospective observational study (AURELIO - rAte of venous thrombosis in acutely iLl patIents hOspitalized) to assess the rate of deep vein thrombosis (DVT) in unselected acutely ill patients hospitalized in medical wards using compression ultrasound (CUS) at admission and discharge. Additionally, we evaluated the rate of pharmacological thromboprophylaxis administration in this population and analyzed the thrombotic risk by assessing RAMs (Risk Assessment Models) such as the IMPROVE-VTE and PADUA scores following the clinician's decision to administer thromboprophylaxis. Patients with IMPROVE-VTE scores ≥3 and/or PADUA scores ≥4 were classified as high thrombotic risk; those with IMPROVE-VTE scores <3 and/or PADUA scores <4 were classified as low risk.

We recruited 2371 patients (1233 males [52 %] and 1138 females [48 %]; mean age 72 ± 16 years). The median length of hospitalization was 13 ± 12 days. Overall, 442/2371 (18.6 %) patients received prophylactic parenteral anticoagulants (subcutaneous low weight molecular heparin or fondaparinux once daily) at admission. Assessing the thrombotic risk of the population recruited 1016 (42.9 %) patients were classified as high risk and 1354 (57.1 %) were low risk. Among high-risk patients, 339/1016 (33.4 %) received anticoagulant prophylaxis compared to 103/1354 (7.6 %) low-risk patients. During hospitalization, 9 patients developed DVT, comprising 7 asymptomatic and 2 symptomatic cases of proximal DVT. Of these, 3 patients were on anticoagulant prophylaxis, while 6 were not. Among the high-risk population, 7 out of 1016 patients (0.7 %) experienced proximal DVT during hospitalization, with 2 out of these 7 (28 %) receiving anticoagulant thromboprophylaxis. In the low-risk population, 2 out of 1354 patients (0.2 %) developed DVT, with 1 out of these 2 (50 %) receiving anticoagulant thromboprophylaxis. Age, heart or respiratory failure, pneumonia, active neoplasia, previous VTE, reduced mobility, and absence of kidney failure were more frequent in patients receiving prophylaxis. Multivariable logistic regression identified age (RR 1.010; CI 95 % 1002-1019; p = 0.015), heart/respiratory failure (RR 1.609; CI 95 % 1248-2075; p < 0.0001), active neoplasia (RR 2.041; CI 95 % 1222-2141; p < 0.0001), pneumonia (RR 1.618; CI 95 % 1557-2676; p < 0.0001), previous VTE (RR 1.954; CI 95 % 1222-3125; p < 0.0001), and reduced mobility (RR 4.674; CI 95 % 3700-5905; p < 0.0001) as independent predictors of thromboprophylaxis.

This study, conducted without pre-established thromboembolic risk scores, offers a comprehensive view of venous thromboembolism prophylaxis in medical patients with acute conditions hospitalized in internal medicine departments. It reveals that advanced age, heart or respiratory failure, active cancer, pneumonia, previous VTE, and reduced mobility are predictors that may influence the decision to administer thromboprophylaxis in these patients.

This study aims to determine the prevalence of perioperative PE and outcomes in patients with RCC scheduled for nephrectomy. A total of 418 patients were included in this single-center, observational study. Three hundred patients with RCC were retrospectively reviewed between 2016 and 2020, and the remaining patients were prospectively collected between 2020 and 2022 to minimize the effect of the long-time span. Patients with incomplete medical data and those who refused to participate were excluded. The primary outcome was the prevalence of perioperative PE. Secondary outcomes were associated factors, method of PE prophylaxis, rate of intraoperative transesophageal echocardiography (TEE) utilization, and 30-day mortality. The prevalence of perioperative PE was 1.9 % and most commonly occurred during the postoperative period (75 %). The prevalence rose to 7.5 % in patients with tumor thrombus. Significant factors related to PE included smoking (OR 6.78, 95 % CI 1.13-40.56) and change in tumor thrombus stage (OR 21.55, 95 % CI 3.69-125.71). There was no difference in the rate or method of PE prophylaxis between the two groups. Of the patients, 2.9 % underwent intraoperative TEE monitoring and 0.2 % received rescue TEE. Pneumonia and acute respiratory distress syndrome were significantly correlated with PE (P < 0.001 and P = 0.03, respectively). Finally, there was no significant difference in 30-day mortality (P = 0.07). The overall prevalence of PE in patients with RCC scheduled for nephrectomy was rare but more likely to occur in those with tumor thrombus.

Central venous catheters including totally implantable venous access devices (TIVADs) have revolutionised the management of pulmonary infections and exacerbations in patients with cystic fibrosis (CF). While being better tolerated by the patient, these have allowed aggressive intravenous antibiotic therapies during recurrent hospitalisations. Given improvement in procedural strategies and operator experience, many patients with CF undergo lung transplants in the course of their disease nowadays. TIVADs can be associated with thrombosis leading to superior vena cava (SVC) obstruction and SVC syndrome which can pose a challenge, especially during the transplant surgery. We describe a case of successful management of SVC syndrome in a patient with CF undergoing a lung transplant, highlighting the strategies used to minimise risks associated with such a procedure.

Venous thromboembolism (VTE) is still considered to be a significant medical issue. Physical measures to prevent perioperative venous thrombosis include early mobilization and intermittent pneumatic compression (IPC). The aim of this study was to evaluate whether IPC can reduce the incidence of postoperative thromboembolic events in patients with oral squamous cell carcinoma (OSCC) undergoing maxillofacial surgery.

Between March 2020 and May 2021, 75 patients with OSCC who did not receive perioperative prophylaxis using IPC were retrospectively examined to determine the occurrence of postoperative thromboembolism. Accordingly, 79 patients who received perioperative thrombosis prophylaxis using an IPC system as part of surgical tumor therapy from May 2021 to September 2023 were included in the study. The primary outcome measure was the occurrence of postoperative thromboembolism.

In the control group without IPC, thromboembolic events were observed in five out of 75 patients during postoperative hospitalization. In the intervention group, no thromboembolic occurrences were identified among the 79 patients studied (p = 0.02). The mean Caprini score in the control group was 7.72, whereas in the intervention group it averaged 8.30 (p = 0.027).

The implementation of IPC-devices as supplementary perioperative thrombosis prophylaxis resulted in a notable decrease in postoperative venous thromboembolism (Number Needed to Treat = 15), which is why implementation of the system as a regular part of the clinical routine for perioperative management of OSCC patients can be considered a sensible approach.

The use of IPC enhances patient outcomes and may lead to improved postoperative care protocols in this high-risk patient population.

To determine the timing of symptomatic venous thromboemboli (VTE) in patients sustaining a pelvic and/or acetabular fracture. Secondly, to evaluate for any factors that may influence this timing.

A retrospective cohort of 47 patients with acetabular and/or pelvic ring injuries who developed VTEs at a single academic level I trauma center were identified from 2012 to 2018. The chronology of VTE diagnosis in relation to date of injury, initial surgery, final surgery, and date of discharge was evaluated. Patients who developed VTEs were then evaluated based on known risk factors for VTE to determine if any of these affected timing.

Symptomatic VTEs were diagnosed in 3.8% of patients with pelvic and/or acetabular fractures. In patients who developed a thromboembolism, diagnosis occurred on average 21.5 (± 19.2), 20.7 (± 19.9), 9.8 (± 23.4), and 4.3 (± 27.6) days after injury, index procedure, final procedure, and date of discharge. 25% of patients developed VTE more than 4 weeks after their initial injury. No known risk factors effected the timing of VTE.

The 2015 OTA expert panel recommends 4 weeks of anticoagulation for orthopedic trauma patients at high risk of VTE, which may be too short a duration. In our cohort, 25% of VTEs occurred greater than 4 weeks after injury. Additional research is needed to clarify the exact duration of anticoagulation after pelvic and acetabular fractures; however, surgeons may want to consider anticoagulating patients for greater than 4 weeks.

Level III-retrospective cohort.

Strain-gauge venous occlusion plethysmography (SGVOP) is a means of acquiring hemodynamic data non-invasively, unlike other methods used routinely for the diagnosis and follow-up of venous diseases. The present study compares the plethysmographic data with early- and mid-term routine data of patients with acute deep-vein thrombosis (DVT) who underwent pharmacomechanical thrombolysis.

Included in this retrospective study were 118 patients with acute DVT, who underwent pharmacomechanical thrombolysis between February 2018 and July 2019. Pre- and post-procedure follow-up data including CIVIQ-20 (quality of life), VCSS (Venous Clinical Severity Score), D-Dimer, Doppler USG results, venous capacity (VC), and venous outflow (VO) obtained by SGVOP were recorded and compared.

In all 118 (100%) patients who underwent the procedure, early- and mid-term patency was seen to have been provided on Doppler USG follow-up, and various degrees of venous insufficiency were identified. A statistically significant improvement was observed in VCSS, CIVIQ-20, D-Dimer, VO, and VC measurements, although when the discrepancies between CIVIQ-20 and plethysmographic measurements were examined individually during the 6-month follow-up, nine (13.1%) patients were identified with comorbidities.

Pharmacomechanical thrombolysis is an effective treatment approach for patients with acute DVT. Providing non-invasive objective data supporting the diagnosis and follow-up of venous diseases, the SGVOP approach offers significant benefits and should be considered more frequently as a viable therapy.

Venous thromboembolism (VTE) is a notable contributor to the morbidity and mortality of patients with orthopaedic trauma. Several associations have published guidelines on VTE prophylaxis, with a strong predilection toward low-molecular-weight heparin for chemoprophylaxis. However, previous recommendations may be revisited because recent high-level evidence demonstrated aspirin to be noninferior to low-molecular-weight heparin in preventing serious complications of VTE. Direct oral anticoagulants are emerging as safe alternatives to injectable medication and may offer improved patient compliance. There is no consensus on postinjury duration of chemoprophylaxis as an outpatient. Mechanical prophylaxis remains an important adjunctive VTE preventive measure for inpatients with pelvis and extremity fractures. Proteomics and novel laboratory measurements may be able to predict high-risk patients and detect early thrombus formation. Despite high-quality prospective research over the past decade, we still have much to learn about patient- and injury-specific risk factors.

Cancer-associated venous thromboembolism (CAVTE) is a preventable, life-threatening complication with a considerable morbidity and mortality. Primary venous thromboembolism (VTE) prophylaxis is currently recommended; however, the health and economic benefits have not been evaluated and compared in China. This study aimed to assess and compare the cost-effectiveness of anticoagulants in primary CAVTE prevention among cancer patients in China.

A Markov model with a 5-year horizon was established to evaluate the costs and effectiveness of direct oral anticoagulants (DOACs) compared to low-molecular-weight heparins (LMWHs) and no prevention in primary prophylaxis of CAVTE in China. Key clinical outcomes were obtained from the available clinical trials, comparing DOACs (rivaroxaban and apixaban) with LMWHs or with no thromboprophylaxis. Utility and the cost inputs were all obtained from the published literature or local data with public sources. The total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated as the main endpoints of the modal for each strategy. The assessment of uncertainty was performed involving deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA). Impact of time horizon, generic drug price, and individual DOACs were assessed in scenario and subgroup analyses.

Primary prophylaxis using DOACs were projected to yield 1.866 QALYs at a cost of $3,287.893, resulting in the ICERs of $12,895.851 (DOACs vs. no-thromboprophylaxis) and $43,613.184/QALYs (LMWHs vs. DOACs). Sensitivity analysis revealed that ICER was sensitive to the VTE and bleeding risk, drug cost of anticoagulants, self-payment ratio, and overall death rate of cancer. Probabilistic sensitivity analysis showed that DOACs and LMWHs had a 48% and 45% probability of being cost-effective at a 5-year time horizon, respectively. When the time horizon extended to 10 years, DOACs achieved a cost-effective probability of 43%. Among individual DOACs, apixaban was found to be the preferred strategy in VTE prevention due to its incremental health gain with an acceptable cost increase.

Primary thromboprophylaxis with DOACs was cost-effective in cancer patients at a willing-to-pay (WTP) threshold of $37,125.24/QALY in China. Cancer death rate, risk of VTE and major bleeding, and the drug cost assumed greater relevance and importance in the decision-making process for primary thromboprophylaxis in cancer.

Pulmonary embolism is defined as the abrupt obliteration of the trunk or a branch of the pulmonary artery by an embolus most often from a deep vein thrombosis of the lower limbs. It is serious, underdiagnosed, and can be life-threatening. We report the case of a patient who presented with a massive acute pulmonary embolism while taking olanzapine. The interest of our case lies in its rarity, its seriousness but also the possibility of prevention and adequate management in the case of any suggestive clinical symptoms.

Inflammation-induced dysregulation of the coagulation cascade and vascular stasis in hospitalized patients with acute necrotizing pancreatitis (ANP) serve as a milieu for venous thromboembolism (VTE). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are often underrecognized. We evaluated the incidence and risk factors for VTE in a cohort of patients with ANP.

All adult patients with ANP at our center between 2009 and 2022 were followed for three months after index hospitalization and categorized into cases and controls based on development of VTE. Demographic, clinical, and radiologic characteristics during admission were compared. A multivariable analysis was done to identify independent predictors for VTE. A p value of <0.05 was taken as significant.

Among 643 ANP patients, 512 [males-350, median age-52 years] were eligible for inclusion. VTE developed in 64 (12.5 %) patients - 28 DVT (5 %), 22 PE (4 %) and both in 14 (3 %) after a median 16 days from the diagnosis of ANP. Significant independent predictors for VTE on multivariable analysis were age ≥60 years (OR 1.91; 95 % CI 1.04-3.53), peri-pancreatic extent of necrosis (OR 7.61; 95 % CI 3.94-14.70), infected necrosis (OR 2.26; 95 % CI 1.13-4.50) and total length of stay ≥14 days (OR 4.08; 95 % CI 1.75-9.50).

The overall incidence of VTE in our cohort of patients with ANP was 12.5 %, which was usually diagnosed within one month of hospitalization. High-risk patients can be stratified based on clinical and imaging characteristics and may benefit from intensive DVT screening and prophylaxis during hospitalization and following discharge.

Postoperative venous thromboembolism (VTE) risk is pronounced after abdominal cancer surgery. Enoxaparin shows promise in preventing VTE in gastrointestinal, gynecological, and urological cancers, but its application after surgery for hepatobiliary-pancreatic malignancy has been under-evaluated due to bleeding concerns. We confirmed the safety of enoxaparin administration in patients undergoing curative hepatobiliary-pancreatic surgery for malignancies in a prospective, multi-center, phase I study.

The study was conducted from April 2015 to May 2021 across eight specialized centers. Patients (n = 262) were randomized to enoxaparin prophylaxis given postoperatively for 8 days (n = 131) or control (n = 131). The primary endpoint was the efficacy in reducing VTE. Secondary endpoints examined safety.

The full analysis set included 259 patients (131 control, 129 enoxaparin). The per-protocol population included 233 patients (117 control, 116 enoxaparin). Most cases were hepatic malignancies (111 control, 111 enoxaparin). The median administration duration of enoxaparin was 7 days, with 92% receiving 4000 units/day. Despite a reduction in the relative risk (RR) of VTE due to postoperative enoxaparin administration, the results were not significant (control: four cases, 3.4% vs. treatment: two cases, 1.7%; RR 0.50, 95% CI 0.09-2.70; p = 0.6834). No significant difference was found in the incidence of bleeding events (control: five cases, 4.3% vs. treatment: five cases, 4.3%, RR 1.00, 95% CI 0.53-1.89; p = 1.0000).

The perioperative administration of enoxaparin in hepatobiliary-pancreatic malignancies is feasible and safe. However, further case accumulation and investigation are necessary to assess its potential in reducing the occurrence of VTE.