Comparison between standard Vs. Escalated dose venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19: A two centers,observational study

IntroductionThe risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill patients with COVID-19. Thus, this study aims to compare the effectiveness and safety of standard versus escalated dose pharmacological venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19.MethodsA two-center retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the intensive care unit (ICU) at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or Unfractionated heparin 5000 Units three times daily were grouped under the “standard dose VTE prophylaxis and patients who received higher than the standard dose but not as treatment dose were grouped under ”escalated VTE prophylaxis dose“. The primary outcome was the occurance of thrombotic events, and the secondary outcomes were bleeding, mortality, and other ICU-related complications.ResultsA total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). In patients who received escalated dose pharmacological VTE prophylaxis, any case of thrombosis and VTE were similar between the two groups (OR 1.22;95 %CI 0.52–2.86; P = 0.64 and OR 0.75; 95% CI 0.16–3.38; P = 0.70 respectively). However, the odds of minor bleeding was higher in patients who received escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08–10.61; P = 0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95 %CI0.79–1.73; P = 0.43 and HR 1.08;95 %CI 0.76–1.53; P = 0.83, respectively).ConclusionEscalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous evidence regarding the optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.     

妊娠相关静脉血栓栓塞症评估与预防的最佳证据总结

目的 检索、分析和汇总妊娠相关静脉血栓栓塞症（pregnancy associated venous thromboembolism,PA-VTE）评估与预防的最佳证据,为临床中完善对PA-VTE患者的管理提供参考。 方法 检索UpToDate、BMJ Best Practice、Embase、Springer Link等网站或数据库中关于PA-VTE评估与预防的所有证据,包括指南、系统评价、最佳临床实践信息册、证据总结、专家共识等。检索时限为2015年1月—2021年5月。由2名研究人员独立进行文献评价,4名研究人员进行证据提取、翻译及整合。 结果 共纳入11篇文献,其中指南4篇、临床决策1篇、专家共识3篇、系统评价3篇。从PA-VTE危险因素的评估、评估时机、评估工具、基础预防、物理预防、药物预防、健康宣教7个方面总结20条证据。 结论 该研究总结了PA-VTE评估与预防的最佳证据,建议制订符合本国国情的PA-VTE风险评估工具,筛查相关危险因素并分层管理,加强孕产妇PA-VTE健康教育,以达到降低发生率的目标。     

一例胰十二指肠切除术后腹腔出血再次手术后并发下肢静脉血栓的护理

胰十二指肠切除术（PD）是壶腹周围癌和十二指肠癌的最主要的治疗方法,给患者带来了希望,解决了患者的痛苦。但手术复杂,并发症很高,其中,术后出血的发生率为1%-10%。深静脉血栓形成（Deep venous thrombosis,DVT）是指血液在深静脉内不正常凝结,阻塞管腔,导致静脉回流障碍,是许多疾病的一种并发症,多发于下肢。     

Retrograde Inversion Stripping as a Complication of the Clarivein? Mechanochemical Venous Ablation Procedure

The endovenous revolution has accelerated the development of new techniques and devices for the treatment of varicose veins. The ClariVein^® mechanochemical ablation device offers tumescentless treatment with a rotating ablation tip that can theoretically become stuck in tissue. We present the first report of retrograde stripping of the small saphenous vein without anaesthesia following attempted use of the ClariVein^® device, without adverse sequelae.     

新鲜下肢骨折术前深静脉血栓形成危险程度评分量表初探

目的 初步尝试建立新鲜下肢骨折术前深静脉血栓形成危险程度评分量表,用于院内下肢骨折患者术前深静脉血栓形成危险程度的客观判断.方法 回顾性分析2011年1月至2012年12月北京积水潭医院创伤骨科治疗的新鲜下肢骨折患者资料,依据排除标准剔除病例后共纳入分析1 705例.这些患者被随机分为两组,研究组(879组)通过logistic回归分析筛选出危险因素,以多因素logistic回归OR值赋分的方法产生新鲜下肢骨折术前深静脉血栓形成危险程度评分量表,检验组(826例)对评分表进行验证.结果 纳入患者中男性1 106例,女性599例;平均年龄(50±18)岁,logistic回归分析显示可以预测深静脉血栓形成的因素包括年龄、待术时间、受伤原因、受伤部位、心脑血管疾病史以及D-二聚体(D-Dimer)检测值.根据回归OR值得出的分值分别是:年龄≤35岁为1分,＞35 ～ ＜65岁为4分,≥65岁为6分;待术时间＜8d为1分,≥8d为2分;受伤原因低能量为1分,高能量为3分;受伤部位中,足踝损伤为1分,小腿骨折为3分,膝关节周围骨折为5分,股骨中上段为7分,骨盆髋臼为4分,多发骨折为6分;无心脑血管疾病史为1分,有心脑血管疾病史为2分;D-Dimer＜ 600 μg/L为1分,≥600μg/L为3分.受试者工作特征曲线下面积为0.79,临界点15.5分,总体数据临界点灵敏度为77.00％,特异度为68.17％.结论 新鲜下肢骨折术前血栓危险程度评分量表对深静脉血栓形成具有一定的预测效能,但是存在局限性.     

急性下肢深静脉血栓形成后肺栓塞严重程度的危险因素分析

目的 探讨急性下肢深静脉血栓形成患者肺栓塞严重程度的危险因素.方法 本研究为前瞻性研究.2010年7月至2012年7月收集首都医科大学附属北京世纪坛医院血管外科诊断的急性下肢深静脉血栓形成的患者资料,其中符合纳入、排除标准的208例患者纳入本研究.其中男性101例,女性107例,平均年龄(59±16)岁.利用肺动脉CT血管造影、肺动脉磁共振血管造影或肺动脉数字减影血管造影筛查肺栓塞,并评估其肺栓塞程度.采用x2检验和Logistic回归对深静脉血栓形成患者发生肺栓塞程度的危险因素进行单因素和多因素分析.结果 208例下肢深静脉血栓形成患者中70例发生肺栓塞,总体发生率为33.7％.单因素分析结果显示,下肢深静脉血栓范围(x2=17.286,P=0.004)、下肢深静脉血栓部位(x2=15 602,P=0.008)对肺栓塞的严重程度有影响.年龄(x2=7.099,P=0.260)、性别(x2=7.014,P=0.067)、明显血栓危险因素(x2=3.335,P=0.345)对肺栓塞的严重程度无影响.多因素有序Logistic回归分析显示肺栓塞的程度随着下肢深静脉血栓范围的扩大和部位的增加而加重,髂股静脉血栓(OR =6.172,95％ CI:1.590 ～ 23.975,P=0.009)、双下肢深静脉血栓(OR=7.140,95％ CI:2.406 ～ 24.730,P=0.001)是肺栓塞严重程度的独立危险因素.结论 髂股静脉血栓形成、双侧下肢深静脉血栓形成是发生严重肺栓塞的独立危险因素,对这些高危患者应更加注重肺栓塞的防治.     

Neoplastic and non‐neoplastic complications of solid organ transplantation in patients with preexisting monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance (MGUS) occurs in 3–7% of the elderly population, with higher prevalence in renal failure patients, and is associated with a 25‐fold increased lifetime risk for plasma cell myeloma (PCM), also known as multiple myeloma. Using the California State Inpatient, Emergency Department, and Ambulatory Surgery Databases components of the Healthcare Cost and Utilization Project (HCUP), we sought to determine whether patients with MGUS who undergo solid organ allograft (n = 22 062) are at increased adjusted relative risk (aRR) for hematologic malignancy and other complications. Among solid organ transplant patients, patients with preexisting MGUS had higher aRR of PCM (aRR 19.46; 95% CI 7.05, 53.73; p < 0.001), venous thromboembolic events (aRR 1.66; 95% CI 1.15, 2.41; p = 0.007), and infection (aRR 1.24; 95% CI 1.06, 1.45; p = 0.007). However, when comparing MGUS patients with and without solid organ transplant, there was decreased aRR for PCM with transplant (aRR 0.34; 95% CI 0.13, 0.88; p = 0.027), and increased venous thromboembolic events (aRR 2.33; 95% CI 1.58, 3.44; p < 0.001) and infectious risks (aRR 1.44; 95% CI 1.23, 1.70; p < 0.001). While MGUS increased the risk of PCM overall following solid organ transplantation, there was lower risk of PCM development compared to MGUS patients who did not receive a transplant. MGUS should not preclude solid organ transplant.     

射频消融术治疗舌部静脉畸形

目的 探讨射频消融术治疗舌部静脉畸形的效果.方法 回顾性分析2013年7月至2014年7月收治的30例舌部静脉畸形的病例资料,从单侧病变到弥漫性广泛病变,其中23例接受了射频消融术,选取直径为0.5 mm的工作尖端的射频消融电极针,功率调至25 W,将工作尖端刺入距病变最底部即最深处约1 mm处,通电行消融工作15 ～30 s,其后依次退出电极针1 mm,直至距病变表面1 mm处,分别行多点消融.结果 15例单侧病变一期手术彻底消融;8例双侧均受累及病例,一期行一侧病变射频消融术,术后3～6个月再行二期射频消融手术,其中5例彻底消融.23例术后随访3个月至1年半,手术消融20例,无复发,且舌两侧对称,无明显瘢痕,外观满意.另外3例仍有部分残余.结论 射频消融术弥补了传统手术的不足,治疗舌静脉畸形基本达到治愈,无明显并发症,且外观良好.