Thrombosis Journal最新文献

Background: Over the past few years, a growing number of knee arthroscopy (KA) procedures have been associated with an escalating incidence of postoperative venous thromboembolism (VTE), posing a significant threat to patient well-being. Nevertheless, the purpose of this study is to evaluate and synthesize the risk factors associated with VTE following KA, thereby establishing a scientific foundation for developing evidence-based clinical preventive measures.

Methods: We conducted a comprehensive search across the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant literature spanning from January 1, 2019, to January 1, 2025. We meticulously reviewed all English-language observational studies about the risk factors associated with VTE after KA. The quality of the selected studies was critically appraised utilizing the Newcastle-Ottawa Scale (NOS). Subsequently, odds ratios (OR) and 95% confidence intervals (CI) were determined to assess the relationship between various risk factors and the incidence of VTE after KA.

Results: A total of 11 observational studies were included, all of which demonstrated moderate to high methodological quality. The studies involved 875,099 patients who underwent arthroscopic KA. The meta-analysis results indicated that the risk factors for venous thrombosis after KA include age over 30 years (OR = 1.59, 95% CI: [1.20, 2.12], P < 0.001), body mass index (BMI) over 25 (OR = 1.23, 95% CI: [1.07, 1.41], P = 0.004), and D-dimer over 0.62 mg/L (OR = 5.69, 95% CI: [1.41, 22.89], P = 0.014).

Conclusion: Age over 30 years, BMI over 25, and D-dimer over 0.62 mg/L are significant risk factors for VTE following KA. Limited evidence also suggests an association between oral contraceptive use and a higher risk of VTE following KA.

Background: Critically ill patients are at high risk for venous thromboembolism (VTE). In non-Caucasian patients, routine thromboprophylaxis is controversial. No standard guidelines exist for critically ill Thai patients.

Objectives: To evaluate the efficacy and safety of a risk-adapted VTE prophylaxis protocol in medically ill patients.

Methods: A single-center, prospective pre- and post-implementation trial conducted from March to December 2024. Patients admitted to three medical ICUs were enrolled. Patients were stratified by risk of VTE and bleeding. In the pre-implementation phase, patients did not receive thromboprophylaxis, whereas in the post-implementation phase, patients received thromboprophylaxis with either pharmacological or mechanical prophylaxis. The primary outcome was the 45-day incidence of VTE, VTE-related death, and bleeding events. Secondary outcomes included all-cause mortality, ICU stay, and days on mechanical ventilation.

Results: There were 462 patients enrolled with a mean age of 65.82 ± 16.65 years and 53.90% were male. In the post-implementation phase, 151 out of 211 patients (65.37%) received thromboprophylaxis, primarily with pneumatic compression (41.56%), low molecular weight heparin/unfractionated heparin (15.58%) and aspirin (7.36%). VTE events occurred in 14 patients (6.06%) in the pre-implementation group and 5 (2.16%) in the post-implementation group. The composite primary outcome occurred in 14 patients (6.06%, 95% CI 3.35-9.96%) in the pre-implementation group and 5 (2.16%, 95% CI 0.71-4.98%) in the post-implementation group (RR 0.35, 95% CI 0.13-0.97, P = 0.04). A competing-risks analysis showed that post-implementation group was associated with significantly lower risk of VTE (adjusted subdistribution hazard ratio 0.35, 95% CI 0.13-0.97; p = 0.043). No VTE-related deaths occurred. Overall bleeding occurred in 28.14% of pre-implementation and 32.03% of post-implementation patients (RR 1.13, 95% CI 0.86-1.50, P = 0.361). Major bleeding rates were 11.26% vs. 8.22%, respectively (RR 0.65, 95% CI 0.40-1.07, P = 0.075).

Conclusion: A risk-adapted VTE prophylaxis protocol significantly reduced VTE incidence in critically ill Asian patients without increasing bleeding complication.

Clinical trial registration: TCTR20230927002, First Posted Date: 27 September 2023.

Background: Central venous catheter (CVC)-related thrombosis (CRT) has become a common iatrogenic complication in burn patients. Early and precise prediction is the foundations of effective prevention of CRT. However, there is not specific tool to predict CRT in burn populations. This study aimed to investigate the risk factors of CRT and develop a prediction model for CRT in burn populations.

Methods: This retrospective observational study was conducted at a large burn center in Southwest China from January 2018 to December 2022. All adult patients with burn injuries undergoing central venous catheterization were included in the cohort. The clinical data, thrombosis profile, and catheter management were collected and analyzed.

Results: A total of 271 burn patients (mean burn area: 53.29 ± 23.65%) with 797 CVCs were finally included. The incidence of CRT was 13.28%, with a mean time from burn injuries to CRT onset of 25.96 ± 19.00 days. Half of the thrombotic events occurred between 15 and 30 days following burn trauma. Notably, 91.07% and 87.5% of CRT cases had diameters less than 5 mm and lengths shorter than 7 mm, respectively. Compared with the non-CRT cohort, the CRT cohort exhibited significantly larger burn area, more insertion times, higher proportion of blood purification procedures, and longer in-bed durations. Logistic regression and LASSO regression analyses identified burn index and continuous blood purification as independent risk factors for CRT. Consequently, a predictive nomogram model for CRT was successfully developed, achieving an AUROC of 0.75 (95% CI: 0.675-0.834) and a mean absolute error of the calibration curve of 0.029.

Conclusion: The incidence of CRT was relatively high in burn populations. The established nomogram could provide a straightforward, quantitative and effective strategy for identifying patients at high-risk for CRT. Clinicians can utilize this assessment tool periodically to facilitate the early identification of individuals at high risk for CRT.

Objective: Deep vein thrombosis (DVT) is a serious complication in patients with tibial plateau fractures, yet the association between surgical delay and preoperative DVT risk remains insufficiently explored. This study aimed to investigate the impact of fracture-to-operation time on preoperative DVT risk in this patient population.

Methods: A retrospective association analysis was conducted on 267 patients with tibial plateau fractures treated at Quanzhou Orthopedic Hospital between January 2020 and January 2022. The primary exposure was fracture-to-operation time, and the outcome was preoperative DVT confirmed by ultrasound. Multiple regression analyses and generalized additive models were employed, adjusting for demographic, clinical, and coagulation parameters.

Results: The incidence of thrombosis before the operation for tibial plateau fractures is as high as 27.34%. Each day of surgical delay was associated with a 48% increased risk of DVT (adjusted OR = 1.48, 95% CI: 1.32-1.67). A non-linear trend was observed, with risk increasing more rapidly within the first 14 days post-fracture. Patients in the highest tertile of surgical delay had a significantly elevated DVT risk compared to the lowest tertile (adjusted OR = 35.27, 95% CI: 9.53-130.56). Subgroup analyses confirmed the robustness of this association across age groups, calcaneus traction status, and D-dimer levels.

Conclusion: Delayed surgery is associated with increased preoperative DVT risk in tibial plateau fracture patients, and this association appears stronger within the first 14 days post-injury. Early surgical intervention may mitigate this risk, supporting the need for timely management in clinical practice. However, these findings require validation in prospective studies.

Background: The optimal dosing strategy for recombinant human soluble thrombomodulin (rhTM) in clinical practice for sepsis-induced disseminated intravascular coagulation (DIC) has not been comprehensively evaluated. This study aimed to investigate whether different rhTM dosing strategies influence mortality outcomes in patients with sepsis-induced DIC.

Methods: This retrospective, single-center cohort study included hospitalized patients aged ≥ 18 years who were diagnosed with sepsis and received rhTM for DIC treatment between 2011 and 2024. The primary outcome was in-hospital mortality across different rhTM dosing strategies (standard-dose or reduced-dose). The distribution of mortality between the two groups was compared using the log-rank test, and mortality estimates were analyzed using Cox proportional hazards analysis. To address confounding bias, we employed a double robust method that adjusted the model with covariates while accounting for inverse probability weighting of the treatment.

Results: A total of 167 patients were included in the analysis. Of these, 84 patients were in the standard-dose group and 83 patients were in the reduced-dose group. The median rhTM dosage for the entire cohort was 328 U/kg/day, with estimated plasma trough concentrations of 1622 ng/mL and 835 ng/mL in the standard-dose and reduced-dose groups, respectively. The mortality rate was 30% in the standard-dose group and 42% in the reduced-dose group, showing significantly better outcomes (adjusted hazard ratio: 0.561; 95% confidence interval, 0.323-0.973; P = 0.039).

Conclusions: This study demonstrated that a kidney function-based dose reduction strategy for rhTM administration is associated with inferior mortality outcomes in patients with sepsis-induced DIC. Although our findings are limited by the retrospective nature of this study, they provide valuable insights for future verification.

Background: Coronavirus Disease 2019 (COVID-19) has been linked to thromboembolic complications, especially in severely ill patients. Intracardiac thrombi are uncommon and pose a very high risk. Coinfection with tuberculosis (TB) may worsen the prothrombotic state and complicate treatment. A 21-year-old male patient from Afghanistan developed active pulmonary tuberculosis (TB) and COVID-19. He had a large, mobile thrombus in the right atrium and an acute pulmonary embolism (PE), but no deep vein thrombosis (DVT). He received remdesivir, anti-TB medication, anticoagulation, and underwent a successful surgical embolectomy. At a nine-month follow-up, he remained symptom-free.

Conclusion: This case highlights the rare occurrence of a right atrial thrombus in COVID-19, possibly exacerbated by TB co-infection. Early detection and tailored treatment, including surgery, are crucial to lowering mortality in these high-risk patients, but further research is needed to establish optimal management strategies and confirm the role of TB in thrombotic complications.