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Thromb Haemost 2019 Jan 16. Epub 2019 Jan 16.

McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada.

The double-blind, randomized, AMPLIFY trial compared 6 months' treatment with apixaban (10 mg twice daily for 7 days and 5 mg twice daily thereafter) versus conventional treatment (subcutaneous enoxaparin [1 mg/kg twice daily for ≥ 5 days] overlapped and followed by warfarin [international normalized ratio = 2.0-3.0]) in patients with acute venous thromboembolism (VTE). Read More

JAMA Cardiol 2019 Jan 16. Epub 2019 Jan 16.

London School of Hygiene and Tropical Medicine, London, United Kingdom.

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE).

Objective: To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism.

Design, Setting, And Participants: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Read More

Ortop Traumatol Rehabil 2018 Oct;20(5):401-408

Klinika Traumatologii i Ortopedii, Wojskowy Instytut Medyczny, Warszawa, Polska / Department of Traumatology and Orthopaedics, Military Institute of Medicine, Warsaw, Poland.

Background: Total hip replacement activates the coagulation and fibrinolysis systems. The aim of this paper is to describe the concentrations of these proteins following elective total hip replacement.

Material And Methods: This prospective laboratory study enrolled 30 patients (including 18 women) who had been qualified for primary total hip replacement due to idiopathic osteoarthritis. Read More

BMJ 2019 Jan 15;364:l162. Epub 2019 Jan 15.

J Am Heart Assoc 2019 Jan;8(2):e010973

1 Unit of Internal Medicine Department of Medicine University of Verona Italy.

Background Apolipoprotein CIII (apo CIII ) is a crucial player in triglyceride-rich lipoprotein metabolism, but may also act pleiotropically, provoking inflammatory responses and stimulating coagulation. Elevated apo CIII plasma levels have been associated with increased activity of coagulation factors. Since these features of prothrombotic diathesis are linked with venous thromboembolism ( VTE ), we hypothesized that apo CIII plays a role in VTE . Read More

JAMA Netw Open 2018 Nov 2;1(7):e184741. Epub 2018 Nov 2.

Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.

Importance: Numerous interventions have improved prescription of venous thromboembolism (VTE) prophylaxis; however, many prescribed doses are not administered to hospitalized patients, primarily owing to patient refusal.

Objective: To evaluate a real-time, targeted, patient-centered education bundle intervention to reduce nonadministration of VTE prophylaxis.

Design, Setting, And Participants: This nonrandomized controlled, preintervention-postintervention comparison trial included 19 652 patient visits on 16 units at The Johns Hopkins Hospital, Baltimore, Maryland, from April 1 through December 31, 2015. Read More

JAMA Netw Open 2018 Sep 7;1(5):e181924. Epub 2018 Sep 7.

Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.

Importance: The associations of a family history of venous thromboembolism (FH-VTE) with postoperative venous thromboembolism (VTE) and major bleeding after joint replacement surgical procedures are unknown.

Objective: To determine the risk of VTE and major bleeding in patients after primary hip or knee replacement surgical procedures.

Design, Setting, And Participants: Cohort study using nationwide population-based databases of Swedish patients without a history of VTE who underwent joint replacement surgical procedures. Read More

Circ Genom Precis Med 2019 Jan;12(1):e002196

Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom (C.P.N., F.Y.L., M.N., S.Y., T.R.W., N.J.S.).

Background: Although short-term trials have suggested that PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors are safe and reduce risk of cardiovascular diseases, their long-term safety is unclear. Genetic variants associated with lower activity of a gene can act as proxies to identify potential long-term side effects of drugs as recently exemplified by association of LDL (low-density lipoprotein)-lowering variants in the HMGCR (target for statins) and PCSK9 genes with increased risk of type 2 diabetes mellitus (T2DM). However, analyses of the full spectrum of potential side effects of PCSK9 inhibition using a genetic approach have not been undertaken. Read More

J Vasc Bras 2018 Jul-Sep;17(3):215-219

Universidade do Estado do Rio de Janeiro (UERJ), Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brasil.

Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. Read More

J Vasc Bras 2018 Jul-Sep;17(3):184-192

Universidade Estadual de Campinas - UNICAMP, Faculdade de Odontologia de Piracicaba - FOP, Piracicaba, SP, Brasil.

Background: Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly.

Objectives: To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. Read More

Blood 2019 Jan 14. Epub 2019 Jan 14.

Department of Epidemiology, University of Washington, Seattle, WA, United States.

Factor VII (FVII) is an important component of the coagulation cascade. Few genetic loci regulating FVII activity and/or levels have been discovered to date. We conducted a meta-analysis of nine genome-wide association studies of plasma FVII levels (seven FVII activity and two FVII antigen) among 27,495 participants of European and African ancestry. Read More

J Stroke Cerebrovasc Dis 2019 Jan 11. Epub 2019 Jan 11.

Centro Hospitalar de Setubal, Cardiology Department, Setubal Portugal.

Background: Atrial high-rate episodes (AHREs) are common in pacemaker patients. Our aims were to compare patients with AHREs to those without them and to assess if, in those with AHREs, the initiation of oral anticoagulation (OAC) has any clinical impact on the occurrence of ischemic and hemorrhagic events.

Methods: From 2014-2017 we selected patients with pacemaker in whom AHREs were detected. Read More

Clin Ther 2019 Jan 11. Epub 2019 Jan 11.

Renown Institute for Heart and Vascular Health, Reno, NV, USA.

Purpose: Renown Health (Reno, Nevada), a large, locally owned, not-for-profit integrated health care network, has developed an institution-wide policy to shift the treatment of deep vein thrombosis (DVT) from a short-acting anticoagulant and vitamin K antagonist to the direct oral anticoagulant rivaroxaban combined with pharmacy-directed follow-up at an outpatient anticoagulation clinic. We examined data on hospitalizations and costs pre-/post-policy change.

Methods: Data were obtained from the electronic health records of adults with newly diagnosed DVT treated at Renown Health. Read More

PLoS One 2019 14;14(1):e0210835. Epub 2019 Jan 14.

Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.

Multiple myeloma (MM) patients have increased risk of developing venous thromboembolism, but the underlying mechanisms and the effect on the coagulation system of the disease and the current cancer therapies are not known. It is possible that cancer-associated extracellular vesicles (EV), carrying tissue factor (TF) and procoagulant phospholipids (PPL) may play a role in thrombogenesis. The aim of this study was to perform an in-depth analysis of procoagulant activity of small and large EVs isolated from 20 MM patients at diagnosis and after receiving first-line treatment compared with 20 healthy control subjects. Read More

Dis Mon 2019 Jan 8. Epub 2019 Jan 8.

The University of Chicago Pritzker School of Medicine, Chicago, IL, USA. Electronic address:

Venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) is one of the leading causes of preventable cardiovascular disease in the United States (US) and is the number one preventable causes of death following a surgical procedure. Post operative VTE is associated with multiple short and long term complications. We will focus on reviewing the many faces of VTE in detail as they represent common challenging scenarios in clinical practice. Read More

J Thromb Thrombolysis 2019 Jan 12. Epub 2019 Jan 12.

Department of Biomedical Science, College of Life Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam, South Korea.

Despite much progress in microRNA (miRNA) research, information regarding the association between miRNAs and venous thromboembolism (VTE), especially in Asian patients, remains limited. This case-control study sought to determine the correlation between the presence of polymorphisms in the genes encoding the miRNAs miR-146a, miR-149, miR-196a2, miR-499, and VTE in Korean patients. We observed no statistically significant differences in the genotype frequency of miRNA polymorphisms between 300 control individuals and 203 VTE patients. Read More

Arch Orthop Trauma Surg 2019 Jan 14. Epub 2019 Jan 14.

Department of Orthopedics, The Third Hospital of Mianyang (Sichuan Mental Health Center), No. 190 The East Jiannan Road, Mianyang, 621000, China.

Introduction: The efficacy and safety of intravenous (IV) tranexamic acid (TXA) during hip fracture surgery remain controversial. This meta-analysis aimed to assess the efficacy of IV-TXA administration during hip fracture surgery for reducing the transfusion requirement and blood loss as well as its safety regarding the risk of thrombolysis.

Materials And Methods: PubMed, EMBASE, Web of Science, and the Cochrane Library Database were systematically searched for randomized controlled trials (RCTs) that focused on the efficacy and safety of IV-TXA in patients during hip fracture surgery. Read More

Ann Vasc Dis 2018 Dec;11(4):531-534

Research Institute, Shizuoka Cancer Center, Shizuoka, Japan.

: To determine the effect of switching from the initial direct oral anticoagulant (DOAC) to another DOAC on exacerbation of deep vein thrombosis (DVT). : We retrospectively reviewed the data of patients with advanced cancer who experienced exacerbated DVT during initial treatment with DOAC due to new venous thromboembolism (VTE). After switching to another DOAC for VTE recurrence, changes in the thrombus and bleeding were evaluated for 3 months. Read More

Ann Vasc Dis 2018 Dec;11(4):503-510

Department of Cardiovascular Surgery, Japan Red Cross Kumamoto Hospital, Kumamoto, Japan.

Kumamoto was hit by a series of strong earthquakes beginning on April 14, 2016. We treated many deep vein thrombosis (DVT) patients and pulmonary thrombosis (PTE) patients. We came up with a strategy for diagnosis and therapy of venous thromboembolism (VTE). Read More

BMJ Case Rep 2019 Jan 10;12(1). Epub 2019 Jan 10.

Department of Cardiovascular Medicine, Tokushima University Graduate School of BiomedicalSciences, Tokushima, Japan.

Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterised by thromboembolic events including venous thromboembolism (VTE) in association with the presence of antiphospholipid antibodies. The standard treatment of VTE historically consists of anticoagulation therapy with warfarin, a vitamin K antagonist. Recently, direct oral anticoagulants, including rivaroxaban have become available for the treatment of VTE. Read More

BMJ Case Rep 2019 Jan 10;12(1). Epub 2019 Jan 10.

Cardiology, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK.

A 51-year-old woman with known primary antiphospholipid syndrome presented with a 4-day history of chest and abdominal pain, inferior ST-segment elevation on a 12-lead ECG and a subtherapeutic international normalised ratio. In view of a significantly raised high-sensitivity troponin I assay, inferior wall hypokinesis on transthoracic echocardiography and despite unobstructed epicardial vessels on emergency coronary angiography, a diagnosis of myocardial infarction was made. Furthermore, the patient also developed both bilateral adrenal haemorrhages leading to acute adrenal insufficiency and microvascular thrombotic renal disease concurrently. Read More

Gynecol Oncol 2019 Jan 8. Epub 2019 Jan 8.

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Dana-Farber Cancer Institute, Boston, MA, United States of America.

Objectives: To determine whether perioperative red blood cell transfusion (PRBCT) affects infection, thrombosis, or survival rates in epithelial ovarian cancer (EOC) patients undergoing neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS).

Methods: Demographics, operative characteristics, and outcome data were abstracted from records of stage IIIC-IV EOC patients managed with NACT-IDS from 01/2010-07/2015. Associations of PRBCT with morbidity and oncologic outcomes were evaluated. Read More

BMC Cardiovasc Disord 2019 Jan 11;19(1):15. Epub 2019 Jan 11.

Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 1070, Thailand.

Background: LV systolic dysfunction presents an elevated risk of thromboembolism. Previous studies demonstrated low left ventricular ejection fraction (LVEF), ischemic cardiomyopathy and increased myocardial scarring as independent risk factors for LV thrombus formation. Structural changes that alter the size and shape of LV apex may have a significant role in predicting LV thrombus, but there is no definite evidence exists in this entity. Read More

Cancers (Basel) 2019 Jan 10;11(1). Epub 2019 Jan 10.

Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmne diseases (FAI2R), Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, F-75010 Paris, France.

Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients and leads to a significant increase in health care costs. Cancer patients often suffer from multiple co-morbidities and have both a greater risk of VTE recurrence and bleeding compared to non-cancer patients. Anticoagulation is therefore challenging. Read More

Thromb Res 2019 Jan 3;174:163-165. Epub 2019 Jan 3.

Graduate Program in Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand. Electronic address:

J Trauma Acute Care Surg 2019 Jan 10. Epub 2019 Jan 10.

Department of Surgery, Denver Health Medical Center, University of Colorado.

Background: Viscoelastic tests (VETs), specifically thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are gaining popularity in the management of critically ill surgical patients with hemorrhage or thrombosis due to their comprehensive characterization of the coagulation process and point-of-care availability in comparison to conventional coagulation tests (CCTs). We review current evidence for VET use in patients in the surgical intensive care unit (SICU).

Methods: We searched PUBMED, EMBASE and the Cochrane Library through May 30, 2018 for articles that evaluated the use of VETs in patient populations and clinical scenarios germane to the surgical intensivist. Read More

Ann Surg 2019 Jan 8. Epub 2019 Jan 8.

Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago, IL.

Objectives: The aims of this study were to: (1) measure the rate of failure to provide defect-free postoperative venous thromboembolism (VTE) chemoprophylaxis, (2) identify reasons for failure to provide defect-free VTE chemoprophylaxis, and (3) examine patient- and hospital-level factors associated with failure.

Summary Background Data: Current VTE quality measures are inadequate. VTE outcome measures are invalidated for interhospital comparison by surveillance bias. Read More

Aging Male 2019 Jan 11:1-8. Epub 2019 Jan 11.

e Department of Pulmonary Diseases , Health Sciences University Yedikule Training and Research Hospital , Istanbul , Turkey.

Objectives: Fibulin-1, -2, -4, and -5 have important role in several vascular diseases. We aimed to investigate if fibulin-4 and -5 can be used as a biomarker for pulmonary thromboembolism (PTE).

Methods: This is a prospective case control study. Read More

Br J Haematol 2019 Jan 10. Epub 2019 Jan 10.

Department of Paediatric Haematology and Oncology, Schneider Children's Medical Centre of Israel, Petach Tivka, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

This study investigated the prevalence of inherited thrombophilia, risk of venous thromboembolism (VTE) and benefit of low molecular weight heparin prophylaxis in 476 Israeli children with acute lymphoblastic leukaemia (ALL) treated between 2004 and 2016. Thrombophilia was found in 15·5%. Arab children had a higher prevalence of F5 R506Q (factor V Leiden) than Jewish children (19·4% vs. Read More

Hematol Rep 2018 Nov 12;10(4):7753. Epub 2018 Dec 12.

Department of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.

Venous thromboembolism is one of the complications in patients prescribed antipsychotic medications. Neuroleptic malignant syndrome (NMS) is a rare side effect of antipsychotic medications in this population. In this case, a young patient, who presented with NMS after a recent start of antipsychotic medications, had developed a pulmonary embolism despite standard of care measures of venous thromboprophylaxis and early mobilization. Read More

Haematologica 2019 Jan 10. Epub 2019 Jan 10.

Dept. of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;

Emerg Med J 2019 Jan 10. Epub 2019 Jan 10.

Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Background: In the USA, The Joint Commission and Institute of Medicine have called for collection of patient sexual orientation (SO) and gender identity (GI) information in healthcare. In a recent study, we reported that ED clinicians believe patients will refuse to provide this information; however, very few patients say they would refuse to provide SO/GI. As part of this study, we interviewed patients and providers regarding the importance of collecting this information. Read More

Zhonghua Jie He He Hu Xi Za Zhi 2019 Jan;42(1):24-29

Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China.

To analyze the clinical features, diagnosis and differential diagnosis of diffuse pulmonary meningotheliomatosis (DPM), a rare subtype of minute pulmonary meningothelial-like nodules (MPMN), so as to improve the understanding of this disorder. The clinical data of a patient diagnosed as DPM admitted in department of Respiratory Medicine, Peking University Third Hospital in August 2016 were reported and the related literatures were reviewed. With "pulmonary meningothelial-like nodules" , "minute pulmonary meningothelial-like nodules" or "diffuse pulmonary meningotheliomatosis" as the search terms, and the search time before November 1st 2017 for Wanfangdata, China National Knowledge Infrastructure (CNKI), and PubMed. Read More

Semin Thromb Hemost 2019 Jan 10. Epub 2019 Jan 10.

Department of Clinical Haematology, Monash Medical Centre, Clayton, VIC, Australia.

In trials assessing venous thromboembolism (VTE) treatment, obese patients are under-represented or excluded. The main objective of this article is to examine the safety of weight-based enoxaparin dosing in obesity, as assessed by anti-factor Xa (anti-Xa) activity, bleeding, and recurrence. A 5-year retrospective audit of patients with acute VTE, weighing > 100 kg, prescribed enoxaparin 1 mg/kg twice daily, with an anti-Xa level 2 to 6 hours post-dose. Read More

Br J Radiol 2019 Jan 10:20180695. Epub 2019 Jan 10.

3 Department of Radiology, Tekden Hospital , Denizli , Turkey.

Objective:: We aimed to determine the diagnostic performance of the contrast-enhanced and unenhanced combined pulmonary arterial MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism (VTE).

Methods:: 44 patients who underwent CT pulmonary angiography (CTPA) for suspected PE constituted the study population. Patients underwent combined pulmonary and lower extremity MRI, and Doppler ultrasonography within 72 h after CTPA. Read More

J Drug Target 2019 Jan 10:1-25. Epub 2019 Jan 10.

a Cancer Research Center, Medical College, Xiamen University , Xiamen , Fujian , China.

The cellular transmembrane receptor Neuropilin-1(NRP-1) is overexpressed in tumor tissue and endothelial cells of tumor vessels, whereas it has limited expression in normal tissues. This study aimed to design a novel recombinant protein tTF-EG3287, which consisting of the truncated tissue factor (tTF) and the NRP-1 targeting peptide EG3287. The procoagulant protein selectively activates blood coagulation in tumor vessels once bound to the cell surface of the tumor vasculature by a targeting peptide EG3287. Read More

BMJ 2019 Jan 9;364:k4810. Epub 2019 Jan 9.

Division of Primary Care, University of Nottingham, Nottingham NG2 7RD, UK.

Objective: To assess the association between risk of venous thromboembolism and use of different types of hormone replacement therapy.

Design: Two nested case-control studies.

Setting: UK general practices contributing to the QResearch or Clinical Practice Research Datalink (CPRD) databases, and linked to hospital, mortality, and social deprivation data. Read More

Cancers (Basel) 2019 Jan 8;11(1). Epub 2019 Jan 8.

Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia.

Prevention of cancer-associated thromboembolism (TE) remains a significant clinical challenge and priority world-wide safety initiative. In this prospective non-small cell lung cancer (NSCLC) cohort, longitudinal TE risk profiling (clinical and biomarker) was undertaken to develop risk stratification models for targeted TE prevention. These were compared with published models from Khorana, CATS, PROTECHT, CONKO, and CATS/MICA. Read More

Kardiologiia 2018 Dec 25;58(12):60-65. Epub 2018 Dec 25.

Pirogov Russian National Research Medical University (RNRMU).

Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE).

Material And Methods: We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. Read More

Arch Endocrinol Metab 2018 ;62(6):648-654

Instituto de Investigaciones Neurológicas "Dr. Raúl Carrea", FLENI, Pathology, Buenos Aires, Argentina.

Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. Read More

Clin Orthop Relat Res 2019 Jan 4. Epub 2019 Jan 4.

M. Faour, N. S. Piuzzi, D. P. Brigati, A. K. Klika, M. M. Mont, W. K. Barsoum, C. Higuera-Rueda, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA N. S. Piuzzi, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Background: Aspirin is established as an effective prophylaxis for venous thromboembolism (VTE) after THA; however, there is no consensus as to whether low- or regular-dose aspirin is more effective at preventing VTE.

Questions/purposes: (1) Is there a difference in the incidence of symptomatic VTE within 90 days of elective THA using low-dose aspirin compared with regular-dose aspirin? (2) Is there a difference in the risk of significant bleeding (gastrointestinal and wound bleeding) and mortality between low- and standard-dose aspirin within 90 days after surgery?

Methods: We retrospectively evaluated 7488 patients in our database who underwent THA between September 2012 and December 2016. A total of 3936 (53%) patients received aspirin alone for VTE prophylaxis after THA. Read More

Clin Orthop Relat Res 2019 Jan 3. Epub 2019 Jan 3.

M. Sloan, G.-C. Lee Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA N. Sheth Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, PA, USA.

Background: Deep venous thrombosis (DVT) and pulmonary embolus (PE) remain an important cause of morbidity and mortality after THA and TKA. Prior recommendations have advocated for more aggressive prophylaxis for patients with obesity, whereas the evidence supporting these recommendations is conflicting and often based on underpowered studies.

Questions/purposes: (1) What is the association between obesity and DVT and PE after primary and revision THA and TKA? (2) Is there a body mass index (BMI) threshold beyond which DVT and PE risk is elevated?

Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2016 to evaluate the reported 30-day rates of DVT, PE, and combined venous thromboembolism (VTE) after primary THA, primary TKA, revision THA, and revision TKA according to BMI as a continuous variable and a categorical variable as defined by the World Health Organization cutoffs for underweight, normal weight, overweight, and obesity. Read More

Clin Orthop Relat Res 2019 Jan 7. Epub 2019 Jan 7.

A. H. S. Harris, T. Bowe, N. J. Giori Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA A. C. Kuo San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA A H. S. Harris, Y. Weng, A. W. Trickey Stanford-Surgical Policy Improvement Research and Education Center, Stanford, CA, USA N. J. Giori Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.

Background: Existing universal and procedure-specific surgical risk prediction models of death and major complications after elective total joint arthroplasty (TJA) have limitations including poor transparency, poor to modest accuracy, and insufficient validation to establish performance across diverse settings. Thus, the need remains for accurate and validated prediction models for use in preoperative management, informed consent, shared decision-making, and risk adjustment for reimbursement.

Questions/purposes: The purpose of this study was to use machine learning methods and large national databases to develop and validate (both internally and externally) parsimonious risk-prediction models for mortality and complications after TJA. Read More

J Am Acad Orthop Surg 2019 Jan 7. Epub 2019 Jan 7.

From the Department of Orthopaedics (Dr. Ellis, Ms. Sabatino, Mr. Clarke, Mr. Dennis, Ms. Fletcher, Mr. Wyatt, and Dr. Wilson), Texas Scottish Rite Hospital for Children, and the Department of Orthopaedic Surgery (Dr. Ellis, and Dr. Wilson), and Department of Pediatrics-Hematology-Oncology (Dr. Zia), University of Texas Southwestern, Dallas, TX.

Introduction: Deep vein thrombosis and pulmonary embolism are major complications that can occur in common orthopaedic procedures such as knee arthroscopy. The purpose of this study is to determine the incidence of venous thromboembolism (VTE) risk factors in adolescent patients undergoing elective lower extremity arthroscopy. A second objective is to determine whether a targeted, standardized screening tool is both cost- and clinically effective in the identification of VTE risk factors in adolescents. Read More

Acta Anaesthesiol Scand 2019 Jan 8. Epub 2019 Jan 8.

Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Background: The aim of the study was to explore occurrence, risk factors and outcome of venous thromboembolism (VTE) in intensive care unit (ICU) patients.

Methods: Prospective observational study of ICU patients receiving thromboprophylaxis at Oslo University Hospital in Norway. Adult medical and surgical patients with ICU length of stay (LOS) longer than 48 hours were included. Read More

J Gen Intern Med 2019 Jan 8. Epub 2019 Jan 8.

Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.

Background: Bridging anticoagulation is commonly prescribed to patients with atrial fibrillation during initiation and interruption of warfarin. Guidelines recommend bridging patients at high risk of stroke, while a recent randomized trial demonstrated overall harm in a population at comparatively low risk of ischemic stroke. Theory suggests that patients at high risk of stroke and low risk of hemorrhage may benefit from bridging, but data informing patient selection are scant. Read More

Cell Death Dis 2019 Jan 8;10(1):22. Epub 2019 Jan 8.

Department of Biology, York University, Toronto, ON, M3J 1P3, Canada.

There are conflicting reports on the adverse effects of erythropoietin (EPO) for the management of cancer-associated anemia. The recognition that erythropoietin receptors (EPORs) are expressed outside the erythroid lineage and concerns that erythropoiesis-stimulating agents (ESAs) may cause tumors to grow and increase the risk of venous thromboembolism have resulted in substantially fewer cancer patients receiving ESA therapy to manage myelosuppressive chemotherapy. In this study, we found that EPO suppresses p53-dependent apoptosis induced by genotoxic (daunorubicin, doxorubicin, and γ-radiation) and non-genotoxic (nutlin-3a) agents and induces a senescence-like state in myeloid leukemia cells. Read More

Cancers (Basel) 2019 Jan 5;11(1). Epub 2019 Jan 5.

Division of Haematology and Haematology Central Laboratory, CHUV, University Hospital of Lausanne, 1011 Lausanne, Switzerland.

Cancer patients develop a hypercoagulable state with a four- to seven-fold higher thromboembolic risk compared to non-cancer patients. Thromboembolic events can precede the diagnosis of cancer, but they more often occur at diagnosis or during treatment. After malignancy itself, they represent the second cause of death. Read More

Cancers (Basel) 2019 Jan 7;11(1). Epub 2019 Jan 7.

Department of Hematology, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Sorbonne Université, INSERM UMR S938, 75012 Paris, France.

Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Read More

Hamostaseologie 2019 Jan 8. Epub 2019 Jan 8.

Ehemals Klinikum Rechts der Isar, Technische Universität München, München, Deutschland, Germany.

Low molecular weight heparins and fondaparinux have been the cornerstones for prevention of venous thromboembolism (VTE) in acutely ill medical patients for almost two decades. Guidelines recommend the use of these parenteral anticoagulants for 6 to 14 days but advise against extended-duration thromboprophylaxis after hospital discharge because no compelling scientific evidence has been provided for pharmacological prophylaxis beyond hospital stay. Five large randomized clinical trials, one with low molecular weight heparin and four with nonvitamin K antagonist oral anticoagulants, have failed to show significant clinically relevant benefit in this indication. Read More