Genetic risk stratification of inflammatory bowel disease-associated venous thromboembolism:An Asian perspective

The utilisation of polygenic scoring models may enhance the clinician’s ability to risk stratify an inflammatory bowel disease patient’s individual risk for venous thromboembolism(VTE)and guide the appropriate usage of VTE thromboprophylaxis,yet there is a need to validate such models in ethnically diverse populations.

Post-operative venous thromboembolism in patients after extracranial otologic surgery: A case series

Objective:This study aimed to report 9 venous thromboembolism(VTE)cases after extracranial otologic surgery and analyze the potential risk factors.Study design:Case series.Setting:Single tertiary-level academic center.Methods:Totally,9 cases of VTE were identified among adults who underwent extracranial otologic surgery at our hospital from January 2018 to December 2020.Caprini risk scores were calculated,and comprehensive preoperative,operative,and postoperative clinical data within 14 days were collected to assess the evidence of VTE.Results:The median age of 9 patients was 64 years old.Among them,7(77.8%)patients presented with intramuscular vein thrombosis,1(11.1%)patient had deep vein thrombosis,and 1(11.1%)patient experienced pulmonary embolism.Preoperatively,8(88.9%)patients had low or middle Caprini risk scores(≤4)with an average of 2.67±0.47 points.The average Caprini scores for all patients were 4.44±0.35 on postoperative day(POD)1 and 5.67±0.64 on POD14.D-dimer levels were collected,indicating an average of 0.55±0.17 mg/FEU preoperatively,8.53±3.94 mg/FEU at day 1,and 3.76±0.45 mg/FEU at POD14.In postoperative period,7(77.8%)patients experienced vertigo/dizziness and/or head immobility/bed rest.Conclusion:The present study highlighted that patients with low-and middle-risk of VTE undergoing otologic surgery should be also vigilant about postoperative VTE.Vertigo/dizziness and/or head immobility/bed rest in postoperative period should be considered as minor risk factors for developing VTE in patients undergoing extracranial otologic surgery.Conducting perioperative assessments,including Caprini risk score evaluation,Ddimer testing,and venous ultrasound of lower extremities,is recommended to ensure patients’safety.

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

Estimation of the Direct Cost of Management of Venous Thromboembolism in Three Reference Hospitals in the City of Yaoundé: A Retrospective Study over a Three-Year Period

Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.

Anticoagulant use before COVID-19 diagnosis prevent COVID-19 associated acute venous thromboembolism or not:A systematic review and meta-analysis

BACKGROUND Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019(COVID-19)patients.There is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 disease.AIM To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 patients.METHODS A Literature search was performed on LitCovid PubMed,WHO,and Scopus databases from inception(December 2019)till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with COVID-19.The primary outcome was the risk of thromboembolic events in COVID-19 patients taking anticoagulants.Secondary outcomes included COVID-19 disease severity,in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection,and mortality.The random effects models were used to calculate crude and adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs).RESULTS Forty-six observational studies met our inclusion criteria.The unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk[n=43851,9 studies,odds ratio(OR)=0.67(0.22,2.07);P=0.49;I2=95%].The association between prior anticoagulation and disease severity was non-significant[n=186782;22 studies,OR=1.08(0.78,1.49);P=0.64;I2=89%].However,pre-hospital anticoagulation significantly increased all-cause mortality risk[n=207292;35 studies,OR=1.72(1.37,2.17);P<0.00001;I2=93%].Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk[aOR=0.87(0.42,1.80);P=0.71],mortality[aOR=0.94(0.84,1.05);P=0.31],and disease severity[aOR=0.96(0.72,1.26);P=0.76].CONCLUSION Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events,improved survival,and lower disease severity in COVID-19 patients.

Venous thromboembolism in inflammatory bowel disease

Patients with inflammatory bowel disease(IBD)are at an increased risk for venous thromboembolism(VTE).VTE events carry significant morbidity and mortality,and have been associated with worse outcomes in patients with IBD.Studies have suggested that the hypercoagulable nature of the disease stems from a complex interplay of systems that include the coagulation cascade,natural coagulation inhibitors,fibrinolytic system,endothelium,immune system,and platelets.Additionally,clinical factors that increase the likelihood of a VTE event among IBD patients include older age(though some studies suggest younger patients have a higher relative risk of VTE,the incidence in this population is much lower as compared to the older IBD patient population),pregnancy,active disease,more extensive disease,hospitalization,the use of certain medications such as corticosteroids or tofacitinb,and IBD-related surgeries.Despite the increased risk of VTE among IBD patients and the safety of pharmacologic prophylaxis,adherence rates among hospitalized IBD patients appear to be low.Furthermore,recent data suggests that there is a population of high risk IBD patients who may benefit from post-discharge prophylaxis.This review will provide an overview of patient specific factors that affect VTE risk,elucidate reasons for lack of VTE prophylaxis among hospitalized IBD patients,and focus on recent data describing those at highest risk for recurrent VTE post-hospital discharge.

Inflammatory bowel disease and thromboembolism

Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians&#x02019; awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.

Prophylaxis for venous thromboembolism after resection of hepatocellular carcinoma on cirrhosis: Is it necessary?

AIM: To assess the safety and effectiveness of prophylaxis for venous thromboembolism (VTE) in a large population of patients with hepatocellular carcinoma (HCC) on cirrhosis.METHODS: Two hundred and twenty nine consecutive cirrhotic patients with HCC who underwent hepatic resection were retrospectively evaluated to assess whether there was any difference in the incidence of thrombotic or hemorrhagic complications between those who received and those who did not receive prophylaxis with low-molecular weight heparin.Differences and possible effects of the following parameters were investigated: age,sex,Child-Pugh and model for end-stage liver disease (MELD) score,platelet count,presence of esophageal varices,type of hepatic resection,duration of surgery,intraoperative transfusion of blood and fresh frozen plasma (FFP),body mass index,diabetes and previous cardiovascular disease.RESULTS: One hundred and fifty seven of 229 (68.5%) patients received antithromboembolic prophylaxis (group A) while the remaining 72 (31.5%) patients did not (group B).Patients in group B had higher Child-Pugh and MELD scores,lower platelet counts,a higher prevalence of esophageal varices and higher requirements for intraoperative transfusion of FFP.The incidence of VTE and postoperative hemorrhage was 0.63% and 3.18% in group A and 1.38% and 1.38% in group B,respectively;these differences were not significant.None of the variables analyzed including prophylaxis proved to be risk factors for VTE,and only the presence of esophageal varices was associated with an increased risk of bleeding.CONCLUSION: Prophylaxis is safe in cirrhotic patients without esophageal varices;the real need for prophylaxis should be better assessed.

Efficacy and Safety of Low Molecular Weight Heparin Prophylaxis for Venous Thromboembolism Following Lumbar Decompression Surgery

Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.

Risk scores,prevention,and treatment of maternal venous thromboembolism

BACKGROUND At present,the preventive treatment for pregnancy-related venous thromboembolism(VTE)in China is in its infancy,and there is no uniform or standardized industry guide.Drug prevention and treatment of pregnancyrelated VTE rely highly on foreign guidelines;however,due to the differences in ethnicity and national conditions,there are many controversies over the indications for drug treatment,drug selection,and dose selection for anticoagulant therapy.AIM To investigate the risk scores,prevention,and treatment of maternal VTE to promote the prevention and standardized treatment of maternal thrombosis.METHODS A retrospective analysis was performed on 7759 patients who gave birth at our hospital from June 2018 to June 2019.Risk factors for pregnancy-related VTE,prenatal and postpartum VTE risk scores,prophylactic anticoagulant therapy,side effects after medication,and morbidity were analysed.RESULTS The risk factors for VTE were mainly caesarean delivery,obesity,and advanced maternal age.Regarding pregnancy-related VTE risk scores,there were 7520 patients in the low-risk group with a prenatal score<3 points and 239 in the high-risk group with a score≥3,and 44 patients received drug prevention and treatment during pregnancy.There were 4223 patients in the low-risk group with a postpartum score<2 points and 3536 in the high-risk group with a score≥2 points,and 824 patients received drug prevention and treatment for 10 d.Among the patients who did not present with VTE before delivery,we found one case each of pulmonary embolism secondary to lower extremity venous thrombosis,intracranial venous sinus thrombosis,and asymptomatic lower extremity venous thrombosis during the postpartum follow-up.CONCLUSION VTE poses a serious threat to maternal safety,and the society should increase its vigilance against pregnancy-related VTE.

Facing the challenge of venous thromboembolism prevention in patients undergoing major abdominal surgical procedures for gastrointestinal cancer

Venous thromboembolism(VTE)refers to a hypercoa-gulable state that remains an important and preven-table factor in the surgical treatment of malignancies.VTE includes two identical entities with regards to deep vein thrombosis and pulmonary embolism.The incidence of VTE after major abdominal interventions for gastro-intestinal,hepato-biliary and pancreatic neoplastic disor-ders is as high as 25%without prophylaxis.Prophylactic use of classic or low-molecular-weight heparin,anti-Xa factors,antithrombotic stocking,intermittent pneumatic compression devices and early mobilization have been described.Nevertheless,thromboprophylaxis is often dis-continued after discharge,although a serious risk may persist long after the initial triggering event,as the coagu-lation system remains active for at least 14 d post-opera-tively.The aim of this review is to evaluate the results of the current practice of VTE prevention in cancer patients undergoing major abdominal surgical operations,with special attention to adequately elucidated guidelinesand widely accepted protocols.In addition,the recent literature is presented in order to provide an update on the current concepts concerning the surgical manage-ment of the disease.

Venous thromboembolism in the emergency department:A survey of current best practice awareness in physicians and nurses in China

BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).

High prevalence of nonalcoholic fatty liver in patients with idiopathic venous thromboembolism

AIM:To assess the prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with idiopathic venous thromboembolism (VTE). METHODS:In a case-control study,after excluding subjects with well-consolidated risk factors for VTE,idiopathic VTE was documented in 138 consecutive patients who were referred to our department. Two hundred and seventy-six healthy sex/age/body-massindex-matched subjects,without any clinical/instrumental evidence of VTE,served as controls. All underwent a clinical/laboratory/ultrasound assessment for the presence of metabolic syndrome and NAFLD. RESULTS:NAFLD was detected in 112/138 cases (81%) and in 84/276 controls (30%) [risk ratio:2.7,95% confidence interval (CI):2.2-3.2,P < 0.0001]. Metabolic syndrome and smoking habit were more prevalent in patients with idiopathic VTE. The high prevalence of NAFLD in VTE was also confirmed after adjustment for inherited thrombophilia. NAFLD was clearly predicted by VTE (odds ratio:1.8,95% CI:1.2-2.7,P < 0.0001).

Incidence of venous thromboembolism and the role of D-dimer as predictive marker in patients with advanced gastric cancer receiving chemotherapy:A prospective study

To investigated the incidence and risk factors of venous thromboembolism (VTE) in patients with advanced gastric cancer (AGC) receiving chemotherapy. METHODSAll consecutive chemotherapy-naïve patients with AGC who would receive palliative chemotherapy between November 2009 and April 2012 in our hospital were recruited. Their pretreatment clinical and laboratory variables, including D-dimer, were recorded. The frequency of VTE development and survival rates during each chemotherapy cycle and regularly thereafter were assessed. RESULTSA total of 241 patients enrolled between November 2009 and April 2012 were analyzed. During a median follow-up duration of 10.8 mo (95%CI: 9.9-11.7), 27 patients developed VTE and the incidence of VTE was 17.5% (95%CI: 10.5-24.0, 12.0 events/100 person-years). The 6-mo and 1-year cumulative incidences were 7.8% (95%CI: 4.2%-11.4%) and 12.4% (95%CI: 7.3-17.2), respectively. Thirteen (48.1%) patients were symptomatic and the other 14 (51.9%) patients were asymptomatic. In multivariate analysis, pretreatment D-dimer level was the only marginally significant risk factor associated with VTE development (hazard ratio = 1.32; 95%CI: 1.00-1.75, P = 0.051). CONCLUSIONThe incidence of VTE is relatively high in patients with AGC receiving chemotherapy, and pretreatment D-dimer level might be a biomarker for risk stratification of VTE.

Venous thromboembolism in patients with inflammatory bowel disease:Focus on prevention and treatment

Inflammatory bowel disease(IBD)patients have an increased risk of venous thromboembolism(VTE),which represents a significant cause of morbidity and mortality.The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system,followed by the portal and mesenteric veins.However,other sites may also be involved,such as the cerebrovascular and retinal veins.The aetiology of VTE is multifactorial,including both inherited and acquired risk factors that,when simultaneously present,multiply the risk to the patient.VTE prevention involves correcting modifiable risk factors,such as disease activity,vitamin deficiency,dehydration and prolonged immobilisation.The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial.However,although guidelines recommend thromboprophylaxis for IBD patients,this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients.Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.

Evaluation of the safety and effectiveness of direct oral anticoagulants and low molecular weight heparin in gastrointestinal cancer-associated venous thromboembolism

BACKGROUND Gastrointestinal cancer(GICA)is associated with a higher incidence of venous thromboembolism(VTE)compared to other solid tumors,moreover,recurrent VTE and major bleeding(MB)complications during anticoagulation treatment have an associated increase rate.GICA-VTE remains a challenging clinical scenario with MB concerns for utilization of direct oral anticoagulants(DOAC),especially with active cancer therapies.AIM To evaluate patient risk factors,effectiveness(VTE)and safety(MB)of DOACs and low molecular weight heparin(LMWH)in patients with active GICA-VTE.METHODS A retrospective chart review of patients receiving DOACs and LMWH with GICA and symptomatic or incidental VTE treated at comprehensive cancer center from November 2013 to February 2017 was performed.Inclusion criteria included active GI cancer diagnosed at any stage or treatment+/-6 mo of VTE diagnosis,whom were prescribed 6 mo or more of DOACs or LMWH.The Chi-squared test was used for overall and the Fisher exact test for pairwise comparisons of the proportions of patients experiencing recurrent VTE and MB events.Odds ratios were used to compare the relative odds of the occurrence of the outcome given exposure to the risk factor.RESULTS A total of 144 patients were prescribed anticoagulation,in which 106 fulfilled inclusion criteria apixaban(27.3%),rivaroxaban(34.9%)and enoxaparin(37.7%),and 38 were excluded.Patients median age was 66.5 years at GICA diagnosis and 67 years at CAVTE event,with 62%males,80%Caucasian,70%stage IV,pancreatic cancer(40.5%),30%Khorana Score(≥3 points),and 43.5%on active chemotherapy.Sixty-four percent of patients completed anticoagulation therapy(range 1 to 43 mo).Recurrent VTE at 6 mo was noted in 7.5%(n=3),6.8%(n=2)and 2.7%(n=1)of patients on enoxaparin,apixaban and rivaroxaban,respectively(all P=NS).MB at 6 mo were 5%(n=2)for enoxaparin,6.8%(n=2)for apixaban and 21.6%(n=8)for rivaroxaban(overall P=0.048;vs LMWH P=0.0423;all other P=NS).Significant predictors of a primary or secondary outcome for all anticoagulation therapies included:Active systemic treatment(OR=5.1,95%CI:1.3-19.3),high Khorana Score[≥3 points](OR=5.5,95%CI:1.7-17.1),active smoker(OR=6.7,95%CI:2.1-21.0),pancreatic cancer(OR=6.8,95%CI:1.9-23.2),and stage IV disease(OR=9.9,95%CI:1.2-79.1).CONCLUSION Rivaroxaban compared to apixaban and enoxaparin had a significantly higher risk of MB on GICA-VTE patients with equivocal efficacy.

Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

AIM To summarize the current knowledge on vascular complications and deep venous thrombosis(DVT) prophylaxis after anterior cruciate ligament(ACL) reconstruction.METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane,Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined.RESULTS Fourty-seven studies were included in the review.Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism.Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism.CONCLUSION After ACL reconstruction, the incidence of arterial complications,symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction.

Ulcerative colitis complicated with colonic necrosis, septic shock and venous thromboembolism: A case report

BACKGROUND Severe total colonic necrosis,septic shock and venous thromboembolism secondary to ulcerative colitis (UC) are rare and life-threatening.No such severe complications have been reported in the literature.CASE SUMMARY We report a 36-year-old woman who developed total colonic necrosis and septic shock secondary to UC.The patient was treated with emergency surgery because computed tomography showed suspicious perforations.Persistent massive ascites occurred after operation and computed tomography angiography demonstrated portal vein,mesenteric vein and splenic vein thrombosis.The patient was discharged from hospital after active treatment.CONCLUSION Clinicians should pay attention to venous thrombosis,colonic necrosis and septic shock in UC patients.Close observation of surgical indications and timely surgical intervention are the key to reduce mortality and complications in UC.

Risk of venous thromboembolism in children and adolescents with inflammatory bowel disease: A systematic review and meta-analysis

BACKGROUND A two-to three-fold increased risk of venous thrombotic events(VTE) has been demonstrated in patients with inflammatory bowel disease(IBD) compared to the general population, but less is known about the risk of VTE in child-and pediatric-onset IBD. In recent years, several studies have reported the rising incidence rate of VTE in juvenile patients with IBD, and the related risk factors have been explored.AIM To evaluate the risk of VTE in children and adolescents with IBD.METHODS Articles published up to April 2021 were retrieved from Pub Med, Embase, Cochrane Library, Web of Science, Sino Med, CNKI, and WANFANG. Data from observational studies and clinical work were extracted. The outcome was the occurrence of VTE according to the type of IBD. The available odds ratio(OR) and the corresponding 95% confidence interval(CI) were extracted to compare the outcomes. Effect size(P), odds ratio(OR), and 95%CI were used to assess the association between VTE risk and IBD disease. Subgroup analyses stratified by subtypes of VTE and IBD were performed.RESULTS Twelve studies(7450272 IBD patients) were included in the meta-analysis. Child and adolescent IBD patients showed increased VTE risk(P = 0.02, 95%CI: 0.01-0.03). Subgroup analyses stratified by IBD(ulcerative colitis(UC): P = 0.05, 95%CI: 0.03-0.06;Crohn’s disease(CD): P = 0.02, 95%CI: 0.00-0.04) and VTE subtypes(portal vein thrombosis: P = 0.04, 95%CI: 0.02-0.06;deep vein thrombosis: P = 0.03, 95%CI: 0.01-0.05;central venous catheter-related thrombosis: P = 0.23, 95%CI: 0.00-0.46;thromboembolic events: P = 0.02, 95%CI: 0.01-0.03) revealed a significant correlation between VTE risk and IBD. Patients with IBD were more susceptible to VTE risk than those without IBD(OR = 2.99, 95%CI: 1.45-6.18). The funnel plot was asymmetric, suggesting the presence of significant publication bias. Pediatric and adolescent IBD patients have an increased VTE risk. UC and CD patients exhibited a high risk of VTE. The risk of VTE subtypes was increased in IBD patients.CONCLUSION The current meta-analysis showed that the incidence and risk of VTE are significantly increased in pediatric and adolescent IBD patients. Thus, IBD might be a risk factor for VTE in children and young adults. High-quality prospective cohort studies are necessary to confirm these findings.

Burden of venous thromboembolism in patients with pancreatic cancer

Pancreatic cancer(PC)is a devastating malignancy with fewer than 10%of patients being alive at 5 years after diagnosis.Venous thromboembolism(VTE)occurs in approximatively 20%of patients with PC,resulting in increased morbidity,mortality and significant health care costs.The management of VTE is particularly challenging in these frail patients.Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges.The International Initiative on Thrombosis and Cancer multi-language web-based mobile application(downloadable for free at www.itaccme.com)has been developed to help clinicians in decision making in the most complex situations.In this narrative review,we will discuss the contemporary epidemiology and burden of VTE in PC patients,the performances and limitations of current risk assessment models to predict the risk of VTE,as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support updated clinical practice guidelines.