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.

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.

VTE风险预警在口腔专科的建设及应用效果

目的:静脉血栓栓塞(VTE)是外科手术后的高危并发症之一。为了提高口腔专科患者的安全性并预防VTE的发生,建设有效的VTE风险预警系统至关重要。方法:本研究以某医院口腔科室为对象,收集患者的临床资料和VTE相关风险因素数据,建立了基于人工智能的VTE风险预测模型。该模型考虑了患者的年龄、性别、手术类型、术后活动水平等多个因素。将基于该模型的VTE系统嵌入医护工作站,通过业务流程实时提醒医护人员及时处理。结果:统计VTE风险预警系统上线后的2022年10月的数据,出院患者426人,VTE评估人数426人,初始风险评估率100%,发生VTE低危患者7人,发生率为1.64%,中高危患者3人,发生率为0.70%,而系统上线前的2021年10月同期出院患者372人,VTE评估人数325人,初始风险评估率为87.37%,发生VTE低危患者11人,发生率2.95%,中高危患者4人,发生率1.07%。低危患者的发生率同比下降36.4%,中高危患者的发生率同比下降25%。对接入智能VTE系统前后的VTE评估率进行统计学检验,χ^(2)值为7.835,P<0.05,表明系统上线前后VTE防治比率有显著差异。结论:在口腔专科中建设和应用VTE风险预警系统具有显著效果。该系统可提高患者的安全性,减少VTE的发生,并帮助医务人员采取有效预防措施。进一步的研究和推广应考虑不同医院和患者群体的特点,以优化预警系统的准确性和可操作性。

Risk assessment of venous thromboembolism in inflammatory bowel disease by inherited risk in a population-based incident cohort

Inflammatory bowel disease(IBD),including Crohn’s disease(CD)and ulcerative colitis(UC),is a chronic inflammatory disease of the digestive tract with increasing prevalence globally.Although venous thromboembolism(VTE)is a major complication in IBD patients,it is often underappreciated with limited tools for risk stratification.AIM To estimate the proportion of VTE among IBD patients and assess genetic risk factors(monogenic and polygenic)for VTE.METHODS Incident VTE was followed for 8465 IBD patients in the UK Biobank(UKB).The associations of VTE with F5 factor V leiden(FVL)mutation,F2 G20210A prothrombin gene mutation(PGM),and polygenic score(PGS003332)were tested using Cox hazards regression analysis,adjusting for age at IBD diagnosis,gender,and genetic background(top 10 principal components).The performance of genetic risk factors for discriminating VTE diagnosis was estimated using the area under the receiver operating characteristic curve(AUC).RESULTS The overall proportion of incident VTE was 4.70%in IBD patients and was similar for CD(4.46%),UC(4.49%),and unclassified(6.42%),and comparable to that of cancer patients(4.66%)who are well-known at increased risk for VTE.Mutation carriers of F5/F2 had a significantly increased risk for VTE compared to non-mutation carriers,hazard ratio(HR)was 1.94,95%confidence interval(CI):1.42-2.65.In contrast,patients with the top PGS decile had a considerably higher risk for VTE compared to those with intermediate scores(middle 8 deciles),HR was 2.06(95%CI:1.57-2.71).The AUC for differentiating VTE diagnosis was 0.64(95%CI:0.61-0.67),0.68(95%CI:0.66-0.71),and 0.69(95%CI:0.66-0.71),respectively,for F5/F2 mutation carriers,PGS,and combined.CONCLUSION Similar to cancer patients,VTE complications are common in IBD patients.PGS provides more informative risk information than F5/F2 mutations(FVL and PGM)for personalized thromboprophylaxis.

Acute myocardial infarction after initially diagnosed with unprovoked venous thromboembolism: A case report

BACKGROUND Protein C deficiency is typically associated with venous thromboembolism;however,arterial thrombosis has been reported in several cases.We report the case of a patient with pulmonary thromboembolism and deep vein thrombosis following acute myocardial infarction with high thrombus burden.CASE SUMMARY A 40-year-old man was diagnosed with pulmonary thromboembolism and deep vein thrombosis without any provoking factors.The patient was treated with anticoagulants for six months,which were then discontinued.Three months after the discontinuation of anticoagulant therapy,the patient was hospitalized with chest pain and diagnosed with acute myocardial infarction with high thrombus burden.Additional tests revealed protein C deficiency associated with thrombophilia.The patient was treated with anticoagulants combined with dual antiplatelet agents for 1 year after percutaneous coronary intervention,and no recurrent events were reported during a follow-up period of 5 years.CONCLUSION Recurrent thromboembolic events including acute myocardial infarction with thrombus should be considered an alarming sign of thrombophilia.

Case-control analysis of venous thromboembolism risk in nonalcoholic steatohepatitis diagnosed by transient elastography

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein thrombosis.Specifically,there is paucity of data on the association of NASH and venous thromboembolism(VTE),with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients.The mechanism is believed to be a hepatocellular injury,which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors.There has been no prior analysis of the degree of steatosis and fibrosis(measured using transient elastography,commonly known as FibroScan)in NASH and its association with VTE.AIM To examine the association between the degree of hepatic steatosis and fibrosis,quantified by transient elastography,and the incidence of VTE in patients with NASH.METHODS In our case-control study,we included patients with a documented diagnosis of NASH.We excluded patients with inherited thrombophilia,hemoglobinopathy,malignancy,alcohol use disorder,autoimmune hepatitis,and primary biliary cirrhosis.The collected data included age,demographics,tobacco use,recreational drug use,medical history,and vibration controlled transient elastography scores.VTE-specific data included the location,type of anticoagulant,need for hospital stay,and history of VTE recurrence.Steatosis was categorized as S0-S1(mild)and S2-S3(moderate to severe)based on the controlled attenuation parameter score.Fibrosis was classified based on the kilopascal score and graded as F0-F1(Metavir stage),F2,F3,and F4(cirrhosis).χ^(2) and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses,respectively.Furthermore,we performed a logistic regression using VTE as the dependent variable.RESULTS A total of 415 patients were analyzed,and 386 met the inclusion criteria.51 and 335 patients were included in the VTE and non-VTE groups,respectively.Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group(P<0.014).Patients with VTE had a higher body mass index(31.14 kg/m²vs 29.30 kg/m²)and a higher prevalence of diabetes mellitus(29.4%vs 13.1%).The history of NASH was significantly higher in the VTE group(45.1%vs 30.4%,P<0.037).Furthermore,moderate-to-severe steatosis was significantly higher in the VTE group(66.7%vs 47.2%,P<0.009).Similarly,the F2-F4 fibrosis grade had a prevalence of 58.8%in the VTE group compared to 38.5%in the non-VTE group(P<0.006).On logistic regression,using VTE as a dependent variable,diabetes mellitus had an odds ratio(OR)=1.702(P<0.015),and F2-F4 fibrosis grade had an OR=1.5(P<0.033).CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE,especially deep vein thrombosis.There was a statistically significant association between the incidence of VTE,moderate-to-severe steatosis,and fibrosis.All hospitalized patients should be considered for medical thromboprophylaxis,particularly those with NASH.

Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients:A single center experience

Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.

死亡与并发症病例讨论会制度在VTE防治中的实践探索

目的分析死亡与并发症病例讨论会(Mortality and Morbidity Conferences,MMC)制度在医院相关性静脉血栓栓塞症(venous thromboembolism,VTE)防治中的应用效果,为医院系统落实VTE防治措施提供参考。方法选取北京市某三级综合医院于2023年8—9月实施的两次MMC,运用头脑风暴、根因分析等方法对会议所选取的高度可疑死于急性肺栓塞的2例病例进行剖析。结果对VTE的认知程度不足、对VTE诊断敏感度不足、不良事件管理不到位和未确立VTE风险评估流程是导致医院相关性VTE事件发生的根本原因。结论医院要建立VTE防治的管理组织架构,定期开展VTE培训,建立VTE信息系统,明确标准化的VTE风险评估流程,增强医务人员对患者异常情况的敏感度。

信息化临床决策提醒系统对VTE规范预防及发生的影响

目的 通过建立院内静脉血栓栓塞症(venous thromboembolism, VTE)预防临床决策提醒信息系统,提高住院患者院内VTE的规范预防率,降低院内VTE发生率,减少潜在的院内非预期死亡及围手术期死亡,提高医疗质量、保障患者安全。方法 分别选取2023年6月与2023年10月某院住院的VTE高风险且无出血高风险的患者作为对照组与观察组,观察组采用医院VTE预防临床决策提醒系统,通过信息化警示、临床决策辅助、规范医嘱套组等方式提醒医师,将护理人员对患者的VTE罹患风险评估等级与医师应给予的规范预防之间进行信息化关联,结合培训、宣教等方式,比较两组VTE预防质量指标情况。结果 通过建立医院VTE预防临床决策提醒系统,药物预防执行率由18.01%提升至56.10%,医院相关性VTE发生率从2.42%下降至1.75%,差异均有统计学意义。结论 通过建立医院VTE预防临床决策提醒系统可有效提高院内VTE规范预防率,对医院的医疗质量和安全管理起促进作用。

A Study on Risk Factors for Venous Thromboembolism and the Requirement of Thromboprophylaxis in Pregnancy and Postpartum Period in a Tertiary Care Centre in South Asian Country: A Cross Sectional Study

Introduction: Thrombosis is a major cause of maternal death worldwide. During pregnancy, the risk of venous thromboembolism (VTE) increases fourfold to five-fold and contributes towards maternal morbidity and mortality. Sri Lanka does not have a proper assessment tool to detect and manage it in the antenatal care. Objectives: To identify risks factors for VTE among pregnant mothers, postpartum mothers according to RCOG (Royal College of Obstetricians) risk categorization and to assess the requirement of thromboprophylaxis. Method: A cross sectional study was conducted at the antenatal clinics and obstetrics and gynaecology wards (ward 2, 5, 8) of De Soysa Hospital for Women in 2021. Obstetric thromboprophylaxis risk assessment tool recommended by the RCOG was used for the risk assessment of pregnant mothers during the antenatal and postpartum period. Results: In antenatal period, obesity (BMI > 35), age more than 35 years and parity more than 3 were the commonest risk factors. Out of 404 mothers, 67.33% did not have any risk factors. Among others, 18.56%, 0.40%, 2.72%, 0.99% had a score of 1, 2, 3 and 4 respectively. Patients with intermediate (0.99%) and high risk (2.72%) were commenced on thromboprophylaxis from 28 weeks. The low-risk category was not started on any treatment (28.96%, n = 97). Approximately 96% of mothers did not require any thromboprophylaxis during antenatal period. Another 404 postnatal mothers were recruited for the study group. Elective caesarean section and caesarean section during labour were the main risks identified other than pre-existing antenatal risks. 39.95 % of mothers did not have any risk factors and 37.22% of mothers had a score of 1. Conclusions: VTE risk assessment tool can be implemented at national level to detect patients at risk of VTE and improve maternal care.

Assessment of nurses’knowledge of the prevention of hospital-associated venous thromboembolism in a tertiary health institution in Nigeria

Objective:This study assessed the level of nurses’knowledge of the prevention of venous thromboembolism(VTE)in a tertiary health institution.Materials and Methods:This descriptive cross-sectional study was conducted with 328 eligible respondents,selected using a random sampling method in a teaching hospital in Nigeria.A self-administered structured questionnaire was used to collect data on the basic knowledge,risk factors,and preventive measures of VTE.Results:Findings from the study revealed that 51.2%scored above the mean score of 28.6±3.1.The educational status of the respondents had a significant influence on their knowledge of risk factors of VTE(F=4.696,P=0.031).Conclusion:The overall knowledge of nurses is satisfactory,although the majority could not answer correctly questions on the administration of prefilled anticoagulants and identification of some key risk factors of VTE.

流程化VTE预防质量控制管理在妇科恶性肿瘤患者围术期血栓预防中的应用效果

目的探讨流程化静脉血栓栓塞症(VTE)预防质量控制管理在妇科恶性肿瘤患者围术期血栓预防中的应用效果。方法选取2019年5月至2022年5月我院收治的70例妇科恶性肿瘤患者,按照干预方案不同将其分为对照组和研究组,各35例。对照组给予常规管理,研究组开展流程化VTE预防质量控制管理。比较两组的下肢静脉血流速度、疼痛评分、下肢静脉血栓发生情况、凝血功能指标及知信行(KAP)评分。结果干预前,两组的下肢静脉血流速度及视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);干预后,研究组的下肢静脉血流速度大于对照组,VAS评分低于对照组,差异具有统计学意义(P<0.05)。研究组的下肢静脉血栓发生率低于对照组,差异具有统计学意义(P<0.05)。干预前,两组的凝血酶原时间、纤维蛋白原、D-二聚体水平及血小板计数比较,差异无统计学意义(P>0.05);干预后,研究组的凝血酶原时间长于对照组,纤维蛋白原、D-二聚体水平及血小板计数低于对照组,差异具有统计学意义(P<0.05)。研究组的KAP各维度评分高于对照组,差异具有统计学意义(P<0.05)。结论流程化VTE预防质量控制在妇科恶性肿瘤患者围手术期中的应用效果显著,能够改善凝血功能,加速下肢静脉血流速度,缓解疼痛,并提高患者的知信行水平,值得临床推广和应用。

基于TAT、PIC联合Padua评分在早期筛查慢性呼吸系统疾病合并VTE患者中的价值

目的:探究基于凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)联合Padua评分在早期筛查慢性呼吸系统疾病合并静脉血栓栓塞症(VTE)患者中的价值。方法:收集2022年10月—2023年9月时间段内在我院呼吸与危重症医学科接受住院诊疗的慢性呼吸系统疾病患者100例,按照是否发生VTE分组,分为VTE组(n=43)与非VTE组(n=57)。接受血清TAT、PIC检测分析以及Padua评分评估。比较两组血清TAT、PIC水平以及Padua评分。采用ROC曲线分析血清TAT、PIC与Padua评分单一或联合对慢性呼吸系统疾病合并VTE的诊断效能。结果:VTE组患者的血清TAT、PIC水平以及Padua评分均较非VTE组患者高(P<0.05),且VTE组患者VTE高风险(Padua评分≥4分)占比高于非VTE组(P<0.05)。经分析,当血清TAT≥16.18ng/mL时,其诊断灵敏度为71.43%、特异度为77.59%;当血清PIC≥3.10μg/mL时,其诊断灵敏度为76.60%、特异度为86.79%;当Padua评分≥4分时,其诊断灵敏度为80.85%、特异度为90.57%。经血清TAT、PIC与Padua评分联合诊断的AUC为0.959,其诊断灵敏度为93.48%、特异度为100.00%。结论:慢性呼吸系统疾病合并VTE患者血清TAT、PIC水平及Padua评分明显较高,通过TAT、PIC联合Padua评分可早期筛查慢性呼吸系统疾病合并VTE,且诊断效能较高。

Protein C deficiency with venous and arterial thromboembolic events

Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.

品管圈在提高VTE中高风险患者预防措施落实率中的应用效果

目的探讨品管圈(QCC)在提高静脉血栓栓塞(VTE)中高风险患者预防措施落实率中的应用效果。方法选取我院2021年5月至6月收治的108例神经外科VTE中高风险患者为实施前组,另选取我院2021年12月至2022年1月收治的108例神经外科VTE中高风险患者为实施后组。2021年7月成立QCC小组并确定活动主题后,通过QCC步骤开展活动,对引起患者VTE预防措施落实率低的现象进行现状调查和原因分析,并确定改善重点,设定目标值,拟定对策并实施。分析QCC活动的实施效果。结果QCC活动实施后的预防措施落实率为85.2%,显著高于实施前的40.5%,差异具有统计学意义(P<0.01);目标达成率为108.0%,进步率为110.4%。QCC活动实施后,患者的平均住院时间显著短于实施前,平均住院费用显著少于实施前,差异具有统计学意义(P<0.01)。QCC活动实施后,圈员综合能力均有一定程度的提升。结论实施QCC活动能够显著提高VTE中高风险患者的预防措施落实率,对住院患者VTE预防具有十分重要的意义,还可以提高医护人员参与临床质量管理的能动性,促进神经外科VTE防治工作的持续改进,值得在临床当中推广与应用。

Functional Capacity of Patients with Venous Thromboembolic Disease Six to Twelve Months after Treatment

Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.

Research progress on venous thrombosis development in patients with malignant tumors

The coexistence of venous thromboembolism(VTE)within patients with cancer,known as cancer-associated thrombosis(CAT),stands as a prominent cause of mortality in this population.Over recent years,the incidence of VTE has demonstrated a steady increase across diverse tumor types,influenced by several factors such as patient management,tumor-specific risks,and treatment-related aspects.Furthermore,mutations in specific genes have been identified as potential contributors to increased CAT occurrence in particular cancer subtypes.We conducted an extensive review encompassing pivotal historical and ongoing studies on CAT.This review elucidates the risks,mechanisms,reliable markers,and risk assessment methodologies that can significantly guide effective interventions in clinical practice.

Venous thromboembolism prophylaxis of a patient with MYH-9 related disease and COVID-19 infection:A case report

BACKGROUND The May-Hegglin anomaly is among a group of genetic disorders known as MYH9-related disease.Patients with inherited platelet disorders such as May-Hegglin anomaly are at a variably increased risk for bleeding due to a combination of platelet dysfunction and thrombocytopenia.Patients admitted to the hospital with coronavirus disease 2019(COVID-19)infection are at an increased risk for a venous thromboembolism event(VTE).The National Institutes of Health COVID-19 treatment guidelines recommend using a prophylactic dose of heparin as VTE prophylaxis for adults who are receiving high-flow oxygen.We describe a patient admitted for COVID-19 infection with pneumonia and a history of May-Hegglin anomaly.The patient presented a challenge to determine prophylactic anticoagulation as there are no clear guidelines for this patient population.CASE SUMMARY Herein,we describe the case of a 39-year-old woman admitted with acute hypoxic respiratory failure secondary to COVID-19 pneumonia.She had a history of May-Hegglin anomaly and demonstrated risk for bleeding since childhood,including a life-threatening bleeding event at the age of 9 years requiring blood and platelet transfusions.Her baseline platelet count was 40-50×109/L throughout her adult life.Her family history was also notable for May-Hegglin disorder in her mother,maternal uncle,maternal grandfather and her son.Computed tomography/pulmonary angiography revealed bilateral consolidative opacities consistent with multifocal pneumonia.Complete blood count was notable for platelet count of 54×109/L.She was admitted for inpatient respiratory support with high-flow oxygen per nasal cannula and was managed with guideline-directed therapy for COVID-19,including baricitinib and dexamethasone.The Hematology/Oncology consultation team was requested to assist with management of VTE prophylaxis in the setting of active COVID-19 infection and an inherited bleeding disorder.After review of the literature and careful consideration of risks and benefits,it was decided to treat the patient with prophylactic enoxaparin.She was closely monitored in the hospital for bleeding and worsening thrombocytopenia.She had no bleeding or signs of VTE.Her respiratory status improved,and she was discharged home after 5 d of hospitalization with supplemental oxygen by nasal cannula and dexamethasone.At the 6-month follow-up,the patient successfully discontinued her home oxygen use after only a few weeks following discharge.CONCLUSION The patient presented a challenge to determine prophylactic anticoagulation as anticoagulation guidelines exist for patients with COVID-19,but there are no clear guidelines for management of patients with COVID-19 and inherited bleeding disorders,particularly those with MYH9-related disease.She was discharged after recovery from the COVID-19 infection without bleeding or thrombosis.As there are no published guidelines for this situation,we present a pragmatic,informed approach to a patient with MYH9-related disease who had an indication for anticoagulation.

基于人工智能技术的骨科VTE防治系统的开发与应用

目的提高骨科患者静脉血栓栓塞(VTE)评估效率和准确性,减少VTE的发生。方法将2586例骨科住院手术患者按入院时间段分为对照组1023例、观察组1563例。对照组采用纸质评估表评估患者VTE情况、手动录入HIS等常规VTE风险管理;观察组开发VTE防治全链路系统进行患者VTE风险管理。结果观察组VTE评估效率、评估正确率及医护人员管理满意度显著高于对照组(均P<0.05),VTE发生率显著低于对照组(P<0.05)。结论骨科VTE防治全链路系统的应用,可有效提高骨科住院手术患者VTE评估效率和正确率,减少VTE的发生,提高医护人员工作满意度。