PLOS ONE: [sortOrder=DATE_NEWEST_FIRST, sort=Date, newest first, filterJournals=PLoSONE, q=subject:"Thromboembolism"]PLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/search/feed/atom?sortOrder=DATE_NEWEST_FIRST&unformattedQuery=subject:%22Thromboembolism%22&sort=Date,+newest+first&filterJournals=PLoSONEAll PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-28T08:58:03ZImpact of extracorporeal membrane oxygenation-related complications on in-hospital mortalityEunae ByunPil Je KangSung Ho JungSeo Young ParkSang Ah LeeTae-Won KwonYong-Pil Cho10.1371/journal.pone.03007132024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Eunae Byun, Pil Je Kang, Sung Ho Jung, Seo Young Park, Sang Ah Lee, Tae-Won Kwon, Yong-Pil Cho</p>
Introduction <p>Although extracorporeal membrane oxygenation (ECMO) is a well-established treatment for supporting severe cardiopulmonary failure, the morbidity and mortality of patients requiring ECMO support remain high. Evaluating and correcting potential risk factors associated with any ECMO-related complications may improve care and decrease mortality. This study aimed to assess the predictors of ECMO-related vascular and cerebrovascular complications among adult patients and to test the hypothesis that ECMO-related complications are associated with higher in-hospital mortality rates.</p> Methods <p>This single-center, retrospective study included 856 ECMO runs administered via cannulation of the femoral vessels of 769 patients: venoarterial (VA) ECMO (<i>n</i> = 709, 82.8%) and venovenous (VV) ECMO (<i>n</i> = 147, 17.2%). The study outcomes included the occurrence of ECMO-related vascular and cerebrovascular complications and in-hospital death. The association of ECMO-related complications with the risk of in-hospital death was analyzed.</p> Results <p>The incidences of ECMO-related vascular and cerebrovascular complications were 20.2% and 13.6%, respectively. The overall in-hospital mortality rate was 48.7%: 52.8% among VA ECMO runs and 29.3% among VV ECMO runs. Multivariable analysis indicated that age (<i>P</i> < 0.01), cardiopulmonary cerebral resuscitation (<i>P</i> < 0.01), continuous renal replacement therapy (<i>P</i> < 0.01), and initial platelet count [<50×10<sup>3</sup>/μL (<i>P</i> = 0.02) and 50–100(×10<sup>3</sup>)/μL (<i>P</i> < 0.01)] were associated with an increased risk of in-hospital death. ECMO-related vascular and cerebrovascular complications were not independently associated with higher in-hospital mortality rates for VA or VV ECMO runs.</p> Conclusion <p>ECMO-related vascular and cerebrovascular complications were not associated with an increased risk of in-hospital death among adult patients.</p>Safety profile of rivaroxaban in first-time users treated for venous thromboembolism in four European countriesAna RuigómezTania SchinkAnnemarie VossRon M. C. HeringsElisabeth SmitsKarin Swart-PolinderYanina BalabanovaGunnar BrobertKiliana Suzart-WoischnikLuis Alberto García Rodríguez10.1371/journal.pone.02985962024-03-07T14:00:00Z2024-03-07T14:00:00Z<p>by Ana Ruigómez, Tania Schink, Annemarie Voss, Ron M. C. Herings, Elisabeth Smits, Karin Swart-Polinder, Yanina Balabanova, Gunnar Brobert, Kiliana Suzart-Woischnik, Luis Alberto García Rodríguez</p>
Background <p>The European rivaroxaban post-authorization safety study evaluated bleeding risk among patients initiated on rivaroxaban or vitamin K antagonists for the treatment and secondary prevention of venous thromboembolism in routine clinical practice.</p> Methods <p>Cohorts were created using electronic healthcare databases from the UK, the Netherlands, Germany and Sweden. Patients with a first prescription of rivaroxaban or vitamin K antagonist during the period from December 2011 (in the UK, January 2012) to December 2017 (in Germany, December 2016) for venous thromboembolism indication, with no record of atrial fibrillation or recent cancer history, were observed until the occurrence of each safety outcome (hospitalization for intracranial, gastrointestinal, urogenital or other bleeding), death or study end (December 2018; in Germany, December 2017). Crude incidence rates of each outcome per 100 person-years were computed.</p> Results <p>Overall, 44 737 rivaroxaban and 45 842 vitamin K antagonist patients were enrolled, mean age, 59.9–63.8 years. Incidence rates were similar between rivaroxaban and vitamin K antagonist users with some exceptions, including higher incidence rates for gastrointestinal bleeding in rivaroxaban users than in vitamin K antagonist users. Among rivaroxaban users, mortality and bleeding risk generally increased with age, renal impairment and diabetes.</p> Conclusions <p>This study provides further data from routine clinical practice that broadly support safety profile of rivaroxaban for VTE indication and complement findings from previous randomized clinical trials.</p>Safety and efficacy of percutaneous Watchman 2.5 device versus Amplatzer Amulet for left atrial appendage closure in patients with non-valvular atrial fibrillation: A systematic review and study-level meta-analysisFarah YasminEman AliAbdul MoeedFarwa ZaidiMuhammad UmarVikash Virwani10.1371/journal.pone.02958042024-02-14T14:00:00Z2024-02-14T14:00:00Z<p>by Farah Yasmin, Eman Ali, Abdul Moeed, Farwa Zaidi, Muhammad Umar, Vikash Virwani</p>
Introduction <p>In patients with non-valvular atrial fibrillation (NVAF), mechanical occlusion of the left atrial appendage (LAA) using a permanently implanted device may be an effective alternative to oral anti-coagulants (OAC). To facilitate left atrial appendage closure (LAAC), multiple percutaneous devices have been proposed. Watchman Generation 2.5 and Amplatzer Amulet are the two most popular used devices for preventing stroke in patients with NVAF. We sought to compare safety and efficacy outcomes between Watchman 2.5 and Amplatzer Amulet in patients undergoing LAAC procedure.</p> Methods <p>We carried out a comprehensive and systematic search of the databases PubMed and Scopus, for all studies that compared the safety and efficacy of Watchman 2.5 and Amplatzer Amulet devices, from inception, till June 2023. We performed the statistical analysis using Review Manager (V.5.4.1 Cochrane Collaboration, London, United Kingdom). The safety outcomes of interest included device success, device-related thrombus, device embolization perioperatively and at follow-up, perioperative pericardial perfusion events, and perioperative cardiac tamponade events. Efficacy outcomes were all-cause mortality perioperatively and at follow-up, cardiovascular (CV) mortality at follow-up, stroke, major and minor bleeding events at follow-up, transient ischemic attack (TIA) in follow-up period, thromboembolic events in follow-up period, and peri-device leakage in perioperative period. All data was analysed using a random-effects model, and presented as risk ratios (RRs) with 95% confidence intervals (95%CIs).</p> Results <p>Regarding safety outcomes, device success was non-significantly reduced in Watchman group when compared with Amulet (RR 0.99, p = 0.57; I<sup>2</sup> = 34%). In contrast, device-related thrombus was non-significantly increased in Watchman 2.5 group in comparison to Amulet (RR 1.44, p = 0.11; I<sup>2</sup> = 0%). There was no significant difference between the devices in terms of device embolization in the perioperative (RR 0.36, p = 0.38; I2 = 22%) and follow-up (RR 2.24, p = 0.13; I<sup>2</sup> = 0%) periods. Likewise, there was no significant difference in the risks of pericardial effusion (RR 0.98, p = 0.98; I<sup>2</sup> = 0%), and cardiac tamponade (RR 0.65, p = 0.76; I2 = 62%) perioperatively. Regarding efficacy outcomes, no significant difference was observed in all-cause mortality between devices perioperatively (RR 0.51, p = 0.32; I<sup>2</sup> = 0%) and at follow-up (RR 1.08, p = 0.56; I<sup>2</sup> = 0%). CV-mortality was non-significantly reduced in Watchman group when compared with Amulet (RR 0.57, p = 0.20; I<sup>2</sup> = 0%). The Amulet device was not superior to the Watchman device in terms of stroke at follow-up (RR 1.13, p = 0.63; I<sup>2</sup> = 0%). Sub-group analysis showed comparable ischaemic and haemorrhagic stroke events between two devices. Furthermore, at follow-up, there was no significant difference in major (RR 1.06, p = 0.63; I<sup>2</sup> = 0%) and minor bleeding events (RR 1.81, p = 0.17; I<sup>2</sup> = 0%) between the two devices. No difference was observed for trans-ischemic attack (RR 1.89, p = 0.24; I<sup>2</sup> = 0%) and thromboembolic events (RR 0.96, p = 0.96; I<sup>2</sup> = 0%) at follow-up. No significant difference was observed between devices for peri-device leakage in perioperative period (RR 2.16, p = 0.05; I<sup>2</sup> = 0%).</p> Conclusion <p>The data suggested that LAAC is safe and efficacious procedure irrespective of device used, with generally low complication rates. Watchman generation 2.5 remains non-superior to Amplatzer Amulet in terms of safety and efficacy outcomes.</p>Caffeinated beverages intake and risk of deep vein thrombosis: A Mendelian randomization studyTong LinHaiyan MaoYuhong Jin10.1371/journal.pone.02981232024-02-13T14:00:00Z2024-02-13T14:00:00Z<p>by Tong Lin, Haiyan Mao, Yuhong Jin</p>
This study aimed to explore the potential link between coffee and tea consumption and the risk of deep vein thrombosis (DVT) through Mendelian randomization (MR) analysis. Employing the MR, we identified 33 single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for coffee intake and 38 SNPs for tea intake. The investigation employed the inverse-variance weighted (IVW) method to evaluate the causal impact of beverage consumption on DVT risk. Additionally, MR-Egger and MR-PRESSO tests were conducted to assess pleiotropy, while Cochran’s Q test gauged heterogeneity. Robustness analysis was performed through a leave-one-out approach. The MR analysis uncovered a significant association between coffee intake and an increased risk of DVT (odds ratio [OR] 1.008, 95% confidence interval [CI] = 1.001–1.015, P = 0.025). Conversely, no substantial causal effect of tea consumption on DVT was observed (OR 1.001, 95% CI = 0.995–1.007, P = 0.735). Importantly, no significant levels of heterogeneity, pleiotropy, or bias were detected in the instrumental variables used. In summary, our findings suggest a modestly heightened risk of DVT associated with coffee intake, while tea consumption did not exhibit a significant impact on DVT risk.Synthetic data in cancer and cerebrovascular disease research: A novel approach to big dataRonda LunDeborah SiegalTim RamsayGrant StottsDar Dowlatshahi10.1371/journal.pone.02959212024-02-07T14:00:00Z2024-02-07T14:00:00Z<p>by Ronda Lun, Deborah Siegal, Tim Ramsay, Grant Stotts, Dar Dowlatshahi</p>
Objectives <p>Synthetic datasets are artificially manufactured based on real health systems data but do not contain real patient information. We sought to validate the use of synthetic data in stroke and cancer research by conducting a comparison study of cancer patients with ischemic stroke to non-cancer patients with ischemic stroke.</p> Design <p>retrospective cohort study.</p> Setting <p>We used synthetic data generated by MDClone and compared it to its original source data (i.e. real patient data from the Ottawa Hospital Data Warehouse).</p> Outcome measures <p>We compared key differences in demographics, treatment characteristics, length of stay, and costs between cancer patients with ischemic stroke and non-cancer patients with ischemic stroke. We used a binary, multivariable logistic regression model to identify risk factors for recurrent stroke in the cancer population.</p> Results <p>Using synthetic data, we found cancer patients with ischemic stroke had a lower prevalence of hypertension (52.0% in the cancer cohort vs 57.7% in the non-cancer cohort, p<0.0001), and a higher prevalence of chronic obstructive pulmonary disease (COPD: 8.5% vs 4.7%, p<0.0001), prior ischemic stroke (1.7% vs 0.1%, p<0.001), and prior venous thromboembolism (VTE: 8.2% vs 1.5%, p<0.0001). They also had a longer length of stay (8 days [IQR 3–16] vs 6 days [IQR 3–13], p = 0.011), and higher costs associated with their stroke encounters: $11,498 (IQR $4,440 –$20,668) in the cancer cohort vs $8,084 (IQR $3,947 –$16,706) in the non-cancer cohort (p = 0.0061). A multivariable logistic regression model identified 5 predictors for recurrent ischemic stroke in the cancer cohort using synthetic data; 3 of the same predictors identified using real patient data with similar effect measures. Summary statistics between synthetic and original datasets did not significantly differ, other than slight differences in the distributions of frequencies for numeric data.</p> Conclusion <p>We demonstrated the utility of synthetic data in stroke and cancer research and provided key differences between cancer and non-cancer patients with ischemic stroke. Synthetic data is a powerful tool that can allow researchers to easily explore hypothesis generation, enable data sharing without privacy breaches, and ensure broad access to big data in a rapid, safe, and reliable fashion.</p>The effect of obligatory Padua prediction scoring in hospitalized medically ill patients: A retrospective cohort studyGenady DrozdinskyOren ZusmanShiri KushnirLeonard LeiboviciAnat Gafter-Gvili10.1371/journal.pone.02926612024-02-07T14:00:00Z2024-02-07T14:00:00Z<p>by Genady Drozdinsky, Oren Zusman, Shiri Kushnir, Leonard Leibovici, Anat Gafter-Gvili</p>
Background <p>Venous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.</p> Aim <p>To evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.</p> Methods <p>Retrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.</p> Results <p>18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.</p> Conclusions <p>Padua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</p>D-dimer levels to exclude pulmonary embolism and reduce the need for CT angiography in COVID-19 in an outpatient populationAnita KovácsDóra HantosiNikoletta SzabóAnnamária LetohaCsaba LengyelImre FöldesiKatalin BuriánAndrás PalkóDániel VerébZsigmond Tamás Kincses10.1371/journal.pone.02970232024-01-17T14:00:00Z2024-01-17T14:00:00Z<p>by Anita Kovács, Dóra Hantosi, Nikoletta Szabó, Annamária Letoha, Csaba Lengyel, Imre Földesi, Katalin Burián, András Palkó, Dániel Veréb, Zsigmond Tamás Kincses</p>
Objectives <p>Emerging results indicate that, in COVID-19, thromboembolic complications contribute to the high mortality and morbidity. Previous research showed that the prevalence of pulmonary embolism (PE) is between 25–50% in COVID-19 patients, however, most of these reports are based on data from patients with severe pneumonia, treated in intensive care units.</p> Materials and methods <p>We conducted a retrospective, single-center, observational study to estimate the prevalence of PE in COVID-19 patients who underwent CT angiography and to identify the most important predictors.Adult outpatients with COVID-19, who presented at our COVID Outpatient Clinic between 1<sup>st</sup> and 31<sup>st</sup> of March in 2021 and underwent CTA examination were included in this study. Multiple linear regression analysis was used to identify predictors of PE in COVID-19 patients. The predictors were: age, gender, disease duration, CT severity index and log-transformed quantitative D-dimer (logQDDIM) value.</p> Results <p>843 COVID-19 patients were included into the study. 82.56% (693 patients) of the infected patients had a pulmonary CTA examination and D-dimer levels (mean age: 59.82 years ± 15.66). 7.61% (53 patients) of the patients had PE. 2.02% (14 patients) of the patients had main branch or lobar PE.The multiple regression analysis found that only logQDDIM was a significant predictor. A logQDDIM cut-off value of 0.0169 (1.0171 ug/ml serum D-dimer) predicted PE with 99% sensitivity (p<0.0001, degree-of-freedom = 570, AUC = 0.72).</p> Conclusions <p>We demonstrated in a large cohort of COVID-19 patients that a cut-off value of QDDIM of 1ug/ml can exclude pulmonary embolism in an outpatient setting, implicating that QDDIM might potentially supersede CTA as a screening approach in COVID-19 outpatient clinics.</p>Incidence and preventive treatment for deep vein thrombosis with our own preventive protocol in total hip and knee arthroplastyTakashige MomoseMasaki NakanoYukio NakamuraTakashi MaedaMasashi Nawata10.1371/journal.pone.02938212024-01-17T14:00:00Z2024-01-17T14:00:00Z<p>by Takashige Momose, Masaki Nakano, Yukio Nakamura, Takashi Maeda, Masashi Nawata</p>
The aim of the present study was to investigate the perioperative and postoperative incidence of deep vein thrombosis (DVT) and validate the effectiveness of our own preventive treatment protocol for venous thromboembolism (VTE) occurrence in lower extremity arthroplasty patients. The subjects were 1,054 patients (mean age: 74.3 years) who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) at our institutions between April 2014 and March 2017. We examined the frequencies of pre- and post-operative DVT by lower extremity Doppler images, and the incidence rate at proximal or distal regions as well as that according to preoperative DVT status were evaluated. Preoperative DVT was detected in 6.5% (69 cases) of our cohort and those were located 1.4% (15 cases) at proximal and 5.1% (54 cases) at distal regions. A significantly higher rate of postoperative DVT development was observed in preoperative DVT+ THA patients (<i>P</i> = 0.0075), but not in TKA patients only with a higher tendency (<i>P</i> = 0.56). The overall incidence of DVT up to 2 weeks after surgeries was 27.3% (288 cases); however, the rate in proximal femur regions was suppressed to 2.8% (30 cases), and there was no symptomatic pulmonary thromboembolism (PTE) case. The results demonstrated the importance of regular Doppler examination for early detection of postoperative DVT occurrence and the following immediate treatment initiation. Our own VTE preventive treatment protocol could reduce the development of proximal DVT, and the periodic monitoring as well as prompt treatment might prevent the fatal PTE. osteoarthritis (OA), rheumatoid arthritis (RA).Effectiveness and safety of oral anticoagulant therapy in a real-world cohort with atrial fibrillation: The SIESTA-A study protocolM. C. Montero-BalosaJ. A. Limón-MoraA. Leal-AtienzaL. G. Luque-RomeroM. J. Aguado-RomeoR. Isabel-GómezM. T. Molina-López10.1371/journal.pone.02948222023-11-29T14:00:00Z2023-11-29T14:00:00Z<p>by M. C. Montero-Balosa, J. A. Limón-Mora, A. Leal-Atienza, L. G. Luque-Romero, M. J. Aguado-Romeo, R. Isabel-Gómez, M. T. Molina-López</p>
Introduction <p>Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD).</p> Methods and analysis <p>Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA<sub>2</sub>DS<sub>2</sub>-VAS<sub>C</sub>, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching.</p>An efficient machine learning framework to identify important clinical features associated with pulmonary embolismBaiming ZouFei ZouJianwen Cai10.1371/journal.pone.02921852023-09-28T14:00:00Z2023-09-28T14:00:00Z<p>by Baiming Zou, Fei Zou, Jianwen Cai</p>
A misdiagnosis of pulmonary embolism (PE) can have severe consequences such as disability or death. It’s crucial to accurately identify key clinical features of PE in clinical practice to promptly identify potential PE patients who may present asymptomatically, and to prevent misdiagnosing PE as asthma exacerbation in patients with symptoms like dyspnea or chest pain. However, reliably identifying these important features can be challenging due to many factors influencing the likelihood of PE development in complex fashions (e.g., the interactions among these factors). To address this difficulty, we presented an effective framework using the deep neural network (DNN) model and the permutation-based feature importance test (PermFIT) procedure, i.e., PermFIT-DNN. We applied the PermFIT-DNN framework to the analysis of data from a PE study for asthma exacerbation patients. Our analysis results show that the PermFIT-DNN framework can robustly identify key features for classifying PE status. The important features identified can also aid in accurately predicting the PE risk.Association of total cholesterol variability with risk of venous thromboembolism: A nationwide cohort studyHyungjong ParkYoonkyung ChangHeajung LeeIksun HongTae-Jin Song10.1371/journal.pone.02897432023-08-17T14:00:00Z2023-08-17T14:00:00Z<p>by Hyungjong Park, Yoonkyung Chang, Heajung Lee, Iksun Hong, Tae-Jin Song</p>
Background <p>The effects of total cholesterol (TC) on coagulation and hemostatic systems could contribute to the development of venous thromboembolism (VTE). We investigated this possible association using TC variability.</p> Methods <p>From the Korean NHIS-HEALS database, 1,236,589 participants with health screenings between 2003 and 2008 were included. TC variability was assessed using various parameters, including the coefficient of variation (CV), standard deviation (SD), and variability independent of mean (VIM). Occurrence of VTE was established by identifying at least two medical claims with a diagnostic code including various types of VTE: deep vein thrombosis (DVT) (I80.2–80.3), pulmonary embolism (PE) (I26, I26.0, I26.9), intraabdominal VTE (I81, I82, I82.2–82.3), and other VTE (I82.8–82.9).</p> Results <p>Throughout the study’s median follow-up period of 12.4 years (interquartile range 12.2–12.6) years, TC levels were assessed a total of 5,702,800 times. VTE occurred in 11,769 (1.08%) patients (DVT (4,708 (0.43%)), PE (3,109 (0.29%)), intraabdominal VTE (5,215 (0.48%)), and other VTE (4,794, (0.44%)). As a result, there was gradual association was observed between higher TC variability and occurrence of VTE. Multivariable analysis showed that quartile of TC variability using CV showed a positive correlation with the occurrence of VTE (adjusted hazard ratio (the highest versus lowest quartile), 1.14, 95% confidence interval, 1.08–1.20, p < 0.001). This result remained consistent applying to SD and VIM. In addition, higher quartile of TC variability was consistently associated with the development of various types of VTE in subgroup analysis.</p> Conclusions <p>Increased TC variability may be associated with increased VTE risk. This analysis highlights the importance of maintaining stable TC levels to prevent the development of VTE.</p>Venous congestion affects neuromuscular changes in pigs in terms of muscle electrical activity and muscle stiffnessKeun-Tae KimDuguma T. GemechuEunyoung SeoTaehoon LeeJong Woong ParkInchan YounJong Woo KangSong Joo Lee10.1371/journal.pone.02892662023-08-03T14:00:00Z2023-08-03T14:00:00Z<p>by Keun-Tae Kim, Duguma T. Gemechu, Eunyoung Seo, Taehoon Lee, Jong Woong Park, Inchan Youn, Jong Woo Kang, Song Joo Lee</p>
Early detection of venous congestion (VC)-related diseases such as deep vein thrombosis (DVT) is important to prevent irreversible or serious pathological conditions. However, the current way of diagnosing DVT is only possible after recognizing advanced DVT symptoms such as swelling, pain, and tightness in affected extremities, which may be due to the lack of information on neuromechanical changes following VC. Thus, the goal of this study was to investigate acute neuromechanical changes in muscle electrical activity and muscle stiffness when VC was induced. The eight pigs were selected and the change of muscle stiffness from the acceleration and muscle activity in terms of integral electromyography (IEMG) was investigated in three VC stages. Consequently, we discovered a significant increase in the change in muscle stiffness and IEMG from the baseline to the VC stages (<i>p</i> < 0.05). Our results and approach can enable early detection of pathological conditions associated with VC, which can be a basis for further developing early diagnostic tools for detecting VC-related diseases.JAK-inhibitors and risk on serious viral infection, venous thromboembolism and cardiac events in patients with rheumatoid arthritis: A protocol for a prevalent new-user cohort study using the Danish nationwide DANBIO registerMaria Luisa FaquettiEnriqueta Vallejo-YagüeRené CordtzLene DreyerAndrea M. Burden10.1371/journal.pone.02887572023-07-27T14:00:00Z2023-07-27T14:00:00Z<p>by Maria Luisa Faquetti, Enriqueta Vallejo-Yagüe, René Cordtz, Lene Dreyer, Andrea M. Burden</p>
Janus Kinase inhibitors (JAKis) are targeted synthetic disease-modifying antirheumatic drugs and represent an important alternative to treat patients with moderate to high rheumatoid arthritis (RA) disease activity. Safety concerns associated with increased risk for venous thromboembolism (VTE), serious viral infection, and, more recently, major adverse cardiovascular events (MACE) in JAKi users have emerged worldwide. However, as the exact mechanisms to explain these safety concerns remain unclear, the increased risk of VTE, MACE, and serious viral infection in JAKi users is heavily debated. In light of the need to enrich the safety profile of JAKis in real-world data, we aim to quantify the incidence and risk of MACE, VTE, and serious viral infections in RA patients registered in the Danish DANBIO registry, a nationwide registry of biological therapies used in rheumatology. Therefore, we will conduct a population-based cohort study using a prevalent new-user design. We will identify all RA patients in the DANBIO, ≥ 18 years old, receiving a JAKi or a tumor necrosis factor α inhibitor (TNF-αi) from January 2017 to December 2022. Prevalent and new users of JAKis will be matched to TNF-αi comparators with similar exposure history using time-conditional propensity scores (TCPS). We will describe the cumulative incidence of the outcomes (VTE, MACE, serious viral infection) in each exposure group (JAKi users; TNF-αi users), stratified by outcome type. Additionally, the Aalen-Johansen method will be used to estimate the time-to-event survival function stratified by outcome type. We will also estimate the hazard ratio (HR) with 95% confidence interval (CI) of each outcome in both exposure groups using the time-dependent Cox proportional hazards model. Results will enrich the safety profile of JAKis in real-world data.Cost-effectiveness of mechanical thromboprophylaxis for cesarean deliveries in BrazilAlex VelozUbong SilasRhodri SaundersJody GrisamoreAndré Luiz Malavasi10.1371/journal.pone.02878122023-06-29T14:00:00Z2023-06-29T14:00:00Z<p>by Alex Veloz, Ubong Silas, Rhodri Saunders, Jody Grisamore, André Luiz Malavasi</p>
Objective <p>To evaluate the cost-effectiveness of using mechanical thromboprophylaxis for patients undergoing a cesarean delivery in Brazil.</p> Methods <p>A decision-analytic model built in TreeAge software was used to compare the cost and effectiveness of intermittent pneumatic compression to prophylaxis with low-molecular-weight heparin or no prophylaxis from the perspective of the hospital. Related adverse events were venous thromboembolism, minor bleeding, and major bleeding. Model data were sourced from peer-reviewed studies through a structured literature search. A willingness-to-pay threshold of R$15,000 per avoided adverse event was adopted. Scenario, one-way, and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainties on the results.</p> Results <p>The costs of care related to venous thromboembolism prophylaxis and associated adverse events ranged from R$914 for no prophylaxis to R$1,301 for low-molecular-weight heparin. With an incremental cost-effectiveness ratio of R$7,843 per adverse event avoided. Intermittent pneumatic compression was cost-effective compared to no prophylaxis. With lower costs and improved effectiveness, intermittent pneumatic compression dominated low-molecular-weight heparin. The probabilistic sensitivity analyses showed that the probability of being cost-effective was comparable for intermittent pneumatic compression and no prophylaxis, with low-molecular-weight heparin unlikely to be considered cost-effective (0.07).</p> Conclusions <p>Intermittent pneumatic compression could be a cost-effective option and is likely to be more appropriate than low-molecular-weight heparin when used for venous thromboembolism prophylaxis for cesarean delivery in Brazil. Use of thromboprophylaxis should be a risk-stratified, individualized approach.</p>Variability of response on prophylactic prasugrel for endovascular treatment of intracranial aneurysms: Clinical implicationsNoah HongSeung Bin KimHee-Jin YangYoung-Je Son10.1371/journal.pone.02871902023-06-23T14:00:00Z2023-06-23T14:00:00Z<p>by Noah Hong, Seung Bin Kim, Hee-Jin Yang, Young-Je Son</p>
Background and purpose <p>Prophylactic prasugrel for endovascular treatment of intracranial aneurysms has been introduced and increased, but HTPR (high on-treatment platelet reactivity) or LTPR (low on-treatment platelet reactivity) of prasugrel is not uncommon in clinical circumstances. To investigate the predisposing factors of HTPR and LTPR on prasugrel premedication in the neurointerventional field and to determine its clinical implications.</p> Materials and methods <p>Between February 2016 and December 2020, 191 patients treated with coil embolization using prophylactic prasugrel in 234 intracranial aneurysms were the final candidates for this study. Patient and aneurysm characteristics, clinical status, and laboratory study values were carefully reviewed retrospectively. We performed risk factor analyses for HTPR and LTPR on prasugrel.</p> Results <p>Ultimately, 20 patients (10.5%) had HTPR, and 74 patients (38.7%) were categorized as having LTPR. In multivariable analyses, the factors related to HTPR were BMI (adjusted OR 1.21, 95% CI 1.04–1.41, p = 0.01), history of antithrombotics (adjusted OR 3.79, 95% CI 1.39–10.34, p = 0.01), and hematocrit (adjusted OR 0.91, 95% CI 0.84–0.99, p = 0.03). Low BMI was the only risk factor for LTPR (adjusted OR 0.84, 95% CI 0.76–0.94, p = 0.001).</p> Conclusion <p>In the neurointerventional field, high BMI and prior use of antithrombotic agents were related to HTPR, and low BMI was associated with LTPR on prophylactic prasugrel. High hematocrit levels decreased the risk of HTPR. When preparing endovascular treatment for intracranial aneurysms, attention to patients with these clinical features is required to address the possibility of ischemic or bleeding complications.</p>