Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism.

CONCLUSIONS: We reviewed RCTs that implemented a variety of system-wide strategies aimed at improving thromboprophylaxis in hospitalized patients. We found increased prescription of prophylaxis associated with alerts and multifaceted interventions, and increased prescription of appropriate prophylaxis associated with alerts. While multifaceted interventions were found to be less effective than alerts, a multifaceted intervention with an alert was more effective than one without an alert. Alerts, particularly computer alerts, were associated with a reduction in symptomatic VTE at three months, although there were not enough studies to pool computer alerts and human alerts results separately.Our analysis was underpowered to assess the effect on mortality and safety outcomes, such as bleeding.The incomplete reporting of relevant study design features did not allow complete assessment of the certainty of the evidence. However, the certainty of the evidence for improvement in outcomes was judged to be better than for our previous review (low- to moderate-certainty evidence, compared to very low-certainty evidence for most outcomes). The results of our updated review will help physicians, hospital administrators, and policy makers make practical decisions about adopting specific system-wide measures to improve prescription of thromboprophylaxis, and ultimately prevent VTE in hospitalized patients. PMID: 29687454 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research

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Authors: Yu J, Liu X, Zhou J, Xue X, Muenzel M, Schulze PC, Moebius-Winkler S, Keil T, Meng Z, Tang S Abstract OBJECTIVES: To report long-term safety and efficacy of combined percutaneous LAA and PFO/ASD closure. METHODS: A retrospective study of 370 consecutive patients undergoing LAAC procedures using the Watchman (WM) device. Data were compared between 330 cases only with LAAC procedure (Group I) and 25/5 (PFO/ASD) cases with sequential procedures of LAAC and PFO/ASD closure (Group II). RESULTS: Compared to Group I, Group II had more males (86.7% vs. 65.8%, p
Source: Expert Review of Medical Devices - Category: Medical Devices Tags: Expert Rev Med Devices Source Type: research
We read with great interest your recent publication by Dieplinger et  al1 in the Journal of Vascular Surgery. Unfractionated heparin (UFH) is usually employed in arterial vascular surgery, generally at lower doses compared with those in cardiac surgery (50-100 IU/kg); the goal is a balance between the need of anticoagulation to avoid thrombosis and, on the other han d, limiting bleeding and surgical revision.2 Much evidence supports its use also in endovascular procedures. Even if data in literature show a lower incidence of complications, thromboembolic and cardiologic events still continue to occur even when endovas...
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Letter to the editor Source Type: research
AbstractVon Willebrand Factor (vWF) is a large glycoprotein with a broad range of physiological and pathological functions in health and disease. While vWF is critical for normal hemostasis, vascular integrity and repair, quantitative and qualitative abnormalities in the molecule can predispose to serious bleeding and thrombosis. The heritable form of von Willebrand Disease was first described nearly a century ago, but more recently, recognition of an acquired condition known as acquired von Willebrand Syndrome (AVWF) has emerged in persons with hematological, endocrine and cardiovascular diseases, disorders and conditions...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
In conclusion, de-escalation commonly occurs in real-world practice. Although rates of major cardiovascular and bleeding events in this analysis were generally low, the profile of patients suitable for de-escalation, the impact of de -escalation on adverse clinical outcomes and how this is affected by the timing after index ACS warrants further large-scale investigation.
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Pulmonary arteriovenous fistula (PAVF), a vessel malformation connecting the pulmonary circulation to the systemic circulation while bypassing the pulmonary capillaries, can cause paradoxical cerebral infarction. It is often associated with hereditary hemorrhagic telangiectasia (HHT), a genetic disease characterized by multiple dermal, mucosal, and visceral telangiectasia causing recurrent bleeding. Paradoxical cerebral embolism caused by PAVF without HHT is rare. Here, we report a patient with isolated PAVF who experienced an ischemic stroke caused by a paradoxical embolism from deep venous thrombosis; the patient was suc...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
Emilio Rodríguez-Castro1,2, Manuel Rodríguez-Yáñez1,2, Susana Arias1,2, María Santamaría1,2, Iria López-Dequidt1,2, Ignacio López-Loureiro1, Manuel Rodríguez-Pérez1, Pablo Hervella1, Tomás Sobrino1, Francisco Campos1, José Castillo1* and Ramón Iglesias-Rey1* 1Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain2Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
CONCLUSION: No difference in net clinical outcome was observed in patients who received a DOAC or aspirin for VTE prophylaxis after major orthopedic surgery. PMID: 30994169 [PubMed - as supplied by publisher]
Source: American Journal of Health-System Pharmacy : AJHP - Category: Drugs & Pharmacology Authors: Tags: Am J Health Syst Pharm Source Type: research
Massive bleeding is a serious complication associated with impaired survival after surgery for acute type A aortic dissection (ATAAD). There are no previous reports evaluating the effect of ATAAD and associated surgery on von Willebrand factor (VWF). The aim of the present study was to analyze VWF activity (VWF:GPIbM) and thus the potential of Factor (F) VIII/VWF concentrate as a treatment for refractory bleeding in surgery for acute type A aortic dissection.
Source: Thrombosis Research - Category: Hematology Authors: Tags: Full Length Article Source Type: research
Conclusion Figure 4 shows that the 27 different molecular defects within the ALB so far reported to cause CAA are located in ten different exons (1, 3, 4, 5, 7, 8, 9, 10, 11, and 12) and in seven different introns (1, 2, 3, 6, 10, 11, and 12) (The Albumin Website, 2018; Caridi et al., 2019). Variations in the last two coding exons (13 and 14) would probably cause the presence of a circulating C-terminal variant of the protein and not CAA. The first twelve exons of ALB, with the exception of the two shortest, exons 2 and 6, were reported to contain at least one molecular defect resulting in CAA (The Albumin Website, 2018; ...
Source: Frontiers in Genetics - Category: Genetics & Stem Cells Source Type: research
The mammalian hemostatic system involves complex interactions between protein components of the coagulation cascade and platelets. The fibrinolytic system removes the hemostatic plug. Dysregulation of coagulation or fibrinolytic systems can induce bleeding or thrombosis. Animals, such as snakes, worms and insects, have evolved to express proteins that modulate the mammalian coagulation and fibrinolytic systems. Many of these proteins have been isolated and characterized. Understanding the mechanisms by which these exogenous factors from venoms and animal saliva modulate the mammalian coagulation and fibrinolytic systems ha...
Source: Thrombosis Research - Category: Hematology Authors: Tags: Review Article Source Type: research
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