PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

UC Davis research advances efforts to prevent dangerous blood clots

Study will help physicians calculate risk of post-surgical venous thromboembolisms

2013-03-20
(Press-News.org) (SACRAMENTO, Calif.) -- New research from the UC Davis Comprehensive Cancer Center, published in the Journal of Surgical Research, may help clinicians determine which patients are at highest risk for post-surgical blood clots in the legs or lungs.

A team led by Robert Canter, UC Davis associate professor of surgery, studied the medical histories of more than 470,000 surgical patients to determine which factors increased their risk of blood clots, also called venous thromboembolism (VTE). The team then created a nomogram, a type of calculator, which can help clinicians predict an individual's 30-day VTE risk. The results could change clinical practice by providing a more rational approach to preventing dangerous blood clots.

Blood clots are a critical safety and quality challenge for hospitals around the nation. While they can be prevented by administering blood thinners, such as heparin, these measures increase the risk of bleeding. To complicate matters, clinicians have had no way of determining which patients are at higher risk for blood clots, forcing them to adopt a one-size-fits-all approach to prevention.

"The standard preventive measure is heparin," said Canter. "However, there are many questions surrounding its use: What type of heparin should be administered? What dosage? Should we give it to patients before or after surgery? By identifying patients who are at higher risk for VTE, we attempt to answer many of these questions and help to personalize treatment."

Blood clots of the legs or lungs are a serious surgical complication, which can cause shortness of breath, longer hospital stays and, in rare cases, death. Successful treatment often requires patients to take the blood thinner Coumadin for three to six months after discharge.

The researchers combed through the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database to identify 471,000 patients who underwent abdominal or thoracic surgeries between 2005 and 2010. Their goal was to identify VTE events within 30 days of surgery, both in the hospital and after discharge (VTEDC). VTE includes deep vein thrombosis (clots in the legs) or pulmonary embolism (clots in the lungs).

The team considered many patient factors: age, body mass index (BMI), gender, race, pre-existing conditions, medical history, smoking and others. The group also factored in different approaches to surgery—abdominal, thoracic, laparoscopic, etc. — as well as the specific procedure type such as gastrointestinal, hernia, bariatric, splenectomy or lung. They also looked at post-operative complications, as these could affect both the length of stay and blood clot prevention efforts.

"There are a multitude of factors that go into whether a patient is at risk for VTE, as well as how to prevent it," said Canter. "Prior to this study, no one had ever looked at so many of these factors so comprehensively."

Overall, 1.5 percent of patients experienced a blood clot before discharge, while .5 percent experienced one after discharge. These rates were very consistent throughout the study years. A variety of factors were associated with increased blood clot risk, including age, high BMI, preoperative infection, cancer and non-bariatric laparoscopic surgery. Splenectomies carried the highest risk for blood clot, while bariatric surgeries had a lower incidence. In addition, major complications after surgery raised the incidence of VTEDC.

Perhaps most significant, the risks indicated by the study deviate sharply from current Joint Commission risk appraisals. For example, based on the study's findings, a patient with a history of colon cancer who is having his colon partially removed laparoscopically to treat recurrent cancer has a 10 percent chance of suffering a blood clot. Meanwhile, a patient having an emergency hernia repair has less than a 5 percent risk. Under current guidelines, however, both patients would be treated as having equal risk. Use of the nomogram to calculate risk could allow clinicians to more precisely respond to each patient's individual risk factors.

Charles LaFlamme, of Sacramento, is a good example of a patient whose care could have benefited from a better understanding of blood-clot risks. After having a very large liposarcoma removed from his abdomen, he was sent to the intensive care unit, where he experienced a persistent elevated heart beat but no other symptoms. Approximately a week later, he experienced shortness of breath while walking in his hospital room. A CT scan identified a pulmonary embolism. Aggressive treatment was prescribed for his remaining hospital stay and, after discharge he was placed on Coumadin for six months. The treatment was successful and LaFlamme fully recovered.

"The medical staff handled the situation well, but I would have preferred to have avoided it altogether," said LaFlamme.

The UC Davis research produced a couple of surprises. Though high BMI generally increased risk, the risk did not carry over to bariatric procedures, perhaps because more aggressive measures are often taken to prevent blood clots in bariatric cases. That splenectomies put patients at higher risk for clots was also a surprise, as the researchers expected the procedure would instead expose them to a higher risk of bleeding.

Canter notes that while hospitals around the nation have been focused for several years on reducing VTE and VTEDC, these measures have not reduced their frequency.

"Despite all the attention to eliminating this as a post-operative complication, the numbers have remained static," said Canter. "This shows us that the approach needs to be more individualized."

While these results need to be validated, Canter believes the data will help clinicians take a more evidence-based approach to administering heparin and reducing the incidence of blood clots. He says use of the information fits with hospitals' overall concern about safety, quality and cost. Specifically, these data could help hospitals and clinicians better focus their quality-of-care initiatives, ensuring that incentives and penalties are based on an accurate model of patient risk.

INFORMATION:

UC Davis Comprehensive Cancer Center is the only National Cancer Institute-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its specialists provide compassionate, comprehensive care for more than 9,000 adults and children every year, and access to more than 150 clinical trials at any given time. Its innovative research program engages more than 280 scientists at UC Davis, Lawrence Livermore National Laboratory and Jackson Laboratory (JAX West), whose scientific partnerships advance discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis collaborates with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer care. Its community-based outreach and education programs address disparities in cancer outcomes across diverse populations. For more information, visit http://cancer.ucdavis.edu.

END



ELSE PRESS RELEASES FROM THIS DATE:

Restoration and recommendations for flood-damaged bottomlands

Restoration and recommendations for flood-damaged bottomlands
2013-03-20
URBANA - Although the 2012 drought in the Midwest may have dimmed the memories for some of the 2011 Ohio and Mississippi River flood, engineers, landowners, conservationists, crop scientists and soil scientists haven't forgotten. They are working hard to repair levees and restore the flood damaged Birds Point-New Madrid floodway in preparation for the next big flood which will eventually happen. "After the waters recede, people forget about the catastrophic flooding and damage to agricultural lands, road infrastructure, homes, and businesses and the ongoing restoration ...

Inherited genetic variations have a major impact on childhood leukemia risk

2013-03-20
Humans have between 20,000 and 25,000 genes that carry instructions for assembling the proteins that do the work of cells. Work led by St. Jude Children's Research Hospital found that children who inherit certain variations in four particular genes are at much higher risk of developing acute lymphoblastic leukemia (ALL). The study also showed that Hispanic patients were more likely than patients of European or African ancestry to inherit high-risk versions of two of these genes. ALL rates are known to be higher among Hispanic children than those of European or African ...

180,000 deaths worldwide may be associated with sugary soft drinks

2013-03-20
Sugar-sweetened sodas, sports drinks and fruit drinks may be associated with about 180,000 deaths around the world each year, according to research presented at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions. Sugar-sweetened beverages are consumed throughout the world, and contribute to excess body weight, which increases the risk of developing diabetes, cardiovascular diseases and some cancers. Using data collected as part of the 2010 Global Burden of Diseases Study, the researchers linked ...

Discharge diagnosis from emergency department may not accurately identify nonemergency visits

2013-03-20
Among patients with emergency department (ED) visits with the same presenting complaint as those with visits ultimately given a primary care-treatable diagnosis based on the ED discharge diagnosis, a substantial proportion required immediate emergency care or hospital admission, findings that do not support use of discharge diagnosis as the basis for policies discouraging ED use, according to a study in the March 20 issue of JAMA. "With increasing medical care costs, policymakers have turned to ED utilization as a potential source for cost savings," according to background ...

Adults who experience stroke before age 50 have higher risk of death over long-term

2013-03-20
In an examination of long-term mortality after stroke, adults 50 years of age and younger who experienced a stroke had a significantly higher risk of death in the following 20 years compared with the general population, according to a study in the March 20 issue of JAMA. "Stroke is one of the leading causes of mortality, with an annual 6 million fatal events worldwide. Stroke mainly affects elderly people, yet approximately 10 percent of strokes occur in patients younger than 50 years. Despite this considerable proportion, only limited data exist on long-term prognosis ...

Drug does not significantly reduce risk of death among patients with severe sepsis

2013-03-20
Administration of the drug eritoran to patients with severe sepsis and septic shock failed to demonstrate a significant effect on reducing all-cause 28-day mortality or 1-year mortality, compared with placebo, according to a study in the March 20 issue of JAMA. Severe sepsis, a syndrome of acute infection complicated by organ dysfunction, is caused by a dysregulated systemic inflammatory response. Sepsis can progress to systemic hypotension (septic shock), multiple organ dysfunction, and death. "Lipopolysaccharide (LPS) or endotoxin, the major component of the outer ...

Heart failure patients with depression have 4 times risk of death

2013-03-20
Heart failure patients who are moderately or severely depressed have four times the risk of dying and double the risk of having to go to the emergency room or be hospitalized compared to those who are not depressed, according to new research reported in Circulation: Heart Failure, an American Heart Association Journal. "Depression is a key driver of healthcare use in heart failure," said Alanna M. Chamberlain, Ph.D., M.P.H., the study's lead author and assistant professor of epidemiology in the Department of Health Sciences Research at the Mayo Clinic in Rochester, Minn. ...

Anxiety, depression identify heart disease patients at increased risk of dying

2013-03-20
Heart disease patients who have anxiety have twice the risk of dying from any cause compared to those without anxiety, according to new research in the Journal of the American Heart Association. Patients with both anxiety and depression have triple the risk of dying, researchers said. "Many studies have linked depression to an increased risk of death in heart disease patients," said Lana Watkins, Ph.D., lead author of the study and an associate professor in Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, N.C. "However, anxiety hasn't received ...

Sexually naïve male mice, fathers respond differently to pups

2013-03-20
Washington, DC — Sexually naïve male mice respond differently to the chemical signals emitted by newborn pups than males that have mated and lived with pregnant females, according to a study published March 20 in The Journal of Neuroscience. The findings may help scientists to better understand the changes that take place in the brains of some mammals during the transition into parenthood. Sex differences in the behaviors mice display toward newborn pups are well documented. While virgin female mice routinely provide parental care to pups upon first encounter, ...

Under the skin, a tiny laboratory

Under the skin, a tiny laboratory
2013-03-20
VIDEO: EPFL scientists have developed a tiny, portable personal blood testing laboratory: a minuscule device implanted just under the skin provides an immediate analysis of substances in the body, and a... Click here for more information. Humans are veritable chemical factories - we manufacture thousands of substances and transport them, via our blood, throughout our bodies. Some of these substances can be used as indicators of our health status. A team of EPFL scientists ...

LAST 30 PRESS RELEASES:

Amphibians bounce-back from Earth’s greatest mass extinction

Better semen quality is linked to men living longer

Enhancing mosquito repellent effectiveness

Prenatal maternal stressors linked to higher blood pressure during first year after birth, study shows

Resistance exercise may be best type for tackling insomnia in older age

Global 130%+ rise in postmenopausal osteoarthritis and associated disability over past 3 decades

OU Health Sciences rises to 102 in national ranking

Bonobos and chimps offer clues to how our early ancestors had sex for social purposes

Lebanon multidimensional crisis diminishing trust in public education and worsening inequality, study shows

Cold atoms on a chip

Rice University study reveals how rising temperatures could lead to population crashes

WVU research reveals adults with disabilities misuse prescription drugs at high rates

Consumers value domestic vanilla -- when informed, research shows

Are higher doses of folic acid in pregnancy safe?

Survey confirms radiation and orthopedic health hazards in cardiac catheterization laboratories are ‘unacceptable’

Study finds consumer devices can be used to assess brain health

Teachers' negative emotions impact engagement of students, new study finds

Researchers see breakthrough with biofuel

White blood cells use brute force to dislodge bacteria

Foundation AI model predicts postoperative risks from clinical notes

Brain functional networks adapt in response to surgery and Botox for facial palsy

Multimodal AI tool supports ecological applications

New University of Minnesota research shows impact of anxiety and apathy on decision-making

Fred Hutch announces 10 recipients of the 2025 Harold M. Weintraub Graduate Student Award

30 million euros for a novel method of monitoring the world's oceans and coastal regions using telecommunications cables

New multicenter study shows: Which treatment helps best with high-risk acute pulmonary embolism

Hidden dangers and myths: What you need to know about HPV and cancer

SNU researchers develop world’s first technology to observe atomic structural changes of nanoparticles in 3D

SNU researchers develop a new synthesis technology of single crystal 2D semiconductors, “Hypotaxy,” to enhance the commercialization of next-generation 2D semiconductors

Graphene production method offers green alternative to mining

[Press-News.org] UC Davis research advances efforts to prevent dangerous blood clots
Study will help physicians calculate risk of post-surgical venous thromboembolisms