Introduction: Despite convincing evidence toward causal role of Lipoprotein(a) in occlusive arterial disease, the data is conflicting when it comes to venous thromboembolism (VTE) and pulmonary embolism (PE). Also it is not known if intervention to normalize Lipoprotein(a) will decrease risk of recurrent VTE and PE eliminating the need for life long anticoagulation. To our knowledge this isfirst data set report focusing on evaluating association between Lipoprotein(a) and VTE in patients younger than 50 years old. Methods: Inthis retrospective study, chart review was completed for twenty-six consecutive patients referred to hematology clinic with diagnosis of deep vein thrombosis (DVT) or PE in year 2017-2018 . Four patients older than 50 years old at the time of acute events were excluded. Lipoprotein(a) had only been measured in patients who had negative hypercoagulable work up with normal lipid panel but had obesity . Protein C, S and anti-thrombin were not measured if patients were already on anticoagulation. Serum level of Lipoprotein(a) greater than 75 nmol/L was considered to be elevated. Results: Total of 22 patients (18 females) were included in the data analysis. Nine patients had DVT, 5 patients had PE, and 8 patients had both DVT and PE. Median age was 34 (12-47). Lipoprotein(a) level was not checked on eight patients who had SLE (n=1), surgery (n=1), Factor V Leiden mutation (n=1), protein S deficiency (n=1), anti-phospholipid syndrome (n=2), prothrombin gene mutation (n=1), and one patient who had lost follow up. The median Lipoprotein(a) level was 107 (8-276). Serum Lipoprotein(a) was elevated in 8 out of the 14 screened patients (57%) with the median of 135 (107-276). Out of 8 patients with elevated Lipoprotein(a), only 1 patient had additional clinical risk factors for thrombosis (history of smoking, alcohol abuse, hypertriglyceridemia and elevated LDL). In an attempt to normalize Lipoprotein(a) level, 3 patients were started on niacin but only one tolerated maximum 1000 mg niacin daily which resulted in decrease in level but did not achieve normalization. Conclusion: This data suggests that elevated serum Lipoprotein(a) in females younger than 50 years old is associated with DVT/PE events. Further investigation is required to confirm this finding. At this time it is not known if attempt to normalize Lipoprotein(a) will prevent recurrent PE/DVT and eliminate need for long life anticoagulation in patients with unprovoked VTE who have elevated lipoprotein(a). Disclosures Pakbaz: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
The Ciaglia percutaneous tracheostomy method has been in use since its inception in 1985, and percutaneous approaches to tracheostomies have become increasingly favored over surgical modalities because of risk of maceration, infection, prevention of routine maintenance, and skin irritation. This study investigates the effect of foregoing sutures on post-procedural complications of percutaneous tracheostomies. METHODS: Patients who received tracheostomies by medical and surgical intensivists at RUHSMC between January 2010 and March 2016 were enrolled. All tracheostomies were secured with collar fixation only. Data were collected through retrospective chart review. Baseline patient demographics included age, ethnicity and body mass index (BMI). Primary safety endpoints (complications) included accidental decannulation, surgical site infection rates and bleeding. Secondary endpoints included ICU length of stay and hospital length of stay. Data was collected from time of admission to end of hospitalization. All analyses were performed using SAS program (university edition; SAS Institute Inc., Cary, NC). RESULTS: Among the 241 patients, 58% were male and 61% were white. The mean age was 57AE16 years and mean BMI was 28AE9 (Kg/m 2). The rate of accidental decannulation was 2.1% (95% CI: 0.3-3.9%) and the rate of surgical site infections was 0.4% (95% CI: À0.4-1.2%). Bleeding requiring intervention occurred in 5.0% (95% CI: 2.3-7.8%) of patients. The mean hospital length of stay was 41AE32 days. Mean ICU length of stay was 31AE19 days. CONCLUSIONS: Collar fixation alone of a percutaneously inserted tracheostomy tube is feasible, with acceptably low rates of accidental decannulation, surgical site infections, and bleeding. CLINICAL IMPLICATIONS: More study is necessary to determine if collar fixation alone of a percutaneously inserted tracheostomy tube is superior to collar fixation with suturing with regard to incidence of complications.
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