The role of D-dimer in one year recurrence of venous thromboembolism after anticoagulation withdrawal following a first idiopathic deep vein thrombosis

Background: After discontinuing oral anticoagulant therapy (OAT), the recurrence of venous thromboembolism (VTE) is greatest in the 1st year and gradually diminishes. D-dimer assay was proposed to be eff ective in selecting patients with idiopathic DVT. Th e aim of this study was to determine the rate of VTE recurrence after discontinuing OAT according to the results of D-dimer. Materials and Methods: Th is prospective study was conducted in patients with a fi rst episode of symptomatic proximal deep vein thrombosis (DVT) who had received OAT for at least 3 months. Patients were re-evaluated at 1st, 6th and 12th months of their follow-up. At the fi rst (T0) and 30-day (T1) visits, venous blood samples were taken for D-dimer test. At each follow-up visit, we examined patients for clinical symptoms or signs of recurrent VTE, bleeding, postthrombotic manifestations, adherence to treatment, and concomitant analgesic or antiinflammatory therapy. Th e endpoint outcomes were VTE recurrence and complete of this survey follow-ups. Results: A total of 68 eligible patients was enrolled. Four patients (two patients need to use long-term oral anticoagulation, and two patients lost their fi rst follow-up) were excluded. At T0, D-dimer and compression ultrasonongraphy (CUS) was normal in 28 patients (44%). Moreover, 36 patients had abnormal D-dimer but normal CUS. A follow-up of 12 months was available in 44 patients. During the follow-up, three recurrent events were recorded. All Recurrent events were ipsilateral DVT. Among these index cases, all had an abnormal D-dimer at either T0 and/or T1. Th e recurrence rate was higher in males than in females (8.6% vs. 2.2%, P = 0.04) with an abnormal D-dimer at T0 and/or T1 with a multivariate hazard ratio of 2.1 (95% confi dence intervals [CI]: 1.2-5.2; P = 0.02). Patients older than 65 years had a higher rate of events than younger and hazard ratio was about 3.8 (95% CI: 2.1-4.2; P = 0.02). Patients with recurrences had higher mean D-dimer at both T0 and T1 when compared with those without recurrences, but the diff erence was signifi cant only for D-dimer at T1 (P = 0.03). During the follow-up, two patients died (3%). Conclusion: Within 12 months followup, the risk of recurrence with an abnormal D-dimer, either during or at 1-month after discontinuing OAT, was 4.6% which is much lower to the annual risk of recurrence in most studies with idiopathic and provoked VTE. D-dimer has an acceptable prognostic value in detecting recurrence of idiopathic VTE before discontinuing the anticoagulant therapy

The prediction role of D-dimer in recurrence of venous thromboembolism 1-year after anticoagulation discontinuing following idiopathic deep vein thrombosis

Background: After discontinuing oral anticoagulant therapy (OAT), the recurrence of venous thromboembolism (VTE) is greatest in the 1st year and gradually diminishes. D-dimer assay was proposed to be effective in selecting patients with idiopathic DVT. The aim of this study was to determine the rate of VTE recurrence after discontinuing OAT according to the results of D-dimer. Materials and Methods: This prospective study was conducted in patients with a first episode of symptomatic proximal deep vein thrombosis (DVT) who had received OAT for at least 3 months. Patients were re-evaluated at 1st, 6th and 12th months of their follow-up. At the first (T0) and 30-day (T1) visits, venous blood samples were taken for D-dimer test. At each follow-up visit, we examined patients for clinical symptoms or signs of recurrent VTE, bleeding, postthrombotic manifestations, adherence to treatment, and concomitant analgesic or antiinflammatory therapy. The endpoint outcomes were VTE recurrence and complete of this survey follow-ups. Results: A total of 68 eligible patients was enrolled. Four patients (two patients need to use long-term oral anticoagulation, and two patients lost their first follow-up) were excluded. At T0, D-dimer and compression ultrasonongraphy (CUS) was normal in 28 patients (44%). Moreover, 36 patients had abnormal D-dimer but normal CUS. A follow-up of 12 months was available in 44 patients. During the follow-up, three recurrent events were recorded. All Recurrent events were ipsilateral DVT. Among these index cases, all had an abnormal D-dimer at either T0 and/or T1. The recurrence rate was higher in males than in females (8.6% vs. 2.2%, P = 0.04) with an abnormal D-dimer at T0 and/or T1 with a multivariate hazard ratio of 2.1 (95% confidence intervals [CI]: 1.2-5.2; P = 0.02). Patients older than 65 years had a higher rate of events than younger and hazard ratio was about 3.8 (95% CI: 2.1-4.2; P = 0.02). Patients with recurrences had higher mean D-dimer at both T0 and T1 when compared with those without recurrences, but the difference was significant only for D-dimer at T1 (P = 0.03). During the follow-up, two patients died (3%). Conclusion: Within 12 months follow-up, the risk of recurrence with an abnormal D-dimer, either during or at 1-month after discontinuing OAT, was 4.6% which is much lower to the annual risk of recurrence in most studies with idiopathic and provoked VTE. D-dimer has an acceptable prognostic value in detecting recurrence of idiopathic VTE before discontinuing the anticoagulant therapy

The feasibility of PETHEMA ALL-96 regimen on treatment of patients with acute lymphoid leukemia

Background: Asparaginase-based treatment regimen for acute lymphocytic leukemia (ALL) is considered as feasible, but there is still a lack of data. In this study, considering the results of other regimen that were not optimum in previous studies. Here, we aimed to investigate the feasibility of PETHEMA ALL-96 treatment regimen. Materials and Methods: This is a retrospective feasibility study that was performed in 2019–2021 on 13 patients diagnosed with B-cell ALL. Patients were treated by PETHEMA ALL-96 regimen during induction, consolidation, reinduction, and maintenance phases. Patients were followed for 2 years after initiation of PETHEMA ALL-96 regimen for disease-free survival (DFS) and overall survival (OS) of all patients were evaluated after 2 years. Results: Data of 11 patients were analyzed. Within 28 days after treatments, all patients (100%) had no blasts in the bone marrow that was considered as complete remission (CR). The CR rate was 100% within 6 months and 12 months and 81.8% within 2 years after the treatments. Evaluation of OS, CR, and DFS regarding 6, 12, and 24 months showed 100% for all items after 6 and 12 months. After 24 months, the CR was 90.9%, the OS was 81.8% and the DFS was 90.9%. None of the patients died during the induction phase and during the 12 months study. No side effects were observed. Conclusion: The PETHEMA ALL-96 had high feasibility and survival rates with no side effects during the study course. It is believed that PETHEMA ALL-96 regimen has beneficial outcomes in young patients with ALL

The efficacy of different doses of Midazolam added to Lidocaine for upper extremity Bier block on the sensory and motor block characteristics and postoperative pain

OBJECTIVE: This study was designed to evaluate the effect of different doses of midazolam on anesthesia and analgesia quality when added to lidocaine during the intravenous regional anesthesia (IVRA). METHODS: One hundred and forty patients underwent hand surgery were randomly allocated into four groups to receive 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the control Group L-C (n = 35), 30 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M1 (n = 35), 40 μg/kg midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the midazolam Group L-M2 (n = 35), and 50 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M3 (n = 35). Sensory and motor block and recovery times, tourniquet pain, intra-operative analgesic requirement, and visual analog scale (VAS) scores were recorded. FINDINGS: Onset time of sensory and motor block in L-M3 Group was shorter than the L-M2 and L-M1 and L-C Groups (P < 0.001). Furthermore, prolonged sensory (P = 0.005) and motor recovery time (P = 0.001) in L-M3 were longer than the other groups. Intra-operative VAS score and intra-operative fentanyl consumption in L-M3 were lower than the other groups (P < 0.001). The numbers of patients needed to pethidine in Group L-M3 were significantly less compared with the other groups (P = 0.035). VAS scores were significantly lower in Group L-M3 in different time intervals in the postoperative period compared with the other groups (P < 0.001). CONCLUSION: Addition of 50 μg/kg midazolam for IVRA (Group L-M3) enhanced intra-operative analgesia and improved anesthesia quality better than other groups receiving lower midazolam doses as well as a control group