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A new study by Liang Qiao and team showed that deep vein thrombosis (DVT) was shown to be strikingly more common in primary total knee arthroplasty (TKA) patients with a preoperative Caprini score of ≥ 4 and D-dimer values of ≥ 1.0 mg/L. The findings of this study were published in the Journal of Orthopaedic Surgery and Research.

D-dimer and the Caprini score are well-known indicators for assessing deep vein thrombosis. However, due to their vulnerability to different post-operative circumstances, their usefulness in directing post-arthroplasty DVT risk is limited, making them less effective as reminders. Also, these indicators are more stable prior to surgery. In spite of this, there is a dearth of studies on the pre-operative prognostic usefulness of the D-dimer and Caprini score for DVT after primary total knee arthroplasty (TKA).

This study examined patient data from individuals who had primary TKA between August 2015 and December 2022 in a retrospective research. Caprini scores were evaluated upon admission, and complete blood panels were collected from fasting blood samples. vascular Doppler ultrasonography OF Lower limb was done on every patient before to surgery in order to rule out any patients who already had DVT, and all patients had another DVT evaluation after surgery.

A total of 2,873 patients, 676 males and 2,197 women, with an average age of 67.98 ± 7.54 years, were included in this study. In this research, 57 (1.98%) instances had lower limb symptoms, and 303 (10.55%) patients had postoperative DVT. Significant differences (P < 0.05) were seen in the incidence of DVT among patients with pre-operative Caprini scores of 1-2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%). Individuals with pre-operative D-dimer levels ≥ 1 mg/L had a greater risk of DVT (14.8%) than the individuals with values < 0.5 mg/L (8.98%) and 0.5–1 mg/L (10.61%) (P < 0.05).

Postoperative DVT occurred in only 5.84% of patients with D-dimer levels < 0.5 mg/L and Caprini ratings of 1-2. The postoperative DVT incidence rate increased to 24.81% for patients with Caprini scores > 4 and D-dimer levels ≥ 1.0 mg/L, with an odds ratio (OR) of 4.744 when compared to the previous group.

After TKA, tge patients with higher preoperative Caprini scores and D-dimer had a greater risk of developing DVT. Also, the ones who have a preoperative Caprini score of > 4 and a D-dimer level of ≥ 1.0 mg/L are considered high-risk for DVT after TKA, with a considerably higher probability of having DVT (24.81%). These results have important implications for preoperative DVT risk reduction strategy and DVT risk categorization in main TKA patients.

Source:

Qiao, L., Yao, Y., You, X., Wu, D., Tsai, H., Zhou, G., Xu, Z., & Jiang, Q. (2024). Identifying high-risk groups for deep vein thrombosis after primary total knee arthroplasty using preoperative Caprini scores and D-dimer levels. In Journal of Orthopaedic Surgery and Research (Vol. 19, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13018-024-05074-3

A new study published in the Journal of American Medical Association showed that rare instances of noninfectious intraocular inflammation may be linked to faricimab (Vabysmo) intravitreal injections.

The US Food and Drug Administration has approved faricimab, a humanized, biospecific immunoglobulin G (IgG) monoclonal antibody, for use as an intravitreal injection (IVI) to treat neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and macular edema caused by retinal vein occlusion. This medicinal compound is intended to improve vascular stability by inhibiting neovascularisation and hyperpermeability by targeting the vascular endothelial growth factor A (VEGF-A) and angiopoietin 2 pathways.

Clinical studies using randomization were used to prove the safety and effectiveness of drugs. Even if causality cannot be established, evidence of adverse events linked to these medications in a clinical practice context can be helpful in developing theories about less frequent safety concerns. Thereby, Mariano Cozzi and colleagues thus carried out this investigation to report and examine instances of intraocular inflammation linked to faricimab treatment in patients who were sent to a solitary European facility.

This review of an observational case series began in April 2024. The patients came from a single Swiss tertiary referral center that was academically orientated. The patients who were referred for intraocular inflammation shortly after getting an intravitreal injection of faricimab between June 1, 2022, and March 5, 2024 were included in the study. Faricimab, 6 mg was used for diabetic macular edema or neovascular age-related macular degeneration (0.05 mL of a 120 mg/mL solution). 

In this study, 12 eyes from 7 individuals over a 22-month period were found to have noninfectious intraocular inflammation following intravitreal faricimab injections. In two of these instances, anterior and posterior inflammation coexisted with retinal vasculitis. An occlusive type of artery and vein vasculitis affected one of the two eyes which resulted in nonperfusion of the macular capillaries and a clinically significant permanent decline in vision from 20/80 to 20/2000.

Moderate anterior segment inflammation without significant alterations in vision was observed in the remaining eyes. The incident of intraocular inflammation transpired following a median of 3.5 injections of faricimab. The diagnosis of inflammation was made 28 days after the previous faricimab dose. 3 individuals experienced an elevated intraocular pressure of at least 30 mm Hg. Overall, these findings highlight the significance of continuing monitoring for possibly sight-threatening intraocular inflammation following intravitreal faricimab treatment.

Reference:

Cozzi, M., Ziegler, A., Fasler, K., Muth, D. R., Blaser, F., & Zweifel, S. A. (2024). Sterile Intraocular Inflammation Associated With Faricimab. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2024.3828