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L. Joseph Melton - One of the best experts on this subject based on the ideXlab platform.
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Risk factors and underlying mechanisms for Venous Stasis syndrome: a population-based case–control study
Vascular medicine (London England), 2009Co-Authors: Aneel A. Ashrani, Marc D. Silverstein, Brian D. Lahr, Tanya M. Petterson, Kent R. Bailey, L. Joseph Melton, John A. HeitAbstract:Venous Stasis syndrome may complicate deep vein thrombosis (DVT; i.e. post- phlebitic syndrome), but, in most cases, Venous Stasis syndrome is not post-phlebitic. The objective of this study was to determine the risk factors (including prior DVT) for Venous Stasis syndrome, and to assess Venous outflow obstruction and Venous valvular incompetence as possible mechanisms for Venous Stasis syndrome. This was a case- control study nested within a population-based inception cohort. The study population consisted of 232 Olmsted County, MN residents with a first lifetime Venous thromboem- bolism (VTE) and 133 residents without VTE. Measurements included a questionnaire and physical examination for Venous Stasis syndrome; strain gauge outflow plethysmog- raphy, Venous continuous wave Doppler ultrasonography and passive Venous drainage and refill testing for Venous outflow obstruction and Venous valvular incompetence. Altogether, 161 (44%), 43 (12%), and 136 (38%) subjects respectively, had Venous Stasis syndrome, Venous outflow obstruction and Venous valvular incompetence. Independent risk factors for Venous Stasis syndrome included increasing patient age and body mass index (BMI), prior DVT, longer time interval since DVT, and varicose veins. Both Venous outflow obstruction (p = 0.003) and Venous valvular incompetence (p < 0.0001) were strongly associated with Venous Stasis syndrome. Increasing age and prior DVT were significantly associated with Venous outflow obstruction, while prior DVT, varicose veins and Venous Stasis syndrome diagnosed prior to the incident DVT were significantly asso- ciated with Venous valvular incompetence. The risks of Venous outflow obstruction, Venous valvular incompetence and Venous Stasis syndrome were higher with left leg DVT. In conclusion, increasing patient age and BMI, prior DVT (particularly left leg DVT), longer time interval since DVT and varicose veins are independent risk factors for Venous Stasis syndrome. Venous Stasis syndrome related to DVT is due to Venous out- flow obstruction and Venous valvular incompetence, while Venous Stasis syndrome related to older age and to varicose veins is due to Venous outflow obstruction and to Venous valvular incompetence, respectively.
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Trends in the incidence of Venous Stasis syndrome and Venous ulcer: A 25-year population-based study
Journal of vascular surgery, 2001Co-Authors: John A. Heit, Marc D. Silverstein, Tanya M. Petterson, Thom W. Rooke, David N. Mohr, Christine Lohse, W. Michael O'fallon, L. Joseph MeltonAbstract:Abstract Background: The incidence rates of Venous Stasis syndrome and Venous ulcer are uncertain, and trends in incidence are unknown. Methods: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of Venous Stasis syndrome and Venous ulcer during the 25-year period, 1966 to 1990, and to describe trends in incidence. Results: A total of 1131 patients received a first lifetime diagnosis of Venous Stasis syndrome. A total of 263 patients received a first lifetime diagnosis of Venous ulcer. The overall incidence of Venous Stasis syndrome and Venous ulcer were 76.1 and 18.0 per 100,000 person-years, respectively. The incidence of both was higher in women than in men (83.7 vs 67.4 per 100,000 person-years for Venous Stasis syndrome; 20.4 vs 14.6 per 100,000 for Venous ulcer) and increased with age for both sexes. There was no clear trend in the incidence of Venous Stasis syndrome over the 25-year period. Compared with 1966 to 1970, the incidence of Venous ulcer decreased in 1971 to 1980, but was unchanged after 1981. Among 945 patients with Venous Stasis only, 60 subsequently had a Venous ulcer. The average (± SD) time from Venous Stasis diagnosis to development of a Venous ulcer was 5.0 (± 5.0) years. Conclusion: Venous Stasis syndrome and Venous ulcer are common, especially in the elderly population. The incidence of Venous Stasis syndrome has not changed since 1966, and Venous ulcer incidence is unchanged since 1981. More accurate identification of patients at risk for Venous Stasis syndrome and Venous ulcer and more effective prevention are needed. (J Vasc Surg 2001;33:1022-7.)
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The Venous Stasis syndrome after deep Venous thrombosis or pulmonary embolism: a population-based study.
Mayo Clinic proceedings, 2000Co-Authors: David N. Mohr, Marc D. Silverstein, Tanya M. Petterson, John A. Heit, W. Michael O'fallon, L. Joseph MeltonAbstract:Objectives To estimate the incidence and determine predictors of Venous Stasis syndrome and Venous ulcers after deep Venous thrombosis and pulmonary embolism. Patients and Methods This population-based retrospective cohort study reviewed medical records of 1527 patients with incident deep Venous thrombosis or pulmonary embolism between 1966 and 1990. We recorded baseline characteristics, event type (deep Venous thrombosis with or without pulmonary embolism or pulmonary embolism alone), leg side and site of deep Venous thrombosis (proximal with or without distal deep Venous thrombosis vs distal deep Venous thrombosis alone), and Venous Stasis syndrome and Venous ulcer. Results Two hundred forty-five patients developed Venous Stasis syndrome. One-year, 5-year, 10-year, and 20-year cumulative incidence rates were 7.3%, 14.3%, 19.7%, and 26.8%, respectively. By 20 years the cumulative incidence of Venous ulcers was 3.7%. Patients with deep Venous thrombosis with or without pulmonary embolism were 2.4-fold (95% confidence interval, 1.7-fold-3.2-fold) more likely to develop Venous Stasis syndrome than patients with pulmonary embolism and no diagnosed deep Venous thrombosis. In patients aged 40 years or younger with proximal compared with distal-only deep Venous thrombosis, Venous Stasis syndrome was 3.0-fold more likely (95% confidence interval, 1.6-fold-4.7-fold). In patients with unilateral leg deep Venous thrombosis, Venous Stasis syndrome usually developed in the concordant leg ( P Conclusions The cumulative incidence of Venous Stasis syndrome continues to increase for 20 years after Venous thromboembolism. Pulmonary embolism alone is less likely to cause Venous Stasis syndrome.
Gian Cesare Guidi - One of the best experts on this subject based on the ideXlab platform.
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Venous Stasis and whole blood platelet aggregometry: a question of data reliability and patient safety
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 2015Co-Authors: Gabriel Lima-oliveira, Giuseppe Lippi, Gian Luca Salvagno, Stefania Gaino, Giovanni Poli, Matteo Gelati, Geraldo Picheth, Gian Cesare GuidiAbstract:The assessment of platelet function by multiple electrode aggregometry (MEA) (Multiplate, Roche Diagnostics GmbH) is common in laboratory hematology. As regards the ISO 15189:2012 international standard, appropriate use of laboratory equipment requires appropriate pre-examination activities (e.g., blood collection). Venous Stasis can influence several blood analytes, but the tourniquet time is rarely regarded as a source of variability. Aim of the present study was to evaluate the impact of Venous Stasis on platelet function by MEA. A total of 6 ml of blood was collected from 20 volunteers into two 3.0 ml Hirudin vacuum tube (Roche Diagnostics GmbH), and subjected to two procedures: procedure 1 (no Stasis) - collection after localization of forearm vein by subcutaneous tissue transilluminator device without tourniquet; procedure 2 (Stasis) - collection after localization of vein by prior 60 s tourniquet application. Samples were processed on Multiplate, for: ADP-test (without prostaglandin E1), ADP HS-test (with prostaglandin E1), ASPI-test, COL-test, RISTO H-test (high concentration, 0.77 mg/ml), RISTO L-test (low concentration, 0.20 mg/ml), and TRAP-test. The significance of the differences between samples was assessed by Wilcoxon ranked-pairs test. Surprisingly, the results of ADP HS-test, ASPI-test, COL-test, and RISTO H-test appeared unbiased by Venous Stasis. RISTO L-test, ADP-test, and TRAP-test were significantly biased; the mean percent difference between Stasis and no Stasis were -7.2% (P = 0.040), -28.4% (P = 0.015), and 1.1% (P = 0.031), respectively. In conclusion, the tourniquet should be avoided when assessing platelet function by MEA.
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Venous Stasis and routine hematologic testing.
Clinical and laboratory haematology, 2006Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Mario Franchini, Gian Cesare GuidiAbstract:Prolonged Venous Stasis, as generated by a long tourniquet placement, produces spurious variations in several measurable analytes. To verify to what extent Venous Stasis influences routine hematologic testing, we assessed routine hematologic parameters, including hemoglobin, hematocrit, red blood cell count (RBC), main cell hemoglobin (MHC), main cell volume (MCV), platelet count (PLT), main platelet volume (MPV), white blood cell count (WBC) and WBC differential on the Advia 120 automated hematology analyzer in 30 healthy volunteers, either without Venous Stasis (no Stasis) or after application of a 60 mmHg standardized external pressure by a sphygmomanometer, for 1 (1-min Stasis) and 3 min (3-min Stasis). Although the overall correlation between measures was globally acceptable, the mean values for paired samples were significantly different in all parameters tested, except MCV, MHC, PLT, MPV, eosinophils, basophils and large unstained cells after 1-min Stasis and all parameters except MCV, MHC, MPV and basophils after 3-min Venous Stasis. As expected RBC, hemoglobin and hematocrit displayed a significant trend towards increase, whereas WBC and the WBC subpopulations were decreased. Difference between measurements by Bland and Altman plots exceeded the current analytical quality specifications for desirable bias for WBC, RBC, hemoglobin, hematocrit, lymphocytes and monocytes in samples collected after either 1- and 3-min Stasis. These results provide clear evidence that Venous Stasis during venipuncture might produce spurious and clinically meaningful biases in the measurement of several hematologic parameters, prompting further considerations on the usefulness of adopting appropriate preventive measures for minimizing such influences.
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Short-term Venous Stasis influences routine coagulation testing.
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 2005Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Gian Cesare GuidiAbstract:Preanalytical variability is a common source of errors in coagulation testing, as clotting assays are particularly susceptible to poor standardization of the whole analytical process. To investigate the effect of a short-term Venous Stasis on routine coagulation testing, we measured activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimer in plasma specimens collected either without Venous Stasis or following the application of a 60 mmHg constant, standardized external pressure by a sphygmomanometer, for 1 (1-min Stasis) and 3 min (3-min Stasis). When compared with blood specimens collected without Stasis, the Pearson's correlation coefficients and the corresponding slopes of the Passing and Bablok regression line of samples collected following 1 and 3-min Stasis were acceptable. However, statistically significant differences by paired Student's t-test could be observed for all parameters tests following 3-min Stasis, and for all but the activated partial thromboplastin time after 1-min Stasis. Significant difference between specimens collected after 1- and 3-min Stasis was also achieved for prothrombin time (P < 0.01), fibrinogen (P < 0.01) and D-dimer (P < 0.05). The agreement between measurements was yet acceptable after 1-min Stasis, but achieved clinical significance for prothrombin time, fibrinogen and D-dimer after 3-min Stasis. Taken together, results of the present investigation confirm that the effects of Venous Stasis during venipuncture are clinically meaningful. As hematocrit values and activities of clotting factors VII, VIII and XII significantly increased, whereas that of activated factor VII remained unchanged, we hypothesize that a short-term Venous Stasis, as induced by up to 3-min tourniquet placing, might not be sufficient to produce additional procoagulant responses besides hemoconcentration.
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Influence of short-term Venous Stasis on clinical chemistry testing.
Clinical chemistry and laboratory medicine, 2005Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Giorgio Brocco, Gian Cesare GuidiAbstract:Control and standardization of preanalytical variability is a critical factor for achieving accuracy and precision in laboratory testing. Although Venous Stasis from tourniquet placement during venepuncture should be minimized, as it has been claimed to account for spurious and significant variations for several analytes in plasma, there is controversy surrounding its real impact on laboratory testing. The aim of the present study was the investigation of the influence of short-term Venous Stasis on routine biochemical testing, by measuring the plasma concentration of 12 common analytes, including proteins, protein-bound substances, enzymes and electrolytes, in plasma specimens collected either without Venous Stasis or following the application of standardized external pressure of 60 mm Hg using a sphygmomanometer for 1 and 3 min. Although the overall correlation between measures was acceptable, the pattern of change was mostly dependent on the length of Stasis, size and protein-binding characteristics of the analytes, achieving clinical significance for albumin, calcium and potassium after 1-min Stasis, and alanine aminotransferase, albumin, calcium, chloride, total cholesterol, glucose and potassium after 3-min Stasis. Statistically significant differences could be observed in seven (alanine aminotransferase, albumin, calcium, total cholesterol, creatine kinase, iron and potassium) and ten (alanine aminotransferase, albumin, calcium, chloride, total cholesterol, creatine kinase, creatinine, glucose, iron and potassium) out of the 12 analytes tested, after 1- and 3-min Venous Stasis, respectively. The most clinically significant changes from standard venepuncture, when compared to the current analytical quality specifications for desirable bias, occurred for potassium (1-min Stasis, -2.8%; 3-min Stasis, -4.8%, both p
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influence of short term Venous Stasis on clinical chemistry testing
Clinical Chemistry and Laboratory Medicine, 2005Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Giorgio Brocco, Gian Cesare GuidiAbstract:Control and standardization of preanalytical variability is a critical factor for achieving accuracy and precision in laboratory testing. Although Venous Stasis from tourniquet placement during venepuncture should be minimized, as it has been claimed to account for spurious and significant variations for several analytes in plasma, there is controversy surrounding its real impact on laboratory testing. The aim of the present study was the investigation of the influence of short-term Venous Stasis on routine biochemical testing, by measuring the plasma concentration of 12 common analytes, including proteins, protein-bound substances, enzymes and electrolytes, in plasma specimens collected either without Venous Stasis or following the application of standardized external pressure of 60 mm Hg using a sphygmomanometer for 1 and 3 min. Although the overall correlation between measures was acceptable, the pattern of change was mostly dependent on the length of Stasis, size and protein-binding characteristics of the analytes, achieving clinical significance for albumin, calcium and potassium after 1-min Stasis, and alanine aminotransferase, albumin, calcium, chloride, total cholesterol, glucose and potassium after 3-min Stasis. Statistically significant differences could be observed in seven (alanine aminotransferase, albumin, calcium, total cholesterol, creatine kinase, iron and potassium) and ten (alanine aminotransferase, albumin, calcium, chloride, total cholesterol, creatine kinase, creatinine, glucose, iron and potassium) out of the 12 analytes tested, after 1- and 3-min Venous Stasis, respectively. The most clinically significant changes from standard venepuncture, when compared to the current analytical quality specifications for desirable bias, occurred for potassium (1-min Stasis, -2.8%; 3-min Stasis, -4.8%, both p<0.001), calcium (1-min Stasis, +1.6%, p<0.05; 3-min Stasis, +3.6%, p<0.001) and albumin (1-min Stasis, +3.5%; 3-min Stasis, +8.6%, both p<0.001). As most of these effects are dependent on the Stasis time during venepuncture and biochemical or physiological characteristics of the analyte, these variations could likely be anticipated, allowing the most appropriate preventive measures to be adopted.
John A. Heit - One of the best experts on this subject based on the ideXlab platform.
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risk factors and underlying mechanisms for Venous Stasis syndrome a population based case control study
Vascular Medicine, 2009Co-Authors: Aneel A. Ashrani, Marc D. Silverstein, Brian D. Lahr, Tanya M. Petterson, Kent R. Bailey, Joseph L Melton, John A. HeitAbstract:Venous Stasis syndrome may complicate deep vein thrombosis (DVT; i.e. post- phlebitic syndrome), but, in most cases, Venous Stasis syndrome is not post-phlebitic. The objective of this study was to determine the risk factors (including prior DVT) for Venous Stasis syndrome, and to assess Venous outflow obstruction and Venous valvular incompetence as possible mechanisms for Venous Stasis syndrome. This was a case- control study nested within a population-based inception cohort. The study population consisted of 232 Olmsted County, MN residents with a first lifetime Venous thromboem- bolism (VTE) and 133 residents without VTE. Measurements included a questionnaire and physical examination for Venous Stasis syndrome; strain gauge outflow plethysmog- raphy, Venous continuous wave Doppler ultrasonography and passive Venous drainage and refill testing for Venous outflow obstruction and Venous valvular incompetence. Altogether, 161 (44%), 43 (12%), and 136 (38%) subjects respectively, had Venous Stasis syndrome, Venous outflow obstruction and Venous valvular incompetence. Independent risk factors for Venous Stasis syndrome included increasing patient age and body mass index (BMI), prior DVT, longer time interval since DVT, and varicose veins. Both Venous outflow obstruction (p = 0.003) and Venous valvular incompetence (p < 0.0001) were strongly associated with Venous Stasis syndrome. Increasing age and prior DVT were significantly associated with Venous outflow obstruction, while prior DVT, varicose veins and Venous Stasis syndrome diagnosed prior to the incident DVT were significantly asso- ciated with Venous valvular incompetence. The risks of Venous outflow obstruction, Venous valvular incompetence and Venous Stasis syndrome were higher with left leg DVT. In conclusion, increasing patient age and BMI, prior DVT (particularly left leg DVT), longer time interval since DVT and varicose veins are independent risk factors for Venous Stasis syndrome. Venous Stasis syndrome related to DVT is due to Venous out- flow obstruction and Venous valvular incompetence, while Venous Stasis syndrome related to older age and to varicose veins is due to Venous outflow obstruction and to Venous valvular incompetence, respectively.
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Risk factors and underlying mechanisms for Venous Stasis syndrome: a population-based case–control study
Vascular medicine (London England), 2009Co-Authors: Aneel A. Ashrani, Marc D. Silverstein, Brian D. Lahr, Tanya M. Petterson, Kent R. Bailey, L. Joseph Melton, John A. HeitAbstract:Venous Stasis syndrome may complicate deep vein thrombosis (DVT; i.e. post- phlebitic syndrome), but, in most cases, Venous Stasis syndrome is not post-phlebitic. The objective of this study was to determine the risk factors (including prior DVT) for Venous Stasis syndrome, and to assess Venous outflow obstruction and Venous valvular incompetence as possible mechanisms for Venous Stasis syndrome. This was a case- control study nested within a population-based inception cohort. The study population consisted of 232 Olmsted County, MN residents with a first lifetime Venous thromboem- bolism (VTE) and 133 residents without VTE. Measurements included a questionnaire and physical examination for Venous Stasis syndrome; strain gauge outflow plethysmog- raphy, Venous continuous wave Doppler ultrasonography and passive Venous drainage and refill testing for Venous outflow obstruction and Venous valvular incompetence. Altogether, 161 (44%), 43 (12%), and 136 (38%) subjects respectively, had Venous Stasis syndrome, Venous outflow obstruction and Venous valvular incompetence. Independent risk factors for Venous Stasis syndrome included increasing patient age and body mass index (BMI), prior DVT, longer time interval since DVT, and varicose veins. Both Venous outflow obstruction (p = 0.003) and Venous valvular incompetence (p < 0.0001) were strongly associated with Venous Stasis syndrome. Increasing age and prior DVT were significantly associated with Venous outflow obstruction, while prior DVT, varicose veins and Venous Stasis syndrome diagnosed prior to the incident DVT were significantly asso- ciated with Venous valvular incompetence. The risks of Venous outflow obstruction, Venous valvular incompetence and Venous Stasis syndrome were higher with left leg DVT. In conclusion, increasing patient age and BMI, prior DVT (particularly left leg DVT), longer time interval since DVT and varicose veins are independent risk factors for Venous Stasis syndrome. Venous Stasis syndrome related to DVT is due to Venous out- flow obstruction and Venous valvular incompetence, while Venous Stasis syndrome related to older age and to varicose veins is due to Venous outflow obstruction and to Venous valvular incompetence, respectively.
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Venous Stasis syndrome: the long-term burden of deep vein thrombosis.
Hospital medicine (London England : 1998), 2003Co-Authors: John A. HeitAbstract:Currently there is no cure for Venous Stasis syndrome, a common complication of deep vein thrombosis. Prophylaxis with anticoagulant agents, including new drugs presently under investigation, may decrease the incidence and costs associated with this condition.
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Trends in the incidence of Venous Stasis syndrome and Venous ulcer: A 25-year population-based study
Journal of vascular surgery, 2001Co-Authors: John A. Heit, Marc D. Silverstein, Tanya M. Petterson, Thom W. Rooke, David N. Mohr, Christine Lohse, W. Michael O'fallon, L. Joseph MeltonAbstract:Abstract Background: The incidence rates of Venous Stasis syndrome and Venous ulcer are uncertain, and trends in incidence are unknown. Methods: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of Venous Stasis syndrome and Venous ulcer during the 25-year period, 1966 to 1990, and to describe trends in incidence. Results: A total of 1131 patients received a first lifetime diagnosis of Venous Stasis syndrome. A total of 263 patients received a first lifetime diagnosis of Venous ulcer. The overall incidence of Venous Stasis syndrome and Venous ulcer were 76.1 and 18.0 per 100,000 person-years, respectively. The incidence of both was higher in women than in men (83.7 vs 67.4 per 100,000 person-years for Venous Stasis syndrome; 20.4 vs 14.6 per 100,000 for Venous ulcer) and increased with age for both sexes. There was no clear trend in the incidence of Venous Stasis syndrome over the 25-year period. Compared with 1966 to 1970, the incidence of Venous ulcer decreased in 1971 to 1980, but was unchanged after 1981. Among 945 patients with Venous Stasis only, 60 subsequently had a Venous ulcer. The average (± SD) time from Venous Stasis diagnosis to development of a Venous ulcer was 5.0 (± 5.0) years. Conclusion: Venous Stasis syndrome and Venous ulcer are common, especially in the elderly population. The incidence of Venous Stasis syndrome has not changed since 1966, and Venous ulcer incidence is unchanged since 1981. More accurate identification of patients at risk for Venous Stasis syndrome and Venous ulcer and more effective prevention are needed. (J Vasc Surg 2001;33:1022-7.)
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The Venous Stasis syndrome after deep Venous thrombosis or pulmonary embolism: a population-based study.
Mayo Clinic proceedings, 2000Co-Authors: David N. Mohr, Marc D. Silverstein, Tanya M. Petterson, John A. Heit, W. Michael O'fallon, L. Joseph MeltonAbstract:Objectives To estimate the incidence and determine predictors of Venous Stasis syndrome and Venous ulcers after deep Venous thrombosis and pulmonary embolism. Patients and Methods This population-based retrospective cohort study reviewed medical records of 1527 patients with incident deep Venous thrombosis or pulmonary embolism between 1966 and 1990. We recorded baseline characteristics, event type (deep Venous thrombosis with or without pulmonary embolism or pulmonary embolism alone), leg side and site of deep Venous thrombosis (proximal with or without distal deep Venous thrombosis vs distal deep Venous thrombosis alone), and Venous Stasis syndrome and Venous ulcer. Results Two hundred forty-five patients developed Venous Stasis syndrome. One-year, 5-year, 10-year, and 20-year cumulative incidence rates were 7.3%, 14.3%, 19.7%, and 26.8%, respectively. By 20 years the cumulative incidence of Venous ulcers was 3.7%. Patients with deep Venous thrombosis with or without pulmonary embolism were 2.4-fold (95% confidence interval, 1.7-fold-3.2-fold) more likely to develop Venous Stasis syndrome than patients with pulmonary embolism and no diagnosed deep Venous thrombosis. In patients aged 40 years or younger with proximal compared with distal-only deep Venous thrombosis, Venous Stasis syndrome was 3.0-fold more likely (95% confidence interval, 1.6-fold-4.7-fold). In patients with unilateral leg deep Venous thrombosis, Venous Stasis syndrome usually developed in the concordant leg ( P Conclusions The cumulative incidence of Venous Stasis syndrome continues to increase for 20 years after Venous thromboembolism. Pulmonary embolism alone is less likely to cause Venous Stasis syndrome.
Giuseppe Lippi - One of the best experts on this subject based on the ideXlab platform.
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Venous Stasis and whole blood platelet aggregometry: a question of data reliability and patient safety
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 2015Co-Authors: Gabriel Lima-oliveira, Giuseppe Lippi, Gian Luca Salvagno, Stefania Gaino, Giovanni Poli, Matteo Gelati, Geraldo Picheth, Gian Cesare GuidiAbstract:The assessment of platelet function by multiple electrode aggregometry (MEA) (Multiplate, Roche Diagnostics GmbH) is common in laboratory hematology. As regards the ISO 15189:2012 international standard, appropriate use of laboratory equipment requires appropriate pre-examination activities (e.g., blood collection). Venous Stasis can influence several blood analytes, but the tourniquet time is rarely regarded as a source of variability. Aim of the present study was to evaluate the impact of Venous Stasis on platelet function by MEA. A total of 6 ml of blood was collected from 20 volunteers into two 3.0 ml Hirudin vacuum tube (Roche Diagnostics GmbH), and subjected to two procedures: procedure 1 (no Stasis) - collection after localization of forearm vein by subcutaneous tissue transilluminator device without tourniquet; procedure 2 (Stasis) - collection after localization of vein by prior 60 s tourniquet application. Samples were processed on Multiplate, for: ADP-test (without prostaglandin E1), ADP HS-test (with prostaglandin E1), ASPI-test, COL-test, RISTO H-test (high concentration, 0.77 mg/ml), RISTO L-test (low concentration, 0.20 mg/ml), and TRAP-test. The significance of the differences between samples was assessed by Wilcoxon ranked-pairs test. Surprisingly, the results of ADP HS-test, ASPI-test, COL-test, and RISTO H-test appeared unbiased by Venous Stasis. RISTO L-test, ADP-test, and TRAP-test were significantly biased; the mean percent difference between Stasis and no Stasis were -7.2% (P = 0.040), -28.4% (P = 0.015), and 1.1% (P = 0.031), respectively. In conclusion, the tourniquet should be avoided when assessing platelet function by MEA.
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Venous Stasis and routine hematologic testing.
Clinical and laboratory haematology, 2006Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Mario Franchini, Gian Cesare GuidiAbstract:Prolonged Venous Stasis, as generated by a long tourniquet placement, produces spurious variations in several measurable analytes. To verify to what extent Venous Stasis influences routine hematologic testing, we assessed routine hematologic parameters, including hemoglobin, hematocrit, red blood cell count (RBC), main cell hemoglobin (MHC), main cell volume (MCV), platelet count (PLT), main platelet volume (MPV), white blood cell count (WBC) and WBC differential on the Advia 120 automated hematology analyzer in 30 healthy volunteers, either without Venous Stasis (no Stasis) or after application of a 60 mmHg standardized external pressure by a sphygmomanometer, for 1 (1-min Stasis) and 3 min (3-min Stasis). Although the overall correlation between measures was globally acceptable, the mean values for paired samples were significantly different in all parameters tested, except MCV, MHC, PLT, MPV, eosinophils, basophils and large unstained cells after 1-min Stasis and all parameters except MCV, MHC, MPV and basophils after 3-min Venous Stasis. As expected RBC, hemoglobin and hematocrit displayed a significant trend towards increase, whereas WBC and the WBC subpopulations were decreased. Difference between measurements by Bland and Altman plots exceeded the current analytical quality specifications for desirable bias for WBC, RBC, hemoglobin, hematocrit, lymphocytes and monocytes in samples collected after either 1- and 3-min Stasis. These results provide clear evidence that Venous Stasis during venipuncture might produce spurious and clinically meaningful biases in the measurement of several hematologic parameters, prompting further considerations on the usefulness of adopting appropriate preventive measures for minimizing such influences.
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Short-term Venous Stasis influences routine coagulation testing.
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis, 2005Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Gian Cesare GuidiAbstract:Preanalytical variability is a common source of errors in coagulation testing, as clotting assays are particularly susceptible to poor standardization of the whole analytical process. To investigate the effect of a short-term Venous Stasis on routine coagulation testing, we measured activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimer in plasma specimens collected either without Venous Stasis or following the application of a 60 mmHg constant, standardized external pressure by a sphygmomanometer, for 1 (1-min Stasis) and 3 min (3-min Stasis). When compared with blood specimens collected without Stasis, the Pearson's correlation coefficients and the corresponding slopes of the Passing and Bablok regression line of samples collected following 1 and 3-min Stasis were acceptable. However, statistically significant differences by paired Student's t-test could be observed for all parameters tests following 3-min Stasis, and for all but the activated partial thromboplastin time after 1-min Stasis. Significant difference between specimens collected after 1- and 3-min Stasis was also achieved for prothrombin time (P < 0.01), fibrinogen (P < 0.01) and D-dimer (P < 0.05). The agreement between measurements was yet acceptable after 1-min Stasis, but achieved clinical significance for prothrombin time, fibrinogen and D-dimer after 3-min Stasis. Taken together, results of the present investigation confirm that the effects of Venous Stasis during venipuncture are clinically meaningful. As hematocrit values and activities of clotting factors VII, VIII and XII significantly increased, whereas that of activated factor VII remained unchanged, we hypothesize that a short-term Venous Stasis, as induced by up to 3-min tourniquet placing, might not be sufficient to produce additional procoagulant responses besides hemoconcentration.
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Influence of short-term Venous Stasis on clinical chemistry testing.
Clinical chemistry and laboratory medicine, 2005Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Giorgio Brocco, Gian Cesare GuidiAbstract:Control and standardization of preanalytical variability is a critical factor for achieving accuracy and precision in laboratory testing. Although Venous Stasis from tourniquet placement during venepuncture should be minimized, as it has been claimed to account for spurious and significant variations for several analytes in plasma, there is controversy surrounding its real impact on laboratory testing. The aim of the present study was the investigation of the influence of short-term Venous Stasis on routine biochemical testing, by measuring the plasma concentration of 12 common analytes, including proteins, protein-bound substances, enzymes and electrolytes, in plasma specimens collected either without Venous Stasis or following the application of standardized external pressure of 60 mm Hg using a sphygmomanometer for 1 and 3 min. Although the overall correlation between measures was acceptable, the pattern of change was mostly dependent on the length of Stasis, size and protein-binding characteristics of the analytes, achieving clinical significance for albumin, calcium and potassium after 1-min Stasis, and alanine aminotransferase, albumin, calcium, chloride, total cholesterol, glucose and potassium after 3-min Stasis. Statistically significant differences could be observed in seven (alanine aminotransferase, albumin, calcium, total cholesterol, creatine kinase, iron and potassium) and ten (alanine aminotransferase, albumin, calcium, chloride, total cholesterol, creatine kinase, creatinine, glucose, iron and potassium) out of the 12 analytes tested, after 1- and 3-min Venous Stasis, respectively. The most clinically significant changes from standard venepuncture, when compared to the current analytical quality specifications for desirable bias, occurred for potassium (1-min Stasis, -2.8%; 3-min Stasis, -4.8%, both p
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influence of short term Venous Stasis on clinical chemistry testing
Clinical Chemistry and Laboratory Medicine, 2005Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Martina Montagnana, Giorgio Brocco, Gian Cesare GuidiAbstract:Control and standardization of preanalytical variability is a critical factor for achieving accuracy and precision in laboratory testing. Although Venous Stasis from tourniquet placement during venepuncture should be minimized, as it has been claimed to account for spurious and significant variations for several analytes in plasma, there is controversy surrounding its real impact on laboratory testing. The aim of the present study was the investigation of the influence of short-term Venous Stasis on routine biochemical testing, by measuring the plasma concentration of 12 common analytes, including proteins, protein-bound substances, enzymes and electrolytes, in plasma specimens collected either without Venous Stasis or following the application of standardized external pressure of 60 mm Hg using a sphygmomanometer for 1 and 3 min. Although the overall correlation between measures was acceptable, the pattern of change was mostly dependent on the length of Stasis, size and protein-binding characteristics of the analytes, achieving clinical significance for albumin, calcium and potassium after 1-min Stasis, and alanine aminotransferase, albumin, calcium, chloride, total cholesterol, glucose and potassium after 3-min Stasis. Statistically significant differences could be observed in seven (alanine aminotransferase, albumin, calcium, total cholesterol, creatine kinase, iron and potassium) and ten (alanine aminotransferase, albumin, calcium, chloride, total cholesterol, creatine kinase, creatinine, glucose, iron and potassium) out of the 12 analytes tested, after 1- and 3-min Venous Stasis, respectively. The most clinically significant changes from standard venepuncture, when compared to the current analytical quality specifications for desirable bias, occurred for potassium (1-min Stasis, -2.8%; 3-min Stasis, -4.8%, both p<0.001), calcium (1-min Stasis, +1.6%, p<0.05; 3-min Stasis, +3.6%, p<0.001) and albumin (1-min Stasis, +3.5%; 3-min Stasis, +8.6%, both p<0.001). As most of these effects are dependent on the Stasis time during venepuncture and biochemical or physiological characteristics of the analyte, these variations could likely be anticipated, allowing the most appropriate preventive measures to be adopted.
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Trends in the incidence of Venous Stasis syndrome and Venous ulcer: A 25-year population-based study
Journal of vascular surgery, 2001Co-Authors: John A. Heit, Marc D. Silverstein, Tanya M. Petterson, Thom W. Rooke, David N. Mohr, Christine Lohse, W. Michael O'fallon, L. Joseph MeltonAbstract:Abstract Background: The incidence rates of Venous Stasis syndrome and Venous ulcer are uncertain, and trends in incidence are unknown. Methods: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of Venous Stasis syndrome and Venous ulcer during the 25-year period, 1966 to 1990, and to describe trends in incidence. Results: A total of 1131 patients received a first lifetime diagnosis of Venous Stasis syndrome. A total of 263 patients received a first lifetime diagnosis of Venous ulcer. The overall incidence of Venous Stasis syndrome and Venous ulcer were 76.1 and 18.0 per 100,000 person-years, respectively. The incidence of both was higher in women than in men (83.7 vs 67.4 per 100,000 person-years for Venous Stasis syndrome; 20.4 vs 14.6 per 100,000 for Venous ulcer) and increased with age for both sexes. There was no clear trend in the incidence of Venous Stasis syndrome over the 25-year period. Compared with 1966 to 1970, the incidence of Venous ulcer decreased in 1971 to 1980, but was unchanged after 1981. Among 945 patients with Venous Stasis only, 60 subsequently had a Venous ulcer. The average (± SD) time from Venous Stasis diagnosis to development of a Venous ulcer was 5.0 (± 5.0) years. Conclusion: Venous Stasis syndrome and Venous ulcer are common, especially in the elderly population. The incidence of Venous Stasis syndrome has not changed since 1966, and Venous ulcer incidence is unchanged since 1981. More accurate identification of patients at risk for Venous Stasis syndrome and Venous ulcer and more effective prevention are needed. (J Vasc Surg 2001;33:1022-7.)
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The Venous Stasis syndrome after deep Venous thrombosis or pulmonary embolism: a population-based study.
Mayo Clinic proceedings, 2000Co-Authors: David N. Mohr, Marc D. Silverstein, Tanya M. Petterson, John A. Heit, W. Michael O'fallon, L. Joseph MeltonAbstract:Objectives To estimate the incidence and determine predictors of Venous Stasis syndrome and Venous ulcers after deep Venous thrombosis and pulmonary embolism. Patients and Methods This population-based retrospective cohort study reviewed medical records of 1527 patients with incident deep Venous thrombosis or pulmonary embolism between 1966 and 1990. We recorded baseline characteristics, event type (deep Venous thrombosis with or without pulmonary embolism or pulmonary embolism alone), leg side and site of deep Venous thrombosis (proximal with or without distal deep Venous thrombosis vs distal deep Venous thrombosis alone), and Venous Stasis syndrome and Venous ulcer. Results Two hundred forty-five patients developed Venous Stasis syndrome. One-year, 5-year, 10-year, and 20-year cumulative incidence rates were 7.3%, 14.3%, 19.7%, and 26.8%, respectively. By 20 years the cumulative incidence of Venous ulcers was 3.7%. Patients with deep Venous thrombosis with or without pulmonary embolism were 2.4-fold (95% confidence interval, 1.7-fold-3.2-fold) more likely to develop Venous Stasis syndrome than patients with pulmonary embolism and no diagnosed deep Venous thrombosis. In patients aged 40 years or younger with proximal compared with distal-only deep Venous thrombosis, Venous Stasis syndrome was 3.0-fold more likely (95% confidence interval, 1.6-fold-4.7-fold). In patients with unilateral leg deep Venous thrombosis, Venous Stasis syndrome usually developed in the concordant leg ( P Conclusions The cumulative incidence of Venous Stasis syndrome continues to increase for 20 years after Venous thromboembolism. Pulmonary embolism alone is less likely to cause Venous Stasis syndrome.