AUCTORES
Globalize your Research
Research article
*Corresponding Author: Kathryn B. Metcalf, University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine Department of Orthopedic Trauma Surgery, Cleveland, Ohio 11100 Euclid Ave Cleveland, Ohio 44106.
Citation: Kathryn B. Metcalf., Jerry Y. Du., Corina C. Brown., Robert J. Wetzel., John K. Sontich, et al., (2022). Does Aspirin Provide Adequate Chemoprophylaxis for Venous Thromboembolic Events in Operative Pelvic and Acetabular fractures?. J. Clinical Orthopedics and Trauma Care, 4(3); DOI:10.31579/2694-0248/026
Copyright: © 2022 Kathryn B. Metcalf, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 10 January 2022 | Accepted: 31 January 2022 | Published: 04 February 2022
Keywords: venous thromboembolism; pelvic acetabular
Pelvic and acetabular fractures often result from high-energy mechanisms and represent unique treatment challenges. These fractures commonly occur with concomitant polytraumatic injuries and in the setting of significant medical comorbidities. Pelvic-acetabular trauma injuries are complex, frequently require surgical intervention, and carry a high risk of complications with sequelae leading to poor patient outcomes and large economic health-care burdens.
Pelvic and acetabular fractures often result from high-energy mechanisms and represent unique treatment challenges. These fractures commonly occur with concomitant polytraumatic injuries and in the setting of significant medical comorbidities. Pelvic-acetabular trauma injuries are complex, frequently require surgical intervention, and carry a high risk of complications with sequelae leading to poor patient outcomes and large economic health-care burdens. [1,2]
Development of a venous thromboembolism (VTE) following surgical fixation of pelvic and acetabular fractures is a serious and sometimes life-threatening complication. Previous studies of these complicated injuries have elucidated independent risk factors that predispose the patient to increased risk of PE and deep vein thrombosis (DVT) such as age, associated injuries, injury severity, and time to surgery. [3-6] Additionally, VTE events are associated with significant economic implications. One recent study in hip fracture patients demonstrated that VTE events were an independent reason for a 2-fold increase hospital length of stay and cost. [7] With rates of VTE ranging from 10-30%, coupled with a small but significant rate of pulmonary embolism (PE) in pelvic and acetabular fractures, prevention strategies are critical. [3-5,8,9] In fact, the risk of post-operative VTE is even greater in those fracture patients who receive no chemoprophylactic treatment, with reported rates as high as 40-68%.[10-13]
Although VTE is a known complication, there is limited data and no consensus on optimal thromboprophylactic agents and algorithms following operative fixation of pelvic and acetabular fractures. [8,14,15] There is high variability among different institutions. It is often debated if aspirin is an effective anticoagulation agent that provides adequate thromboprophylaxis in the setting of these complex injuries. The different mechanisms of action of agents play a role in this controversy of optimal thromboprophylaxis. Where aspirin acts via anti-platelet aggregation, the more traditionally used agents, enoxaparin and heparin, activate and accelerate antithrombin III (AT), inactivating thrombin and factor Xa. Although a multitude of anticoagulants are used in the prevention of VTE, the associated risk of bleeding or hematoma development is another important consideration in choice of thromboprophylactic agent. Despite the extensive reports on the effectiveness of various anticoagulants in total joint arthroplasty literature, [16-19] very little data exists regarding these thromboprophylactic medications in the setting of fracture patients, particularly pelvic and acetabular fractures. In fact, to the author’s knowledge no studies evaluating the efficacy of aspirin compared to enoxaparin or heparin in preventing VTE in these complicated injuries is described in the literature.
The objective of this study is to evaluate the efficacy of aspirin in prevention of VTE, including both DVT and PE, compared to the short-acting injectable anticoagulants, enoxaparin and heparin, following operative fixation of pelvic and acetabular fractures. A secondary aim was to evaluate the incidence of hematoma formation between anticoagulants. We anticipated that aspirin would be an efficacious VTE prophylaxis agent and have a lower rate of hematoma development compared to other agents.
After institutional review board (IRB) approval, a retrospective chart review of patients who sustained pelvic ring and acetabular fractures treated with operative fixation was performed. Current Procedural Terminology (CPT) codes identified 163 pelvic or acetabular fractures managed operatively between 2015-2020 at our level 1 trauma center. Patients were included if the were ³18 years of age, received aspirin, enoxaparin, or heparin as their primary anticoagulant, and had a minimum of 6 weeks post operative follow up, for injury or surgically related VTE events occur within a 6 week threshold, as nearly all post-operative VTE occur early within this timeframe. [20,21] Patients were excluded if they were <18>
Three fellowship-trained traumatologists treated all fractures. Surgical approach was dictated by fracture pattern and surgeon preference. The primary team determined treatment with aspirin, enoxaparin, or heparin. Patient demographics, medical comorbidities, and post-operative weight bearing status were accounted for across groups and normalized in a multivariate analysis.
The primary outcome measures were development of DVT or PE within a 6-week post-operative period. Hematoma development was considered a secondary outcome. Hematoma formation was defined by evidence on computed tomography (CT) and a drop in hemoglobin. Patients were treated with aspirin 81 milligrams (mg) twice a day, enoxaparin 40mg daily, or 5,000 units heparin twice a day. Mechanical prophylaxis of ambulation and sequential compressive devices (SCDs) were used in all patients. The rate of VTE and hematoma formation was compared between patients receiving aspirin and short-acting injectables, enoxaparin and heparin. Incidence of VTE and post-operative hematoma was evaluated between these groups.
Other variables reported to affect development of VTE were collected. Age, gender, time to surgery, type of anticoagulant, weight bearing status, past medical history including diabetes mellitus (DM), hypertension (HTN), chronic kidney disease (CKD), coronary artery disease (CAD), body mass index (BMI) smoking status, previous history of DVT, head trauma were assessed as potential risk factors of VTE. Trauma scores such as abbreviated injury scale (AIS) and injury severity scale (ISS), intensive care unit (ICU) length of stay (LOS), hospital LOS, and ventilator time were also assessed as potential confounders. Additionally, in this study both posterior (Kocher-Langerbeck) and anterior (anterior intrapelvic, Pfannenstiel, or ilio-inguinal) approaches were used and evaluated as confounding variables.
Statistical Analysis
Categorical variables are expressed as percentages and continuous variables are expressed as mean ± standard deviation. Continuous variables were found to not be normally distributed by Kolmogorov-Smimov tests. Univariate analysis comparing incidence of confounding variables and complications was performed using Mann-Whitney U test or chi-squared/fisher’s exact tests as appropriate.
Multivariate binary logistic regression models were created for complications that were significantly different based on surgical approach on univariate analysis. Confounding variables with p<0 An a=0.05>
There were 144 pelvic and acetabular fractures that met inclusion criteria. Mean age was 42.2 ± 17.1 years. There were 95 males (66.0%) and 49 females (34.0%). There were 6 patients (4.2%) that developed DVT and 5 patients (3.5%) that developed PE. Two patients developed both (1.4%).
There were 54 patients treated with aspirin (37.5%) and 90 patients treated with heparin or enoxaparin (62.5%). On univariate analysis of complications, there was a significantly lower incidence of hematoma formation in the aspirin cohort (n=3, 5.6% vs. n=19, 21.1%, p =0.015) (Table 1).
There were no differences in incidence of DVT, PE, or transfusion between cohorts. Similarly, there were no differences in the incidences of infection or mortality.
On univariate assessment of potential demographic and comorbidity confounders, the aspirin cohort was found to have a lower incidence of obesity (n=13, 24.1% vs. n=40, 46%, p=0.009) (Table 2).
On univariate analysis of potential injury and perioperative confounders, the aspirin cohort was found to have lower ISS (11.0±7.9 vs. 15.6±10.4, p=0.010), lower incidence of ICU stay (n=10, 22.7% vs. n=37, 51.4%, p=0.002), less weight bearing restrictions (p=0.001), and received more heterotopic ossification prophylaxis (p=0.031) (Table 3). Furthermore, there was no difference in rate of DVT or PE based on an anterior or posterior approach (Table 3).
On multivariate analysis of major complications, accounting for the confounding variables found on univariate analysis, there were no significant differences incidence of VTE between aspirin and enoxaparin/heparin cohorts (Table 4).
However, aspirin trended on significance as protective against post-operative hematoma formation (adjusted odds ratio [aOR]: 0.687, 95% Confidence Interval [CI]: 0.015-1.315, [p=0.085]).
Several strategies exist to prevent venous thromboembolism (VTE) in operative pelvic and acetabular fractures, however the current literature lacks consensus on optimal thromboprophylaxis, particularly on the use of aspirin compared to other anticoagulant agents. This study suggests that there is no significant difference in the rate of VTE with aspirin compared to short-acting injectables enoxaparin and heparin and there is a trend towards a lower rate of hematoma associated with the use of aspirin.
Development of postoperative hematoma has been associated with an increased rate of surgical site infection (SSI). [22] Often patients suffering from pelvic trauma are polytraumatized patients and at high risk for complications. The reported rate of surgical site infections occur following operative fixation of pelvic and acetabular fractures is 5-8%.[23,24] The ability to limit infection and recognizing factors that may be protective in these patients is critical since infection and can greatly hinder the recovery of patients and add an unprecedented burden to the patient and the medical system.
Many patients with pelvic and acetabular fractures undergo a long stay in an ICU, are immobilized with weight bearing restrictions and have high ISS scores. Previous studies demonstrate that these factors are associated with increased development of VTE. [6,25] In this study these variables, while noted to be lower in the aspirin cohort, were controlled for in the multivariate analysis to eliminate their confounding effect. Thus, there was no evidence to indicate that aspirin was inferior to enoxaparin or heparin. This study suggests that aspirin provides adequate VTE chemoprophylaxis following operative fixation of pelvic and acetabular fractures.
In patients with pelvic and acetabular fracture, previous studies have noted that early initiation of VTE chemoprophylaxis is a significant preventative measure, [25] but its use must be balanced with the risk for bleeding and development of post-operative hematoma. With aspirin trending towards significance as protective against hematoma, this may represent a favorable option in the appropriate patients.
Additionally, there was no significant association in the risk of VTE events and the approach utilized for the pelvis or acetabulum fractures. We anticipated that the anterior approach would be a risk factor for VTE events due to mobilization and direct manipulation of great vessels that is often required. We theorized that there could be a potential risk that this could increased turbulence and thus increase the risk of a VTE event. However, this was not demonstrated in this study. Another recent study showed that this theoretical risk was not substantiated and that the rate of VTE was not increased in the anterior approach.6 Furthermore, this was a variable that was controlled for in the multivariate analysis. Regardless of approach aspirin appears to be an efficacious chemoprophylactic agent in patients with pelvic and acetabular fractures that undergo operative fixation.
Aspirin as an effective anticoagulation agent has been recognized in the total joint arthroplasty literature. [19] This study suggests that it is also an effective thromboprophylactic medication in pelvic and acetabular fractures and represents certain benefits for patients. The ease of administration compared to enoxaparin and heparin is a substantial consideration. Additionally, the relatively low cost of an over the counter medication is significant. These factors could potentially lead to increased patient compliance post-operatively.
This study is not without limitations. There are inherent limitations given the retrospective nature. Although it represents one of the larger cohorts of pelvic and acetabular fractures in the literature that reviews VTE prophylaxis, a larger population would be beneficial. With this small sample size that showed differences between groups such as less obesity, lower ISS, shorter ICU LOS and less restrictive weightbearing were analyzed using a multivariate regression model. However, a larger cohort examined prospectively would provide greater understanding of the optimal VTE prophylactic protocol. Furthermore, this study only examined aspirin compared to short-acting injectables, enoxaparin and heparin. However in there very few patients were excluded for receiving an alternative anticoagulation regimen for VTE prophylaxis, and thus this may not be a significant limitation. While this study suggests that aspirin is not inferior to other anticoagulants, larger randomized controlled trials are necessary to further determine the optimal anticoagulation agent to reduce the risk of both VTE and postoperative hematoma formation in operative pelvic and acetabular fractures.
This study suggests that aspirin is an acceptable method of VTE thromboprophylaxis with no inferior results to other common anticoagulants used in operative pelvis and acetabular fractures. In fact, aspirin is likely protective against hematoma formation in these injuries, making it potentially advantageous as hematoma increases infection risk and can lead to further complications in patient recovery.
Conflicts of Interest:
There are no conflicts of interest or sources of funding for any of the authors.
Conflicts of Interest and Source of Funding:
Dr. Ochenjele is a paid consultant for Stryker.
Dr. Wetzel is a paid consultant for Stryker, Biocomposites Inc, Bone Solutions Inc, and Medical Advance and receives royalties from Innomed Inc.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
