Occurrence and predictors of recurrence after a first episode of acute venous thromboembolism: population-based Worcester Venous Thromboembolism Study

Abstract Background: Thrombophilia screens are performed frequently in persons with a history of acute venous thromboembolism especially in those for whom the etiology is unprovoked or idiopathic. The optimal timing of the thrombophilia screen is controversial. Elevation of Factor VIII levels are a more recently described thrombophilia that is felt to be hereditary, however, the exact mode of inheritance is not certain. Factor VIII is also known to be elevated as an acute phase reactant. The accuracy of assessing Factor VIII levels at the time of diagnosis of acute venous thromboembolism is not known. The purpose of this study was to determine if there is a difference in Factor VIII levels measured at the time of diagnosis of acute venous thromboembolism as compared to six months later while patients are on oral anticoagulation. Methods: Consecutive patients with a first episode of idiopathic acute venous thromboembolism were eligible. Patients were excluded if they were <18 years of age or had already been started on oral anticoagulants. Plasma was collected within 48 hours of diagnosis in.105 mmol sodium citrate, double spun at 1,500 G and frozen at −70 Celsius for batch testing. Factor VIII levels were assessed with a three point assay on an ACL 9000 (Beckman Coulter, Mississauga). A seven-point reference curve was used for all factor assays. Linear regression showed r2 values were always > 0.99 on calibration lines. Controls at two levels, 1.00 U/mL normal pooled plasma and 0.32 U/mL were run with all assays. All patients were treated with dalteparin at 200u/kg sc daily for 5–7 days and simultaneously initiated on warfarin for six months. At the six-month point repeat Factor VIII assessments were performed while the patients were still receiving oral anticoagulation with warfarin. Results: There were 61 patients (37 male) and the mean age was 50.4 years (18–85 years). Thirty patients had deep vein thrombosis, 23 pulmonary embolism and 8 patients had both diagnoses. The patients’ Factor VIII levels at baseline and six months were compared. At baseline the mean Factor VIII level was 1.77 units/ml and at six months it was 1.59 units/ml. The 95% confidence interval for difference in means was 0.04 – 0.32. These results were statistically significant, (paired t-test p=.01). Conclusion: This study confirms that caution should be used in interpreting Factor VIII levels drawn as part of a thrombophilia screen at the time of diagnosis of acute idiopathic venous thromboembolism. Factor VIII levels will be lower six-months later when patients are stable on oral anticoagulation.

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Venous thromboembolism 2011–2018 in Stockholm: a demographic study

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-019-01966-y ◽

2019 ◽

Vol 48 (4) ◽

pp. 668-673 ◽

Cited By ~ 2

Author(s):

Per Wändell ◽

Tomas Forslund ◽

Helene Danin Mankowitz ◽

Anna Ugarph-Morawski ◽

Staffan Eliasson ◽

...

Keyword(s):

Venous Thromboembolism ◽

Oral Anticoagulants ◽

Clinical Situation ◽

Population Based ◽

First Episode ◽

Drug Register ◽

Time Period ◽

First Occurrence ◽

Treatment Naïve ◽

Using Data

Abstract Venous thromboembolism (VTE) is an important cause of morbidity and mortality in Western countries. The incidence rate of VTE is estimated at 1–2 cases per 1000 annually. This study was a population-based cohort study of previously treatment naïve patients with a first occurrence of venous thromboembolism (VTE), using data from the administrative health data register of the Stockholm Region 2011–2018. Data on anticoagulant treatment was taken from the Swedish Prescribed Drug Register. We also analyzed all VTE events between 2011 and 2018. Altogether 14,849 naïve incident VTE cases were identified. In 2011 the majority of patients with a first episode of VTE were prescribed warfarin versus non-vitamin K antagonist oral anticoagulants (NOACs), 1144 versus 5. In contrast in 2018, the majority of patients were treated with NOACs, 1049 versus 59 treated with warfarin. Treatment with low molecular weight heparin only decreased from 814 to 683 patients. The frequency of all VTE events in the population increased over time from 1.88/1000 to 1.93/1000 (p = 0.072), and PE diagnoses increased from 0.69/1000 to 0.76/1000 (p = 0.003). In conclusion, during 2011–2018 there has been a shift of prescription of warfarin to a clear predominance of NOACs in the treatment of VTE in the Stockholm Region, in line with current recommendations. In the clinical situation, treatment has been simplified as monitoring of warfarin has decreased substantially. PE events increased during the time period in the population even if the increase was rather modest, while all VTE events did not increase significantly.

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Reduced Physical Activity Levels in Children after a First Episode of Acute Venous Thromboembolism

The Journal of Pediatrics ◽

10.1016/j.jpeds.2019.12.062 ◽

2020 ◽

Vol 219 ◽

pp. 229-235.e2

Author(s):

Ayesha Zia ◽

Zhuo Yang ◽

Song Zhang ◽

Tony Babb

Keyword(s):

Physical Activity ◽

Venous Thromboembolism ◽

First Episode ◽

Activity Levels ◽

Physical Activity Levels ◽

Reduced Physical Activity ◽

Acute Venous Thromboembolism

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Excess Risk of Cancer in Patients With Primary Venous Thromboembolism: A National, Population-based Cohort Study

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70275-6 ◽

2006 ◽

Vol 2006 ◽

pp. 358-359

Author(s):

G.L. Moneta

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Population Based ◽

Excess Risk ◽

National Population ◽

Risk Of Cancer

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Risk Factors for Bleeding during Treatment of Acute Venous Thromboembolism

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650643 ◽

1996 ◽

Vol 76 (05) ◽

pp. 682-688 ◽

Cited By ~ 33

Author(s):

Jos P J Wester ◽

Harold W de Valk ◽

Karel H Nieuwenhuis ◽

Catherine B Brouwer ◽

Yolanda van der Graaf ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Small Body ◽

Bleeding Risk ◽

Risk Scores ◽

Risk Of Bleeding ◽

Acute Venous Thromboembolism

Summary Objective: Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism. Design: Secondary analysis of a prospective, randomized, assessor-blind, multicenter clinical trial. Setting: One university and 2 regional teaching hospitals. Patients: 188 patients treated with heparin or danaparoid for acute venous thromboembolism. Measurements: The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively. Results: Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area ≤2 m2 (odds ratio 2.3, 95% Cl 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% Cl 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders. Conclusions: A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.

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