scholarly journals Predictors of thromboembolic events in COVID-19 ambulatory patients

2022 ◽  
Vol 14 (1) ◽  
pp. 126-127
Author(s):  
R. Hammami ◽  
J. Jihen ◽  
S. Charfeddine ◽  
A. Bahloul ◽  
R. Gargouri ◽  
...  
Keyword(s):  
Thromboembolic Events ◽  
Ambulatory Patients

scholarly journals Assessing Full Benefit of Rivaroxaban Prophylaxis in High-Risk Ambulatory Patients with Cancer: Thromboembolic Events in the Randomized CASSINI Trial

TH Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e107-e112 ◽  
Author(s):  
Alok A. Khorana ◽  
Mairéad G. McNamara ◽  
Ajay K. Kakkar ◽  
Michael B. Streiff ◽  
Hanno Riess ◽  
...  
Keyword(s):  
High Risk ◽  
Lower Extremity ◽  
Controlled Study ◽  
Number Needed To Treat ◽  
Thromboembolic Events ◽  
Intervention Period ◽  
Double Blind ◽  
Patients With Cancer ◽  
Ambulatory Patients ◽  
Full Benefit

Abstract Introduction In the CASSINI study, rivaroxaban thromboprophylaxis significantly reduced primary venous thromboembolism (VTE) endpoints during the intervention period, but several thromboembolic events designated as secondary efficacy endpoints were not included in the primary analysis. This study was aimed to evaluate the full impact of rivaroxaban thromboprophylaxis on all prespecified thromboembolic endpoints occurring on study. Methods CASSINI was a double-blind, randomized, placebo-controlled study in adult ambulatory patients with cancer at risk for VTE (Khorana score ≥2). Patients were screened at baseline for deep-vein thrombosis (DVT) and randomized if none was found. The primary efficacy endpoint was a composite of lower extremity proximal DVT, symptomatic upper extremity, or lower extremity distal DVT, any pulmonary embolism, and VTE-related death. This analysis evaluated all prespecified thromboembolic endpoints occurring on study to determine the full benefit of rivaroxaban prophylaxis. All endpoints were independently adjudicated. Results Total thromboembolic events occurred in fewer patients randomized to rivaroxaban during the full study period (29/420 [6.9%] and 49/421 [11.6%] patients in rivaroxaban and placebo groups, respectively [hazard ratio (HR) = 0.57; 95% confidence interval (CI): 0.36–0.90; p = 0.01]; number needed to treat [NNT] = 21). Similarly, fewer patients randomized to rivaroxaban experienced thromboembolism during the intervention period (13/420 [3.1%] patients) versus placebo (38/421 [9.0%] patients; HR = 0.33; 95% CI: 0.18–0.62; p < 0.001; NNT = 17). Conclusion Our findings confirm the substantial benefit of rivaroxaban thromboprophylaxis when considering all prespecified thromboembolic events, even after excluding baseline screen-detected DVT. The low NNT, coupled with prior data demonstrating a high number needed to harm, should assist clinicians in determining the risk/benefit of thromboprophylaxis in high-risk patients with cancer.

scholarly journals COVID-19 Associated Coagulopathy: Thrombosis, Hemorrhage and Mortality Rates with an Escalated-Thromboprophylaxis Strategy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 23-24
Author(s):  
Molly Daughety ◽  
Thomas L. Ortel ◽  
Erin Frost ◽  
Andrew Morgan ◽  
Chester Kao ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Conflicts Of Interest ◽  
Mortality Rates ◽  
Thromboembolic Events ◽  
Prothrombotic State ◽  
Major Hemorrhage ◽  
Risk Of Bleeding ◽  
Ambulatory Patients ◽  
Novel Coronavirus ◽  
Overall Mortality

Introduction: Early studies identified a prothrombotic state associated with novel coronavirus disease 2019 (COVID-19) as well as a survival benefit observed with heparin use in severely ill COVID-19 patients. There is a need to clarify the incidence of thromboembolic events (TEs), as well as major hemorrhage in COVID-19 patients in the context of an escalated-dose thromboprophylaxis strategy. Methods: We conducted a single center, retrospective study of 192 consecutive patients with COVID-19 admitted to the hospital between March 26th and May 8th 2020. Our study aimed to investigate the rates of thromboembolic events (TEs), hemorrhage and mortality of in the context of an escalated-dose thromboprophylaxis strategy implemented early in our experience with hospitalized patients with COVID-19. Results: The incidence of radiographically-confirmed venous thromboembolism (VTE) was 7.3% (n=14), and the rate of combined TEs was 12% (n=23). The rate of major hemorrhage was 6.3% (n=12), including one fatal CNS bleed. The overall mortality rate was 27.6% (n=53). Conclusion: The rate of VTE and overall TE was much lower than was reported in early studies, and the majority of VTEs occurred in ambulatory patients. Our data suggest that an escalated-dose thromboprophylaxis strategy may help reduce the incidence of inpatient VTEs, and that ambulatory COVID-19 patients may benefit from primary thromboprophylaxis. However, the risk of bleeding was not negligible, and must therefore be assessed on an individual and continual basis when using a more aggressive thromboprophylaxis strategy. Disclosures No relevant conflicts of interest to declare.

Accuracy of complete compression ultrasound in ruling out suspected deep venous thrombosis in the ambulatory setting

2009 ◽  
Vol 102 (07) ◽  
pp. 166-172 ◽  
Author(s):  
Marie-Antoinette Sevestre ◽  
Pierre Casez ◽  
Luc Bressollette ◽  
Mébarka Taiar ◽  
Gilles Pernod ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Anticoagulant Therapy ◽  
Thromboembolic Events ◽  
Office Setting ◽  
Compression Ultrasound ◽  
Venous Thromboembolic Events ◽  
Ambulatory Patients ◽  
Venous Thromboembolic

SummaryEvidence on the safety of complete compression ultrasound for ruling out deep venous thrombosis (DVT) is derived from studies conducted in tertiary care centers, although most patients with suspected DVT are managed in the ambulatory office setting. It was the objective of this study to estimate the rate of venous thromboembolism when anticoagulant therapy is withheld from ambulatory patients with normal findings on a single complete compression ultrasound. As part of a prospective cohort study, 3,871 ambulatory patients with clinically suspected DVT were enrolled by 255 board-certified vascular medicine physicians practicing in private offices in France. Compression ultrasound of the entire lower extremities was performed using a standardised examination protocol. Anticoagulant therapy was withheld from patients with negative findings on compression ultrasound, and 1,254 of them were randomly selected for follow-up. The main outcome measure was the three-month incidence of symptomatic venous thromboembolic events confirmed by objective testing. DVT was detected in 1,023 patients (26.4%),including 454 (11.7%) and 569 (14.7%) cases of proximal and isolated distal DVT, respectively. Of the 1,254 patients with negative results sampled for follow-up, six received anticoagulant therapy during follow-up and five were lost to follow-up. Five of 1,243 patients (0.4%, 95% confidence interval [CI], 0.1–0.9) experienced non-fatal symptomatic venous thromboembolic events (pulmonary embolism in two patients and DVT in three patients) and eight of 1,254 patients (0.6%, 95% CI, 0.3–1.2) died during the three-month follow-up. In conclusion, anticoagulant therapy can be safely withheld after negative complete compression ultrasound without further testing in the ambulatory office setting.

1101: Factors Associated with Clinical Evident Thromboembolic Events Following Nephrectomy

2006 ◽  
Vol 175 (4S) ◽  
pp. 354-354
Author(s):  
Joseph A. Pettus ◽  
Scott E. Eggener ◽  
Brent Yanke ◽  
Ahmad Shabsigh ◽  
Angel Serio ◽  
...  
Keyword(s):  
Thromboembolic Events ◽  
Factors Associated

COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 333-337 ◽  
Author(s):  
Francisco Leonardo Galastri ◽  
Leonardo Guedes Moreira Valle ◽  
Breno Boueri Affonso ◽  
Marcela Juliano Silva ◽  
Rodrigo Gobbo Garcia ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Dynamic Process ◽  
Therapeutic Option ◽  
Massive Pulmonary Embolism ◽  
Percutaneous Intervention ◽  
Thromboembolic Events ◽  
Emergency Center ◽  
Catheter Directed Thrombolysis

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

Pulmonary emboli due to venous aneurysm of extremities

VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Gabrielli ◽  
Rosati ◽  
Vitale ◽  
Millarelli ◽  
Siani ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Surgical Resection ◽  
Potential Risk ◽  
Acute Pulmonary Embolism ◽  
Prophylactic Surgery ◽  
Venous Aneurysm ◽  
Pulmonary Emboli ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Risk Patients

Venous aneurysms are uncommon but they can have devastating consequences, including pulmonary embolism, other thromboembolic events and death. We report six cases of venous aneurysm of the extremities, in which the first sign of presence was acute pulmonary embolism. Surgical resection is recommended whenever possible. Our experience suggests that prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for extremity deep and superficial venous aneurysms for their potential risk of developing thromboembolic complications despite adequate anticoagulation. Other venous aneurysms should be excised only if they are symptomatic or enlarging.

Contraception and thrombophilia

2009 ◽  
Vol 29 (02) ◽  
pp. 193-196 ◽  
Author(s):  
H. Rott ◽  
A. Kruempel ◽  
G. Kappert ◽  
U. Nowak-Göttl ◽  
S. Halimeh
Keyword(s):  
Chronic Illness ◽  
High Risk ◽  
Children And Adolescents ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
Thromboembolic Events ◽  
Contraceptive Methods ◽  
Secondary Complications ◽  
Increased Risk ◽  
Coagulation Proteins

SummaryThe risk of thromboembolic events (TE) is increased by acquired or inherited thrombo -philias (IT). We know that some hormonal contraceptives also increase the risk of thrombosis, thus, the use of such contraceptives are discussed as contraindications in women with IT. TEs are infrequent events in children and adolescents and in the majority of cases are associated with secondary complications from underlying chronic illness. Although adolescents are not typically considered to be at high-risk for TE, this cohort is frequently using hormonal contraception, leading to an increased risk in cases with unknown IT. The risk of TE with pregnancy alone is higher than associated with combined hormonal contra -ception. Progestin-only methods have not been found to increase the risk of TE with only moderate changes of coagulation proteins compared to normal reference values. Conclusion: Thrombophilic women are good candidates for progestin-only contraceptive methods.

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