Prevalence and Risk Factors for Symptomatic Thromboembolic Events after Shoulder Arthroplasty

Background: Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. Patients, Methods: TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. Results: Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : >CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9–191.6); chemotherapy OR = 7.8 (95% CI 2.3–26.6); CVA OR = 30.5 (95% CI 11.0–84.3). Multivariable analysis identified only CS > 1 (OR = 16.9; 95% CI 3.5–82.4) and CVA (OR = 9.0; 95% CI 2.9–27.5) as independent risk factors. Conclusions: Patients with CSs >CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.

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Venous thromboembolic events in T-cell lymphoma patients: Incidence, risk factors and clinical features

Leukemia Research ◽

10.1016/j.leukres.2021.106537 ◽

2021 ◽

Vol 103 ◽

pp. 106537

Author(s):

Yingxia Lan ◽

Jinqiu Guan ◽

Jia Zhu ◽

Juan Wang ◽

Mengzhen Li ◽

...

Keyword(s):

Risk Factors ◽

T Cell ◽

Clinical Features ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Incidence Risk

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Risk factors for wound-related reoperations in patients with metastatic spine tumor

Journal of Neurosurgery Spine ◽

10.3171/2017.10.spine1765 ◽

2018 ◽

Vol 28 (6) ◽

pp. 663-668 ◽

Cited By ~ 8

Author(s):

Hannah M. Carl ◽

A. Karim Ahmed ◽

Nancy Abu-Bonsrah ◽

Rafael De la Garza Ramos ◽

Eric W. Sankey ◽

...

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Tumor Resection ◽

Multivariate Model ◽

Wound Complications ◽

Karnofsky Performance Scale ◽

Thromboembolic Events ◽

Spine Tumor ◽

Wound Breakdown ◽

Metastatic Spine Tumor

OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

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Prevalence and risk factors for venous thromboembolic events in critically ill patients with SARS-CoV-2 infection: a prospective observational study

Minerva Anestesiologica ◽

10.23736/s0375-9393.21.15510-5 ◽

2021 ◽

Author(s):

Alessandro F. CHIESA ◽

Marco PREVISDOMINI ◽

Elisa VALENTI ◽

Elisa STOIRA ◽

Hans STRICKER ◽

...

Keyword(s):

Risk Factors ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

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Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.12.018 ◽

2018 ◽

Vol 27 (6) ◽

pp. 968-975 ◽

Cited By ~ 20

Author(s):

Gregory T. Mahony ◽

Brian C. Werner ◽

Brenda Chang ◽

Brian M. Grawe ◽

Samuel A. Taylor ◽

...

Keyword(s):

Risk Factors ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenohumeral Osteoarthritis

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Thromboembolic Events Following Splenectomy: Risk Factors, Prevention, Management and Outcomes

World Journal of Surgery ◽

10.1007/s00268-017-4185-2 ◽

2017 ◽

Vol 42 (3) ◽

pp. 675-681 ◽

Cited By ~ 14

Author(s):

Amihai Rottenstreich ◽

Geffen Kleinstern ◽

Galia Spectre ◽

Nael Da’as ◽

Esther Ziv ◽

...

Keyword(s):

Risk Factors ◽

Thromboembolic Events

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Venous Thromboembolic Events in Diffuse Large B Cell Lymphoma Patients: Risk Factors and Outcomes

Blood ◽

10.1182/blood.v128.22.3611.3611 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3611-3611

Author(s):

Sabarish Ram Ayyappan ◽

Vinita Gupta ◽

Akiva Diamond ◽

Brenda Cooper ◽

Ben K. Tomlinson ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

Cell Lymphoma ◽

Statistical Significance ◽

B Cell Lymphoma ◽

Thromboembolic Events ◽

Large B Cell Lymphoma ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Large B Cell

Abstract Venous thromboembolic events (VTE) are common after the diagnosis of lymphoma. Although various risk factors have been associated with VTE in cancer patients, there is no specific VTE risk prediction score for diffuse large B cell lymphoma (DLBCL) patients. The Khorana score is a prediction-model of VTE in cancer patients receiving chemotherapy that incorporates clinical and laboratory parameters. We evaluated the risk factors for VTE, the effect of VTE on the outcomes of DLBCL patients and the utility of the Khorana score in DLBCL patients. Methods: We searched the Hematologic Malignancies Database of University Hospitals Seidman Cancer Center for newly diagnosed DLBCL patients between 2002 and 2014. Data on patient characteristics including risk factors, disease characteristics, treatment, outcomes and VTE was collected. The Khorana score was calculated using clinical (disease type, body mass index) and laboratory (hemoglobin level, platelet and leukocyte count) parameters. Risk factors identified as having statistical significance on univariate Cox proportional hazards analysis (p <0.05) were selected for multivariate analysis. Cumulative incidence (with death as competing risk) was used to estimate the incidence of VTE. Overall survival (OS) and progression free survival (PFS) were calculated using the Kaplan-Meier method; comparison between groups was done using the log-rank test. Results: Four hundred DLBCL patients were included for analysis. Median age at diagnosis was 63 with 235 patients above the age of 60. Two hundred and thirty seven patients (59.3 %) had advanced stage at diagnosis and 14 patients (3.5%) had a prior history of VTE. Baseline characteristics are listed in Table 1. Sixty percent of patients had a Khorana score of 1 with no risk factors in addition to the diagnosis of lymphoma. At median follow up of 33 months, 70 patients (18%) presented a VTE, with 1-year and 3-year cumulative incidence of 10.1% (95% CI 7.1-13.6) and 14% (95 % CI 10.8-18), respectively. Fifty-seven VTE (81% of all VTEs) were diagnosed in patients with active disease (at diagnosis, relapse or during active therapy). The Khorana score separated DLBCL patients in three VTE risk groups: intermediate (1 point), high (2 points) and very high (3 or more points) with 1 year cumulative incidence of VTE of 6.4%, 11.6% and 22.2%, respectively (p = 0.009) (Figure 1). On univariate analysis, bone involvement by lymphoma, elevated corrected calcium (>12g/dL), increased white cell count (>11,000/mcl), hemoglobin (<10g/dL), monocytosis (>800/mcl) and chromosomal translocations involving MYC presented statistically significant increases in hazard of VTE (Table 2). On multivariate analysis only bone involvement (p=0.017) and anemia (p=0.035) retained statistical significance as risk factors for VTE. Three-year OS for patients presenting with VTE within 1 year of DLBCL diagnosis was 46.7 % (95% CI 30-63.3) vs. 72.3% (95% CI 67.4-77.3) in subjects without early VTE (p=0.05) (Figure 2). Presence of VTE at any time after DLBCL diagnosis was also associated with worse OS rates, with estimated 3-year OS of 52.2 % (95 % CI 39.8-64.7) for subjects experiencing VTE and 74 % (95 % CI 69-79) for those without VTE after DLBCL diagnosis (p<0.0001). Conclusion: Venous thromboembolic events are common after diagnosis of DLBCL and are associated with worsened outcomes. The Khorana score is capable of identifying patient subgroups with increased risk of VTE. Additional parameters associated with aggressive disease and advanced stages could further help in VTE risk stratification for selection of patients who may benefit from antithrombotic prophylaxis. Prospective validation of VTE risk assessments and clinical trials of VTE prevention are needed in this high=risk population. Disclosures Caimi: Gilead: Consultancy; Novartis: Consultancy; Genentech: Speakers Bureau; Roche: Research Funding.

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Higher Incidence of Stroke in Severe COVID-19 Is Not Associated With a Higher Burden of Arrhythmias: Comparison With Other Types of Severe Pneumonia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.763827 ◽

2021 ◽

Vol 8 ◽

Author(s):

Peter Jirak ◽

Zornitsa Shomanova ◽

Robert Larbig ◽

Daniel Dankl ◽

Nino Frank ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Severe Pneumonia ◽

Thromboembolic Events ◽

Therapeutic Anticoagulation ◽

Tertiary Hospitals ◽

Ventricular Tachycardias ◽

Disease Specific ◽

Rhythm Monitoring

Aims: Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.Methods and Results: This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including n =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in n = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %, p = ns and asystole 5.0 vs. 3.3%, p = ns) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, p = ns). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, p = 0.003; newly onset AF 10.0 vs. 30.0%, p = 0.006), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, p = 0.029). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, p = 0.042). These events also happened in the absence of AF (50%) and with TAC (50%).Conclusions: Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.

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