scholarly journals Successful Secondary Endovascular Intervention in Pediatric Patients with Venous Thromboembolic Events

2022 ◽  
Author(s):  
Hannah Glonnegger ◽  
Barbara Zieger ◽  
Jochen Grohmann ◽  
Gabriele Freund ◽  
Thomas Zeller ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multidisciplinary Treatment ◽  
Clinical Signs ◽  
Endovascular Intervention ◽  
Postthrombotic Syndrome ◽  
Thromboembolic Events ◽  
Catheter Directed Thrombolysis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Abstract Background In the past, pediatric patients with venous thromboembolic events (VTE) were treated with low-molecular-weight heparin (LMWH) which was successful in around 70% of the cases. However, anticoagulation alone might not restore patency in all patients, and advanced therapeutic options to prevent postthrombotic syndrome are needed. During recent years, endovascular interventions have become a treatment option for pediatric patients with persistent thrombotic occlusion, not only in life- or limb-threatening VTE. Methods We evaluated 12 consecutive patients (11–17 years) with newly diagnosed VTE being treated at our department during the last 4 years (2017–2020). In case follow-up examination showed persistent venoocclusion under anticoagulation, patients received secondary interventional therapy like recanalization, percutaneous transluminal angioplasty with or without catheter-directed thrombolysis, and stenting. Patients with no clinical signs of venoocclusion or regredient thrombosis in imaging examination received anticoagulation alone. Results Six of 12 (50%) patients underwent catheter intervention. Median time from diagnosis to intervention was 4 months (0–12 months). Reintervention was necessary in one (8%) case and complete recanalization failed in one (8%) case. There were no major bleeding events or other major postinterventional complications, no acute or late local recurrence, and all patients reported clinical improvement after the procedure. Conclusion If endovascular intervention is used in teenage patients with persistent symptomatic VTE, reduction of postthrombotic symptoms is possible, even if intervention is performed secondary to failure of anticoagulation. Multidisciplinary treatment decisions can be based on the clinical course and follow-up imaging.

scholarly journals Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty

2019 ◽  
Vol 8 (12) ◽  
pp. 2158
Author(s):  
Pei-Hsun Sung ◽  
Yao-Hsu Yang ◽  
Hsin-Ju Chiang ◽  
John Y. Chiang ◽  
Hon-Kan Yip ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Thromboembolic Events ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Post Surgery ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Previous data have shown patients with osteonecrosis of the femoral head (ONFH) have increased lifelong risk of unprovoked venous thromboembolic events (VTE) as compared with the general population, according to sharing common pathological mechanism of endothelial dysfunction. However, whether the risk of VTE increases in those ONFH patients undergoing major hip replacement surgery remains unclear. This is a retrospective nationwide Asian population-based study. From 1997 to 2013, a total of 12,232 ONFH patients receiving partial or total hip replacement for the first time and revision surgeries were retrospectively selected from Taiwan Health Insurance surgical files. By 1:1 matching on age, sex, surgical types, and socioeconomic status, 12,232 subjects without ONFH undergoing similar hip surgery were selected as non-ONFH group. The incidence and risk of post-surgery VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), were compared between the ONFH and non-ONFH groups. Results showed that 53.8% of ONFH patients were male and the median age was 61.9 years old. During the mean follow-up period of 6.4 years, the incidences of VTE (1.4% vs. 1.2%), DVT (1.1% vs. 0.9%), and PE (0.4% vs. 0.4%) were slightly but insignificantly higher in the ONFH than in the non-ONFH group undergoing the same types of major hip replacement surgery (all p-values > 0.250). Concordantly, we found no evidence that the risk of VTE was increased in the ONFH patients as compared with the non-ONFH counterparts (adjusted HR 1.14; 95% CI 0.91–1.42; p = 0.262). There were also no increased risks for DVT and PE in the ONFH subgroups stratified by comorbidities, drug exposure to pain-killer or steroid, and follow-up duration after surgery, either. In conclusion, hip arthroplasty in Asian patients with ONFH is associated with similar rates of VTE as compared to patients with non-ONFH diagnoses.

Effects of the Timing and the Type of Venous Thromboembolic Events On Survival in Patients with Pancreatic Cancer

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1151-1151
Author(s):  
Vivek Kesari ◽  
Maithili Shethia ◽  
Xiao Zhou ◽  
Michael Overman ◽  
Saroj Vadhan-Raj
Keyword(s):  
Pancreatic Cancer ◽  
Survival Analysis ◽  
Cancer Diagnosis ◽  
Thromboembolic Events ◽  
Kaplan Meier ◽  
Compression Ultrasound ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
The Impact

Abstract Abstract 1151 Background: Patients (pts) with pancreatic cancer are at high risk for venous thromboembolic events (VTE) and the occurrence of VTE can adversely affect prognosis. However, it is unclear if the type of VTE such as symptomatic vs incidental, deep vein thrombosis (DVT) vs pulmonary embolism (PE), the location of VTE [DVT of extremities vs visceral veins (abdominal/pelvic veins)] or the timing of VTE from diagnosis can influence the survival. The purpose of this study was to evaluate the incidence of different types of VTE, the impact of types and timing of VTE (early vs late) on survival. Methods: Medical records of 260 pts with pancreatic cancer, newly referred to MDACC in 2006, were reviewed for cancer diagnosis, patient demographics (age, gender), presence of metastasis, the date of diagnosis of VTE, timing of VTE, type of VTE, the site of VTE, the incidence of VTE during 2 years of follow up from the date of diagnosis. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was calculated from the date of cancer diagnosis to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results: Of the 260 pts referred, 235 were confirmed to have the diagnosis of pancreatic carcinoma. During the 2-year follow-up, 80 pts (34%) had 109 episodes of VTE, including symptomatic and incidental episodes. The median age of the pts with VTE was 59 years (range: 28–86) and 51% were males. Of the 80 pts with VTE, 21 (26%) had PE, 18 (23%) had DVT of extremities, 28 (35%) had DVT of visceral veins and 13 (16%) had concurrent PE/DVT (diagnosed on the same day). Of the 80 pts, 25 (31%) had 29 recurrent episodes. Kaplan-Meier survival analysis, as shown in the table below, indicated that the pts who had early VTE (defined as VTE diagnosed within 30 days from the date of diagnosis of pancreatic cancer) vs late VTE (> 30 days) and pts with metastasis vs no metastasis had statistically poor 1 year survival (log-rank test). Conclusions: These findings suggest that timing of VTE is an important indicator of prognosis, regardless of whether symptomatic or incidental. Patients with VTE within 30 days of diagnosis have shorter survival. Disclosures: No relevant conflicts of interest to declare.

scholarly journals EPID-10. VENOUS THROMBOEMBOLIC EVENTS IN GLIOBLASTOMA PATIENTS: AN EPIDEMIOLOGICAL VIEW

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi76-vi76
Author(s):  
Dorothee Gramatzki ◽  
Patrick Roth ◽  
Emilie Le Rhun ◽  
Elisabeth Rushing ◽  
Sabine Rohrmann ◽  
...  
Keyword(s):  
Survival Data ◽  
Time Frame ◽  
Rank Test ◽  
Karnofsky Performance Score ◽  
Thromboembolic Events ◽  
Therapeutic Anticoagulation ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Abstract BACKGROUND Venous thromboembolic events (VTE) are a common complication in cancer patients. Anticoagulant use is the appropriate treatment for acute VTE in cancer, although assumed to be associated with increased risk for bleeding. The population-based relationship of VTE and anticoagulant therapy to survival in glioblastoma patients remains unclear. METHODS Frequency, risk factors, treatment and complications of VTE were assessed in a glioblastoma cohort in the Canton of Zurich, Switzerland (2010 to 2014). Survival data were retrospectively analyzed using the log rank test. RESULTS 248 glioblastoma patients with known isocitrate dehydrogenase (IDH) wildtype status were identified in a 5-year time-frame. Median overall survival (OS) was 12.8 months (95% CI 11.0–14.6), with a median follow up of 60.7 months (95% CI 51.4–70.0). VTE were diagnosed in 35 patients (14.4%; 5 out of 248 patients with no follow-up data on VTE). Median time from diagnosis to VTE was 2.23 months (95% CI 0.6–3.9); 3 patients (8.6%) had a history of VTE. Most patients were on steroids at time of diagnosis of VTE (68.6%), and a Karnofsky Performance Score of less than 70% was documented in 21 patients (60%). Most patients with VTE (88.6%) received therapeutic anticoagulation. Complications, resulting in the cessation of therapeutic anticoagulation, occurred in 11 patients (35.5%), mainly (9 patients, 81.8%) due to intracranial hemorrhage. OS did not differ between patients diagnosed with VTE and those without VTE (p=0.103). Tumor progression was the major cause of death (91.3%); 1.4% of patients died from VTE; 1.9% of the patients suffered unexpected sudden death. CONCLUSION Although VTE were identified in 14.4% of glioblastoma patients, VTE were not the major reason for death. These data do not support the implementation of primary thromboprophylaxis in glioblastoma patients. Prospective clinical trials are needed to examine the association of anticoagulant use with survival in glioblastoma patients.

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.

scholarly journals Recurrence of Upper Extremity Deep Vein Thrombosis Secondary to COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 878
Author(s):  
Yesha H. Parekh ◽  
Nicole J. Altomare ◽  
Erin P. McDonnell ◽  
Martin J. Blaser ◽  
Payal D. Parikh
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.

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