Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality

AbstractThe cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. There were 5,072 patients identified: 3,252 had AML and 1,820 had ALL. Three- and 12-month cumulative incidences of UE DVT were 4.8% (95% confidence interval [CI]: 4.1–5.6) and 6.6% (95% CI: 5.8–7.5) for AML and 4.1% (95% CI: 3.2–5.1) and 5.9% (95% CI: 4.9–7.1) for ALL, respectively. Twelve-month cumulative incidences of subsequent VTE after an incident UE DVT diagnosis were 5.3% for AML and 12.2% for ALL. Twelve-month cumulative incidences of subsequent bleeding after an incident UE DVT diagnosis were 15.4% for AML and 21.1% for ALL. UE DVT was associated with an increased risk of subsequent bleeding for both AML (hazard ratio [HR]: 2.07; 95% CI: 1.60–2.68) and ALL (HR: 1.62; 95% CI: 1.02–2.57) but was not an independent risk factor for subsequent PE or LE DVT for either leukemia subtype. Isolated incident UE DVT was associated with increased leukemia-specific mortality for AML (HR: 1.42; 95% CI: 1.16–1.73) and ALL (HR: 1.80; 95% CI: 1.31–2.47). UE DVT is a relatively common complication among patients with AML and ALL and has a significant impact on bleeding and mortality. Further research is needed to determine appropriate therapy for this high-risk population.

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Elevated Hematocrit Concentration and the Risk of Mortality and Vascular Events in Patients Undergoing Major Surgery.

Blood ◽

10.1182/blood.v120.21.2088.2088 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2088-2088 ◽

Cited By ~ 1

Author(s):

Khaled M Musallam ◽

John B Porter ◽

Assaad Soweid ◽

Jamal J Hoballah ◽

Pierre M Sfeir ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Postoperative Mortality ◽

Major Surgery ◽

Vascular Events ◽

Improvement Program ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein ◽

The Impact

Abstract Abstract 2088 Background: Preoperative anemia is associated with adverse outcomes after major surgery. This study evaluates the effect of elevated hematocrit concentration on 30-day postoperative mortality and vascular events in patients undergoing major surgery. Methods: We conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day mortality and vascular events, demographic, and perioperative risk factors were obtained for 197,469 adult patients undergoing major surgery in nonveteran's administration hospitals across the US, Canada, Lebanon, and the UAE during 2008 and 2009. We assessed the adjusted effect of elevated (>0.50) compared to normal preoperative hematocrit concentration (≥0.41–0.50, American Medical Association reference-range) on postoperative outcomes. Separate sex-specific analysis using hematocrit concentration thresholds commonly used in the diagnosis and management of patients with apparent or absolute erythrocytosis was also done. Results: A total of 3,961 patients (2.0%) had elevated hematocrit concentration preoperatively. After adjustment, postoperative mortality at 30 days was higher in patients with elevated hematocrit concentration than in those without (odds ratio [OR]: 2.23, 95% CI: 1.77–2.80). 30-day deep vein thrombosis (OR: 1.95, 95% CI: 1.44–2.64) and pulmonary embolism (OR: 1.79, 95% CI: 1.17–2.73), but not myocardial infarction or cerebrovascular events, were also higher in patients with elevated hematocrit concentration than in those without. Similar evaluation of various clinically relevant hematocrit concentrations revealed the following: an effect on mortality was noted beyond the thresholds of 0.48 in women and 0.52 in men, with the effect estimates becoming considerably high for values >0.54. Values between 0.41–0.45 were not associated with increased odds mortality. Similar observations were noted for deep vein thrombosis, although with higher variation and uncertainty especially in women; while the effects on pulmonary embolism were restricted to men. Conclusion: Elevated hematocrit concentration is associated with an increased risk of 30-day mortality and venous thrombosis following major surgery. Further investigation of the impact of elevated hematocrit concentration and its reduction on surgical outcomes is warranted. Disclosures: No relevant conflicts of interest to declare.

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Risk of pulmonary emboli after removal of an upper extremity central catheter associated with a deep vein thrombosis

Blood Advances ◽

10.1182/bloodadvances.2021004698 ◽

2021 ◽

Vol 5 (14) ◽

pp. 2807-2812

Author(s):

Damon E. Houghton ◽

Henny Heisler Billett ◽

Manila Gaddh ◽

Oluwatomiloba Onadeko ◽

Gemlyn George ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Catheter Removal ◽

Optimal Time ◽

No Removal ◽

Vein Thrombosis ◽

Early Removal ◽

Increased Risk ◽

Deep Vein ◽

Anticoagulated Patients

Abstract Standard treatment of catheter-associated upper extremity deep vein thrombosis (UE-DVT) is anticoagulation, although catheters are often removed for this indication. The optimal time for catheter removal and whether the act and/or timing of catheter removal is associated with pulmonary embolism (PE) remain unknown. A retrospective cohort study was performed at 8 participating institutions through the Venous thromboEmbolism Network US. Patients with hematologic malignancies and central venous catheter (CVC)–associated UE-DVT were included from 1 January 2010 through 31 December 2016. The primary outcome was objectively confirmed PE within 7 days of UE-DVT diagnosis in anticoagulated patients comparing early (≤48 hours) vs delayed (>48 hours) catheter removal. A total of 626 patients were included, among whom 480 were treated with anticoagulation. Among anticoagulated patients, 255 underwent early CVC removal, while 225 had delayed or no CVC removal; 146 patients received no anticoagulation, among whom 116 underwent CVC removal alone. PE within 7 days occurred in 2 patients (0.78%) with early removal compared with 1 patient (0.44%) with delayed or no CVC removal (P > .9). PE or any cause of death within 7 days occurred in 3 patients in both the early removal (1.18%) and delayed/no removal (1.33%) groups (P > .9). In patients treated with CVC removal only (no anticoagulation), there were no PEs but 3 deaths within 7 days. In patients with hematological malignancy and CVC-associated UE-DVT, early removal of CVCs was not associated with an increased risk of PE compared with delayed or no removal.

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Upper-Extremity Deep Vein Thrombosis in Patients With Breast Cancer With Chest Versus Arm Central Venous Port Catheters

Breast Cancer Basic and Clinical Research ◽

10.1177/1178223418771909 ◽

2018 ◽

Vol 12 ◽

pp. 117822341877190 ◽

Cited By ~ 2

Author(s):

Danielle Tippit ◽

Eric Siegel ◽

Daniella Ochoa ◽

Angela Pennisi ◽

Erica Hill ◽

...

Keyword(s):

Breast Cancer ◽

Deep Vein Thrombosis ◽

Upper Extremity ◽

Venous Access ◽

High Risk Population ◽

Safe Delivery ◽

Vein Thrombosis ◽

Venous Access Device ◽

Deep Vein ◽

Active Cancer

Most of the patients undergoing treatment for cancer require placement of a totally implantable venous access device to facilitate safe delivery of chemotherapy. However, implantable ports also increase the risk of deep vein thrombosis and related complications in this high-risk population. The objective of this study was to assess the incidence of upper-extremity deep vein thrombosis (UEDVT) in patients with breast cancer to determine whether the risk of UEDVT was higher with chest versus arm ports, as well as to determine the importance of previously reported risk factors predisposing to UEDVT in the setting of active cancer. We retrospectively reviewed the medical records of 297 women with breast cancer who had ports placed in our institution between the dates of December 1, 2010, and December 31, 2016. The primary outcome was the development of radiologically confirmed UEDVT ipsilateral to the implanted port. Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1 documented case of associated pulmonary embolism. Fourteen (9.5%) of 147 subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150 subjects with chest ports ( P = .0056). Thus, implantation of arm ports as opposed to chest ports may be associated with a higher rate of UEDVT in patients with breast cancer.

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Statin and aspirin use and risk of VTEs in ovarian cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5576 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5576-5576

Author(s):

Hedy S Rennert ◽

Gad Rennert ◽

Ofer Lavie ◽

Shlomi Sagi ◽

Michele Leviov ◽

...

Keyword(s):

Ovarian Cancer ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Cancer Patients ◽

Cox Regression ◽

High Risk Population ◽

Vein Thrombosis ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Deep Vein

5576 Background: Deep vein thrombosis and pulmonary embolism - venous thromboembolic events (VTEs) - are associated with significant morbidity and increased risk of mortality in cancer patients. Ovarian cancer patients are at a particularly increased risk for VTEs. Statins and aspirin have been shown to reduce the risk of VTEs in the general population in randomized trials. However, the effect of these medications on the incidence of VTEs in ovarian cancer patients has not been studied. Methods: Patients diagnosed with ovarian cancer between years 2000 and 2011 were identified through the Israeli Cancer Registry (ICR). Patients insured by Clalit Health Services, the largest HMO in Israel, were included. Data regarding medication use, chronic diseases and VTE diagnosis were extracted from the computerized database. Patients taking Warfarin or Low Molecular Weight Heparin for 3 months or longer were excluded. Statistical analysis was performed using SPSS (v 18). Use of medications was analyzed as a time dependent covariate in a Cox regression model. Results: Of 1,886 patients 179 (9.5%) had a VTE during a median follow up of 3.13 years. 95 patients (5%) had a VTE 2 years after diagnosis of ovarian cancer. In a multivariate analysis use of chemotherapy and stage 3 or 4 at presentation were associated with an increased risk for VTE's 2 years after diagnosis. Age was associated with a trend for increased risk. Statins were used by 43.2% of the patients, and 31.9% used aspirin. Aspirin use was associated with a reduced incidence of a VTE, which was borderline statistically significant (p=0.054). Statin use did not affect the incidence of VTE's in the group of ovarian carcinoma patients. Conclusions: Our results suggest that in patients with ovarian cancer aspirin use is a possible protector from deep vein thrombosis and pulmonary embolism. Prospective trials are warranted to assess the benefit of aspirin and statins for prevention of VTE's in the high risk population of ovarian cancer patients. [Table: see text]

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Increased risk of upper extremity deep vein thrombosis in ovarian hyperstimulation syndrome after assisted reproductive technology: more common than we thought

Fertility and Sterility ◽

10.1016/j.fertnstert.2008.07.1396 ◽

2008 ◽

Vol 90 ◽

pp. S398-S399

Author(s):

M. Al-Khaduri ◽

F. Bissonnette ◽

L. Lapensee ◽

R. Hemmings ◽

B. Couturier ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Assisted Reproductive Technology ◽

Upper Extremity ◽

Ovarian Hyperstimulation Syndrome ◽

Reproductive Technology ◽

Ovarian Hyperstimulation ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein

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The Risk of Subsequent Deep Vein Thrombosis and Pulmonary Embolism in Patients with Nontyphoidal Salmonellosis: A Nationwide Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103567 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3567

Author(s):

Renin Chang ◽

Den-Ko Wu ◽

James Cheng-Chung Wei ◽

Hei-Tung Yip ◽

Yao-Min Hung ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Proportional Hazards ◽

Absolute Risk ◽

Cox Proportional Hazards ◽

Control Group ◽

P Value ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein

The purpose of this study was to evaluate the deep vein thrombosis (DVT) and pulmonary embolism (PE) risk among patients with a diagnosis of nontyphoidal salmonellosis (NTS) in an Asian population. The risk was analyzed in a cohort of 17,855 patients newly diagnosed with NTS and 71,420 individuals without NTS using a hospitalization claim dataset. Both groups were matched by age, sex, and index date as an original analysis. A Cox proportional-hazards regression model was applied to estimate the risk of DVT and PE, accounting for any competing event (death). With a follow-up of 4.94 (±3.93) years in the NTS group and 6.30 (±3.67) years in the non-NTS group, the adjusted subhazard ratios (SHRs) of DVT and PE were 1.83 (95% CI 1.44–2.31) and 1.84 (95% CI 1.30–2.60). The NTS group had an increased risk of DVT and PE compared with the control group in all of the age subgroups. Stratified analyses showed that patients aged 18–39 years in the NTS group had significantly higher DVT and PE risks compared with patients of the same age in the non-NTS group (aHR, 5.95; 95% CI, 2.22–15.91 for DVT; aHR 6.72; 95% CI, 2.23–20.30 for PE). The P-value for interaction between age and exposure of NTS is <0.001 for DVT and 0.004 for PE in our sub-group analyses. The findings were cross-validated by a re-analysis with propensity score matching (PSM), and that revealed consistent results. Despite of low absolute risk, clinicians should be aware that patients with an NTS hospitalization history is at increased risk for VTE especially when assessing patients coincident with other VTE risk factors.

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Patients with Upper Extremity Deep Vein Thrombosis in a Clinical Material of Warsaw Medical University

Polish Journal of Surgery ◽

10.2478/v10035-010-0091-0 ◽

2010 ◽

Vol 82 (11) ◽

Author(s):

Maria Jeleńska ◽

Łukasz Romanowski

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Clinical Material ◽

Vein Thrombosis ◽

Medical University ◽

Deep Vein

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Management of upper extremity deep vein thrombosis in Occitanie: practice assessment

JMV-Journal de Médecine Vasculaire ◽

10.1016/j.jdmv.2020.06.002 ◽

2020 ◽

Vol 45 (5) ◽

pp. 288-293

Author(s):

U. Turrian ◽

J. Malloizel-Delaunay ◽

A. Bura-Rivière

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Vein Thrombosis ◽

Practice Assessment ◽

Deep Vein

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

Viruses ◽

10.3390/v13050878 ◽

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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