Clinical characteristics and outcomes of patients with venous thromboembolism according to diagnosis on weekends versus weekdays: from the COMMAND VTE Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Yamashita ◽  
T Morimoto ◽  
T Makiyama ◽  
K Ono ◽  
T Kimura
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Funding Source ◽  
Medical Systems ◽  
Severe Condition ◽  
Entire Cohort

Abstract Background/Introduction The medical systems of hospitals often differs between on weekends and weekdays. These differences could lead different clinical outcomes for patients with acute medical conditions that require complex treatment strategies. However, the effect of the time of diagnosis on clinical outcomes in patients with acute venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is still controversial. Purpose We sought to evaluate the clinical characteristics and outcomes of patients with VTE comparing on weekends and weekdays in a large observational database of VTE in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. In the current analysis, diagnosis on weekends was defined as diagnosis during the period from 00:00 hours on Saturday to 24:00 on Sunday. All other times were defined as weekdays. We divided the entire cohort into 2 groups; diagnosis on weekends and diagnosis on weekdays groups, and we compared the clinical characteristics, management strategies and 30-day outcomes between the 2 groups. Results The current study population consisted of 337 patients diagnosed on weekends and 2690 patients diagnosed on weekdays. The median days from onset to diagnosis were shorter in the patients diagnosed on weekends than in those diagnosed on weekdays (2 days vs. 4 days, P<0.001). The patients diagnosed on weekends presented with PE more frequently (72% vs. 55%, P<0.001), and they showed more severe condition for PE with a higher simplified pulmonary embolism severity index score. The vast majority of PE patients were diagnosed by contrast-enhanced computed tomography in both groups (97% vs. 97%, P=0.67). The patients diagnosed on weekends more often received initial parenteral anticoagulation therapy and thrombolysis than those diagnosed on weekdays. The cumulative 30-day incidence of all-cause death was not significantly different between the 2 groups among PE patients (diagnosis on weekends: 6.2% vs. diagnosis on weekdays: 6.5%, P=0.87), as well as among DVT patients (0.0% vs. 1.5%, P=0.24) (Figure). After adjusting the confounders, the risk of diagnosis on weekends relative to diagnosis on weekdays for all-cause death among PE patients was still insignificant (adjusted HR: 0.76; 95% CI: 0.42–1.28). The most frequent cause of deaths was fatal PE in both groups among PE patients. The risks for recurrent VTE and major bleeding at 30 days were not significantly different between the 2 groups among PE patients nor DVT patients. Conclusions The VTE patients diagnosed on weekends presented with PE more frequently, and they showed more severe condition for PE, although the risks for short-term mortality were not significantly different between patients diagnosed on weekends and weekdays. Kaplan-Meier curves for all-cause death Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

scholarly journals Clinical Outcomes of Pulmonary Embolism in Mexican Patients With COVID-19

2021 ◽  
Vol 27 ◽  
pp. 107602962110089
Author(s):  
Luis O. Bobadilla-Rosado ◽  
Santiago Mier y Teran-Ellis ◽  
Gabriel Lopez-Pena ◽  
Javier E. Anaya-Ayala ◽  
Carlos A. Hinojosa
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Mexico City ◽  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Coagulation Abnormalities ◽  
Survivor Group ◽  
Increased Risk ◽  
Tertiary Center ◽  
Significant Difference

Coagulation abnormalities have been reported in COVID-19 patients, which may lead to an increased risk of Pulmonary Embolism (PE). We aimed to describe the clinical characteristics and outcomes of COVID-19 patients diagnosed with PE during their hospital stay. We analyzed patients with PE and COVID-19 in a tertiary center in Mexico City from April to October of 2020. A total of 26 (100%) patients were diagnosed with Pulmonary Embolism and COVID-19. We observed that 14 (54%) patients were receiving either prophylactic or full anticoagulation therapy, before PE diagnosis. We found a significant difference in mortality between the group with less than 7 days (83%) and the group with more than 7 days (15%) in Intensive Care Unit ( P = .004); as well as a mean of 8 days for the mortality group compared with 20 days of hospitalization in the survivor group ( P = .003). In conclusion, there is an urgent need to review antithrombotic therapy in these patients in order to improve clinical outcomes and decrease hospital overload.

Thrombosis associated with ventriculoatrial shunts

2008 ◽  
Vol 2 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Norka Wilkinson ◽  
Sandeep Sood ◽  
Steven D. Ham ◽  
Holly Gilmer-Hill ◽  
Patricia Fleming ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Outcome Data ◽  
Single Center Study ◽  
Prophylactic Anticoagulation ◽  
Risk For Thrombosis ◽  
Work Up

Object In this single-center study, the authors examined the clinical characteristics, risk factors, treatment strategies, and outcomes in patients with thrombosis associated with ventriculoatrial (VA) shunts. Methods Inpatient and outpatient charts of patients who underwent treatment and follow-up in the Hematology-Oncology Division at the authors' institution and in whom thrombosis developed secondary to a VA shunt placement were reviewed. A complete thrombophilia work-up was performed in each patient, and these records were also reviewed. Treatment including medical and surgical management was noted and outcome data were recorded. Results Resolution of thrombosis was seen after anticoagulation therapy in all patients; this may be an alternative to surgical therapy. Conclusions Patients with VA shunts represent a unique group at risk for thrombosis. The duration of anticoagulation therapy must be individualized. However, larger studies are needed to evaluate the efficacy of screening for asymptomatic thrombosis and to investigate the role of prophylactic anticoagulation.

Evaluating the use of appropriate anticoagulation with lenalidomide and pomalidomide in patients with multiple myeloma

2018 ◽  
Vol 25 (4) ◽  
pp. 806-812 ◽  
Author(s):  
Sarah M Anderson ◽  
Bradley Beck ◽  
Susan Sterud ◽  
Robin Lockhorst ◽  
Surachat Ngorsuraches
Keyword(s):  
Myocardial Infarction ◽  
Multiple Myeloma ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Anticoagulation Therapy ◽  
Common Adverse Event ◽  
Total Risk ◽  
Oral Tablet ◽  
Major Bleed ◽  
Ambulatory Oncology

Background Lenalidomide and pomalidomide are two immunomodulatory medications with the potential to improve outcomes for patients with multiple myeloma; however, a black box warning for venous thromboembolism exists. Purpose The purpose of this study was to assess overall adherence to guideline recommendations for anticoagulation therapy with lenalidomide and pomalidomide in multiple myeloma patients. Methods This retrospective study at an ambulatory oncology clinic utilized chart reviews from the calendar years 2013–2016. The primary endpoint was prescription of appropriate anticoagulation upon initiation of therapy based on a list of predetermined risk factors. Secondary endpoints included incidence of deep venous thromboembolism, pulmonary embolism, myocardial infarction, stroke, and major bleed; initial anticoagulant prescribed; and whether or not anticoagulation was prescribed for another disease state. Results A total of 130 patients met inclusion criteria: 70.8% (n = 92) and 29.2% (n = 38) were prescribed lenalidomide and pomalidomide, respectively. A total risk score of two was most common (n = 54, 41.5%). Aspirin 81 mg oral tablet was prescribed most often (n = 53, 40.8%), followed by no anticoagulation (n = 30, 23.1%). Overall, 27 patients (20.8%) were prescribed anticoagulation in accordance with National Comprehensive Cancer Network guidelines. Incidence of deep venous thromboembolism was the most common adverse event (n = 4, 3.1%), followed by major bleed (n = 1, 0.8%). No reports of pulmonary embolism, myocardial infarction, or stroke were documented. Conclusions Overall, a disparity exists between appropriate prescribing of prophylactic anticoagulation and current practice guidelines. However, documentation of thromboembolic events was lower than recorded in previously published literature.

scholarly journals Sex Differences in Patients With Occult Cancer After Venous Thromboembolism

2017 ◽  
Vol 24 (3) ◽  
pp. 489-495 ◽  
Author(s):  
Luis Jara-Palomares ◽  
Remedios Otero ◽  
David Jiménez ◽  
Juan Manuel Praena-Fernández ◽  
Agustina Rivas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sex Differences ◽  
Venous Thromboembolism ◽  
Clinical Characteristics ◽  
Treatment Strategies ◽  
Common Cancer ◽  
Occult Cancer ◽  
Increased Risk ◽  
Male Sex ◽  
Increasing Risk

In patients with venous thromboembolism (VTE), male sex has been associated with an increased risk of occult cancer. The influence of sex on clinical characteristics, treatment, cancer sites, and outcome has not been thoroughly investigated yet. We used the Registro Informatizado Enfermedad TromboEmbólica registry to compare the clinical characteristics, treatment strategies, cancer sites, and clinical outcomes in patients with VTE having occult cancer, according to sex. As of June 2014, 5864 patients were recruited, of whom 444 (7.6%; 95% confidence interval: 6.8-8.2) had occult cancer. Of these, 246 (55%) were men. Median time elapsed from VTE to occult cancer was 4 months (interquartile range: 2-8.4), with no sex differences. Women were older, weighed less, and were less likely to have chronic lung disease than men. The most common cancer sites were the lung (n = 63), prostate (n = 42), and colorectal (n = 29) in men and colorectal (n = 38), breast (n = 23), uterine (n = 18), hematologic (n = 17), or pancreas (n = 15) in women. Men were more likely to have lung cancer than women (2.18% vs 0.30%; P < .01) and less likely to have pancreatic cancer (0.17% vs 0.5%; P = .03). Interestingly, breast cancer was more likely found in women aged ≥50 years than in those aged <50 years (0.97% vs 0.14%; P = .03). This study highlights the existence of sex differences in patients with VTE having occult cancer. One in every 2 men had lung, prostate, or colorectal cancer. In women, there is a heterogeneity of cancer sites, increasing risk of breast cancer in those aged >50 years.

scholarly journals Incidental Pulmonary Embolism. Analysis of Mayo Clinic Venous Thromboembolism Database

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1147-1147
Author(s):  
Ewa Wysokinska ◽  
Damon E. Houghton ◽  
Danielle Vlazny ◽  
Aneel A. Ashrani ◽  
David A Froehling ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Cancer Information ◽  
Mortality Data ◽  
Patients With Cancer ◽  
Incidental Pulmonary Embolism ◽  
Underlying Malignancy ◽  
Recurrent Vte

Background: Incidental pulmonary embolism (PE) is not infrequently found on CT scans with highest incidence reported in patients with cancer. It is unclear whether patients with symptomatic pulmonary embolism (iPE) have different clinical profile or outcomes compared to patients with symptomatic PE (sPE) and whether this is affected by the presence or type of malignancy. Objective: Compare baseline characteristics of patients diagnosed with iPE to patients with sPE with attention to cancer-specific risk factors as well as evaluate clinical outcomes. Methods: Consecutive patients enrolled in the Mayo Thrombophilia Clinic VTE Registry between March 1, 2013 and December 31st, 2018 with PE were followed prospectively. Outcomes of recurrent venous thromboembolism (VTE), major bleeding, clinically relevant non-major bleeding (CRNMB) and mortality data were collected every 3 months. Clinical outcomes were analyzed with specific focus on patients with cancer. Information was collected and managed using REDCap (Research Electronic Data Capture) and data analysis was performed using SAS software (SAS Institute Inc., Cary, North Carolina). Results: Out of a total of 1033 patients with PE in VTE registry, there were 655 patients with PE (284 with incidental and 363 symptomatic) who completed at least 3 months of anticoagulation and were started on treatment within 14 days of diagnosis. Apixaban was used in 220 (34 %), Rivaroxaban 175 (27 %), Enoxaparin 179 (27%), and Warfarin in 81 (12 %) patients. Overall cancer was present in 61% of patients and was more common in patients with iPE compared to sPE (80.2% vs 45.2%, p<0.001). Patients with iPE were less likely to have previous VTE (8.2% vs 25.5%, p< 0.0001) and tended to have lower BMI (mean 28.8 vs 31.4, p<0.0001) Characteristics of the subgroup of only cancer patients with PE are summarized in the Table. Of note, pancreatic and GI cancers were more common in patients with iPE. There were no differences in recurrent VTE, major bleeding and CRNMB in patients with iPE compared to sPE. This also held true for patients with underlying malignancies. Mortality rates were significantly higher in all patients with iPE even when adjusting for presence of malignancy (p=0.03). When adjusting for presence of metastatic malignancy though the difference was no longer present (p=0.33). Conclusion: Patients with iPE were more likely to have an underlying malignancy, potentially due to higher likelihood of undergoing staging imaging studies. Additionally, patients with iPE more often had metastatic disease which was associated with higher mortality. Recurrent VTE and bleeding outcomes were similar in patients with iPE and sPE, this was independent of the presence of underlying malignancy. Disclosures McBane: BMS: Research Funding.

scholarly journals Patients with venous thromboembolism after spontaneous intracerebral hemorrhage: a review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qiyan Cai ◽  
Xin Zhang ◽  
Hong Chen
Keyword(s):  
Venous Thromboembolism ◽  
Intracerebral Hemorrhage ◽  
Patient Population ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Hematoma Expansion ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Mechanical Prophylaxis ◽  
Systemic Thrombolytic Therapy

Abstract Background Patients with spontaneous intracerebral hemorrhage (ICH) have a higher risk of venous thromboembolism (VTE) and in-hospital VTE is independently associated with poor outcomes for this patient population. Methods A comprehensive literature search about patients with VTE after spontaneous ICH was conducted using databases MEDLINE and PubMed. We searched for the following terms and other related terms (in US and UK spelling) to identify relevant studies: intracerebral hemorrhage, ICH, intraparenchymal hemorrhage, IPH, venous thromboembolism, VTE, deep vein thrombosis, DVT, pulmonary embolism, and PE. The search was restricted to human subjects and limited to articles published in English. Abstracts were screened and data from potentially relevant articles was analyzed. Results The prophylaxis and treatment of VTE are of vital importance for patients with spontaneous ICH. Prophylaxis measures can be mainly categorized into mechanical prophylaxis and chemoprophylaxis. Treatment strategies include anticoagulation, vena cava filter, systemic thrombolytic therapy, catheter-based thrombus removal, and surgical embolectomy. We briefly summarized the state of knowledge regarding the prophylaxis measures and treatment strategies of VTE after spontaneous ICH in this review, especially on chemoprophylaxis and anticoagulation therapy. Early mechanical prophylaxis, especially with intermittent pneumatic compression, is recommended by recent guidelines for patients with spontaneous ICH. While decision-making on chemoprophylaxis and anticoagulation therapy evokes debate among clinicians, because of the concern that anticoagulants may increase the risk of recurrent ICH and hematoma expansion. Uncertainty still exists regarding optimal anticoagulants, the timing of initiation, and dosage. Conclusion Based on current evidence, we deem that initiating chemoprophylaxis with UFH/LMWH within 24–48 h of ICH onset could be safe; anticoagulation therapy should depend on individual clinical condition; the role of NOACs in this patient population could be promising.

Deep Vein Thrombosis and Venous Thromboembolism in the Critically Ill

2017 ◽  
Author(s):  
Kathryn L. Butler ◽  
George Velmahos
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Vena Cava Filters ◽  
Deep Vein

Venous thromboembolism (VTE) poses unique diagnostic and therapeutic dilemmas in the intensive care unit (ICU). Immobility, inflammatory states, and trauma uniquely predispose surgical ICU patients to deep vein thrombosis and pulmonary embolism. Concurrently, the risks of perioperative and traumatic bleeding complicate management of VTE, with anticoagulation contraindicated in many scenarios. This review surveys the latest evidence in the diagnosis and management of VTE among critically ill surgical patients. It discusses evidence-based guidelines regarding diagnostic imaging, anticoagulation, prophylaxis, inferior vena cava filters, non–vitamin K oral anticoagulants, and surgical and catheter-based therapies. The review also examines the special challenges encountered when treating multisystem trauma patients.  Key words: anticoagulation therapy, deep vein thrombosis, pharmacoprophylaxis, pulmonary embolism, venous thromboembolism  

scholarly journals Pulmonary Embolism While on Aspirin for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty

2018 ◽  
Vol 9 ◽  
pp. 215013271879744
Author(s):  
Francisco Roman ◽  
Jay-Sheree Allen ◽  
Heather Catherine Wurm ◽  
Kathy MacLaughlin
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Anticoagulation Therapy ◽  
Pulmonary Arteries ◽  
Disease Status ◽  
Care Physician ◽  
Drug Eluting Stent ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis

A 62-year-old Caucasian man with past medical history significant for coronary artery disease, status post drug eluting stent to the left anterior descending artery 10 years prior, was admitted for elective total right knee arthroplasty. His intraoperative course was uneventful, and he was discharged on hospital day 2 on aspirin 325 mg twice daily for 6 weeks for venous thromboembolism (VTE) prophylaxis. Three weeks later the patient developed chest pain shortly after an approximately 1-hour flight and presented to a local emergency department where computed tomography angiogram showed pulmonary emboli involving segmental and subsegmental pulmonary arteries bilaterally. He was transitioned from aspirin 325 mg twice a day to rivaroxaban 15 mg twice daily for 21 days, with a plan to transition to 20 mg daily to complete a 3-month course. He returned to his primary care physician 6 days after discharge with questions about his current anticoagulation therapy as well as the regimen he was on prior to the pulmonary embolism. Two major organizations, The American Academy of Orthopedic Surgeons and The American College of Chest Physicians, provide recommendations for VTE prophylaxis, but they differ regarding the preferred pharmacologic modality and duration. Although the goal is to provide optimal patient care, lack of guideline consensus may lead to different postoperative recommendations. It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.

Should the presence of an antiphospholipid antibody affect the duration of anticoagulant treatment in patients with venous thromboembolism?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 681-683 ◽  
Author(s):  
David A. Garcia ◽  
Wendy Lim
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Reference Range ◽  
Laboratory Finding ◽  
Anticoagulation Therapy ◽  
Healthy Woman ◽  
Anticardiolipin Antibody ◽  
First Episode ◽  
Antiphospholipid Antibody ◽  
Anticoagulant Treatment

Abstract A 44-year-old otherwise healthy woman has completed 3 months of anticoagulation therapy for a first episode of unprovoked pulmonary embolism. At the time of diagnosis and before the initiation of anticoagulation, she was found to have an elevated IgG anticardiolipin antibody (ACLA), which was measured at 42 IgG phospholipid (GPL) units (reference range, < 15 GPL units) with negative lupus anticoagulant (LAC) testing. Should this laboratory finding affect the recommended duration of anticoagulant therapy?

Sign in / Sign up

Export Citation Format

Share Document