scholarly journals Questioning the use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies

2016 ◽  
Vol 14 (10) ◽  
pp. 1953-1959 ◽  
Author(s):  
S. Takach Lapner ◽  
J. A. Julian ◽  
L.-A. Linkins ◽  
S. M. Bates ◽  
C. Kearon
Keyword(s):  
Venous Thromboembolism ◽  
Individual Patient Data ◽  
Patient Data ◽  
Diagnostic Studies ◽  
D Dimer

scholarly journals The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta‐analysis

2020 ◽  
Vol 18 (8) ◽  
pp. 1940-1951 ◽  
Author(s):  
Nick Es ◽  
Matthew Ventresca ◽  
Marcello Di Nisio ◽  
Qi Zhou ◽  
Simon Noble ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data

Clinical pre‐test probability adjusted versus age‐adjusted D‐dimer interpretation strategy for DVT diagnosis: A diagnostic individual patient data meta‐analysis

2020 ◽  
Vol 18 (3) ◽  
pp. 669-675 ◽  
Author(s):  
Sameer Parpia ◽  
Sarah Takach Lapner ◽  
Roger Schutgens ◽  
Johan Elf ◽  
Geert‐Jan Geersing ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Test Probability ◽  
D Dimer

Relationship between type of unprovoked venous thromboembolism and cancer location: An individual patient data meta-analysis

2019 ◽  
Vol 176 ◽  
pp. 79-84 ◽  
Author(s):  
L. Jara-Palomares ◽  
N. van Es ◽  
J.M. Praena-Fernandez ◽  
G. Le Gal ◽  
H.M. Otten ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data

scholarly journals Risk of Recurrent Venous Thromboembolism and Major Bleeding in Cancer-Associated Incidental Pulmonary Embolism Amongst Treated and Untreated Patients: A Pooled Analysis of 926 Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 590-590 ◽  
Author(s):  
T van der Hulle ◽  
P L den Exter ◽  
G Meyer ◽  
B Planquette ◽  
S Soler ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Individual Patient Data ◽  
Incidence Rates ◽  
Patient Data ◽  
Anticoagulant Treatment ◽  
Incidental Pulmonary Embolism ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

Abstract Introduction Incidental pulmonary embolism (IPE) is defined as a pulmonary embolism diagnosed on a CT-scan performed for reasons other than a clinical suspicion of PE. Generally identified on staging scans, IPE has been estimated to occur in 3.1% of all cancer patients and is a growing challenge for clinicians and patients. Nevertheless, knowledge about the treatment and prognosis of cancer-associated IPE is scarce. In order to determine the outcome more accurately, and to identify clinical characteristics related to the prognosis, we pooled individual patient data from eleven observational studies and ongoing registries. Methods A systematic literature search aiming to identify studies reporting on patients diagnosed with cancer-associated IPE was performed. Authors of selected studies were invited to participate. Incidence rates of objectively diagnosed symptomatic recurrent venous thromboembolism (VTE), major bleeding and mortality during 6-month follow-up were pooled. Individual patient data was collected to perform subgroup analyses, for which all patients were considered as one cohort. Hazard ratios (HR) were adjusted for age, sex and cancer stage. Results Individual patient data of 926 cancer patients with IPE from 11 observational studies and ongoing registries were included (Table 1). The overall pooled 6-month risk of symptomatic recurrent VTE was 5.8% (95%CI 3.7-8.3), of major bleeding 4.7% (95%CI 3.0-6.8) and of mortality 37% (95%CI 28-47). The VTE recurrence risk was comparable in patients treated with VKA and LMWH with incidence rates of 6.4% (95%CI 2.2-12) and 6.2% (95%CI 3.5-9.6), HR 0.89 (95%CI 0.27-2.9). In contrast, this incidence rate was 12% (95%CI 4.7-23) in patients who were left untreated, HR 2.9 (95%CI 0.65-13; Figure 1). The risk of major bleeding was significantly higher in patients treated with VKA compared to those treated with LMWH, 13% (95%CI 6.4-20) versus 3.9% (95%CI 2.3-5.9), HR of 3.2 (95%CI 1.4-7.4) (Figure 2). The 6-month mortality was 37% (95%CI 29-44) in patients treated with LMWH, 28% (95%CI 18-40) in those treated with VKA and 47% (95%CI 28-66) amongst untreated patients. The all-cause mortality at 6 months was significantly higher for patients with a central thrombus (either central or lobar) compared to those with a more peripheral IPE (either segmental or subsegmental); 42% (95%CI 33-52) versus 30% (95%CI 25-36, HR 1.8 (95%CI 1.4-2.3). Conclusions The most important finding of this study is the 12% 6-month risk of symptomatic recurrent VTE in patients with cancer-associated IPE who did not receive anticoagulant treatment, which is more than double the risk of patients who were anticoagulated. These numbers recall the effect size of anticoagulants used in symptomatic PE and support the judicious initiation of anticoagulant treatment in cancer-associated IPE. The association between more centrally-located thrombi and mortality following IPE is a new finding that parallels outcomes for symptomatic PE, and one which may further support similar management. Regarding the choice of anticoagulant, VKA were associated with a significantly higher risk of major bleeding than LMWH, with a comparable risk of recurrent VTE. The findings of this observational study should be preferably confirmed in a randomized trial. Figure 1: Figure 1:. The 6-month risk of recurrent venous thromboembolism related to anticoagulant treatment. Figure 2: The 6-month risk of major bleeding related to anticoagulant treatment. Figure 2:. The 6-month risk of major bleeding related to anticoagulant treatment. Abstract 590. Table 1: Baseline characteristics Treatment All patients n=926 (100%) LMWH n=732 (79%) VKA n=100 (11%) No treatment n=53 (6%) Other treatment n=41 (4%) Mean age (SD) 65 (12) 64 (12) 68 (12) 65 (14) 68 (13) Male sex, n (%) 491 (53) 378 (52) 60 (60) 31 (58) 22 (54) Cancer stage, n (%) Metastatic 501 (54) 400 (55) 56 (56) 33 (62) 12 (29) Non-metastatic 192 (21) 143 (20) 34 (34) 12 (23) 3 (7.3) Unspecified 233 (25) 189 (26) 10 (10) 8 (15) 26 (63) Cancer type, n (%) Lung 176 (19) 135 (18) 16 (16) 18 (34) 7 (17) Colorectal 185 (20) 150 (20) 20 (20) 9 (17) 6 (15) Other gastrointestinal 187 (20) 147 (20) 15 (15) 13 (25) 12 (29) Breast 65 (7.0) 52 (7.1) 10 (10) 1 (1.9) 2 (4.9) Gynaecological 64 (6.9) 56 (7.7) 5 (5.0) 0 (0) 3 (7.3) Other 206 (22) 155 (21) 31 (31) 10 (19) 10 (24) Haematological 43 (4.6) 37 (5.1) 3 (3.0) 2 (3.8) 1 (2.4) Largest artery involved, n (%) Central 292 (32) 230 (31) 30 (30) 11 (21) 21 (51) Peripheral 495 (53) 395 (54) 62 (62) 29 (55) 9 (22) Unspecified 139 (15) 107 (15) 8 (8.0) 13 (25) 11 (27) Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk scores for occult cancer in patients with unprovoked venous thromboembolism: Results from an individual patient data meta‐analysis

2020 ◽  
Vol 18 (10) ◽  
pp. 2622-2628
Author(s):  
Frits I. Mulder ◽  
Marc Carrier ◽  
Frederiek Doormaal ◽  
Philippe Robin ◽  
Hans‐Martin Otten ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Risk Scores ◽  
Occult Cancer

scholarly journals The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism: an individual patient data meta-analysis

2017 ◽  
Vol 15 (4) ◽  
pp. 678-684 ◽  
Author(s):  
N. van Es ◽  
N. Kraaijpoel ◽  
F. A. Klok ◽  
M. V. Huisman ◽  
P. L. Den Exter ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
D Dimer ◽  
Rule Out
Sign in / Sign up

Export Citation Format

Share Document