Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients?

SummaryProlonged immobilization and advanced age are considered to be important risk factors for venous thromboembolism (VTE). Nevertheless, the need for VTE prophylaxis in long-term bedridden patients is not known. To assess whether very prolonged immobilization (i.e. over three months) carries an increased risk for clinically apparent VTE, we performed a historical-cohort study of nursing home residents during a ten-year period. Data concerning patient’s mobility and incidence of overt deep vein thrombosis or pulmonary embolism were registered. The mean resident age was 85 ± 8.4 years. Eighteen mobile and eight immobile patients were diagnosed with clinically significant thromboembolic events, during 1137 and 573 patient-years of follow up, respectively. The incidence of venous thromboembolic events was similar in both chronically immobilized and mobile patient groups, 13.9 and 15.8 per thousand patient years, respectively (p = 0.77). The rate ratio for having a VTE event in the immobilized patient group as compared with the mobile group was 0.88 (95% Confidence Interval (CI) 0.33 to 2.13). When taking into account baseline characteristics, risk factors and death rates by various causes, no differences were found between the two groups. In conclusion, chronically immobile bedridden patients are no more prone to clinically overt venous thromboembolic events than institutionalized mobile patients. Until further studies are performed concerning the impact of very prolonged immobilization on the risk of VTE, there is no evidence to support primary prevention after the first three months of immobilization. Evidence for efficacy or cost effectiveness beyond this early period is not available.

Download Full-text

Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation

Thrombosis and Haemostasis ◽

10.1160/th14-06-0563 ◽

2015 ◽

Vol 113 (06) ◽

pp. 1176-1183 ◽

Cited By ~ 49

Author(s):

Nicoletta Riva ◽

Marco P. Donadini ◽

Walter Ageno

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Major Trauma ◽

Thromboembolic Events ◽

Prothrombotic State ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Potential Link ◽

Predisposing Conditions

SummaryVenous thromboembolism (VTE) is a multifactorial disease. Major provoking factors (e. g. surgery, cancer, major trauma, and immobilisation) are identified in 50–60 % of patients, while the remaining cases are classified as unprovoked. However, minor predisposing conditions may be detectable in these patients, possibly concurring to the pathophysiology of the disease, especially when co-existing. In recent years, the role of chronic inflammatory disorders, infectious diseases and traditional cardiovascular risk factors has been extensively investigated. Inflammation, with its underlying prothrombotic state, could be the potential link between these risk factors, as well as the explanation for the reported association between arterial and venous thromboembolic events.

Download Full-text

Pulmonary Embolism Following Outpatient Vasectomy

Current Urology ◽

10.1159/000442852 ◽

2015 ◽

Vol 9 (1) ◽

pp. 51-53

Author(s):

Frank E. Mott ◽

Bilal Farooqi ◽

Harry Moore

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Major Surgery ◽

Thromboembolic Events ◽

Radiological Imaging ◽

Review Of The Literature ◽

Pleuritic Chest Pain ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Prolonged Immobilization

Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included.

Download Full-text

Clinical Outcomes and Factors Predicting Development of Venous Thromboembolic Complications in Patients with Advanced Refractory Cancer in a Phase I Clinic: The M. D. Anderson Cancer Center Experience

Blood ◽

10.1182/blood.v112.11.3828.3828 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3828-3828

Author(s):

Apostolia-Maria Tsimberidou ◽

Sushma Vemulapalli ◽

Lakshmi Chintala ◽

Navjot Dhillon ◽

Xiudong Lei ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Phase I ◽

Hazard Ratio ◽

Cancer Center ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

History Of ◽

Weighted Number

Abstract Venous thromboembolism (VTE) is common in patients with advanced cancer and may influence patient eligibility for clinical studies, quality of life, and survival. We reviewed the records of 220 consecutive patients seen in the Phase I Program at M. D. Anderson Cancer Center to determine the frequency of VTE, associated characteristics and clinical outcomes. Of 220 patients, 23 (10.5%) presented to the Phase I clinic with a history of VTE. Twenty-six patients (11.8%) subsequently developed a venous thromboembolic event, with a median follow-up of 8.4 months. These included 9 of 23 patients (39%) with and 17 of 197 (8.6%) without a history of VTE (p < 0.0001). The median time from the first visit to the Phase I clinic to a new thromboembolic episode in the 26 patients was 5.1 months (range, 0 to 27 months). The respective times to development of new thromboembolic events for patients with and without a history of thromboembolism were 3.1 months (n = 9) and 5.3 months (n = 17). Four (15%) of the 26 patients developed venous thromboembolism within one month after their first visit to the Phase I clinic. Among the remaining 22 patients, 18 (69%) developed venous thromboembolism within the first year following their initial visit to the Phase I clinic, and 4 patients developed it after 2.5 years. Fifteen patients developed DVT, seven pulmonary embolism (PE), and one patient each developed one of the following thromboembolic episodes: concurrent DVT and PE; right atrial thrombus; thrombus in the abdominal aorta and DVT; and isolated thrombus in an abdominal aortic aneurysm. The median survival in patients with and without a history of VTE were 4.7 and 10.9 months, respectively (p = 0.0002). Multivariate analysis demonstrated that a history of VTE (hazard ratio 6.2; 95% C.I. 2.6–14.7; p < 0.0001), diagnosis of pancreatic cancer (hazard ratio 4.0; 95% C.I. 1.5–11.2; p=0.007) and platelet count >440 × 109/L (hazard ratio 3.1; 95% C.I. 1.1–8.2; p = 0.026) predicted the development of new venous thromboembolic episodes. These three parameters were used to design a predictive model. Based on the relative risks of the independent covariates, the relative risk of a new thromboembolic episode could be characterized by summing the weighted number of risk factors present at first visit to the Phase I clinic. History of venous thromboembolism was given a score of 2 because the hazard ratio was 6.3, whereas the diagnosis of pancreatic cancer and elevated platelet counts had hazard ratios of 4.7 and 3.0, respectively, and were each given a score of 1. Therefore, patients could have a score ranging from 0 to 4 (no patients had a score of 4). Patients were assigned to one of three risk groups on the basis of their weighted number of presenting risk factors: 0, low risk; 1, medium risk; 2–3, high risk. At 6 months, the rates of a new thromboembolic episode were 3.5%, 12.5%, and 28% for patients with scores 0, 1, or 2–3, respectively (p<0.0001). The median time to a new thromboembolic episode was not reached for patients with a score 0 or 1, and it was 9.1 months for patients with a score of 2–3. In conclusion, a history of VTE or new development of VTE was noted in 40 (18%) of 220 patients seen in our Phase 1 clinic. Our study suggests the need to closely monitor individuals with advanced cancer for the development of venous thromboembolic events. The high risk of recurrent venous thromboembolism in patients with a prior history of venous thromboembolism, whose anticoagulation therapy was discontinued before clinic referral, supports long-term continued prophylaxis in these patients. A prognostic score to predict for time to and frequency of venous thromboembolic events is thereby proposed.

Download Full-text

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

Download Full-text

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

Download Full-text

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.

Download Full-text

Extended thromboprophylaxis for medically ill patients with cancer: a systemic review and meta-analysis

Blood Advances ◽

10.1182/bloodadvances.2020004118 ◽

2021 ◽

Vol 5 (8) ◽

pp. 2055-2062

Author(s):

Soravis Osataphan ◽

Rushad Patell ◽

Thita Chiasakul ◽

Alok A. Khorana ◽

Jeffrey I. Zwicker

Keyword(s):

Meta Analysis ◽

Thromboembolic Events ◽

Medically Ill ◽

Patients With Cancer ◽

Randomized Controlled ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Extended Duration ◽

Medically Ill Patients

Abstract Hospitalized medically ill patients with cancer are at increased risk of both venous thromboembolism and bleeding. The safety and efficacy of extended thromboprophylaxis in patients with cancer are unclear. We conducted a systematic review and meta-analysis of the literature using of MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify cancer subgroups enrolled in randomized controlled trials evaluating extended thromboprophylaxis following hospitalization. The primary outcomes were symptomatic and incidental venous thromboembolic events and hemorrhage (major hemorrhage and clinically relevant nonmajor bleeding). Four randomized controlled trials reported the outcomes of extended thromboprophylaxis in 3655 medically ill patients with active or history of cancer. The rates of venous thromboembolic events were similar between the extended-duration and standard-duration groups (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.61-1.18; I2 = 0%). However, major and clinically relevant nonmajor bleeding occurred significantly more frequently in the extended-duration thromboprophylaxis group (OR, 2.10; 95% CI, 1.33-3.35; I2 = 8%). Extended thromboprophylaxis in hospitalized medically ill patients with cancer was not associated with a reduced rate of venous thromboembolic events but was associated with increased risk of hemorrhage. This study protocol was registered on PROSPERO as #CRD42020209333.

Download Full-text