Management and adherence to VTE treatment guidelines in a national prospective cohort study in the Canadian outpatient setting

2012 ◽  
Vol 108 (09) ◽  
pp. 493-498 ◽  
Author(s):  
Vicky Springmann ◽  
Sam Schulman ◽  
Josée Martineau ◽  
John A. Stewart ◽  
Nelly Komari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Guidelines ◽  
Vitamin K Antagonists ◽  
Outpatient Setting ◽  
Unusual Site ◽  
Patients With Cancer ◽  
End Of Treatment ◽  
American Society ◽  
Outpatient Settings

SummaryDocumenting patterns and outcomes of venous thromboembolism (VTE) management and degree of adherence by clinicians to treatment guidelines could help identify remediable gaps in patient care. Prospective, clinical practice-based data from Canadian outpatient settings on management of VTE, degree of adherence with treatment guidelines and frequency of recurrent VTE and bleeding during follow-up was obtained in a multicentre, prospective observational study. From 12 Canadian centres, we assessed 868 outpatients with acute symptomatic VTE who received the low-molecular-weight heparin (LMWH) enoxaparin alone or with vitamin K antagonists (VKA), at baseline and at six months (or at the end of treatment, whichever came first). Index VTE was limb deep venous thrombosis (DVT) in 583 (67.2%) patients, pulmonary embolism (PE) with or without DVT in 262 (30.2%) patients, and unusual site DVT in 23 (2.6%) patients. VTE was unprovoked in 399 (46.0%) patients, associated with cancer in 74 (8.5%) patients, transient risk factors in 327 (37.7%) patients and hormonal factors in 68 (7.8%) patients. With regard to guideline adherence, 58 (7.3%) patients received <5 days LMWH and 114 (14.5%) had overlap <1 day. Among patients with cancer-related VTE, 59.5% were prescribed LMWH monotherapy and 43.2% received such treatment for >3 months. Only 38.1% of patients with transient VTE risk factors had received thromboprophylaxis. Our study provides useful information on clinical presentation, management and related outcomes in Canadian outpatients with VTE. Our results suggest there may be important gaps in use of thromboprophylaxis to prevent VTE and use of LMWH mono-therapy to treat cancer-related VTE.Note: Part of this study was presented as an Oral Abstract Presentation at the American Society of Hematology meeting, Dec. 4–7, 2010, Orlando, FL, USA.

Patterns of Management and Adherence to Venous Thromboembolism (VTE) Treatment Guidelines In a National Prospective Cohort Study of VTE Management In the Canadian Outpatient Setting: Recovery Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 565-565
Author(s):  
Susan R Kahn ◽  
Sam Schulman ◽  
Josée Martineau ◽  
John A Stewart ◽  
Anne McLeod ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Median Duration ◽  
Research Funding ◽  
Treatment Guidelines ◽  
Outpatient Setting ◽  
Medical Admission ◽  
Recurrent Vte ◽  
Outpatient Settings

Abstract Abstract 565 Introduction: Little is known about patterns and quality of venous thromboembolism (VTE) management in Canadian outpatient settings, including how closely clinicians adhere to evidence based treatment guidelines. Such information could help identify gaps in patient care requiring attention. Objectives: To obtain prospective, clinical practice-based data from Canadian outpatient settings on 1) management of VTE; 2) determinants of patterns of VTE management; 3) degree of adherence with ACCP 2008 VTE treatment guidelines; and 4) frequency of bleeding and recurrent VTE during follow-up. Methods: We performed a multi-centre prospective observational study to evaluate physician practice patterns and degree of adherence to ACCP consensus guidelines for VTE treatment. From 2007–2010, we enrolled 915 consecutive patients with objectively confirmed acute symptomatic VTE who received treatment with the low molecular weight heparin (LMWH) enoxaparin alone or with warfarin in the outpatient setting (mainly thrombosis clinics) in 12 Canadian centers. Patients attended an enrolment visit, where data on demographics, site(s) of VTE, VTE risk factors, bleeding risk factors, creatinine clearance and initial treatment were recorded. A follow-up visit occurred when anticoagulant treatment was stopped or at 6 months, whichever occurred first. Indicators of adherence to VTE treatment guidelines included: (1) having received any thromboprophylaxis for VTE associated with transient risk factors (recent medical admission, major surgery or leg immobilization); (2) use of LMWH monotherapy to treat cancer-associated VTE; (3) at least 5 days median duration of LMWH in patients treated with initial LMWH overlapped with warfarin; (4) at least 1 day overlap of LMWH and warfarin once INR was therapeutic. Recurrent VTE, bleeding and adverse events were recorded throughout study follow-up. Results: At the time of abstract submission, end of study data were available for 747 of 915 enrolled patients. Average age was 56 years, 54% were male and mean body mass index was 28.3 kg/m2. Index VTE was lower or upper extremity deep venous thrombosis (DVT) in 511 (68.4%) patients, pulmonary embolism (PE) with or without DVT in 218 (29.2%) patients, and unusual site DVT in 18 (2.4%) patients. VTE was associated with cancer in 70 (9.4%) patients, transient risk factors in 289 (38.7%) patients, hormonal risk factors in 55 (7.4%) patients and was deemed unprovoked in 331 (44.3%) patients. Overall, enoxaparin was prescribed at a dose/frequency of 1.5 mg/kg QD in 85.4% of patients, 1.0 mg/kg BID in 14.6% of patients and 1.0 mg/kg QD for one patient who had creatinine clearance <30ml/min. Among patients with VTE risk factors such as recent medical admission, recent surgery or paralysis, only 37.3% had been prescribed thromboprophylaxis. Among patients with cancer-related VTE (n=70), 61.4% were prescribed LMWH monotherapy, a majority received 1.5 mg/kg once daily, and 42.9% received such treatment for >3 months. Among patients treated with initial LMWH overlapped with warfarin (n= 667; 89.3%), median duration of LMWH was 8 days (IQR 6–10 days), median duration of warfarin was 182 days (IQR 115–190) and median overlap with LMWH once INR was therapeutic was 1 day (IQR 1–2 days). However, 48 (7.2%) patients received <5 days LMWH and 99 (15%) patients had overlap <1 day. During follow-up, 16 (2.1%) patients had recurrent VTE, at a median of 71 days follow-up; rate of recurrent VTE was highest (8.6%) and occurred earliest (median, 49 days) in cancer patients. Major bleeding events (primarily GI or GU) occurred in 10 (1.3%) patients at a median of 23 days; at the time of bleed, 2 patients were receiving LMWH alone, 3 patients, LMWH and warfarin, and 5 patients, warfarin alone. Conclusions: Our study provides useful information on clinical features of patients, management of VTE and rates of recurrence and bleeding in Canadian outpatients. Our results suggest that there are important gaps in (1) use of thromboprophylaxis to prevent VTE and (2) use of LMWH monotherapy to treat VTE in cancer patients. Conversely, in patients treated with combination LMWH/warfarin therapy, adherence to recommendations regarding minimum duration of LMWH and minimum overlap of LMWH and warfarin once INR was therapeutic was quite good. Disclosures: Kahn: Sigvaris: Research Funding; sanofi-aventis: Advisory Board, Research Funding; Boehringer Ingelheim:. Schulman:Sanofi Aventis: Honoraria.

P675Current status of anticoagulation in patients with breast cancer and atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pardo Sanz ◽  
L M Rincon ◽  
P Guedes Ramallo ◽  
L Belarte ◽  
G De Lara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Atrial Fibrillation ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Bleeding Events ◽  
Patients With Cancer ◽  
Oncologic Patients

Abstract Aims Balance between embolic and bleeding risk is challenging in patients with cancer. There is a lack of specific recommendations for the use of antithrombotic therapy in oncologic patients with atrial fibrillation (AF). We compared the embolic and bleeding risk, the preventive management and the incidence of events between patients with and without cancer. We further evaluated the effectiveness and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) within patients with cancer. Methods The AMBER-AF registry is an observational multicentre study that analysed patients with non-valvular AF treated in Oncology and Cardiology Departments in Spain. 1237 female patients with AF were enrolled: 637 with breast cancer and 599 without cancer. Mean follow-up was 3.1 years. Results Both groups were similar in age, CHA2DS2-VASc and HASB-LED scores. Lack of guidelines recommended therapies was more frequent among patients with cancer. Compared with patients without cancer, adjusted rates of stroke (hazard ratio [95% confidence interval]) in cancer patients were higher (1.56 [1.04–2.35]), whereas bleeding rates remained similar (1.25 [0.95–1.64]). Within the group of patients with cancer, the use of DOACs vs VKAs did not entail differences in the adjusted rates of stroke (0.91 [0.42–1.99]) or severe bleedings (1.53 [0.93–2.53]). Follow-up events Conclusions Antithrombotic management of AF frequently differs in patients with breast cancer. While breast cancer is associated with a higher risk of incident stroke, bleeding events remained similar. Patients with cancer treated with DOACs experienced similar rates of stroke and bleeding as those with VKAs.

Thrombosis and Cancer: Emerging Data for the Practicing Oncologist

2013 ◽  
pp. e337-e345 ◽  
Author(s):  
Gary H. Lyman ◽  
Alok A. Khorana ◽  
Anna Falanga
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Practice Guidelines ◽  
Malignant Disease ◽  
Patients With Cancer ◽  
Treatment And Prevention ◽  
Close Relationship ◽  
Specific Factors ◽  
American Society

The American Society of Clinical Oncology (ASCO) recently updated clinical practice guidelines on the treatment and prevention of venous thromboembolism (VTE) in patients with cancer. Although several new studies have been reported, many questions remain about the close relationship between VTE and malignant disease. The risk of VTE among patients with cancer continues to increase and is clearly linked to patient-, disease- and treatment-specific factors. In general, VTE among patients with cancer is treated in a similar fashion to that in other patient populations. However, the greater risk of VTE in patients with cancer, the multitude of risk factors, and the greater risk of VTE recurrence and mortality among patients with cancer pose important challenges for surgeons, oncologists, and other providers.

scholarly journals Oncology Guidelines Usage in a Low- and Middle-Income Country

2018 ◽  
pp. 1-6 ◽  
Author(s):  
Nofisat Ismaila ◽  
Omolola Salako ◽  
Jimoh Mutiu ◽  
Oladeji Adebayo
Keyword(s):  
Treatment Guidelines ◽  
Guideline Implementation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Patients With Cancer ◽  
Radiation Oncologists ◽  
Local Setting ◽  
American Society ◽  
Low And Middle Income

Purpose There is a paucity of data about current usage of oncology guidelines in low- and middle-income countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years’ experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex.

Anticoagulation Practice in Patients with Cancer-Associated Thrombosis: Insights from GeCAT, a German Prospective Registry Study

2021 ◽  
Author(s):  
Robert Klamroth ◽  
Marianne Sinn ◽  
Christiane Pollich ◽  
Sven Bischoff ◽  
Anja Lohneis ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Patient Adherence ◽  
Vitamin K Antagonists ◽  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Routine Practice ◽  
Registry Study ◽  
Patients With Cancer ◽  
Study Results

Introduction: Cancer-associated venous thrombosis (CAT) is a common and serious complication of active malignancies, increasing in frequency during systemic treatment and radiotherapy. Due to a high risk of recurrence and bleeding, the administration of anticoagulants for initial treatment and secondary prevention of CAT is challenging. We conducted a prospective registry study of patients with acute CAT to evaluate the way treatment is given to these patients in routine practice. Methods: From May 2015 to May 2017, all consecutive patients with acute venous thromboembolism (VTE) admitted to specialty or emergency departments of the participating hospitals in Berlin, Germany, were entered in the registry. Patients with cancer underwent extensive baseline evaluation including the type and location of thrombosis and use of anticoagulant therapy. Follow-up assessments were made at discharge and by telephone interviews at 3 and 6 months. Results: A total of 382 patients with acute CAT were enrolled in the study, representing 24.5% of all patients with thrombosis. 70.4% of CAT patients had deep vein thromboses (DVT), 48.2% had pulmonary embolism (PE), and 18.6% had concurrent PE and DVT. A significant proportion of VTE (27%) were asymptomatic and were diagnosed only incidentally. At baseline, 97.9% of the patients received anticoagulant therapy, predominantly with low-molecular-weight heparin (LMWH) (n=334, 87.4%). Direct oral anticoagulants (DOACs) were given to 5.8% of patients, and vitamin K antagonists (VKAs) were rarely used (<2% of patients). Changes in the prescription of antithrombotic agents were seen at discharge from hospital and during follow-up. Overall, the use of LMWH declined during follow-up, while the proportion of patients treated with DOACs increased to 32.4% at 6 months. At baseline, the most frequently used LMWH were enoxaparin and nadroparin, but many patients were switched to once daily tinzaparin prior to discharge. Initially and after discharge the majority of patients were treated by oncologists. Overall, 263 (68.8%) and 222 (58,1%) patients were still alive and could be contacted at 3 and 6 months of follow-up, respectively. Of these, 84.0% and 71.6% were still on anticoagulant therapy (58.6% and 36.5% on LMWH). Conclusion: In accordance with the guidelines, the majority of CAT patients received anticoagulation therapy for the recommended minimum duration of 3-6 months. LMWH remained the preferred option throughout the study, demonstrating good patient adherence. In deviation from guideline recommendations and available study results during the study period, more than a quarter of CAT patients were treated with DOACs. Only recently, DOACs have been established as another option for anticoagulation in CAT patients.

Sarcopenia and anthracycline cardiotoxicity in patients with cancer

2021 ◽  
pp. bmjspcare-2021-003197
Author(s):  
Onur Bas ◽  
Ahmet Gurkan Erdemir ◽  
Mehmet Ruhi Onur ◽  
Necla Ozer ◽  
Yusuf Ziya Sener ◽  
...  
Keyword(s):  
Psoas Muscle ◽  
Cancer Staging ◽  
Anthracycline Cardiotoxicity ◽  
Skeletal Muscle Index ◽  
Patients With Cancer ◽  
Increased Risk ◽  
American Society ◽  
Definition Of ◽  
European Society Of Cardiology

BackgroundSeveral studies have suggested that sarcopenia is associated with an increased treatment toxicity in patients with cancer. The aim of this study is to evaluate the relationship between sarcopenia and anthracycline-related cardiotoxicity.MethodsPatients who received anthracycline-based chemotherapy between 2014 and 2018 and had baseline abdominal CT and baseline and follow-up echocardiography after anthracycline treatment were included. European Society of Cardiology ejection fraction criteria and American Society of Echocardiography diastolic dysfunction criteria were used for definition of cardiotoxicity. Sarcopenia was defined on the basis of skeletal muscle index (SMI) and psoas muscle index (PMI) calculated on CT images at L3 and L4 vertebra levels.ResultsA total of 166 patients (75 men and 91 women) were included. Sarcopenia was determined in 33 patients (19.9%) according to L3-SMI, in 17 patients (10.2%) according to L4-SMI and in 45 patients (27.1%) according to PMI. 27 patients (16.3%) developed cardiotoxicity. PMI and L3-SMI were significantly associated with an increased risk of cardiotoxicity (L3-SMI: HR=3.27, 95% CI 1.32 to 8.11, p=0.01; PMI: HR=3.71, 95% CI 1.58 to 8.73, p=0.003).ConclusionsThis is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify high-risk patients in whom closer follow-up or cardioprotective measures should be considered.

scholarly journals AB0887 PATIENTS DEMOGRAPHIC CHARACTERISTICS WITH ESTABLISHED OSTEOPOROSIS TREATED WITH DENOSUMAB IN A THIRD LEVEL HOSPITAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1748.3-1748
Author(s):  
E. Andrés Trashaedo ◽  
D. Fernandez ◽  
R. Dos Santos Sobrín ◽  
I. González Fernández ◽  
A. Souto Vilas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Fragility Fracture ◽  
Vertebral Fractures ◽  
University Hospital ◽  
Diagnosis And Treatment ◽  
Adherence To Treatment ◽  
End Of Treatment

Background:Osteoporosis (OP) is the most common cause of fragility fractures. It is characterized by a loss of bone mass that modifies the bone microstructure, increases fragility and predisposes to fractures. There are numerous risk factors for fragility fracture that must be evaluated for diagnosis and treatment. The treatment consists of non-pharmacological measures (balanced diet and exercise), adequate intake of calcium and vitamin D and specific pharmacological treatment (bisphosphonates, teriparatide, denosumab or selective estrogen receptor modulator) 1-3.Objectives:To perform a descriptive evaluation of the demographic and clinical characteristics of patients with osteoporosis treated with Denosumab, their degree of compliance with the therapy as well as the evaluation of the possible causes of treatment cessation.Methods:All patients diagnosed with OP from January 2015 to January 2020 have been reviewed in the Rheumatology Service of the University Hospital of Santiago de Compostela and patients treated with denosumab have been selected. Demographic, clinical and treatment data have been collected from data collected in their electronic medical recordResults:Of the 507 patients diagnosed with Osteoporosis from January 2015 to January 2020, a total of 133 patients (26.2%) have received treatment with Denosumab. The majority are women (92.5% n = 122) with a mean age of 76 years (age range: 49-105 years). Previously, 38% (n = 51) had vertebral fractures, with 8% (n = 11) standing out who had presented 3 or more vertebral fractures prior to Denosumab treatment.The mean time to start Denosumab therapy since the diagnosis of Osteoporosis (by Densitometry or established by fractures) has been 35 months (0 to 84 months from diagnosis)Through the electronic Medical Record the dispensations were accessed in the Denosumab pharmacy office and its administration in Primary Care was verified. Complete adherence to treatment (without skipping any dose) was observed in 73% of patients (n = 97). In 5.2% (n = 7) an omission was avoided. In 21.8% (n = 29) 2 or more dose omissions were corroborated 9 patients (6.8%) completed treatment with Denosumab in the follow-up period (55% due to the need for dental interventions, 33% for loss of follow-up and 12% for fear of secondary effects).In 66 patients (49.6%) risk factors were identified to present Osteoporosis; being corticosteroid therapy at doses greater than 5 mg / day of Prednisone or equivalent (26% n = 33) the most frequently identified risk factor.No vertebral fractures were registered at the end of treatment with Denosumab, with an average time since the end of treatment of 2.77 years (6 months - 8 years).Conclusion:The rate of patients diagnosed with Osteoporosis who receive Denosumab therapy at some time reaches 26%, being the most frequent drug used after bisphosphonates.Complete adherence to treatment has been observed in 73% of patients.We have not observed vertebral fractures after suspension of Denosumab in our series of patients, although the total exposure time (from the end of treatment to the end of follow-up) is short: 2.77 yearsReferences:[1]Passini M. Osteoporosis diagnosis and treatment. Rev Bras Ortop. 2010;45(3):220-229.[2]Lems WF, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017;76:802-810.[3]Naranjo A, et al. Recomendaciones de la Sociedad Española de Reumatología sobre osteoporosis. Reumatol Clin. 2019;15(4):188-210.Disclosure of Interests:None declared

scholarly journals Risk factors for recurrent Clostridium difficile infection among patients in the Clinical Centre of Vojvodina, Serbia: A retrospective clinical trial

2019 ◽  
Vol 76 (4) ◽  
pp. 392-397
Author(s):  
Nadica Kovacevic ◽  
Radoslava Doder ◽  
Tomislav Preveden ◽  
Maria Pete
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Recurrent Clostridium Difficile Infection ◽  
Clinical Center ◽  
End Of Treatment ◽  
Clinical Centre ◽  
Oral Metronidazole

Background/Aim. In the last two decades the incidence of recurrent Clostridium difficile infection (CDI) has risen. The aim of this study was to determine the risk factors for the recurrent CDI among patients hospitalized with the initial CDI. Methods. We conducted a retrospective clinical trial at the Clinic for Infectious Diseases, Clinical Center of Vojvodina, Serbia, between January 2010 and January 2016. We enrolled 488 patients with the initial CDI who were treated with oral vancomycin (125 mg, 4 times per day) or oral metronidazole (400 mg, 3 times per day) for 10 days. After the completion of therapy, there was 60 days of the follow-up period for the assessment of the rates of relapse. To determine the risk factors for the CDI relapse, we compared the demographics, clinical and laboratory characteristics of the patients who had a relapse with the patients who had a stable clinical response. Results. Of the 488 cases, 29.09% recurred. The relapse occured in 22.72% patients who received vancomycin and in 36.60% patients treated with metronidazole (p = 0.038). A statistically significant effect on the CDI relapse had the comorbidities such as a malignancies (19.52% vs 8.82%, p = 0.023) and the postoperative CDI (25.67% vs 10.29%, p = 0.035), hipoalbuminemia (< 25 g/L) (70.27% vs 41.94%; p = 0.034) and the concomitant antibiotic therapy (50.67% vs 20.29%; p = 0.031). The persistence of C. difficile toxin in the stool at the end of treatment was registered in 22.32% of patients treated with metronidazole vs 9.09% of patients given vancomycin (p = 0.03). Conclusion. Our data suggest that the important risk factors for the CDI relapse are comorbidities (surgery within a month before developing CDI and malignancy), hipoalbuminemia (< 25g/L) and concomitant non-CDI antibiotics therapy. Vancomycin is more effective than metronidazole in the elimination of C. difficile toxins. The presence of C. difficile toxins in the stool after the successful completion of the initial CDI therapy does not affect significantly the occurrence of relapse.

scholarly journals Age- and Intravenous Methotrexate-Associated Leukoencephalopathy and Its Neurological Impact in Pediatric Patients with Lymphoblastic Leukemia

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1939
Author(s):  
Ilona Rijmenams ◽  
Daan Moechars ◽  
Anne Uyttebroeck ◽  
Ahmed Radwan ◽  
Jeroen Blommaert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Large Scale ◽  
Lymphoblastic Leukemia ◽  
Linear Regression Models ◽  
Asymptomatic Patients ◽  
End Of Treatment ◽  
Potential Risk Factors ◽  
Mri Scans

Methotrexate (MTX) is associated with leukoencephalopathy (LE) in children treated for lymphoblastic leukemia/lymphoma (ALL/LBL). However, large-scale studies with systematic MR acquisition and quantitative volumetric lesion information remain limited. Hence, the prevalence of lesion burdens and the potential risk factors of LE in this population are still inconclusive. FLAIR-MRI scans were acquired at the end of treatment in children who were treated for ALL/LBL, which were quantitatively analyzed for LE. Voxels were assigned to the lesion segmentation if indicated by two raters. Logistic and linear regression models were used to test whether lesion presence and size were predicted by risk factors such as age at diagnosis, gender, intrathecal (IT-) or intravenous (IV-)MTX dose, CNS invasion, and acute neurological events. Patients with a pre-existing neurological condition or low-quality MR scan were excluded from the analyses. Of the 129 patients, ten (8%) suffered from CNS invasion. Chemotherapy-associated neurological events were observed in 13 patients (10%) during therapy, and 68 patients (53%) showed LE post-treatment. LE was more frequent in cases of lower age and higher cumulative IV-MTX doses, while the extent of LE and neurological symptoms were associated only with IV-MTX doses. Neurological events were not significantly associated with LE, even though symptomatic patients demonstrated a higher ratio of LE (n = 9/13) than asymptomatic patients (n = 59/116). This study suggests leukoencephalopathy frequently occurs in both symptomatic and asymptomatic leukemia patients. Younger children and patients treated with higher cumulative IV-MTX doses might need more regular screening for early detection and follow-up of associated sequelae.

Risk factors for neurosurgical site infections: an 18-month prospective survey

2008 ◽  
Vol 109 (4) ◽  
pp. 729-734 ◽  
Author(s):  
Claire Lietard ◽  
Véronique Thébaud ◽  
Gérard Besson ◽  
Benoist Lejeune
Keyword(s):  
Risk Factors ◽  
Incidence Rate ◽  
Univariate Analysis ◽  
Surgical Site Infections ◽  
Multiple Regression Model ◽  
Cerebrospinal Fluid Leakage ◽  
Prospective Survey ◽  
American Society ◽  
Predictive Risk

Object The purpose of this study was to determine the incidence rate and risk factors of surgical site infections (SSIs) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class. Methods The authors undertook an exhaustive 18-month prospective survey including patients who underwent neurosurgery. In particular, a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant, and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant. The Centers for Disease Control definition of SSI was used. Univariate and multivariate analyses were conducted; all dependent variables found in univariate analysis were entered in the multiple regression model. A stepwise multiple logistic regression method was used. Results Of the 844 patients studied, 35 SSIs were diagnosed, yielding an incidence rate of 4.1% (95% confidence interval 3.6–4.5). Independent predictive risk factors for infection were cerebrospinal fluid leakage, external shunt, Altemeier class, and further neurosurgery. A lack of antibiotic prophylaxis was not found to be a risk factor. Conclusions Infection risk factors occur mainly during the postoperative period.

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