Association of mean platelet volume with risk of venous thromboembolism and mortality in patients with cancer

2014 ◽  
Vol 111 (04) ◽  
pp. 670-678 ◽  
Author(s):  
Alexandra Kaider ◽  
Ilse Schwarzinger ◽  
Julia Riedl ◽  
Eva-Maria Reitter ◽  
Christine Marosi ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Mean Platelet Volume ◽  
Multivariable Analysis ◽  
Observation Time ◽  
Newly Diagnosed ◽  
Platelet Volume ◽  
Observational Cohort ◽  
Study Population ◽  
Underlying Mechanisms

SummaryVenous thromboembolism (VTE) is a frequent complication in cancer patients. Mean platelet volume (MPV) has been associated with arterial and venous thrombosis in patients without cancer. We analysed MPV in cancer patients and investigated the association of MPV with risk of VTE and mortality. MPV was routinely determined in the Vienna Cancer and Thrombosis Study, a prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Study endpoints were occurrence of symptomatic VTE or death during a maximum follow-up of two years. Out of 1,544 included patients, 114 (7.4%) developed VTE and 573 (37.1%) died during a median observation time of 576 days. High MPV ≥75th percentile of the study population; ≥10.8 fL) was associated with decreased risk of VTE compared to MPV below the 75th percentile (HR [95% CI]: 0.59 [0.37–0.95], p=0.031). In multivariable analysis, including age, sex, cancer groups, newly diagnosed vs recurrent disease, platelet count and soluble P-selectin, this association remained statistically significant (0.65 [0.37–0.98], p=0.041). Mortality of patients with MPV (≥75th percentile was significantly decreased compared to those with lower MPV (0.72 [0.59–0.88], p=0.001). Two-year probability of VTE and overall survival was 5.5% and 64.7% in patients with high MPV compared to 9% and 55.7% in those with lower MPV. In conclusion, high MPV is associated with decreased VTE risk and improved survival in cancer patients. This finding is contrary to results observed in patients without cancer. Further studies are needed to confirm our results and elucidate underlying mechanisms.Previous presentations of this manuscript: Data from this study were presented in part at the Annual Spring Meeting of the Austrian Society for Haematology and Oncology (OeGHO) in Linz, Austria, and as an oral presentation at the XXIV. Congress of the International Society on Thrombosis and Haemostasis (ISTH) 2013 in Amsterdam, the Netherlands.

scholarly journals Evaluation of mean platelet volume as a predictive marker for cancer-associated venous thromboembolism during chemotherapy

Haematologica ◽  
2014 ◽  
Vol 99 (10) ◽  
pp. 1638-1644 ◽  
Author(s):  
P. Ferroni ◽  
F. Guadagni ◽  
S. Riondino ◽  
I. Portarena ◽  
S. Mariotti ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Mean Platelet Volume ◽  
Predictive Marker ◽  
Platelet Volume

Outcomes After Vena Cava Filter Placement In Cancer Patients Hospitalized For Acute Venous Thromboembolism

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 936-936
Author(s):  
Richard H. White ◽  
Ann Brunson ◽  
Gwendolyn Ho ◽  
Ted Wun
Keyword(s):  
Venous Thromboembolism ◽  
Propensity Score ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Vena Cava ◽  
Severity Of Illness ◽  
Vena Cava Filter ◽  
Risk Of Death ◽  
Adjusted Model

Abstract Background Evidence supporting use of an inferior vena cava filter (VCF) to prevent death or recurrent venous thromboembolism (rVTE) in cancer patients who are hospitalized for acute VTE is limited. Aims To determine the effectiveness of VCF placement on the 15-day and 30-day incidence of death and the 180-day incidence of rVTE manifested as pulmonary embolism (PE) or recurrent deep-vein thrombosis (DVT) alone among cancer patients hospitalized for acute-VTE. Methods Using a large retrospective observational study of discharge records in California, we analyzed outcomes after VCF placement in cancer patients hospitalized 2005-2009 for acute VTE using propensity-score methodology. We excluded all patients who had a history of a prior VCF placement (1991-2009). Outcomes were death <15-days and <30-days and rVTE (as PE or DVT alone) at 6 months. We used 3 analytic methods: 1) standard risk-adjusted multivariable analysis, 2) adjustment using propensity-score and inverse probability weighing (IPW) and 3) comparison based on matching (2:1) based on propensity score (caliper method). The multivariate model used to generate the propensity score included age, race/ethnicity, insurance coverage, expected bleeding risk, metastatic disease, bleeding present-on-admission, location of bleeding, recent or impending major surgery, use of thrombolytic agents, number of chronic co-morbidities, severity-of-illness (ascertained by 3M, APR-DRG grouper), index PE vs. DVT, and hospital characteristics. IPW of propensity score was applied to a risk-adjusted logistic model to predict death; IPW was applied to risk-adjusted Cox models predicting rVTE (as PE or DVT alone). In the model predicting death, risk-of-mortality on admission was used instead of severity-of-illness. Results Among 14,000 cancer-associated acute-VTE cases, the overall crude 15-day mortality rate was 1396 (10%) and the 30-day mortality was 2247 (16.1%). For 11,253 no-VCF patients, the crude 15-day mortality was 1089 (9.7%) and at 30 days it was 1727 (15.3%). A VCF was placed in 2747 patients (19.6%). The crude mortality in VCF patients was 307 (11.2%) at 15-days, and 520 (18.9%) at 30-days. After accounting for propensity to insert a VCF (using IPW) in a risk-adjusted model, there was no significant reduction in the risk of death associated with VCF use at 15-days (OR=0.90, CI:0.8-1.1, p=0.26) or 30 days (OR=1.04, 95%CI:0.9-1.2, p=0.57); findings were the same using standard multivariable analysis and matching based on propensity score. The crude 180-day incidence of recurrent PE was 3.3%: 2.6% in VCF patients and 3.4% in the no-VCF patients. In the adjusted model using IPW the risk of rVTE manifested as PE, the risk was lower in VCF patients (HR=0.81 95%CI:0.6-1.1, p=0.14) but this did not reach statistical significance. The crude 180-day incidence of rVTE manifested as DVT alone was 4.2% overall: 5.4% in VCF patients and 3.9% in no-VCF patients. In the IPW propensity score model, the risk of rVTE manifested as DVT at 180 days was significantly higher in VCF patients (HR=1.55, 95%CI:1.3-1.9, p<0.001). Models for recurrent VTE manifested by PE or DVT gave similar results whether based on propensity-score matching or multivariable analysis. Conclusions Use of a VCF in cancer patients hospitalized specifically for acute VTE was not associated with a significant reduction in the risk of death at 15 or 30 days, and the overall 30-day mortality was high. There was a 20% reduction in the risk of rVTE manifested as PE at 180-days but this did not reach the level of statistical significance (p>0.05). VCF use was associated with a 55% higher risk of rVTE manifested as DVT at 180 days. Further refinements in modeling incorporating competing outcomes (e.g., death) are underway. Disclosures: Ho: American Society of Hematology: ASH HONORS trainee research award Other.

scholarly journals Mean platelet volume is a risk factor for venous thromboembolism: the Tromsø study

2010 ◽  
Vol 8 (1) ◽  
pp. 157-162 ◽  
Author(s):  
S. K. BRAEKKAN ◽  
E. B. MATHIESEN ◽  
I. NJØLSTAD ◽  
T. WILSGAARD ◽  
J. STØRMER ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Mean Platelet Volume ◽  
Platelet Volume

Bridging efforts to longitudinally improve and evaluate venous thromboembolism prophylaxis uptake in hospitalized cancer patients through interprofessional teamwork (BELIEVE IT): A study by Princess Margaret Cancer Centre.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 170-170
Author(s):  
Jack Toshimine Seki ◽  
Triyu Vather ◽  
Vishal Kukreti ◽  
Monika Karolina Krzyzanowska
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Bleeding Risk ◽  
Primary Study ◽  
Strategy Execution ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Interprofessional Teamwork ◽  
Uptake Rates ◽  
Study Population

170 Background: Thromboprophylaxis continues to be underutilized in hospitalized cancer patients despite the demonstrable risk of venous thromboembolism (VTE). Our study evaluated institutional VTE prophylaxis rates after devising a series of strategic interventions to longitudinally improve adherence rates over a period of eight years. Methods: Solid tumour patients admitted between 2004 and 2012 were selected as the primary study population for analysis. The bleeding risk associated with thromboprophylaxis was discernibly minimal. Guidelines were developed and formalized into an institutional thromboprophylaxis policy. Educational in-services were provided to physicians, nurses and pharmacists to review the most updated guidelines and tools added to encourage compliance to VTE prophylaxis. Support also arose from clinical members of the Cancer Quality Committee. An amalgamation of manual and electronic audit formats were undertaken to asses VTE prophylaxis rates prior to, and following strategy implementation. These audit formats either comprised of visiting inpatient units and examining anticoagulant orders on a per-patient basis, or viewing patient consensus reports and active anticoagulant orders electronically. Results: At the 2004 outset, 11 (19.3%) patients received appropriate pharmacological prophylaxis, and thus formed the baseline of our analysis. Post-2009 policy implementation and educational sessions, 46.5% of an eligible 185 inpatients were administered thromboprophylaxis. Following a two-year grace period to allow for policy acceptance, a series of three audits were conducted in 2011 for which an average prophylaxis rate of 62.3% resulted. In 2012, following awareness by clinicians of previous rates and rigorous strategy execution, a 96.7% rate was achieved and maintained five weeks thereafter. Conclusions: A reproducible 96.7% prophylaxis rate was the result of our cumulative eight-year efforts. A multidisciplinary approach is critical to improving thromboprophylaxis uptake rates and ensuring long-term sustainability of this outcome.

Integrin genetic variants and risk of thromboembolic events in patients with colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 462-462
Author(s):  
Gerald Prager ◽  
Alexandra Schuler ◽  
Cihan Ay ◽  
Clemens Pausz ◽  
Heinz-Josef Lenz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Tumor Biology ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Direct Dna Sequencing ◽  
Increased Risk ◽  
Colorectal Cancer Patients ◽  
Integrin Beta 3

462 Background: Patients with colorectal cancer are at increased risk of venous thromboembolism (VTE). Integrin beta-3 are involved in tumor biology as well as platelet aggregation, thus, we tested as a primary endpoint whether a comprehensive panel of germline single nucleotide polymorphisms (SNPs) in the integrin beta-3 gene could predict the risk of VTE in colorectal cancer patients. Methods: The study population comprises patients recruited into the Vienna Cancer and Thrombosis Study (CATS) (Ay, C et al; JCO 2011 vol. 29 no. 15), an ongoing prospective observational cohort study initiated in October 2003 at the Medical University of Vienna. In 114 out of 139 patients diagnosed with colon cancer DNA was assessable for integrin beta-3 germline SNPs rs3809865, rs5918, rs4642 characterization. Whole blood samples were analyzed using PCR-RFLP or direct DNA-sequencing. VTE events were statistical analyzed using one-way Anova testing. Results: The patient’s demographics and tumor characteristics were balanced between groups. VTE occurred in 14 patients (12.28%). In colorectal cancer patients with an rs3809865 A/A allele profile a statistical significant (p=0.0015) increased risk of VTE events was observed as 12 (25%) of 48 patients experienced VTE. Only 2 of 52 patients (3.85%) harboring an A/T allele VTE was diagnosed. None (0%) of the T/T subgroup had any VTE. Other SNPs revealed no predictive value for VTE. In multivariable analysis including age, sex, chemotherapy, and anti-VEGF therapy rs3809865 A/A allele profile remained a statistical significant risk factor for VTE. Conclusions: This study identifies germline polymorphisms in integrin genes as independent prognostic markers for VTE in colorectal cancer. These data may help to select subgroups of patients who may benefit from an enforced prophylaxis of venous thromboembolism (VTE).

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