Predictors of Post-Thrombotic Ulcer after Acute DVT: The RIETE Registry

2018 ◽  
Vol 118 (02) ◽  
pp. 320-328 ◽  
Author(s):  
Jean-Philippe Galanaud ◽  
Laurent Bertoletti ◽  
Maria Amitrano ◽  
Carmen Fernández-Capitán ◽  
José Pedrajas ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Statistical Significance ◽  
Signs And Symptoms ◽  
Venous Ulcer ◽  
Lower Limbs ◽  
Prior History ◽  
Diabetic Patients ◽  
Vein Thrombosis ◽  
History Of ◽  
End Stage

AbstractIn patients with deep-vein thrombosis (DVT) in the lower limbs, venous ulcer is the most debilitating and end-stage clinical expression of the post-thrombotic syndrome (PTS). To date, risk factors for PTS-related ulcer in DVT patients have not been identified.We used the international observational RIETE registry to assess the evolution of PTS signs and symptoms during a 3-year follow-up period and to identify independent predictors of PTS ulcer at 1 year in patients with acute DVT.Among 1,866 eligible patients, cumulative rates of PTS ulcer at 1, 2 and 3 years were 2.7% (n = 50), 4.3% (n = 54) and 7.1% (n = 60), respectively. The proportion of patients with PTS symptoms at 1, 2 or 3 years remained stable (≈40%), while the proportion of patients with PTS signs increased slightly over time (from 49 to 53%). Prior history of venous thromboembolism (VTE) (odds ratio [OR] = 5.5 [2.8–10.9]), diabetes (OR = 2.3 [1.1–4.7]), pre-existing leg varicosities (OR = 3.2 [1.7–6.1]) and male sex (OR = 2.5 [1.3–5.1]) independently increased the risk of PTS ulcer at 1 year. Obesity also increased the risk but failed to reach statistical significance (OR = 1.8 [0.9–3.3]). DVT treatment characteristics (duration or drug) did not influence the risk.Our results evidence that after acute DVT, pre-existing leg varicosities, prior venous thromboembolism, diabetes and male gender independently increased the risk for PTS ulcer. This suggests that clinicians should consider strategies aimed to prevent ulcers in high-risk DVT patients, such as preventing VTE recurrence, use of stockings in those with pre-existing venous insufficiency, careful monitoring of diabetic patients and encouraging weight loss in obese patients.

Abstract T MP94: Venous Thromboembolism Complications In Patients With Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jennifer Osborne ◽  
Fernando Testai ◽  
Padmini Sekar ◽  
Charles J Moomaw ◽  
Michael L James ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Intracerebral Hemorrhage ◽  
Medical History ◽  
Univariate Analysis ◽  
Previous History ◽  
Prior History ◽  
Past Medical History ◽  
Vein Thrombosis ◽  
History Of

Introduction: Intracerebral hemorrhage (ICH) is often more severe than ischemic stroke. Venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE) can extend length of stay and impede recovery. For ICH patients, there is the added challenge of timing and dosage of anticoagulation used to prevent VTEs. We sought to describe the rate of VTE and factors associated with it among ICH cases in a multi-ethnic population. Methods: ERICH is a multi-center, prospective case-control study of ICH among white, black, and Hispanic patients. Data were collected by hospital chart review and personal interview. CT Images were collected and analyzed by a neuroimaging core. Past medical history and acute clinical data were examined for association with VTE during the hospital stay. Results: Between 8/1/10 and 12/31/13, 2276 cases of ICH were enrolled. CT data are available for 2038 patients. Of these, 63 had VTE complications: 41-DVT, 16-PE, and 6 - both DVT and PE. In univariate analysis, Blacks, previous history of DVT, low GCS at presentation, increased ICH volume, presence of intraventricular hemorrhage (IVH),and need for intubation. In comparison, patients at higher risk for PE were those with past medical history of PE and required intubation (Table). In addition, patients with DVT and PE had higher modified Rankin Scale at both hospital discharge and 3 months. In multivariate analysis, only previous VTE, the need for intubation and the presence of IVH were associated with DVT or PE. Conclusion: We confirmed within a large and ethnically diverse ICH patient population that clinically diagnosed VTE events are relatively rare at 3%. The strongest risk factor for development of DVT/PE was a prior history of DVT/PE. But the most prevalent risk factor was a need for intubation. Further study is needed to understand the efficacy of VTE preventative strategies among ICH patients.

Risk of Venous Thromboembolism Recurrence: High Negative Predictive Value of D-dimer Performed after Oral Anticoagulation Is Stopped

2002 ◽  
Vol 87 (01) ◽  
pp. 7-12 ◽  
Author(s):  
Cristina Legnani ◽  
Benilde Cosmi ◽  
Giuliana Guazzaloca ◽  
Claudia Pancani ◽  
Sergio Coccheri ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Recurrent Events ◽  
Oral Anticoagulant Therapy ◽  
Lower Limbs ◽  
First Episode ◽  
Vein Thrombosis ◽  
D Dimer

SummaryIn some patients with previous venous thromboembolism (VTE) D-dimer levels (D-Dimer) tend to increase after oral anticoagulant therapy (OAT) is stopped. The aim of our study was to evaluate the predictive value of D-Dimer for the risk of VTE recurrence after OAT withdrawal. After a first episode of deep vein thrombosis (DVT) of the lower limbs and/or pulmonary embolism (PE), 396 patients (median age 67 years, 198 males) were followed from the day of OAT discontinuation for 21 months. D-dimer was measured on the day of OAT withdrawal (T1), 3-4 weeks (T2) and 3 months (+/− 10 days, T3) thereafter. The main outcome events of the study were: objectively documented recurrent DVT and/or PE. D-dimer was found to be increased in 15.5%, 40.3% and 46.2% of the patients at T1, T2 and T3, respectively. In 199 (50.2%) patients, D-dimer levels were elevated in at least one measurement. During a follow-up of 628.4 years, 40 recurrences were recorded (10.1% of patients; 6.4% patient-years of follow-up). D-dimer was increased in at least one measurement in 28 of these cases, but remained normal in 11 subjects (three of whom had recurrent events triggered by circumstantial factors, three with malignancyassociated factors) (in one subject D-dimer was not measured). The negative predictive value (NPV) of D-dimer was 95.6% (95% CI 91.6-98.1) at T3 and was even higher (96.7%; 95% CI 92.9-98.8) after exclusion of the six recurrences due to circumstantial factors. Only five idiopathic recurrences occurred in the 186 patients with consistently normal D-dimer. In conclusion, D-dimer has a high NPV for VTE recurrence when performed after OAT discontinuation.

Abstract P254: Risk Factors For Venous Thromboembolism in a Cohort of French Women

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Martin Lajous ◽  
Laura Tondeur ◽  
Agnes Fournier ◽  
Francoise Clavel-Chapelon
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Venous Thromboembolism ◽  
Fruits And Vegetables ◽  
Smoking Status ◽  
Premenopausal Women ◽  
Prior History ◽  
Inverse Association ◽  
Vein Thrombosis

Background: There is controversy over whether cardiovascular disease and venous thromboembolism (VTE) share risk factors. Prospective information on risk factors for VTE in otherwise healthy individuals is limited. Methods and Results We evaluated the relation between known risk factors for cardiovascular disease and incidence of VTE among 65,272 French women in the E3N prospective cohort study with no prior history of VTE and who were free of cardiovascular disease or cancer in 1993. All information was self-reported via mailed questionnaires and diet and physical activity were assessed using previously validated instruments. Between 1993 and 2007, 766 cases of deep vein thrombosis or pulmonary embolism were first identified through self-reports and validated using medical records and information from treating physicians. Cases were considered valid if the diagnosis was based on an imaging procedure. We evaluated the following risk factors: education, menopause, postmenopausal hormone use, treated hypercholesterolemia and hypertension, diabetes, body mass index (BMI), physical activity, smoking status and intake of alcohol, red meat, fish, fruits and vegetables, fiber and coffee. In a multivariable model with age as the time scale, we found that, compared to women with a BMI <22 kg/m2, the HR (95%CI) was 1.35 (1.14, 1.60) for 22–24.9 kg/m2, 2.11 (1.73, 2.57) for 25–29.9 kg/m2 and 2.88 (2.08, 3.98) for ≥30 kg/m2 and the p-trend was <0.0001. Menopause was found to be inversely associated with VTE risk [HR=0.60 (95%CI 0.45–0.80); postmenopausal vs. premenopausal women]. In analyses restricted to postmenopausal women, relative to never users current use of postmenopausal hormones was significantly associated to VTE risk [HR=1.44 (95%CI 1.18–1.74)]. No significant association was found with dietary and other cardiovascular risk factors. Conclusion In this large prospective study only some risk factors for cardiovascular disease were associated to VTE incidence. We observed a strong inverse association between menopause and VTE.

THE MAGNETIC RESONANCE IMAGING OF THE LUMBAR SPINE IN OUT-PATIENTS WITH LOW BACK PAIN

2001 ◽  
Vol 05 (04) ◽  
pp. 261-267 ◽  
Author(s):  
BOHUA CHEN ◽  
STEVE LAVENDER ◽  
GUNNAR B. J. ANDERSSON
Keyword(s):  
Logistic Regression ◽  
Medical Center ◽  
Lumbar Disc ◽  
Statistical Significance ◽  
White Collar ◽  
Individual Characteristics ◽  
Blue Collar ◽  
Prior History ◽  
Spine Pathology ◽  
History Of

This paper aims to estimate the prevalence rates of MRI change in LBP out-patients and to determine the relationship between abnormalities in an MRI and personal and occupational factors. The MRI records were obtained from 200 out-patients with LBP (114 males and 86 females) who received a diagnostic MRI at St. Luke's Medical Center. The mean and standard deviation of this sample's age were 43.8 years and 14.8 years, respectively. Based on the MRI, each lumbar disc was scored as normal or degenerated. Bulging and herniated were also recorded. Each patient completed a short questionnaire that included the measures of height, weight, age, and present occupation and any history of "heavy manual labor". Occupations were grouped into white collar sedentary, white collar professional, blue collar exposed to prolonged sitting and vibration, blue collar exposed to heavy, unemployed or retired, and homemaker. Chi-square tests were used to determine the statistical significance of these trends. A multiple logistic regression was used to develop a predictive model of spine pathology based on a subject's individual characteristics and occupational classification. Normal discs were found in 26% of the patients and degenerated discs in 47.5%. There were bulging/herniated disks in 26.5%. In men who were younger than 29 years, 50% had herniated disks, and 50% were normal. Three fourth of the women in the same age group showed normal discs. Forty-three percent of the subjects reported a history of performing heavy labor. Using the logistic regression model there were two variables predictive of observable MRI pathology: age and prior history of heavy labor. The analysis indicated that an older individual who had a history and heavy labor was more likely to show one or more pathological model discs in an MRI scan.

Epidemiology and Pattern of Thromboembolism in Aseer Central Hospital, a Multispecialty Hospital in Aseer Region, Abha in Southern Saudi Arabia

2020 ◽  
Author(s):  
Aziz S
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Demographic Data ◽  
Venous Blood ◽  
Pulmonary Veins ◽  
Lower Limbs ◽  
Central Hospital ◽  
Vein Thrombosis ◽  
Hospitalization Period ◽  
Deep Vein

Background: Venous Thromboembolism (VTE) is a clinical disorder characterized by the pathological occurrence of single or many thrombi developing mainly in the deep veins of the lower limbs and pulmonary veins but also other parts of the venous circulation, albeit less. A frequently occurring venous thrombosis is a deep vein thrombosis (DVT), which is the presence of thrombus in deep veins of the lower extremity. Once this clot fragment is swept off (embolism), it moves along with the venous blood and flows to the pulmonary vessels, where it may result in a clinically significant disorder called pulmonary thromboembolism (PTE). Thrombosis occurring in the superficial veins would only cause discomfort but generally with insignificant consequences. Aim: This study aimed to assess patterns and risk factors of venous thromboembolism (VTE) among patients in the Aseer region. Methodology: A record-based descriptive analysis (retrospective) was used in this study. The clinical study targeted the patients with venous thromboembolism (VTE including PE & DVT) either admitted with the diagnosis or complicated during the hospitalization period in Aseer Central Hospital during the period from January 2010 to June 2019. Data extracted using pre-structured data collection sheet. The extracted data were patients' bio-demographic data, VTE related data, treatment received and relevant complications of treatment, and patient’s follow-up history. Results: The study included total of 207 patients with thromboembolism. The age of patients was between 15 - 100 years old with the average age being 57.3+12.9 years. Approximately 58% of the patients were female. Deep vein thrombosis (DVT) was recorded in 60.4% of the cases and 27.5% of them were diagnosed with pulmonary embolism (PE) while 12.1% had both PE and DVT. Exact of 59.6% of cases with PE had immobilization history for 24 to 72 hours as compared to 31.2% of DVT and 44% of patients with mixed thromboembolism. DM was recorded among 14% of PE cases and 21.6% of DVT. Warfarin with Enoxaparin was the most frequently given treatment in total (23.2%). Heparin followed by Warfarin was the second most common treatment. Conclusions and recommendation: The study revealed that VTE was commonly reported especially DVT and PE among the recorded cases and it was bilateral in a considerable number of cases. Immobilization with chronic disease and morbid obesity was noted as the most significant predictor for VTE.

scholarly journals Finding of pathological thrombomodulin gene variant in a patient with idiopathic nodular glomerulosclerosis and chronic thrombotic microangiopathy-like changes

2020 ◽  
Vol 8 ◽  
pp. 2050313X2094051
Author(s):  
Ramy Hanna ◽  
Jonathan E Zuckerman ◽  
Antoney Ferrey ◽  
Everado Arias Torres ◽  
Sam Tonthat ◽  
...  
Keyword(s):  
Alternative Pathway ◽  
Pathological Finding ◽  
Smoking History ◽  
Prior History ◽  
Diabetic Patients ◽  
Glomerular Injury ◽  
Nodular Glomerulosclerosis ◽  
Smoking Exposure ◽  
History Of ◽  
Idiopathic Nodular Glomerulosclerosis

Idiopathic nodular glomerulosclerosis is an unusual histopathological finding that has commonly been observed in male smokers with hypertension. It has remained an enigmatic condition and is best described as a diabetic pattern of glomerular injury seen in non-diabetic patients. It is also one of the few nicotine (smoking)-associated/smoking-associated patterns of renal injury. We present an even more unusual manifestation of this pathological finding in a 59-year-old Hispanic female who presented with chronic kidney disease approaching need for renal replacement therapy. The patient had idiopathic nodular glomerulosclerosis on kidney biopsy, despite no prior history of diabetes, nor smoking history, including no secondhand smoking exposure. The patient did have hypertension. The renal biopsy also showed evidence of chronic thrombotic-microangiopathic changes within arteries and arterioles. Genetic testing of the alternative pathway revealed an unusual and likely pathological variant of thrombomodulin supporting complement dysfunction as having a role in the presentation.

Risk of adolescent offspring's completed suicide increases with prior history of their same-sex parents' death by suicide

2013 ◽  
Vol 44 (9) ◽  
pp. 1845-1854 ◽  
Author(s):  
C.-C. J. Cheng ◽  
W.-J. Yen ◽  
W.-T. Chang ◽  
K. C.-C. Wu ◽  
M.-C. Ko ◽  
...  
Keyword(s):  
Conditional Logistic Regression ◽  
Statistical Significance ◽  
Prior History ◽  
Same Sex ◽  
Birth Registry ◽  
Conditional Logistic Regression Model ◽  
Completed Suicide ◽  
Suicidal Death ◽  
History Of ◽  
Maternal Suicide

BackgroundTo investigate the risk of completed suicide in offspring during adolescence in relation to prior history of the same-sex parent's death by suicide and other causes.MethodA total of 500 adolescents who died by suicide at age 15–19 years between 1997 and 2007 were identified from the Taiwan Mortality Registration (TMR). For each case, 30 age- and time-matched controls were selected randomly from all adolescents registered in the Taiwan Birth Registry (TBR). A multivariate conditional logistic regression model was used to assess the risk of adolescent completed suicide in relation to their same-sex parent.ResultsAdolescent suicide risk was positively associated with both paternal [odds ratio (OR) 5.38, 95% confidence interval (CI) 2.17–13.33] and maternal suicide (OR 6.59, 95% CI 1.82–23.91). The corresponding risk estimates associated with paternal and maternal deaths from non-suicidal causes were much lower, at 1.88 and 1.94 respectively. The risk of suicide in male adolescents was significantly associated with prior history of paternal death by suicide (OR 8.23, 95% CI 2.96–22.90) but not of maternal death by suicide (OR 3.50, 95% CI 0.41–30.13). On the other contrary, the risk of suicidal death in female adolescents was significantly associated with prior history of maternal suicide (OR 9.71, 95% CI 1.89–49.94) but not of paternal suicide (OR 2.42, 95% CI 0.30–19.57). However, these differences did not reach statistical significance.ConclusionsAlthough limited by sample size, our study indicates that adolescent offspring suicidal death is associated with prior history of their same-sex parent's death by suicide.

Observational study of ifosfamide (Ifos) neurotoxicity (N): The prospective use of a nursing assessment tool.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19580-e19580
Author(s):  
Jeanne Held-Warmkessel ◽  
Monica Davey ◽  
Samuel Litwin ◽  
John Lee ◽  
Mitchell Reed Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Assessment Tool ◽  
Signs And Symptoms ◽  
Well Being ◽  
Prior History ◽  
Low Grade ◽  
Nursing Assessment ◽  
History Of ◽  
Hand Writing ◽  
Writing Sample

e19580 Background: Ifos chemotherapy is known to cause central nervous system toxicity. Risk factors have not been well identified in the literature, with limited information on the onset, duration, and severity of this toxicity. No clinical tools are available to assess and document N. Methods: We developed a clinical nursing assessment tool based upon review of the literature. Patients initiating inpatient Ifos chemotherapy, after informed consent was obtained under an IRB approved protocol, were prospectively monitored for signs and symptoms of N during 1 cycle of therapy. A full neurologic nursing assessment of 24 signs and symptoms including a hand writing sample was done at baseline and a basic assessment evaluating alertness, orientation, sense of well being and a hand writing sample was repeated every 12 hours. In the event N was identified, a full assessment was repeated; observed N was graded using the NCI CTC, version 3. Other variables collected were demographic traits, dose per day, hydration, and potential risk factors for N: renal function, albumin, largest pelvic tumor dimension, prior Ifos or cisplatin, use of other medications with potential for N, and alcohol use history. Individual factors were analyzed using Fisher’s exact test or the Wilcoxon two-sample test. Results: Eighty patients were accrued from 5/09-1/12. Median age was 54.5 (range: 21-85), 51% were males, PS 0 in 26.3%, 1 in 65%, 2 in 6.3% and 3 or 4 in 1.3% each. Diagnosis was sarcoma in 73.75%, lymphoma 22.5%, or germ cell tumor 3.75%. N was observed in 47.5% of patients. Toxicities in >15% of patients were sleepiness (25%), lethargy and restlessness (16.25% for each), and dizziness (15%). The majority were grade 1-2 (89.6%). Factors associated with N included generic versus brand formulation of Ifos (p=0.041) and prior history of a drug related neurotoxicity (p=0.047). BSA, performance status, gender, age, dose per m2, total planned dose, pretreatment Cr, and pretreatment albumin were not associated. Conclusions: The incidence of Ifos N is common using this nursing assessment tool, although usually low grade. We identified the formulation of Ifos and a prior history of drug related N as statistically correlated with developing N.

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