Abstract 512: Predictors of Mortality in Cancer-Associated Calf Deep Vein Thrombosis

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Juan P Salazar Adum ◽  
Luis Diaz-Quintero ◽  
Harry E Fuentes ◽  
Alfonso Tafur ◽  
Benjamin Lind ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Mortality Prediction ◽  
Categorical Variables ◽  
Mortality Data ◽  
Cancer Type ◽  
Continuous Variables ◽  
Filter Placement ◽  
Predictors Of Mortality ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Venous thromboembolism (VTE) is a leading cause of mortality in cancer patients. The outcomes of patients with cancer-associated calf deep vein thrombosis (CDVT), including mortality data, are less understood compared with proximal thrombosis. Aim: To characterize predictors of mortality among cancer-associated CDVT patients. Methods: Single institution inception cohort of cancer-associated CDVT patients who presented with thrombosis distal to popliteal level confirmed objectively by ultrasound, computed tomography or VQ scan were independently reviewed. Active cancer was defined as metastatic disease or use of chemotherapy at diagnosis. The Khorana risk score (KRS) suggested for DVT and mortality prediction in cancer was abstracted based on laboratory tests and cancer type at diagnosis. Institutional review board approval was obtained prior to the analysis. Categorical variables are expressed as percentages and continuous variables as median (interquartile range). SPSS software version 22 was used and Chi-square, Mann–Whitney U and Cox proportional hazard were applied. Results: One hundred nine patients (Men=44 (40%), Age>65=89 (82%), BMI>30=25 (23%), Smoker=59 (54%)) were included. The majority had a low or intermediate KRS (30%-64% respectively). Forty-seven percent died during a median follow-up time of 2.5 years (0.5-3.1). After multivariate analysis, the predictors of mortality were found to be: smoking (Hazard Ratio 2.3; 95%CI 1.2-4.7), metastasis (HR 5.8; 95%CI 2.9-11.7), gastrointestinal cancer (HR 3.9; 95%CI 1.8-8.5), and lung cancer (HR 4.1 95%CI 1.7-10.3). VTE specific variables not associated with mortality included: bilateral CDVT, concomitant pulmonary embolism, multiple vein involvement, filter placement, or a surgery-associated event. Conclusion: Cancer-specific variables and smoking predicted mortality among CDVT patients in this cohort. Neither the KRS nor VTE specific characteristics were predictive of death. A larger study is necessary to further explore these findings.

DECREASED ACTIVITY of ADAMTS13 IN PATIENTS with DEEP Vein Thrombosis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3991-3991
Author(s):  
Bruna de Moraes Mazetto ◽  
Fernanda A. Orsi ◽  
Silmara Aparecida Lima Montalvao ◽  
Tayana B Mello ◽  
Erich Vinicius de Paula ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Conflicts Of Interest ◽  
Inverse Correlation ◽  
Normal Subjects ◽  
Categorical Variables ◽  
Control Group ◽  
Continuous Variables ◽  
Adamts13 Activity ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Abstract 3991 Poster Board III-927 Introduction Several risk factors, including increased levels of factor VIII (FVIII) and von Willebrand factor (VWF), have already been identified in patients with deep vein thrombosis (DVT). Recently we published a study showing that in a Brazilian population, plasma levels of FVIII over 180U/dl and VWF over 165U/dl were associated with the occurrence of venous thrombosis (odds ratio = 4.1 and 3.8 respectively) (Mello TB et al, 2009). The level of VWF in plasma and consequently FVIII is the result of genetic and acquired factors. ADAMTS13 (ADisintegrin And Metalloprotease with Thrombospondin type 1 repeats) is an enzyme responsible for cleavage of VWF, and its activity could contribute to VWF and FVIII plasmatic levels in patients with DVT. Objective To evaluate the activity of ADAMTS13 in patients with DVT associated with an increase of VWF and FVIII. Patients and methods: Fifty-six patients with FVIII > 180U/dl or FVW>165U/dl were selected from a cohort of 175 patients with DVT from the study mentioned above. Fifty-four normal subjects were selected as controls. The activity of ADAMTS 13 was performed by binding of residual VWF to collagen; VWF activity was measured by collagen binding, VWF antigen was determined by ELISA and FVIII was measured by a one-stage coagulation assay. Continuous variables were analyzed by Mann-whitney test and categorical variables by the Chi-square test. Results The demographic distribution of patients and controls were similar. Among the 56 patients the median age was 37.5 years, 39 were women, 46 had blood typing “non-O”, 34 had DVT caused by transient risk factor, especially the use of oral contraceptives, 10 patients had a hereditary thrombophilia and 3 were carriers of antiphospholipid antibodies. No patient had renal, hepatic or malignant disease. The median ADAMTS 13 activity was significantly lower in patients (112.9%, 44.4 - 327.6%) when compared to controls (142.9%, 76.7 - 323.6%), P = 0.001. The VWF activity was also higher in patients (109.7%, 26.8 - 422.6%) when compared to controls, (79.1%, 45.5 - 203.8%), P=0.038. The median level of VWF antigen was significantly higher in the group of patients when compared to the control group (178.1U/dl versus 111.9 U/dl respectively, P <0.0001). There was an inverse correlation between ADAMTS13 activity and VWF activity. Conclusion: This study suggests that the increased VWF and FVIII activity in patients with DVT can be a result of decreased ADAMTS13 activity. The decreased activity of ADAMTS13 may be influenced by the action of cytokines in inflammatory processes, even after acute period. Future studies will be important to determine the correlation between activity of ADAMTS 13, VWF, and inflammatory markers in the pathogenesis of DVT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Optimal Timing for Removal of an Upper Extremity Central Catheter When Associated with a Deep Vein Thrombosis: A Venous Thromboembolism Network US Multicenter Retrospective Cohort Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 325-325
Author(s):  
Damon E. Houghton ◽  
Henny Heisler H. Billett ◽  
Manila Gaddh ◽  
Oluwatomiloba Onadeko ◽  
Gemlyn George ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Board Of Directors ◽  
Upper Extremity ◽  
Catheter Removal ◽  
Pulmonary Emboli ◽  
Continuous Variables ◽  
Advisory Committees ◽  
No Removal ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Standard treatment for catheter-associated upper extremity deep vein thrombosis (UEDVT) is anticoagulation. If catheter removal is otherwise indicated, it is unknown if catheter removal close to the time of initiation of anticoagulation is associated with a higher incidence of pulmonary embolization. Methods: A multicenter retrospective cohort study was performed at 8 participating institutions through the Venous thromboEmbolism Network US (VENUS). ICD-9/10 codes were used to identify patients with hematologic malignancies and upper extremity deep vein thrombosis (UEDVT) from 1/1/2010 through 12/31/2016. Identified patients underwent medical record review to verify diagnostic codes and determine if a catheter was associated with the upper extremity DVT and assess for outcomes. Patients were excluded if the UEDVT was not catheter provoked or if there were associated lower extremity DVT and/or pulmonary emboli. The anticoagulant start and finish date as well as the timing of the catheter removal, total follow up, and death were recorded. Patients started on anticoagulation at the time of their diagnosis were divided into two groups: 1) anticoagulation with delayed (&gt; 48 hrs) or no catheter removal and 2) anticoagulation with early catheter removal (&lt; 48 hrs). Outcomes were also assessed in patients with no anticoagulation initiation but catheter removal as the only treatment. The primary outcome was clinically identified pulmonary emboli within 7 days and the secondary outcome was pulmonary emboli or death from any cause within 7 days. Baseline characteristics were compared between groups using Χ2 for categorical variables, 2-tailed t-tests for continuous variables, and Wilcoxon rank-sum for nonparametric continuous variables. Fisher's exact test was used to evaluate the primary and secondary outcomes. Results: 663 patients with hematologic malignancies and isolated catheter-associated UEDVT underwent chart review. 512 patients were treated with anticoagulation of which 312 underwent early catheter removal while 200 had delayed or no catheter removal (Figure 1). 151 patients received no anticoagulation and 119 underwent catheter removal alone as the treatment for the DVT. Among patients who were treated with anticoagulation, the mean age was 52.6 years and 44% were male; age and sex did not differ between patients with early vs. delayed or no catheter removal (Table 1). Type of hematologic malignancy, type of central catheter, and DVT location were significantly different between groups. Patients with PICC lines were more likely to have early catheter removal (71% vs. 49%). The median platelet count was not significantly different among patients treated with anticoagulation, but was lower in patients treated with catheter removal only. Most patients were initially treated with low molecular weight heparins (LMWH) and anticoagulation treatment did not differ between groups. Pulmonary emboli within 7 days occurred in 2 patients (0.64%) with early catheter removal compared to 1 patient (0.5%) with delayed or no removal (p=1.0). Pulmonary emboli or any cause death within 7 days occurred in 3 patients (1.0%) with early removal compared to 3 patients (1.5%) with delayed or no removal (p=0.68). In patients treated with catheter removal only (no anticoagulation), there were no pulmonary emboli within 7 days and 3 deaths. All 3 patients with pulmonary emboli within 7 days had PICC lines and leukemia/MDS and the sites of most proximal DVT involvement were brachiocephalic veins (2 patients) and subclavian vein (1 patient). Conclusions: In patients with hematological malignancy and catheter-associated UEDVT, removal of catheters within 48 hours was not associated with increased risk of pulmonary emboli compared to delayed or no removal. Disclosures Billett: Albert Einstein College of Medicine: Patents & Royalties: Patent application pending for NETs AI software. Gaddh:Pfizer: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Hema Biologics: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics LLC: Membership on an entity's Board of Directors or advisory committees. Oo:Medical Education Speakers Network: Honoraria; Janssen and Janssen: Other: Research: site co-investigator . Jaglal:NOVARTIS: Consultancy. Streiff:Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Daiichi-Sankyo: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Portola: Consultancy, Honoraria; Roche: Research Funding. Baumann Kreuziger:Vaccine Injury Compensation Program: Consultancy; CSL Behring: Consultancy.

scholarly journals Incidence of Pulmonary Embolism with Concomitant Deep Vein Thrombosis at an Urban Community Teaching Hospital

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4716-4716
Author(s):  
Uri Goldberg ◽  
Wazhma Nasiri ◽  
Mohamed Alibakhiet ◽  
Henry Jean ◽  
Rajat Mukherji ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Teaching Hospital ◽  
Mortality Risk ◽  
Urban Community ◽  
Positive Finding ◽  
Filter Placement ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Community Teaching

Abstract Introduction Though venous thromboembolism (VTE) is thought to be under-diagnosed, roughly 900,000 people are estimated to be affected by VTE each year in the U.S. According to CDC figures, VTE accounts for roughly 60,000 to 100,000 annual deaths. Recent research has demonstrated that the risk of mortality in patients with pulmonary embolism (PE) who were found to have concomitant deep vein thrombosis (DVT) was higher in comparison to patients with PE who did not have concomitant DVT (Beccatini et al. Chest 2015). We have sought to evaluate the risk of concomitant DVT among patients diagnosed with PE in our hospital population. Methods This is an ongoing retrospective cohort study examining the incidence of PE with concomitant DVT among patients admitted to an urban community teaching hospital between January 2011 and March 2015. Radiological findings for patients who underwent computed tomography angiography (CTA) and venous duplex ultrasound were reviewed. Patients found to have PE were sub-divided into two groups: those with concomitant DVT and those without concomitant DVT. Mortality risk, correlation with inferior vena cava (IVC) filter placement, and association with other comorbidities continue to be evaluated. Results Results of 1,777 CTAs were reviewed of which 160 demonstrated a positive finding of PE: 103 women (64.4%) and 57 men (35.6%). Patient age ranged from 19 to 97 years old. The mean and median ages for all PE-positive patients were 61.9 and 63,respectively. Several patients demonstrated multiple emboli; to wit, 273 distinct PEs were noted among the 160 individual patients. Of the 160 patients with PE, 81 were found to have concomitant DVT (50.6%). Discussion The combination of high mortality and rapid-though often overlooked-onset make VTE a uniquely vexing condition. Though the nature of the relationship between DVT and the increased mortality risk among patients with PE is unclear, the correlation has been convincingly demonstrated by prior research and may signal the need for more aggressive management for patients with concomitant thromboemboli. Our findings, consistent with the literature, suggest that the prevalence of concomitant PE and DVT may be substantial in the hospitalized population. Disclosures No relevant conflicts of interest to declare.

scholarly journals Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry

2020 ◽  
Vol 50 (11) ◽  
pp. 1246-1253
Author(s):  
Yasuo Ohashi ◽  
Masataka Ikeda ◽  
Hideo Kunitoh ◽  
Mitsuru Sasako ◽  
Takuji Okusaka ◽  
...  
Keyword(s):  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Clinical Care ◽  
Gynecologic Cancer ◽  
Cancer Type ◽  
Cancer Stage ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background The Cancer-VTE Registry evaluates the occurrence and management of venous thromboembolism in Japanese participants with major solid tumors. Using Registry data, we evaluated the frequency of concurrent venous thromboembolism in cancer patients prior to treatment initiation by cancer type. Methods The Cancer-VTE Registry is an ongoing (March 2017–September 2020) prospective cohort study using a nationwide, multicentre clinical registry. Participants aged ≥20 years with colorectal, lung, stomach, pancreatic, breast or gynecologic cancer, confirmed staging, ≥6 months life expectancy post-registration and who had undergone venous thromboembolism screening were managed with routine clinical care. Venous thromboembolism frequency at registration was evaluated. Results Of 9735 participants, 571 (5.9%) had venous thromboembolism at baseline, including asymptomatic [5.5% (n = 540)] and symptomatic venous thromboembolism [0.3% (n = 31)]. Most participants with venous thromboembolism (n = 506, 5.2%) had deep vein thrombosis only; 65 (0.7%) had pulmonary embolism with/without deep vein thrombosis. The prevalence of distal and proximal deep vein thrombosis was 4.8% (n = 466) and 0.9% (n = 83), respectively. The highest prevalence of venous thromboembolism was for pancreatic cancer (8.5%) and the lowest for breast cancer (2.0%). Venous thromboembolism prevalence increased as cancer stage advanced. Conclusions Although there was a marked difference in venous thromboembolism by cancer type, the data suggest that cancer stage is an important risk factor for venous thromboembolism. Thus, metastasis seems a critical risk factor for venous thromboembolism. This is the first demonstration of venous thromboembolism prevalence and risk factors in Japanese cancer patients prior to treatment. Trial registration UMIN000024942.

scholarly journals Extensive deep vein thrombosis and pulmonary embolism as a unique clinical manifestation of COVID-19 in a young healthy patient

Vascular ◽  
2021 ◽  
pp. 170853812110409
Author(s):  
Alejandro Llausas-Villarreal ◽  
Marycarmen Mendoza-Silva ◽  
Oliver Antonio Gómez-Gutiérrez ◽  
Mauricio Gonzalez-Urquijo ◽  
Mario Alejandro Fabiani
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Clinical Manifestation ◽  
Vena Cava ◽  
Healthy Patient ◽  
Filter Placement ◽  
Symptomatic Disease ◽  
Vein Thrombosis ◽  
Deep Vein

Background/Objective Deep vein thrombosis and pulmonary embolism have been described as complications in previously diagnosed COVID-19 patients, especially in those admitted in critical ill units, but, to our knowledge, there is no report of venous thromboembolism in an otherwise asymptomatic COVID-19 patient. Methods We report the case of a 22-year-old female, healthy patient with pulmonary embolism (Pulmonary Embolism Severity Index Score 22 points, low risk) and extensive proximal deep vein thrombosis as a unique clinical manifestation of the new coronavirus disease. Results The patient had no risk factors and no familial history of venous thromboembolism. All thrombophilia markers were negative. The patient was treated as first by an independent vascular team, performing vena cava filter placement and open thrombectomy. Her symptoms worsened, and after 3 weeks, she underwent US-enhanced thrombolysis and mechanical thrombectomy. She was isolated for 10 days and did not develop any other clinical manifestation of COVID-19 disease. During follow-up, she remained asymptomatic and complete patency of the venous system was achieved. Full oral anticoagulation was conducted for 6 months. Conclusion COVID-19 appears to be a multi-symptomatic disease, and venous thromboembolism without any other previous described COVID-19 symptom could be considered one of its diverse clinical presentations and RT-PCR for SARS-CoV-2 tests emerge to be mandatory in patients with otherwise unexpected venous thrombosis.

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