Postpartum Period Is a Risk Factor for Cerebral Venous Thrombosis

Background and Purpose— Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk. Methods— Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals and controls from the Dutch MEGA study (Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). Men, women over the age of 50, women using oral contraceptives or with a recent abortion or miscarriage were excluded. We adjusted for age and history of cancer, and stratified for pregnancy versus postpartum, and 0 to 6 versus 7 to 12 weeks postpartum. Results— In total 163/813 cases and 1230/6296 controls were included. Cases were younger (median 38 versus 41 years) and more often had a history of cancer (14% versus 4%) than controls. In total 41/163 (25%) cases and 82/1230 (7%) controls were pregnant or postpartum (adjusted odds ratio, 3.8; 95% CI, 2.4–6.0). The association was fully attributable to an increased risk of CVT during the postpartum period (adjusted odds ratio, 10.6; 95% CI, 5.6–20.0). We found no association between pregnancy and CVT (adjusted odds ratio, 1.2; 95% CI, 0.6–2.3). The risk was highest during the first 6 weeks postpartum (adjusted odds ratio, 18.7; 95% CI, 8.3–41.9). Conclusions— Women who have recently delivered are at increased risk of developing CVT, while there does not seem to be an increased risk of CVT during pregnancy.

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Risk Factors for Ectopic Pregnancy: A Case-Control Study in Tertiary Care Hospitals of Jammu and Kashmir

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2021.0048 ◽

2021 ◽

Vol 3 (4) ◽

pp. 293-299

Author(s):

Neha Mahajan ◽

◽

Rohit Raina ◽

Pooja Sharma ◽

◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Ectopic Pregnancy ◽

Odds Ratio ◽

Tertiary Care ◽

Previous History ◽

Tubal Ligation ◽

Increased Risk ◽

Study Results ◽

History Of

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

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Abstract 3920: Epilepsy as a Long-Term Complication After Cerebral Venous Thrombosis

Stroke ◽

10.1161/str.43.suppl_1.a3920 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Carlos Cantu-Brito ◽

Erwin Chiquete ◽

Antonio Arauz ◽

Marlon Merloz-Benitez

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Presentation ◽

Thrombotic Event ◽

Long Run ◽

Increased Risk ◽

Long Term Follow Up

Background. Seizures is a very common clinical presentation of cerebral venous thrombosis (CVT); however, little is known about the future risk of epilepsy in patients suffering CVT. Our objective was to analyze risk factors for epilepsy in a long-term follow-up after CVT. Methods. This is a cohort descriptive study of consecutive non-selected patients with acute cerebrovascular disease, systematically registered from 1986 to 2010 in a third-level referral center of Mexico City. Here we analyzed 340 patients who survived the first 6 months after CVT, who were not epileptic at baseline and for whom complete long-term information on neurological outcome was available. Results. Seizures occurred in 183 (54%) patients, in 26% of them as a clinical presentation and 74% at some point during follow-up. Focal motor seizures occurred in 6.5%, secondary generalized focal seizures in 13.8% and generalized tonic-clonic seizures in 22.4%. Status epilepticus occurred in 13 (7%) cases. In all, during a median follow-up of 28 months (range 2 to 288 months), epilepsy was present in 14.7% (27.3% of those who presented seizures). In a multivariate analysis adjusted for multiple confounders, risk factors associated with an increased risk of epilepsy during follow-up were presenting seizures as a clinical presentation [odds ratio (OR): 4.32, 95% confidence interval (CI): 2.20-8.48], pregnancy and puerperium (OR: 2.03, 95% CI: 1.11-3.71) and thrombosis of the longitudinal sinus (OR: 1.86, 95% CI: 1.01-3.41). Conclusion. Seizures are common at CVT presentation, but risk increases during the acute phase after thrombotic event. Most seizures resolve during the first month, but epilepsy occurred in 15% of patients with CVT in the long run.

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Estimation of Acutely Ill Medical Patients at Venous Thromboembolism Risk Eligible for Extended Thromboprophylaxis Using APEX Criteria in US Hospitals

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619880008 ◽

2019 ◽

Vol 25 ◽

pp. 107602961988000 ◽

Cited By ~ 1

Author(s):

Anne-Céline Martin ◽

Wei Huang ◽

Samuel Z. Goldhaber ◽

Russell D. Hull ◽

Adrian F. Hernandez ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Venous Thromboembolism ◽

The United States ◽

Care Hospital ◽

Medical Patients ◽

Hospital Discharges ◽

Increased Risk ◽

History Of ◽

History Of Cancer

Major medical illnesses place patients at risk of venous thromboembolism (VTE). Some risk factors including age ≥75 years or history of cancer place them at increased risk of VTE that extends for at least 5 to 6 weeks following hospital admission. Betrixaban thromboprophylaxis is now approved in the United States for this indication. We estimated the annual number of acutely ill medical patients at extended risk of VTE discharged from US hospital. Major medical illnesses (stroke, respiratory failure/chronic obstructive pulmonary disease, heart failure, pneumonia, other infections, and rheumatologic disorders) and 2 common risk factors for extended VTE risk, namely, age ≥75 years and history of cancer (active or past) were examined in 2014 US hospital discharges using the first 3 discharge diagnosis codes in the National Inpatient Sample (database of acute-care hospital discharges from the US Agency for Health Care Quality and Research). In 2014, there were 20.8 million discharges with potentially at risk of nonsurgical-related VTE. Overall, 7.2 million (35%) discharges corresponded to major medical illness that warranted thromboprophylaxis according to 2012 American College of Chest Physicians (ACCP) guideline. Among them, 2.79 million were aged ≥75 years and 1.36 million had a history of cancer (aged 40-74 years). Overall, 3.48 million discharges were at extended risk of VTE. Many medical inpatients at risk of VTE according to 2012 ACCP guideline might benefit from the awareness of continuing risk and some of these patients might benefit from extended thromboprophylaxis, depending on the risk of bleeding and comorbidities.

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Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants

Anesthesiology ◽

10.1097/aln.0000000000002847 ◽

2019 ◽

Vol 131 (4) ◽

pp. 830-839 ◽

Cited By ~ 6

Author(s):

Jorge A. Gálvez ◽

Samuel Acquah ◽

Luis Ahumada ◽

Lingyu Cai ◽

Marcia Polanski ◽

...

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Primary Outcome ◽

Cross Sectional ◽

Emergency Procedures ◽

Academic Center ◽

Healthy Infants ◽

Increased Risk ◽

History Of ◽

American Society

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background The infant airway is particularly vulnerable to trauma from repeated laryngoscopy attempts. Complications associated with elective tracheal intubations in anesthetized infants may be underappreciated. We conducted this study of anesthetized infants to determine the incidence of multiple laryngoscopy attempts during routine tracheal intubation and assess the association of laryngoscopy attempts with hypoxemia and bradycardia. Methods We conducted a retrospective cross-sectional cohort study of anesthetized infants (age less than or equal to 12 months) who underwent direct laryngoscopy for oral endotracheal intubation between January 24, 2015, and August 1, 2016. We excluded patients with a history of difficult intubation and emergency procedures. Our primary outcome was the incidence of hypoxemia or bradycardia during induction of anesthesia. We evaluated the relationship between laryngoscopy attempts and our primary outcome, adjusting for age, weight, American Society of Anesthesiologists status, staffing model, and encounter location. Results A total of 1,341 patients met our inclusion criteria, and 16% (n = 208) had multiple laryngoscopy attempts. The incidence of hypoxemia was 35% (n = 469) and bradycardia was 8.9% (n = 119). Hypoxemia and bradycardia occurred in 3.7% (n = 50) of patients. Multiple laryngoscopy attempts were associated with an increased risk of hypoxemia (adjusted odds ratio: 1.78, 95% CI: 1.30 to 2.43, P < 0.001). There was no association between multiple laryngoscopy attempts and bradycardia (adjusted odds ratio: 1.23, 95% CI: 0.74 to 2.03, P = 0.255). Conclusions In a quaternary academic center, healthy infants undergoing routine tracheal intubations had a high incidence of multiple laryngoscopy attempts and associated hypoxemia episodes.

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Risk factors for major bleeding in the SEATTLE II trial

Vascular Medicine ◽

10.1177/1358863x16676355 ◽

2017 ◽

Vol 22 (1) ◽

pp. 44-50 ◽

Cited By ~ 20

Author(s):

Immad Sadiq ◽

Samuel Z Goldhaber ◽

Ping-Yu Liu ◽

Gregory Piazza ◽

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Major Bleeding ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Low Dose ◽

Vena Cava ◽

Venous Access ◽

Filter Placement ◽

Increased Risk

Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis minimizes the risk of intracranial bleeding compared with systemic full-dose fibrinolytic therapy for pulmonary embolism (PE). However, major bleeding is nevertheless a potential complication. We analyzed the 150-patient SEATTLE II trial of submassive and massive PE patients to describe those who suffered major bleeding events following ultrasound-facilitated, catheter-directed, low-dose fibrinolysis and to identify risk factors for bleeding. Major bleeding was defined as GUSTO severe/life-threatening or moderate bleeds within 72 hours of initiation of the procedure. Of the 15 patients with major bleeding, four (26.6%) developed access site-related bleeding. Multiple venous access attempts were more frequent in the major bleeding group (27.6% vs 3.6%; p<0.001). All patients with major bleeding had femoral vein access for device delivery. Patients who developed major bleeding had a longer intensive care stay (6.8 days vs 4.7 days; p=0.004) and longer hospital stay (12.9 days vs 8.4 days; p=0.004). The frequency of inferior vena cava filter placement was 40% in patients with major bleeding compared with 13% in those without major bleeding ( p=0.02). Massive PE (adjusted odds ratio 3.6; 95% confidence interval 1.01–12.9; p=0.049) and multiple venous access attempts (adjusted odds ratio 10.09; 95% confidence interval 1.98–51.46; p=0.005) were independently associated with an increased risk of major bleeding. In conclusion, strategies for improving venous access should be implemented to reduce the risk of major bleeding associated with ultrasound-facilitated, catheter-directed, low-dose fibrinolysis. ClinicalTrials.gov Identifier: NCT01513759; EKOS Corporation 10.13039/100006522

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Concomitant infections in patients with cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6561 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6561-6561

Author(s):

Kyle T. Enriquez ◽

Gowri Satyanarayana ◽

Maheen Abidi ◽

Shailesh M Advani ◽

Pamela Egan ◽

...

Keyword(s):

Risk Factors ◽

Bacterial Infections ◽

Immune Modulation ◽

Hematologic Malignancies ◽

Mortality Rates ◽

Patients With Cancer ◽

Increased Risk ◽

All Cause Mortality ◽

History Of ◽

History Of Cancer

6561 Background: COVID-19 has been associated with immune modulation that may predispose infected patients to bacterial, viral, or fungal co-infections. Due to critical illness, > 70% of patients with severe COVID-19 receive empiric antibacterial or antifungal therapy, along with standard anti-COVID-19 treatments. However, the frequency of proven or probable secondary infections is < 10%. To our knowledge, there are no studies evaluating co-infections in patients with cancer and COVID-19, a vulnerable group with multiple risk factors for co-infections. We aim to describe the prevalence of bacterial, viral, and fungal co-infections, identify risk factors for coinfection, and investigate the potential impact of co-infections on mortality, in patients with a history of cancer and COVID-19. Methods: The CCC19 registry (NCT04354701) includes patients with active or prior hematologic or invasive solid malignancies reported across academic and community sites. We captured bacterial, fungal, or viral co-infections diagnosed within ±2 weeks from diagnosis of COVID-19, identified factors associated with an increased risk of having a co-infection, and evaluated the association of co-infections with 30-day all-cause mortality. Results: We examined 6732 patients with a history of cancer and a laboratory-confirmed diagnosis of SARS-CoV-2 reported to CCC19 by 82 sites between March 17, 2020 and February 3, 2021, with complete data on coinfection status. Median age was 65 (interquartile range: 55-75) years with 48% male, 52% non-Hispanic white, 19% non-Hispanic black, and 16% Hispanic. 5448 (81%) had solid tumors and 1466 (22%) had hematologic malignancies. Bacterial infections were reported in 823 patients (12%), including 296 Gram+ and 245 Gram- bacterial events. Documented viral (176 patients, 3%) and fungal (59 patients, 0.9%) co-infections were rare. The risk for co-infections increased with age, and they were more frequent among men, older patients, and those with diabetes, pulmonary or renal comorbid conditions, active progressive cancer, or hematologic malignancies (unadjusted P< 0.01). The frequency of reported co-infections decreased over the study period (divided into quartiles, Mantel-Haenszel P< 0.01). All-cause mortality rates were higher among those with bacterial (24% vs. 10%), viral (22% vs. 12%), and fungal (37% vs. 12%) coinfections compared to those without (unadjusted P< 0.01). Conclusions: The frequency of bacterial infections in patients with cancer and COVID-19 is relatively low. Viral and fungal co-infections are uncommon. Co-infections are associated with higher mortality rates. Several patient and tumor factors can be used for risk stratification and guide early empiric antimicrobial agent selection, which may improve clinical outcomes. These data could inform antimicrobial stewardship interventions in this tenuous patient population.

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Abstract 6205: Variants of CYP4V2, SERPINC1 and GP6 Are Associated with Pulmonary Embolism

Circulation ◽

10.1161/circ.118.suppl_18.s_1157-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Lance A Bare ◽

Irene D Bezemer ◽

Carmen H Tong ◽

Andre R Arellano ◽

Charles M Rowland ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thrombosis ◽

Risk Allele ◽

Population Attributable Risk ◽

Nucleotide Polymorphisms ◽

Logistic Regression Models ◽

Vein Thrombosis ◽

Increased Risk ◽

History Of

Background: Pulmonary Embolism is a potentially fatal manifestation of venous thrombosis that may share genetic risk factors with deep vein thrombosis (DVT). Recently, 3 single nucleotide polymorphisms (SNPs) were reported to be associated with DVT in three studies: rs13146272 in CYP4V2 , rs2227589 in SERPINC1 , rs1613662 in GP6 . We investigated whether these 3 SNPs were also associated with pulmonary embolism. Methods: We genotyped 5840 subjects from the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA study). Cases were 1,206 patients who had a pulmonary embolism without a symptomatic DVT: isolated pulmonary embolism (PE iso ). Controls were 4,634 subjects who had no history of DVT or pulmonary embolism. We tested the association between genotypes and PE iso using logistic regression models that adjusted for age and sex. Results: For all three SNPs, the same allele that had been previously found to be associated with increased risk of DVT was also associated with increased risk of PE iso . For homozygous carriers of the risk allele, compared with noncarriers, the ORs were 1.34 (95% CI, 1.08–1.67) for rs13146272 in CYP4V2 , 1.85 (95% CI, 1.08–3.16) for rs2227589 in SERPINC1 , and 1.20 (95% CI, 1.04–1.39) for rs1613662 in GP6. The frequencies of risk allele homozygotes in the controls of the MEGA study were 41% for rs13146272, 1% for rs2227589, and 67% for rs1613662. Conclusions: Three SNPs previously reported to be associated with DVT were found to be associated with PE iso . Because of the high frequencies of two of these polymorphisms in Caucasians, these SNPs are likely make an appreciable contribution to the population attributable risk for PE iso .

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Non-insulin dependent diabetes mellitus and risk factors: a case control study from Andhra Pradesh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195213 ◽

2019 ◽

Vol 6 (12) ◽

pp. 5015

Author(s):

P. Shruti ◽

Anant A. Takalkar

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Odds Ratio ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Medical Sciences ◽

Increased Risk ◽

History Of ◽

Insulin Dependent

Background: It is well known that several factors influence the development of non-insulin dependent diabetes mellitus (NIDDM) such as genetic, environmental and life style factors. Obesity is the strongest modifiable risk factor for NIDDM. Cigarette smoking and alcohol consumption may also have important roles, either indirectly through their effects on obesity or directly through physiological factors related to insulin secretion or insulin resistance. The objective of the study was to study the risk factors of non-insulin dependent diabetes mellitus among the patients attending Chalmeda Anand Rao Institute of Medical Sciences Hospital.Methods: It is a hospital-based case-control study for risk factors in NIDDM. The study was conducted at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar during the period of June 2010 to May 2011 involving 147 cases and controls each. Data collected and analyzed using SPSS 14 version.Results: 21.59% of the male cases were in the age group of 46-50 years and 20.97% female cases from 56-60 yrs age. 42% cases and 12% controls had history of diabetes mellitus in one parent. 34% cases and 4.67% controls had history of diabetes mellitus in both the parents. Current smokers (odds ratio-4.24, 95% CI 2.02-9.15) and ex-smokers (odds ratio-1.31, 95% CI 0.65-2.68) exhibited an increased risk of NIDDM. Ex-drinking but not current-drinking was statistically significantly associated with the risk of NIDDM. Sedentary work was associated with an increased risk of NIDDM with an odds ratio of 3.90 (95% CI 2.30-6.63).Conclusions: Apart from other risk factors, smoking and alcohol consumption are significant lifestyle risk factors for NIDDM in males.

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Cancer incidence and risk factors in dialysis patients with human immunodeficiency virus: a cohort study

Clinical Kidney Journal ◽

10.1093/ckj/sfz191 ◽

2020 ◽

Author(s):

Mihir Patel ◽

Jennifer L Waller ◽

Stephanie L Baer ◽

Vanessa Spearman ◽

Mufaddal Kheda ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Human Immunodeficiency Virus ◽

Risk Factor ◽

Adjusted Relative Risk ◽

Dialysis Patients ◽

Increased Risk ◽

Immunodeficiency Virus ◽

History Of ◽

History Of Cancer

Abstract Background Patients with human immunodeficiency virus (HIV) or end-stage renal disease receiving dialysis have an increased risk of developing malignancies, but few data are available on cancer in patients with both conditions. Thus, the objective of this study was to determine the incidence of selected malignancies and identify their potential risk factors in HIV-infected dialysis patients. Methods This study was a nationwide cohort analysis using the US Renal Data System. Participants included all HIV-infected patients starting dialysis from 2005 to 2011. HIV status, comorbidities and malignancies were identified using International Classification of Diseases, Ninth Revision codes. Descriptive statistics and generalized linear models quantifying risk factors were performed for the overall cohort and the three most common malignancies. Results Overall, 6641 HIV-infected dialysis patients were identified, with 543 (8.2%) carrying a malignancy diagnosis. The most common malignancies were non-Hodgkin’s lymphoma (NHL, 25%), Kaposi sarcoma (KS, 16%) and colorectal cancer (13%). Factors increasing the risk of any malignancy diagnosis included: history of cancer [adjusted relative risk (aRR) = 5.37], two or more acquired immunodeficiency syndrome-defining opportunistic infections (ADOIs) (aRR = 3.11), one ADOI (aRR = 2.23), cirrhosis (aRR = 2.20), male sex (aRR = 1.54) and hepatitis B (aRR = 1.52). For NHL and colorectal cancer, history of cancer (aRR = 7.05 and 9.80, respectively) was the most significant risk factor. For KS, two or more ADOIs (aRR = 6.78) was the largest risk factor. Conclusions Over 8% of HIV-infected dialysis patients developed a malignancy. History of cancer and ADOIs were major risk factors, underscoring the significance of immune dysregulation in malignancy development.

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Pregnancy-associated thrombosis

Hematology ◽

10.1182/asheducation-2009.1.277 ◽

2009 ◽

Vol 2009 (1) ◽

pp. 277-285 ◽

Cited By ~ 69

Author(s):

Andra H. James

Keyword(s):

Risk Factors ◽

Postpartum Period ◽

Case Series ◽

Bleeding Complications ◽

Pregnancy And Childbirth ◽

Risk Of Bleeding ◽

Increased Risk ◽

History Of ◽

Poor Pregnancy Outcome ◽

In Pregnancy

Abstract The main reason for the increased risk of thromboembolism in pregnancy is hypercoagulability, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth. Women are at a 4- to 5-fold increased risk of thromboembolism during pregnancy and the postpartum period compared with when they are not pregnant. Eighty percent of the thromboembolic events in pregnancy are venous, with an incidence of 0.49 to 1.72 per 1000 pregnancies. Risk factors include a history of thrombosis, inherited and acquired thrombophilia, maternal age greater than 35, certain medical conditions, and various complications of pregnancy and childbirth. Despite the increased risk of venous thromboembolism (VTE) during pregnancy and the postpartum period, most women do not require anticoagulation. Candidates include women with current VTE, a history of VTE, thrombophilia and a history of poor pregnancy outcome, or risk factors for postpartum VTE. The intensity of the anticoagulation will depend on the indication and the monitoring will depend on the intensity. At the time of delivery, anticoagulation should be manipulated to reduce the risk of bleeding complications while minimizing the risk of thrombosis. There are no large trials of anticoagulants in pregnancy, and recommendations are based on case series, extrapolations from nonpregnant patients and the opinion of experts. Nonetheless, anticoagulants are believed to improve the outcome of pregnancy for women who have, or have had, VTE.

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