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

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.

Download Full-text

Childhood trauma and being at-risk for psychosis are associated with higher peripheral endocannabinoids

Psychological Medicine ◽

10.1017/s0033291719001946 ◽

2019 ◽

Vol 50 (11) ◽

pp. 1862-1871 ◽

Cited By ~ 2

Author(s):

E. Appiah-Kusi ◽

R. Wilson ◽

M. Colizzi ◽

E. Foglia ◽

E. Klamerus ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Childhood Trauma ◽

Childhood Maltreatment ◽

Peripheral Blood ◽

Endocannabinoid System ◽

History Of Childhood ◽

Increased Risk ◽

History Of

AbstractBackgroundEvidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels.MethodWe compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels.ResultsIndividuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma.ConclusionsOur results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.

Download Full-text

Risk factors for childhood and adult primary brain tumors

Neuro-Oncology ◽

10.1093/neuonc/noz123 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1357-1375 ◽

Cited By ~ 15

Author(s):

Quinn T Ostrom ◽

Maral Adel Fahmideh ◽

David J Cote ◽

Ivo S Muskens ◽

Jeremy M Schraw ◽

...

Keyword(s):

Risk Factors ◽

Ionizing Radiation ◽

Brain Tumors ◽

The United States ◽

Primary Brain Tumors ◽

Clinical Databases ◽

Increased Risk ◽

History Of ◽

Adults And Children ◽

Race Ethnicity

Abstract Primary brain tumors account for ~1% of new cancer cases and ~2% of cancer deaths in the United States; however, they are the most commonly occurring solid tumors in children. These tumors are very heterogeneous and can be broadly classified into malignant and benign (or non-malignant), and specific histologies vary in frequency by age, sex, and race/ethnicity. Epidemiological studies have explored numerous potential risk factors, and thus far the only validated associations for brain tumors are ionizing radiation (which increases risk in both adults and children) and history of allergies (which decreases risk in adults). Studies of genetic risk factors have identified 32 germline variants associated with increased risk for these tumors in adults (25 in glioma, 2 in meningioma, 3 in pituitary adenoma, and 2 in primary CNS lymphoma), and further studies are currently under way for other histologic subtypes, as well as for various childhood brain tumors. While identifying risk factors for these tumors is difficult due to their rarity, many existing datasets can be leveraged for future discoveries in multi-institutional collaborations. Many institutions are continuing to develop large clinical databases including pre-diagnostic risk factor data, and developments in molecular characterization of tumor subtypes continue to allow for investigation of more refined phenotypes. Key Point 1. Brain tumors are a heterogeneous group of tumors that vary significantly in incidence by age, sex, and race/ethnicity.2. The only well-validated risk factors for brain tumors are ionizing radiation (which increases risk in adults and children) and history of allergies (which decreases risk).3. Genome-wide association studies have identified 32 histology-specific inherited genetic variants associated with increased risk of these tumors.

Download Full-text

Incidence of and Risk Factors for Glenohumeral Osteoarthritis After Anterior Shoulder Instability: A US Population–Based Study With Average 15-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120962515 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096251

Author(s):

Bradley M. Kruckeberg ◽

Devin P. Leland ◽

Christopher D. Bernard ◽

Aaron J. Krych ◽

Diane L. Dahm ◽

...

Keyword(s):

Risk Factors ◽

Shoulder Instability ◽

The United States ◽

Anterior Shoulder Instability ◽

Geographic Population ◽

Increased Risk ◽

Modifiable Factors ◽

History Of ◽

Former Smokers

Background: The rate of osteoarthritis (OA) in patients with a history of previous anterior shoulder instability (ASI) varies within the literature, with the majority of studies investigating rates after surgical stabilization. ASI appears to lead to increased rates of OA, although risk factors for developing OA in cohorts treated nonoperatively and operatively are not well-defined. Purpose: To determine the incidence of clinically symptomatic OA and identify potential risk factors for the development of OA in patients younger than 40 years with a known history of ASI. Study Design: Case-control study; Level of evidence, 3. Methods: An established, geographically based database was used to identify patients in the United States who were younger than 40 years and were diagnosed with ASI between 1994 and 2014. Patient information, including demographic, imaging, and surgical details, was collected. Comparative analysis was performed between groups with and without OA at final follow-up as well as between patients who underwent surgical and nonsurgical management. Results: The study population consisted of 154 patients with a mean follow-up of 15.2 years (range, 5.1-29.8 years). The mean age at initial instability event was 20.9 years (95% CI, 19.9-22.0 years). Overall, 22.7% of patients developed clinically symptomatic glenohumeral OA. Multivariate analysis revealed that current or former smokers (odds ratio [OR], 4.3; 95% CI, 1.1-16.5; P = .030), hyperlaxity (OR, 10.1; 95% CI, 1.4-72.4; P = .020), laborer occupation (OR, 6.1; 95% CI, 1.02-36.1; P = .043), body mass index (BMI) (OR, 1.2; 95% CI, 1.03-1.3; P = .012), and age at initial instability (OR, 1.1; 95% CI, 1.02-1.2; P = .013) as potential independent risk factors when accounting for other demographic and clinical variables. Conclusion: In a US geographic population of patients younger than 40 years with ASI, approximately one-fourth of patients developed symptomatic OA at a mean follow-up of 15 years from their first instability event. When accounting for differences in patient demographic and clinical data, we noted a potentially increased risk for the development of OA in patients who are current or former smokers, have hyperlaxity, are laborers, have higher BMI, and have increased age at initial instability event. Smoking status, occupation, and BMI are modifiable factors that could potentially decrease risk for the development of symptomatic OA in these patients.

Download Full-text

Risk of colonic adenoma in patients with non–colorectal cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e13070 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e13070-e13070

Author(s):

Hamzah Abu-Sbeih ◽

Faisal Ali ◽

Wei Qiao ◽

Phillip Lum ◽

Mehnaz Shafi ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

The United States ◽

Personal History ◽

Control Group ◽

Colonic Adenoma ◽

Crc Screening ◽

Adenoma Detection ◽

Increased Risk ◽

History Of

e13070 Background: In the last two decades, the incidence of colorectal cancer (CRC) has decreased dramatically after the implementation of CRC screening in the United States. Several risk factors for colonic adenoma (CA), the main precursor for CRC, have been found. Whether personal history of non-colorectal cancer (NCRC) is a risk factor for CA has not been studied. Here, we assess the risk of CA in patients with NCRCs. Methods: We conducted a retrospective study of cancer patients who underwent colonoscopy after cancer diagnosis between 2009 and 2018. We included patients without history of NCRC as a control group. Multivariate logistic regression was used to assess independent risk factors for CA (Table 1). Results: Total of 9408 patients with NCRC were included; CA was detected in 4503 (48%). Histology revealed tubulovillous features in 611 (14%) patients and villous in 51 (1%). High grade dysplasia was detected in 1,317 (29%) patients and adenocarcinoma in 388 (9%). The rate of adenocarcinoma was the highest in patients with multiple myeloma (14%). Adenoma detection rate (ADR) was 30% in patients younger than 40 years ( n= 1621), 32% in patients between 40 and 50 years ( n= 812), 47% in patients between 50 and 60 years ( n= 2892), and 55% in patients older than 60 years ( n= 4493). Multivariate analysis revealed an increased risk of CA with old age, male sex, family history of CRC, and high body mass index ( P< 0.05). The median time from NCRC diagnosis to CA detection was 3 years (IQR 1-8). Conclusions: ADR in patients with a personal history of NCRC is higher than the ADR of patients without NCRC. CRC screening should be performed after the diagnosis of NCRC is made, even if it was before the standard threshold of CRC screening age of 50 years.[Table: see text]

Download Full-text

Stroke Risk in Blood or Marrow Transplant (BMT) Survivors - a Report from the BMT Survivor Study (BMTSS)

Blood ◽

10.1182/blood-2019-124564 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3298-3298

Author(s):

Radhika Gangaraju ◽

Yanjun Chen ◽

Lindsey Hageman ◽

Jessica Wu ◽

Wendy Landier ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Stroke Risk ◽

Comparison Group ◽

Lymphoblastic Leukemia ◽

Late Complication ◽

Primary Cancer ◽

Allogeneic Bmt ◽

Increased Risk ◽

History Of

BACKGROUND: BMT recipients are vulnerable to accelerated atherosclerosis due to prior exposure to radiation with or without chemotherapy, and consequent long-term cardiovascular morbidity, such as stroke. A comprehensive evaluation of the risk of late-occurring stroke in adult BMT survivors and the associated risk factors has not been performed. We addressed this gap using the resources offered by the BMTSS. METHODS: BMTSS includes patients transplanted between 1974 and 2014 at 3 US sites who survived ≥2y after BMT, were alive and ≥18y at BMTSS survey completion. The survey asked participants to report if a healthcare provider had diagnosed specific chronic health conditions (including stroke), or relapse of primary cancer or development of new cancer, along with age at diagnosis. The participants provided information on sociodemographics, health behaviors and medication use. Medical record abstraction was used for information regarding primary cancer diagnosis, therapeutic exposures (pre-BMT chemotherapy/radiation, transplant preparative regimens), stem cell source (autologous, allogeneic), graft type (bone marrow, cord blood or peripheral blood stem cells), and history of chronic graft vs. host disease (GvHD). A cohort of 908 siblings also completed the BMTSS survey and served as a comparison group. Informed consent was obtained from all participants. RESULTS: The study included 3,479 BMT survivors; 50.3% had received an allogeneic BMT, 54.8% were males; 71.4% were non-Hispanic whites. Median age at study participation was 59y (range: 18-89y) for BMT survivors and 57y (range: 18-90y) for siblings. Patient characteristics are shown in Table 1. BMT survivors were followed for a median of 9y (range: 2-41 y) from BMT. Stroke was reported by 136 BMT survivors (67 allogeneic, 69 autologous); of these, 75 (55%) patients developed stroke ≥2y after BMT. Conditional on surviving ≥2y after BMT, the 10y cumulative incidence of stroke was 3.8% (Fig 1), and was comparable for allogeneic (3.4±0.5%) and autologous (4.2±0.6%) BMT recipients, p=0.3. Stroke in BMT recipients compared with siblings: Using logistic regression, and after adjusting for sociodemographics, physical activity and relevant comorbidities, we found that allogeneic BMT survivors were at a 2.1-fold higher odds of reporting stroke as compared to siblings (95%CI: 1.2-3.7, p=0.01), and autologous BMT recipients were at a 1.7-fold higher odds of reporting stroke compared to siblings (95%CI: 0.9-3.0, p=0.09). Stroke after Allogeneic BMT: History of hypertension (HR=2.2, 95%CI: 1.2-3.9, p=0.007), venous thromboembolism (HR=3.4, 95%CI: 1.6-7.1, p=0.002), diagnosis of acute lymphoblastic leukemia (HR=4.9, 95%CI: 1.6-15.0, p=0.006), acute myeloid leukemia/ myelodysplastic syndrome (HR=5.2, 95%CI: 1.4-19.0, p=0.013) (ref: non Hodgkin lymphoma), pre-BMT exposure to alkylating agents (HR=3.3, 95%CI: 1.3-8.5, p=0.01) and pre-BMT neck radiation (HR=5.4, 95%CI: 1.2-23.8, p=0.03) were associated with increased stroke risk. Exercise was associated with lower stroke risk (HR: 0.5, 95%CI: 0.3-0.9, p=0.01). Stroke after Autologous BMT: The risk factors for stroke in autologous BMT survivors included: increasing age at BMT (HR=1.02/y, 95%CI: 1.0-1.1, p=0.05), history of hypertension (HR=1.8, 95%CI: 1.1-3.2, p=0.03), coronary heart disease (HR=2.8, 95%CI: 1.3-6.4, p=0.01) and venous thromboembolism (HR=2.3, 95%CI: 1.1-4.7, p=0.02). Relapse of primary disease or development of new cancer were not associated with increased stroke risk in either autologous or allogeneic BMT recipients. CONCLUSION: In this large study, we found that the incidence of stroke was 4% among BMT survivors, and that they are at an increased risk of developing stroke when compared to an unaffected comparison group. The study also identified subgroups among BMT survivors at increased risk of stroke such as those who received neck radiation and those with cardiovascular comorbidity. These findings suggest a need for increased awareness of stroke as a late complication of BMT, such that aggressive management of cardiovascular risk factors can be instituted among those at highest risk. Disclosures Weisdorf: Incyte: Research Funding; Fate Therapeutics: Consultancy; Pharmacyclics: Consultancy.

Download Full-text

P126 EPIDEMIOLOGY AND RISK FACTORS OF BREAST CANCER IN INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES BETWEEN 2014 AND 2019: A POPULATION-BASED STUDY

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.056 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S24-S25

Author(s):

Emad Mansoor ◽

Mohannad Abou-Saleh ◽

Muhammad Talal Sarmini ◽

Vijit Chouhan ◽

Miguel Regueiro ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Tobacco Use ◽

Ileoanal Anastomosis ◽

Malignant Neoplasm ◽

The United States ◽

Intestinal Surgery ◽

Electronic Health Record Data ◽

Increased Risk ◽

History Of

Abstract Background The risk of extra-colonic cancer in IBD is unclear. While thiopurines and tumour necrosis factor-α antagonists (anti-TNFs) are associated with increased risk of skin cancer and lymphoma in IBD, there is scant data on breast cancer in IBD. We evaluated the prevalence of breast cancer in IBD and investigated the role of biologics, immunomodulators, and clinical characteristics of IBD in patients with IBD and breast cancer. Methods We queried a commercial database (Explorys Inc), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 1999 to 2019. We identified a cohort of eligible patients with a diagnosis of “Crohn’s disease” (CD) and “Ulcerative Colitis” (UC) between June 2014 and 2019, based on Systemized Nomenclature Of Medicine – Clinical Terms. We calculated the prevalence of “primary malignant neoplasm of breast” in IBD overall, and among different sub-groups and identified risk factors for breast cancer in IBD utilizing linear regression. Results Of the 35,521,930 individuals in the database from October 2014–2019, we identified 165,750 and 140,640 individuals with a diagnosis of CD and UC with an overall prevalence rate of 0.47% and 0.4% respectively. Out of these, 3,160 individuals with CD and 3,340 individuals with UC had a co-diagnosis of breast cancer. The prevalence of breast cancer in individuals without IBD was 1.1%. Compared to individuals with breast cancer without IBD, the prevalence of breast cancer in CD was increased at 1.9% [OR: 1.79, 95% CI: 1.73–1.85, p<0.0001] and in UC was 2.3% [OR: 2.24, 95% CI: 2.17–2.32, p<0.0001]. Compared to individuals with IBD and no malignancy, individuals with IBD and breast cancer were predominantly females, elderly (>65yo), Caucasians, had history of tobacco use and appendectomy (Table 1). Anti-TNFs and vedolizumab were associated with increased risk of breast cancer in CD (ORs 1.82 and 1.38) but not in UC. Azathioprine was associated with increased risk of breast cancer in both CD and UC (ORs 1.9 and 1.29). For UC, history of colectomy was associated with an increased risk of breast cancer with OR 1.51. For CD, history of total abdominal colectomy (TAC) with ileostomy or with ileoanal anastomosis, partial resection of the colon and small intestinal surgery were all associated increased risk of breast cancer. However, fistulizing disease, peri-anal disease, and incision and drainage of perineal or perirectal abscess were not associated with increased risk of breast cancer (Table 1). Conclusion We found a two-fold higher prevalence of breast cancer in patients with IBD compared to individuals without IBD. We identified tobacco use, appendectomy and surrogate markers of luminal inflammation (use of immunomodulators, biologic agents and history of intestinal surgery) to increase risk of breast cancer. Further prospective studies are needed to confirm these findings which have implications on agressive screening of breast cancer in females with IBD.

Download Full-text

Identification of Medical Patients Who Should Receive Venous Thromboembolism Prophylaxis.

Blood ◽

10.1182/blood.v104.11.1786.1786 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1786-1786

Author(s):

Alexander T. Cohen ◽

Raza Alikhan ◽

Juan I. Arcelus ◽

Jean-François Bergmann ◽

Sylvia Haas ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Respiratory Disease ◽

Strong Evidence ◽

Medical Patient ◽

Evidence Based ◽

Medical Patients ◽

Related Factors ◽

Vte Prophylaxis ◽

History Of

Abstract Introduction Despite various medical illnesses/conditions and patient-related factors known to increase venous thromboembolism (VTE) risk in medical patients, there is no worldwide consensus regarding which of these patients should receive VTE prophylaxis. As a result, many medical patients remain at risk from this potentially fatal disease. Our objective was to develop a simple risk assessment model (RAM) that could be used at the bedside to identify medical patients who should receive prophylaxis. Methods Acute medical illnesses/conditions and risk factors were included in the RAM if there was strong evidence from prospective clinical studies to show that they significantly increase VTE risk in medical patients, or VTE prophylaxis was beneficial in these cases. If strong evidence was not available, the illness/condition or factor was only included if there was consensus from the authors that VTE prophylaxis is beneficial for these patients. Results Table 1 shows acute medical illnesses/conditions and factors associated with significant VTE risk that are included in the RAM. If a medical patient is >40 years old with an acute medical illness and reduced mobility and has one of the illnesses/conditions or factors shown in Table 1, the RAM recommends prophylaxis with low-molecular-weight heparin (LMWH: enoxaparin 40 mg o.d. or dalteparin 5000 IU o.d.) or unfractionated heparin (5000 IU q8h). LMWH is preferred due to a better safety profile. If pharmacologic prophylaxis is contraindicated, mechanical prophylaxis is recommended. Conclusion Acute medical illnesses/conditions and patient-related factors that increase the risk for VTE in medical patients have been identified and used to develop a novel RAM. The RAM is evidence-based wherever possible, and can be easily revised as new evidence becomes available. The RAM is simple in design, and can assist physicians to assess whether VTE prophylaxis is warranted in an individual medical patient. Table 1. Factors that increase the risk of VTE in medical patients Acute medical illnesses/conditions Risk factors *Note: The risk of hemorrhagic transformation should be assessed before giving VTE prophylaxis. Evidence-based: Acute MI, acute heart failure (NYHA III/IV), active cancer requiring therapy, severe infection/sepsis, respiratory disease (respiratory failure with/without mechanical ventilation, exacerbation of chronic respiratory disease), rheumatic disease (including acute arthritis of lower extremities, and vertebral compression), ischemic stroke*, paraplegia Consensus view only: Inflammatory disorder with immobility, inflammatory bowel disease Evidence-based: History of VTE, history of malignancy, concurrent acute infectious disease, age >75 years Consensus-based from strong evidence in other settings: Prolonged immobility, age >60 years, varicose veins, obesity, hormone therapy, pregnancy/postpartum, nephrotic syndrome, dehydration, thrombophilia, thrombocytosis

Download Full-text

Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women

Thrombosis and Haemostasis ◽

10.1160/th07-05-0329 ◽

2007 ◽

Vol 98 (12) ◽

pp. 1237-1245 ◽

Cited By ~ 66

Author(s):

Joachim Dudenhausen ◽

Andree Faridi ◽

Thorsten Fischer ◽

Samson Fung ◽

Ulrich Geisen ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Pregnant Women ◽

Management Strategies ◽

Prospective Trial ◽

High Risk Group ◽

Group I ◽

Increased Risk ◽

History Of ◽

Heparin Prophylaxis

SummaryWomen with a history of venous thromboembolism (VTE), thrombophilia or both may be at increased risk of thrombosis during pregnancy, but the optimal management strategy is not well defined in clinical guidelines because of limited trial data. A strategy of risk assessment and heparin prophylaxis was evaluated in pregnant women at increased risk of VTE. In a prospective trial (Efficacy of Thromboprophylaxis as an Intervention during Gravidity [EThIG]), 810 pregnant women were assigned to one of three management strategies according to pre-defined risk factors related to history of VTE and thrombophilic profile. Low-risk women (group I), received 50–100 IU dalteparin/ kg body weight/ day for 14 days postpartum, or earlier when additional risk factors occurred. Women at high (group II) or very high risk (group III) received dalteparin from enrolment until six weeks postpartum (50–100 IU and 100–200 IU/ kg/ day, respectively). Objectively confirmed, symptomatic VTE occurred in 5/810 women (0.6%; 95% confidence interval [CI], 0.2 to 1.5%) (group I, 0 of 225; II, 3/469; III, 2/116). The rate of serious bleeding was 3.0% (95 % CI, 1.9 to 4.4%); 1.1% (95 % CI, 0.5 to 2.2%) was possibly dalteparin-related. There was no evidence of heparin- induced thrombocytopenia, one case of osteoporosis, and rates of miscarriage and stillbirth were similar to previous, retrospective studies. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic VTE and few clinically important adverse events. Antepartum heparin prophylaxis is, therefore, warranted in pregnant women with idiopathic thrombosis or symptomatic thrombophilia.

Download Full-text

Foot Pathology and Inappropriate Footwear as Risk Factors for Falls in a Subacute Aged-Care Hospital

Journal of the American Podiatric Medical Association ◽

10.7547/0970213 ◽

2007 ◽

Vol 97 (3) ◽

pp. 213-217 ◽

Cited By ~ 15

Author(s):

Rebecca L. Jessup

Keyword(s):

Risk Factors ◽

Hospital Setting ◽

Clinical Problem ◽

Aged Care ◽

Care Hospital ◽

Increased Risk ◽

Risk Of Falls ◽

History Of ◽

Risk Factors For Falls ◽

Hospital Wards

Background: Falls are a major clinical problem in the hospital setting. This study examined the prevalence of foot pathology and footwear type likely to increase the risk of falls in two subacute-care hospital wards serving elderly patients. Methods: Two wards of a subacute aged-care hospital were selected for study. Patients were assessed for the presence of foot pathology, and their footwear was evaluated for characteristics identified in the literature as placing individuals at increased risk of falls. Results: Of 44 patients assessed, 98% had foot pathology, and 41% had foot pathology requiring podiatric medical management. Eighty-six percent of inpatients wore footwear that was likely to increase their risk of falls, with 66% wearing slippers or moccasins. Conclusions: The results of this study demonstrate the need for hospital inpatients who are identified as being at high risk for falling, or have a history of falls, to undergo an assessment of their foot pathology and footwear so that appropriate measures can be taken to address these risk factors. (J Am Podiatr Med Assoc 97(3): 213–217, 2007)

Download Full-text

Risk factors for venous thromboembolism and prophylaxis in medical inpatients: data from the FADOI ‘‘GEMINI’’ study

Italian Journal of Medicine ◽

10.4081/itjm.2010.23 ◽

2013 ◽

pp. 23-31

Author(s):

Mauro Campanini ◽

Gualberto Gussoni ◽

Mauro Silingardi ◽

Gianluigi Scannapieco ◽

Carlo Buniolo ◽

...

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

Venous Thromboembolism ◽

Bed Rest ◽

Common Finding ◽

Primary Study ◽

Medical Patients ◽

Increased Risk ◽

Medical Inpatients ◽

The Impact

Background: Though venous thromboembolism (VTE) frequently occurs in non-surgical setting, epidemiology and risk factors for VTE in unselected medical inpatients have not been extensively studied, and uncertainties remain about the prophylactic strategy in these patients. Materials and methods: In a prospective, observational, multicenter study we aimed to contemporarily assess the epidemiology of symptomatic VTE in consecutive patients hospitalized in Internal Medicine, to evaluate the impact of potential risk factors, and the attitude of internists towards thromboprophylaxis. A total of 4,846 patients were included, during the period March-September 2006. Results: Symptomatic VTE was registered in 177 (3.65%) patients; of these, 26 cases (0.55%) occurred with onset of symptoms > 48 hours after admission (‘‘hospital-acquired’’ events, primary study end-point). Previous VTE and bed resting were significantly associated with venous thromboembolism, while a trend for increased risk was documented in cancer patients. During hospital stay antithrombotic prophylaxis was globally administered in 41.6% of patients, and in 58.4% of those for which prophylaxis was recommended according to 2004 guidelines by the American College of Chest Physicians. The choice of administering tromboprophylaxis appeared qualitatively adherent to indications from randomized trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Conclusions: Data from our real-world study confirm that VTE is a quite common finding in patients admitted to Internal Medicine departments, and recommended tromboprophylaxis is still underused, in particular in some patients groups. Further efforts are needed to better define the risk profile and to optimize prophylaxis in the heterogeneous setting of medical patients.

Download Full-text