scholarly journals Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival

Blood ◽  
2009 ◽  
Vol 113 (17) ◽  
pp. 3911-3917 ◽  
Author(s):  
Grace H. Ku ◽  
Richard H. White ◽  
Helen K. Chew ◽  
Danielle J. Harvey ◽  
Hong Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Acute Leukemia ◽  
Lymphoblastic Leukemia ◽  
Venous Catheter ◽  
Population Based ◽  
Older Age ◽  
Myelogenous Leukemia ◽  
Vein Thrombosis ◽  
Chronic Comorbidities

Abstract A population-based cohort was used to determine the incidence and risk factors associated with development of venous thromboembolism (VTE) among Californians diagnosed with acute leukemia between 1993 to 1999. Principal outcomes were deep vein thrombosis in both the lower and upper extremities, pulmonary embolism, and mortality. Among 5394 cases with acute myelogenous leukemia (AML), the 2-year cumulative incidence of VTE was 281 (5.2%). Sixty-four percent of the VTE events occurred within 3 months of AML diagnosis. In AML patients, female sex, older age, number of chronic comorbidities, and presence of a catheter were significant predictors of development of VTE within 1 year. A diagnosis of VTE was not associated with reduced survival in AML patients. Among 2482 cases with acute lymphoblastic leukemia (ALL), the 2-year incidence of VTE in ALL was 4.5%. Risk factors for VTE were presence of a central venous catheter, older age, and number of chronic comorbidities. In the patients with ALL, development of VTE was associated with a 40% increase in the risk of dying within 1 year. The incidence of VTE in acute leukemia is appreciable, and is comparable with the incidence in many solid tumors.

scholarly journals Venous Thromboembolism and Its Risk Factors in Children with Acute Lymphoblastic Leukemia in Israel: A Population-Based Study

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2759
Author(s):  
Shlomit Barzilai-Birenboim ◽  
Ronit Nirel ◽  
Nira Arad-Cohen ◽  
Galia Avrahami ◽  
Miri Ben Harush ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Univariate Analysis ◽  
Population Based ◽  
Population Based Study ◽  
Inherited Thrombophilia ◽  
Severe Hypertriglyceridemia

Venous thromboembolism (VTE) is a serious complication of acute lymphoblastic leukemia (ALL) therapy. The aim of this population-based study was to evaluate the rate, risk factors, and long-term sequelae of VTE in children treated for ALL. The cohort included 1191 children aged 1–19 years diagnosed with ALL between 2003–2018, prospectively enrolled in two consecutive protocols: ALL-IC BFM 2002 and AIEOP-BFM ALL 2009. VTEs occurred in 89 patients (7.5%). Long-term sequelae were uncommon. By univariate analysis, we identified four significant risk factors for VTEs: Severe hypertriglyceridemia (p = 0.005), inherited thrombophilia (p < 0.001), age >10 years (p = 0.015), and high-risk ALL group (p = 0.039). In addition, the incidence of VTE was significantly higher in patients enrolled in AIEOP-BFM ALL 2009 than in those enrolled in ALL-IC BFM 2002 (p = 0.001). Severe VTE occurred in 24 children (2%), all of whom had at least one risk factor. Elevated triglyceride levels at diagnosis did not predict hypertriglyceridemia during therapy. In a multivariate analysis of 388 children, severe hypertriglyceridemia and inherited thrombophilia were independent risk factors for VTE. Routine evaluation for these risk factors in children treated for ALL may help identify candidates for intervention.

Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 584-584
Author(s):  
Frederick A. Spencer3 ◽  
Robert J. Goldberg ◽  
Darleen Lessard ◽  
Cathy Emery ◽  
Apar Bains ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Central Venous Catheter ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Venous Catheter ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

scholarly journals Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
C. J. MacDonald ◽  
A. L. Madika ◽  
M. Lajous ◽  
M. Canonico ◽  
A. Fournier ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Cardiovascular Risk ◽  
Venous Thromboembolism ◽  
Cardiovascular Risk Factors ◽  
Arterial Disease ◽  
Population Based ◽  
Cox Models ◽  
Vein Thrombosis

Abstract Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism.

Frequency, Risk Factors, and Outcomes of Vancomycin-Resistant Enterococcus Colonization and Infection in Patients with Newly Diagnosed Acute Leukemia: Different Patterns in Patients with Acute Myelogenous and Acute Lymphoblastic Leukemia

2015 ◽  
Vol 36 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Clyde D. Ford ◽  
Bert K. Lopansri ◽  
Souha Haydoura ◽  
Greg Snow ◽  
Kristin K. Dascomb ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Acute Myelogenous Leukemia ◽  
Molecular Typing ◽  
Lymphoblastic Leukemia ◽  
Myelogenous Leukemia ◽  
Newly Diagnosed ◽  
Acute Myelogenous ◽  
Vancomycin Resistant

OBJECTIVETo determine the frequency, risk factors, and outcomes for vancomycin-resistant Enterococcus (VRE) colonization and infection in patients with newly diagnosed acute leukemia.DESIGNRetrospective clinical study with VRE molecular strain typing.SETTINGA regional referral center for acute leukemia.PATIENTSTwo hundred fourteen consecutive patients with newly diagnosed acute leukemia between 2006 and 2012.METHODSAll patients had a culture of first stool and weekly surveillance for VRE. Clinical data were abstracted from the Intermountain Healthcare electronic data warehouse. VRE molecular typing was performed utilizing the semi-automated DiversiLab System.RESULTSThe rate of VRE colonization was directly proportional to length of stay and was higher in patients with acute lymphoblastic leukemia. Risk factors associated with colonization include administration of corticosteroids (P=0.004) and carbapenems (P=0.009). Neither a colonized prior room occupant nor an increased unit colonization pressure affected colonization risk. Colonized patients with acute myelogenous leukemia had an increased risk of VRE bloodstream infection (BSI, P=0.002). Other risk factors for VRE BSI include severe neutropenia (P=0.04) and diarrhea (P=0.008). Fifty-eight percent of BSI isolates were identical or related by molecular typing. Eighty-nine percent of bloodstream isolates were identical or related to stool isolates identified by surveillance cultures. VRE BSI was associated with increased costs (P=0.0003) and possibly mortality.CONCLUSIONSVRE colonization has important consequences for patients with acute myelogenous leukemia undergoing induction therapy. For febrile neutropenic patients with acute myelogenous leukemia, use of empirical antibiotic regimens that avoid carbapenems and include VRE coverage may be helpful in decreasing the risks associated with VRE BSI.Infect Control Hosp Epidemiol 2015;36(1): 47–53

The Epidemiology of Venous Thromboembolism in the Community

2001 ◽  
Vol 86 (07) ◽  
pp. 452-463 ◽  
Author(s):  
David Mohr ◽  
Tanya Petterson ◽  
Christine Lohse ◽  
W. Michael O’Fallon ◽  
L. Joseph Melton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Varicose Veins ◽  
Hormone Replacement ◽  
Malignant Neoplasm ◽  
Venous Catheter ◽  
The United States ◽  
Venous Stasis ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis

SummaryThe incidence of venous thromboembolism exceeds 1 per 1000; over 200,000 new cases occur in the United States annually. Of these, 30% die within 30 days; one-fifth suffer sudden death due to pulmonary embolism. Despite improved prophylaxis, the incidence of venous thromboembolism has been constant since 1980. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, central venous catheter/ transvenous pacemaker, prior superficial vein thrombosis, and varicose veins; among women, risk factors include pregnancy, oral contraceptives, and hormone replacement therapy. About 30% of surviving cases develop recurrent venous thromboembolism within ten years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm, and extremity paresis. About 28% of cases develop venous stasis syndrome within 20 years. To reduce venous thromboembolism incidence, improve survival, and prevent recurrence and complications, patients with these characteristics should receive appropriate prophylaxis.

scholarly journals Association Between Cardiovascular Risk-factors and Venous Thromboembolism in a Large Longitudinal Study of French Women

2021 ◽  
Author(s):  
Conor MACDONALD ◽  
AL Madika ◽  
Martin Lajous ◽  
M Canonico ◽  
Agnes Fournier ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Cardiovascular Risk ◽  
Venous Thromboembolism ◽  
Cardiovascular Risk Factors ◽  
Arterial Disease ◽  
Population Based ◽  
Cox Models ◽  
Vein Thrombosis

Abstract Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1,000 PY. This included 505 cases of pulmonary embolism and 1,144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism. Hypertension, dyslipidaemia and diabetes should not be considered risk-factors for venous thromboembolism.

The Development Of Venous Thromboembolism May Increase The Risk Of Osteonecrosis In Children With Acute Lymphoblastic Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3864-3864
Author(s):  
Badhiwala H. Jetan ◽  
Trishana Nayiager ◽  
Uma H. Athale
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Venous Thromboembolism ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Older Age ◽  
Regression Analyses ◽  
Female Ratio ◽  
Increased Risk ◽  
The Impact

Abstract Background Osteonecrosis (ON) is a severely disabling complication of anti-leukemic therapy, specifically long-term corticosteroid use. A hypercoagulable state is thought to underlie corticosteroid-related ON. Children with acute lymphoblastic leukemia (ALL) are also at increased risk of venous thromboembolism (VTE), indicating underlying hypercoagulability in this disease entity. Hence, we explored the relationship between ON and VTE, along with the association of ON with other variables, including age and asparaginase (ASP) therapy, in children with ALL. Methods Health records of children (< 18 yrs.) with de novo ALL treated at McMaster Children’s Hospital from 1992 to 2010 were reviewed. Patients were treated according to Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocols. Data regarding demographics, leukemia diagnosis and therapy, development and characteristics of ON and VTE, and thrombophilia work-up, if any, were collected from computer records and chart review. Osteonecrosis was diagnosed by plain X-ray, computed tomography (CT), magnetic resonance (MR) imaging, and/or technetium-99m (99mTc) bone scan. We included ON diagnosed during therapy and/or at any point during post-treatment follow-up. Standard radiological measures, including venous Doppler ultrasound and/or venography (conventional, CT, MR), confirmed VTE. We included only clinically significant thromboembolic events, defined as symptomatic VTE, or asymptomatic VTE requiring anticoagulation, developing during ALL therapy. Logistic regression analyses were performed to identify possible predictors of ON. Odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values were determined. Results Mean age of the study cohort (n = 208) was 5.4 years and male/female ratio 1.2:1. Seventy-eight (37.5%) patients had high-risk (HR) ALL and 127 (61.1%) received dexamethasone (DEX) as post-induction steroid. One hundred and sixty-two (77.9%) patients received E. coli ASP, 19 (9.1%) Erwinia ASP, and 27 (13.0%) PEG ASP. Twenty-one (10.1%) children developed ON. Joints affected by ON included the ankle in 11 subjects, knee in 10, hip in 8, and heel in one. Fourteen of the 21 patients (66.7%) had involvement of more than one joint. All patients were diagnosed with ON during ALL treatment, with the average being 69.2 weeks following ALL diagnosis. Forty-two (20.2%) subjects had a VTE while receiving therapy at an average of 29.4 weeks after ALL diagnosis. Nine patients had cerebral sinovenous thrombosis, 7 deep vein thrombosis (DVT), and one pulmonary embolism (PE). Twenty-six patients developed a central venous line (CVL)-related VTE. Results of univariate logistic regression analyses for osteonecrosis are presented in Table 1. VTE strongly predicted development of ON – OR 8.85 (95% CI 3.37–23.25, p< 0.001). Thirteen (31.0%) patients with VTE developed ON compared to 8 (4.8%) of 166 subjects without VTE. In 10 of 13 (76.9%) patients who developed both VTE and ON, the diagnosis of VTE preceded that of ON. Given that older age is a known risk factor for both VTE and ON, we conducted a multivariate analysis, which confirmed that age, ASP type, and VTE were independent, significant risk factors for ON (Table 2). Conclusion In addition to the known impact of older age, we identified VTE and type of ASP as independent risk factors for ON in children with ALL. These observations suggest overlap in the etiopathogenesis of ON and VTE. We recommend larger, prospective studies to confirm the association of VTE and PEG ASP with ON and to assess the impact of hypercoagulability on the development of ON. This in turn may help develop preventive strategies (e.g., thromboprophylaxis) for ALL-associated ON. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Hospital Associated Venous Thromboembolism in Oklahoma County

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 416-416 ◽  
Author(s):  
Natalie Feland ◽  
Aaron Mark Wendelboe ◽  
Micah Denay McCumber ◽  
Kai Ding ◽  
Dale Bratzler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Hospital Stay ◽  
Significant Proportion ◽  
Population Based ◽  
Adverse Outcomes ◽  
Vein Thrombosis ◽  
University Of Oklahoma ◽  
Superficial Vein Thrombosis ◽  
Risk Factor Data

Abstract Introduction: Venous thromboembolism (VTE) is a leading cause of death and disability of the adverse outcomes associated with a hospital stay among low, middle, and high income countries evaluated by the WHO Patient Safety Program. Objective: Compare characteristics and risk factors for hospital associated and non-hospital associated cases of VTE in Oklahoma County from April 1, 2012 to March 31, 2014. Methods: In collaboration with the Centers for Disease Control and Prevention (CDC), a population-based surveillance system for VTE was established in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Hospital associated VTE is defined as a VTE diagnosis made either during the hospital stay or within 90 days of hospital admission, regardless of the reason for hospitalization. Odds ratios and 95% confidence intervals (CI) were calculated. Those age 80+ years were used as the referent age group. Comparisons between hospital associated and non-hospital associated VTE cases were made by using two-sided χ2tests. Results: We identified 2,737 patients with imaging-confirmed VTE. Of these, 1,223 (44.7%) cases were identified as hospital associated and 1,514 (55.3%) cases as non-hospital associated VTE. Of the hospital associated VTE cases, 863 (70.6%) had VTE diagnosed while hospitalized and 360 (29.4%) were diagnosed VTE as outpatients after hospital discharge; of these 360 cases, 239 (66.4%) were re-admitted to the hospital and 121 (33.6%) were managed as outpatients. Of the non-hospital associated VTE cases, 776 (51.3%) were admitted to the hospital after diagnosis and 738 (48.7%) were treated as outpatients. The median length of stay for hospital-associated cases was 8 days (range 1-206 days). The distribution of PE (p = 0.17) and DVT (p = 0.07) were similar in hospital associated cases and non-hospital associated cases. The distributions of race (p = 0.34) and sex (p = 0.17) were similar for patients with and without hospital associated VTE; however, hospital associated cases of VTE tended to be older than non-hospital associated cases (p<0.01; 18-39 years OR = 1.7, 95% CI 1.2-2.2, 40-49 years OR = 1.8, 95% CI 1.3-2.4, 50-59 years OR = 1.3, 95% CI 1.0-1.7, 60-69 years OR = 1.1, 95% CI 0.84-1.4, 70-79 years OR = 1.2, 95% CI 0.91-1.5). Venous catheterization in the last 6 months (OR= 4.4, 95% CI 3.4-5.7), surgery (OR = 3.4, 95% CI 2.8-4.0) and trauma (OR = 3.0, 95% CI 2.3-3.9) in the last 12 months, and histories of: congestive heart failure (OR = 2.6, 95% CI 2.0-3.3), stroke (OR = 2.6, 95% CI 1.9-3.6), myocardial infarction (OR = 2.2, 95% CI 1.6-3.1), superficial vein thrombosis (OR = 1.8, 95% CI 1.3-2.5), and cancer (OR = 1.5, 95% CI 1.3-1.8) were risk factors for hospital associated cases of VTE. Hospital associated VTE cases had 3.5 times the odds of death (95% CI 2.4-5.0) than non-hospital associated cases. Discussion: A significant proportion (45%) of the total VTE burden continues to be hospital associated. A substantial proportion of hospital associated cases are diagnosed after discharge and result in re-admission, with the potential for significant financial penalties under Medicare value-based payment programs. Hospital associated cases of VTE were older, had more risk factors, and were more likely to die than non-hospital associated cases. Disclosures Raskob: Bayer Healthcare: Consultancy; BMS: Consultancy; Daiichi Sankyo: Consultancy; Janssen Pharmaceuticals: Consultancy; Pfizer: Consultancy; ISIS Pharmaceuticals: Consultancy.

High Incidence of Venous Thromboembolism in Patients with Lymphoma Receiving Chemotherapy: Assessment of Risk Factors.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4103-4103
Author(s):  
Shyam Teegala ◽  
Xiao Zhou ◽  
Auris Huen ◽  
Yuan Ji ◽  
Luis Fayad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Multivariate Logistic Regression Analysis ◽  
Venous Catheter ◽  
Large Cell ◽  
Cycle Number ◽  
Vein Thrombosis ◽  
Significant Independent Risk Factor ◽  
Increased Risk ◽  
Risk Patients

Abstract Background: Venous thromboembolism (VTE) is a significant cause of cancer morbidity and mortality. Lymphoma patients (pts) are at increased risk of VTE, however, the exact incidence and risk factors are unknown. Methods: Of the 1050 newly referred Lymphoma pts to MDACC in 2003 identified, medical records (MR) of 538 consecutive pts were reviewed for demographics, tumor histology, staging, laboratory values, type of chemotherapy (CT) regimens, risk factors for VTE, incidence of VTE and management over a follow up of 2 years. Results: 207 out of 538 pts received at least one cycle of CT at MDACC (total CT cycles 1125). The median age was 56 years (range 17–82); there were 81 females and 126 males. Majority of pts (61.8%) were newly diagnosed and the most common histologies were Large Cell Lymphoma (31.88%), followed by Hodgkin’s Disease (16.9%) and Follicular Lymphoma (14.98%). Thirteen out of 207 (6.28%) pts had history of VTE prior to CT and 37 (17.9 %) pts out of 207 had 41 new episodes of VTE; 29 Deep Vein Thrombosis (DVT) (12 upper and 12 lower extremity) and 12 Pulmonary Embolism (PE); 2 pts had both DVT and PE. All VTE episodes were confirmed by imaging except in 3 pts. The mean baseline hemoglobin (Hb) in VTE pts was 12.8 g/dL. The median cycle number for VTE occurrence was cycle 3 with 24/37 (64.86%) pts experiencing VTE by cycle 3 and 6/37 (16.2%) pts had VTE in cycle 1. Two out of the 37 (5.4%) pts had recurrent VTE. Among those with new VTE, 31/37 (83.78%) pts were of age greater than 40, 25/37 (67.56%) pts had BMI &gt; 25, 32/37 (86.4%) pts had aggressive or highly aggressive histology and 29/37 (78.37%) pts had stage 3 or 4 disease. Twenty-three out of 31 (74.2%) pts had received erythropoietin before or during the cycle of VTE. Fourteen of 207 (6.79%) pts were on thromboprophylaxis before the chemotherapy. Only 1 of these 14 pts experienced VTE, approximately 2 months after the discontinuation of prophylaxis. Central venous catheter (CVC) thrombosis occurred in 6/174 (3.44%) patients with CVC. The most common systemic treatment for VTE was Enoxaparin (12/33). By multivariate logistic regression analysis of many of the previously described risk factors and other variables, Doxorubicin and/or Methotrexate based CT regimen was found to be a significant independent risk factor for VTE (OR 5.58, 95%CI 1.62 to 19.13. p = 0.0062). Conclusion: VTE is a frequent and underestimated complication in Lymphoma pts. These findings underscore the importance of prospective clinical trials of anticoagulation prophylaxis in the high risk patients receiving CT.

Sign in / Sign up

Export Citation Format

Share Document