Bleeding Events and Other Complications during Pregnancy and Childbirth in Women with von Willebrand Disease.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1015-1015
Author(s):  
Andra H. James ◽  
Margaret G. Jamison
Keyword(s):  
Deep Vein Thrombosis ◽  
Gestational Diabetes ◽  
Placental Abruption ◽  
Von Willebrand Disease ◽  
Bleeding Events ◽  
Pregnancy And Childbirth ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Von Willebrand ◽  
Deep Vein

Abstract OBJECTIVE: Case reports and case series suggest that women with von Willebrand disease (VWD) are at an increased risk of bleeding and other complications during pregnancy, delivery and the postpartum period. The purpose of this study was to estimate the incidence of bleeding events and other complications in women with VWD during pregnancy and childbirth using a large national database. METHODS: The Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 2000–2003 was queried for all pregnancy-related discharges. Records with a diagnosis of VWD (ICD-9 code 286.4) were compared to records without a diagnosis of VWD. Logistic regression analyses using stratified sample weights were used to compute odds ratios with 95% confidence intervals. RESULTS: There were 4067 deliveries to women with VWD which was 0.024% of all women who delivered. Black women (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1, 0.3) and Hispanic women (OR 0.3, 95% CI 0.2, 0.4) were significantly less likely to be diagnosed with VWD than white women. During pregnancy, women with VWD were more likely to be diagnosed with hypertension, cardiomyopathy, anemia and thrombocytopenia, but they were no more likely to develop preeclampsia, eclampsia or placental abruption and were less likely to develop gestational diabetes. Although they were more likely to experience antepartum bleeding, they were no more likely to labor prematurely, have a growth restricted fetus or suffer an intrauterine fetal demise. Although their risk of pulmonary embolism was no different than that of other women, none of the women with VWD experienced a deep vein thrombosis. Women with VWD were more likely to experience a postpartum hemorrhage and had a 5-fold increased risk of being transfused. 5 of the 4067 women with VWD died. Their maternal morality rate of 123 per 100,000 deliveries was 10 times higher than the rate for all other women which was 12.7 per 100,000 deliveries. CONCLUSION: Although women with VWD do not appear to be at an increased risk of poor fetal outcomes, they are at an increased of bleeding events and death during pregnancy and childbirth. Odds Ratios (OR) with 95% Confidence Intervals (CI) for Co-Existing Medical Conditions, Pregnancy-Related Complications and Events during Pregnancy in Women with VWD Count OR with 95% CI p value Co-Existing Medical Conditions: Hypertension 54 2.2 (1.1, 3.8) .03 Cardiomyopathy 9 6.8 (1.7, 27.5) .01 Diabetes 34 1.0 (0.4, 2.5) NS Anemia 551 2.1 (1.7, 2.6) < .01 Thrombocytopenia 63 2.5 (1.4, 4.7) < .01 Obesity 21 0.6 (0.2, 1.6) NS Smoking 220 1.9 (1.4, 2.7) < .01 Pregnancy-Related Complications: Gestational diabetes 112 0.6 (0.4, 0.9) .02 Preeclampsia 327 0.9 (0.7, 1.20) NS Eclampsia 13 2.7 (0.7, 10.9) NS Placental abruption 53 1.0 (0.5, 1.8) NS Antepartum bleeding 280 10.2 (7.1, 14.6) < .01 Preterm labor 417 1.1 (0.8, 1.4) NS Fetal growth restriction 49 0.7 (0.3, 1.5) NS Intrauterine fetal death 24 1.6 (0.7, 3.9) NS Thromboembolism, Hemorrhage & Infection: Deep vein thrombosis 0 - - Pulmonary embolus 5 2.0 (0.3, 15.1) NS Postpartum hemorrhage 261 1.5 (1.1, 2.0) < .01 Transfusion 152 4.7 (3.2, 7.0) < .01 Postpartum infection 54 1.0 (0.5, 1.9) NS

scholarly journals Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Non-Hodgkin's Lymphoma: Analysis of the California Cancer Registry

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 932-932
Author(s):  
Christina Poh ◽  
Ann M Brunson ◽  
Theresa H.M. Keegan ◽  
Ted Wun ◽  
Anjlee Mahajan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Steering Committee ◽  
Vein Thrombosis ◽  
California Cancer Registry ◽  
Increased Risk ◽  
Deep Vein

Background Venous thromboembolism (VTE) is a known complication in patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and non-Hodgkin's lymphoma (NHL). However, the cumulative incidence, risk factors, rate of subsequent VTE and impact on mortality of upper extremity deep vein thrombosis (UE DVT) in these diseases is not well-described. Methods Using the California Cancer Registry, we identified patients with a first primary diagnosis of AML, ALL and NHL from 2005-2014 and linked these patients with the statewide hospitalization and emergency department databases to identify an incident UE DVT event using specific ICD-9-CM codes. Patients with VTE prior to or at the time of malignancy diagnosis or who were not treated with chemotherapy were excluded. We determined the cumulative incidence of first UE DVT, adjusted for the competing risk of death. We also examined the cumulative incidence of subsequent VTE (UE DVT, lower extremity deep vein thrombosis (LE DVT) and pulmonary embolism (PE)) and major bleeding after incident UE DVT. Using Cox proportional hazards regression models, stratified by tumor type and adjusted for other prognostic covariates including sex, race/ethnicity, age at diagnosis, neighborhood, sociodemographic status and central venous catheter (CVC) placement, we identified risk factors for development of incident UE DVT, the effect of incident UE DVT on PE and/or LE DVT development, and impact of incident UE DVT on cancer specific survival. The association of CVC placement with incident UE DVT was not assessed in acute leukemia patients, as all who undergo treatment were assumed to have a CVC. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results Among 37,282 patients included in this analysis, 6,213 had AML, 3,730 had ALL and 27,339 had NHL. The 3- and 12-month cumulative incidence of UE DVT was 2.6% and 3.6% for AML, 2.1% and 3% for ALL and 1.0% and 1.6% for NHL respectively (Figure 1A). Most (56-64%) incident UE DVT events occurred within the first 3 months of malignancy diagnosis. African Americans (HR 1.66; CI 1.22-2.28) and Hispanics (HR 1.35; CI 1.10-1.66) with NHL had an increased risk of incident UE DVT compared to non-Hispanics Whites. NHL patients with a CVC had over a 2-fold increased risk of incident UE DVT (HR 2.05; CI 1.68-2.51) compared to those without a CVC. UE DVT was a risk factor for development of PE or LE DVT in ALL (HR 2.53; CI 1.29-4.95) and NHL (HR 1.63; CI 1.11-2.39) but not in AML. The 12-month cumulative incidence of subsequent VTE after an incident UE DVT diagnosis was 6.4% for AML, 12.0% for ALL and 7.6% for NHL. 46-58% of subsequent VTEs occurred within the first 3 months of incident UE DVT diagnosis. The majority of subsequent VTEs were UE DVT which had a 12-month cumulative incidence of 4.6% for AML, 6.6% for ALL and 4.0% for NHL (Figure 1B). The 12-month cumulative incidence of subsequent LE DVT was 1.3% for AML, 1.6% for ALL and 1.9% for NHL (Figure 1C). The 12-month cumulative incidence of subsequent PE was 0.4% for AML, 4.1% for ALL and 1.8% for NHL (Figure 1D). The 12-month cumulative incidence of major bleeding after an UE DVT diagnosis was 29% for AML, 29% for ALL and 20% for NHL. Common major bleeding events included gastrointestinal (GI) bleeds, epistaxis and intracranial hemorrhage. GI bleeding was the most common major bleeding event among all three malignancies (14.2% in AML, 9.6% in ALL and 12.4% in NHL). The rate of intracranial hemorrhage was 6% in AML, 3.5% in ALL and 1.7% in NHL. A diagnosis of incident UE DVT was associated with an increased risk of cancer-specific mortality in all three malignancies (HR 1.38; CI 1.16-1.65 in AML, HR 2.16; CI 1.66-2.82 in ALL, HR 2.38; CI 2.06-2.75 in NHL). Conclusions UE DVT is an important complication among patients with AML, ALL and NHL, with the majority of UE DVT events occurring within the first 3 months of diagnosis. The most common VTE event after an index UE DVT was another UE DVT, although patients also had subsequent PE and LE DVT. UE DVT was a risk factor for development of PE or LE DVT in ALL and NHL, but not in AML. Major bleeding after an UE DVT was high in all three malignancies (>20%), with GI bleeds being the most common. UE DVT in patients with AML, ALL and NHL is associated with increased risk of mortality. Disclosures Wun: Janssen: Other: Steering committee; Pfizer: Other: Steering committee.

scholarly journals THE ASSOCIATION BETWEEN D-DIMER AND DEEP VEIN THROMBOSIS LOCATION AND ITS ABILITY TO PREDICT PULMONARY EMBOLISM, a retrospective pilot study

2019 ◽  
Author(s):  
Sarah Ali Althomali ◽  
Adel S. Alghamdi ◽  
Tareef H. Gnoot ◽  
Mohammad A. Alhassan ◽  
Abdullatif H. Ajaimi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Risk Group ◽  
Great Role ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Risk Patients ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis ◽  
D Dimer

Abstract Background In lower limb deep vein thrombosis; it is important to identify proximal from distal deep vein thrombosis as it carries the highest risk of pulmonary embolism. It is known that D-dimer has a great role in deep vein thrombosis diagnosis. Yet, the use of D-dimer to predict the location of deep vein thrombosis and the risk of pulmonary embolism in deep vein thrombosis patients has not been investigated before. Objective To address the correlation between D-dimer and the location of deep vein thrombosis and to study the efficacy of D-dimer to predict risk of PE in patients with proximal or extensive deep vein thrombosis. Method We included 110 consecutive patients who were hospitalized with the diagnosis of deep vein thrombosis, with or without a concomitant diagnosis of PE, and with D-dimer measured at initial presentation. We categorized the location of deep vein thrombosis as: distal, proximal, and extensive. In the analysis, patients were grouped into high-risk (patients with Proximal or Extensive deep vein thrombosis and pulmonary embolism) and low risk group (patients without pulmonary embolism). Results There was no significant association between D-dimer level and the location of deep vein thrombosis (p=0.519). However, D-dimer level was greater among patients with pulmonary embolism (9.6mg/L) than among patients without pulmonary embolism (7.4mg/L), (p=0.027). D-dimer was a significant predictor of pulmonary embolism as patients with proximal or extensive deep vein thrombosis had 8-folds increased risk of pulmonary embolism than patients with D-dimer less than 4.75mg/L (OR=7.9, p=0.013). Conclusion Though D-dimer was not significantly associated with the location of deep vein thrombosis, it was a significant predictor of pulmonary embolism in patients hospitalized with proximal or extensive deep vein thrombosis.

Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 135-139 ◽  
Author(s):  
J Grommes ◽  
KT von Trotha ◽  
MA de Wolf ◽  
H Jalaie ◽  
CHA Wittens
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Obstruction ◽  
Deep Venous System ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Catheter Directed Thrombolysis ◽  
Increased Risk ◽  
Deep Vein ◽  
Procedural Outcome

The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.

scholarly journals Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality

TH Open ◽  
2020 ◽  
Vol 04 (04) ◽  
pp. e309-e317
Author(s):  
Christina Poh ◽  
Ann Brunson ◽  
Theresa Keegan ◽  
Ted Wun ◽  
Anjlee Mahajan
Keyword(s):  
Deep Vein Thrombosis ◽  
Acute Leukemia ◽  
Upper Extremity ◽  
Lymphoblastic Leukemia ◽  
Cox Proportional Hazards ◽  
High Risk Population ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
The Impact

AbstractThe cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. There were 5,072 patients identified: 3,252 had AML and 1,820 had ALL. Three- and 12-month cumulative incidences of UE DVT were 4.8% (95% confidence interval [CI]: 4.1–5.6) and 6.6% (95% CI: 5.8–7.5) for AML and 4.1% (95% CI: 3.2–5.1) and 5.9% (95% CI: 4.9–7.1) for ALL, respectively. Twelve-month cumulative incidences of subsequent VTE after an incident UE DVT diagnosis were 5.3% for AML and 12.2% for ALL. Twelve-month cumulative incidences of subsequent bleeding after an incident UE DVT diagnosis were 15.4% for AML and 21.1% for ALL. UE DVT was associated with an increased risk of subsequent bleeding for both AML (hazard ratio [HR]: 2.07; 95% CI: 1.60–2.68) and ALL (HR: 1.62; 95% CI: 1.02–2.57) but was not an independent risk factor for subsequent PE or LE DVT for either leukemia subtype. Isolated incident UE DVT was associated with increased leukemia-specific mortality for AML (HR: 1.42; 95% CI: 1.16–1.73) and ALL (HR: 1.80; 95% CI: 1.31–2.47). UE DVT is a relatively common complication among patients with AML and ALL and has a significant impact on bleeding and mortality. Further research is needed to determine appropriate therapy for this high-risk population.

Saddle pulmonary embolism with fluorouracil: A case report

2020 ◽  
Vol 26 (7) ◽  
pp. 1769-1773
Author(s):  
Kylee E White ◽  
Christopher T Elder
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Case Report ◽  
Single Agent ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Additive Risk ◽  
The Right ◽  
Deep Vein ◽  
To Receive

Introduction As a single agent, fluorouracil has been documented to have a small but present chance of causing extravasation of the port when not properly administered. It has also been shown that cancer patients receiving chemotherapy are at increased risk of deep vein thrombosis, symptomatic or silent. Case report A 43-year-old male patient with stage III colon cancer receiving FOLFOX developed a saddle pulmonary embolism involving possible extravasation that was discovered following cycle 3 of chemotherapy. CT scan and lower extremity Doppler confirmed non-occlusive deep vein thrombosis along with saddle pulmonary embolism. Management and outcome: For acute management, patient underwent bilateral pulmonary artery thrombolysis. Following this, the patient was initiated on rivaroxaban indefinitely. The right subclavian port was removed, and a new port was placed in the left subclavian. Patient went on to receive three more cycles of chemotherapy. Discussion Fluorouracil, an inflammitant, has been shown to have damaging potential, especially in terms of the integrity of the endothelium. Over time, this can lead to serious complications such as cardiotoxicity, including deep vein thrombosis formation. Based on how and when the thrombi were discovered, it is not possible to deduce whether the port, the 5-FU, extravasation or other factors were the precipitators of the formation of the thrombi. The combination of chemotherapy treatment along with CVC placement appears to have an additive risk to the formation of a thrombus. Practitioners should take caution when evaluating for extravasation and CVC integrity and note other potential differentials for causes, including deep vein thrombosis/saddle pulmonary embolism formation.

CONGENITAL HYPOFIBRINOGENEMIA, DEEP VEIN THROMBOSIS AND RECURRENT PLACENTAL ABRUPTION

1987 ◽  
Author(s):  
H C Godal ◽  
F Brosstad ◽  
B Holm
Keyword(s):  
Deep Vein Thrombosis ◽  
Close Agreement ◽  
Placental Abruption ◽  
Exact Nature ◽  
Fibrinogen Concentration ◽  
Vein Thrombosis ◽  
Abnormal Rate ◽  
Heterozygous Form ◽  
Congenital Hypofibrinogenemia ◽  
Deep Vein

A patient with hypofibrinogenemia, deep vein thrombosis and recurrent placental abruption is reported. The persistently low plasma fibrinogen concentration strongly suggested that the condition was inherited, and this was supported by low fibrinogen levels and thrombosis tendency in the patient's brother. The exact nature of the condition is not known, but the close agreement between the clottable and immunologic fibrinogen -indicates the presence of a hyperfibrinogenemia sensu stricte rather than dysfibrinogenemia, and this was supported by uniformly negative tests to detect fibrinogen abnormalitied.Up to now, less than 50 cases of congenital hypofibrinogenemia have been reported. It is not entirely clear whether hypofibrinogenemia represents the heterozygous form of afibrinogenemia or whether itrepresents some sort- of dysfibrinogenemia with abnormal rate of biosynthesis but normal clotting and crosslinking functions. Four of the reported patients with hypofibrinogenemia had placental abruption, a complication which occursin less than of pregnancies. In addition, a relatively high proportion of patients withcongenital hypofibrinogenemiahad increased tendency to thrombosis. On this background it is tempting to speculate that the elevated fibrinogen during pregnancy serves other functions than to facilitate the formation of haemostatic plugs. Thus, during pregnancy and other socalled "acute phase" situations, minute amounts of fibrin may be generatedwithin the circulating blood. Since, moreover, the solvent for these fibrin molecules isfibrinogen, the possibility exists that hyperfibrinogenemia contributes to the prevention of thromboembolism by keeping trace amounts of fibrin in solution.

scholarly journals Prophylactic anticoagulant therapy decreases the incidence of deep vein thrombosis in patients with solid tumors: A systematic review and meta-analysis

2017 ◽  
Vol 7 (1) ◽  
pp. 35
Author(s):  
Yunjiao Zhou ◽  
Gong Yang ◽  
Chenglei Huang
Keyword(s):  
Systematic Review ◽  
Deep Vein Thrombosis ◽  
Solid Tumors ◽  
Risk Ratio ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
And Control ◽  
Deep Vein

It is not well understood the efficacy and safety of primary deep vein thrombosis (DVT) prophylaxis of anticoagulants in patients with solid tumors. This systematic review and meta-analysis of randomized controlled trials (RCT) determines the relative ratio of primary DVT, survival rate and bleeding events among patients with solid tumors treated with anticoagulants or placebo. Comprehensive literature searches were conducted through the Pubmed, Ovid MEDLINE and EMBASE databases published from January 1st, 1993 to December 31st, 2015. Statistical analysis was performed by RevMan 5.0 software. For DVT events, therisk ratio in 16 trials between the prophylactic and control patients was statistically significant at 0.45 [0.36-0.58]; for major bleeding events, the risk ratio in 18 trials between the prophylactic and control patients was not statistically significant at 1.33 [0.99-1.79], while that in 15 trials with clinically relevant non-major bleeding was statistically significant at 1.83 [1.46-2.30]; the risk ratio for the mortality rate of patients with solid tumors in 16 trials was not statistically significant at 0.97 [0.93-1.02]. Inconclusion, the risk ratio in this meta-analysis showed a significantly reduced incidence of DVT with anticoagulant use. Treatment to patients who had solid tumors with prophylactic anticoagulants enhanced the incidence rate of non-major bleeding but has no significant impact on the incidence rate of major bleeding. No significant differences were found in the mortality outcomes between anticoagulant and non-anticoagulant groups.

Sign in / Sign up

Export Citation Format

Share Document