Clinical and Laboratory Risk Factors for Venous Thromboembolism in Patients with High-Grade Gliomas: Results of a Prospective Study of 107 Newly-Diagnosed Patients.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1828-1828
Author(s):  
Michael B. Streiff ◽  
Xiaobu Ye ◽  
Serena Desideri ◽  
Thomas Kickler ◽  
Jayesh Jani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Factor Viii ◽  
Blood Group ◽  
Abo Blood Group ◽  
High Grade ◽  
Newly Diagnosed ◽  
Factor Viii Activity ◽  
High Grade Gliomas

Abstract Introduction: Patients with malignant gliomas are at high risk for venous thromboembolism (VTE). The reason for this association is unclear. We sought to identify clinical and laboratory risk factors for VTE in adult patients with high-grade gliomas. Methods: The NABTT CNS Consortium prospectively enrolled patients with newly-diagnosed grade 3 or 4 malignant glioma prior to anti-neoplastic therapy. Patients with a previous history of VTE, anti-neoplastic therapy or on chronic anticoagulation were excluded. At enrollment, we collected demographic and clinical information (age, gender, ethnicity, tumor histopathology and grade, Karnofsky Performance Status (KPS), and ABO blood group) and blood samples for measurement of factor VIII activity (FVIII), fibrinogen, and quantitative D dimer using standard laboratory assays. Endogenous thrombin potential (ETP) was measured using Innovin® and a synthetic chromagenic thrombin substrate on a BCS® coagulation analyzer (Dade Behring Inc. Newark, DE). Fisher’s exact test and the Student’s-T test were used for individual comparison of categorical data and continuous data, respectively. Cox regression modeling was used to examine the association of factors with VTE. The probability of thrombosis-free survival was estimated using the product-limit method of Kaplan and Meier. Results: One hundred seven patients (49% male) with a median age 57 years (range 28–85) were enrolled between 6/05 and 4/08. Ninety patients (84%) had glioblastoma multiforme. Median KPS at enrollment was 90. After a median follow up of 324 days, twenty two patients (21%) have suffered VTE and 45 patients (42%) have died. Median time to VTE was 67 days post-operation (95% Confidence Interval 33–128). No fatal VTE have occurred. VTE was associated with a lower KPS (p=0.008), higher baseline FVIII (178% versus 151%, p=0.04) and greater ETP (473nmol/L versus 438nmol/L, p=0.04) but not with ABO blood group. Patients suffering VTE were more likely to die than patients without VTE (68% versus 35%, p<0.005). Conclusions: In a prospective cohort study of newly-diagnosed patients with high-grade gliomas, we have identified a substantial incidence of VTE. Patients with VTE had a lower initial KPS, higher factor VIII activity, greater ETP and were more likely to die than patients without VTE. With additional follow up, we hope to identify additional clinical and laboratory risk factors for VTE. These data should lead to greater insight into the pathogenesis of VTE in patients with high-grade gliomas and facilitate identification of patients in whom primary long-term VTE prophylaxis may be beneficial.

Elevated factor VIII activity is common in patients with newly diagnosed high-grade gliomas

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 2035-2035
Author(s):  
M. B. Streiff ◽  
S. A. Grossman ◽  
X. Ye ◽  
T. S. Kickler ◽  
G. J. Lesser ◽  
...  
Keyword(s):  
Factor Viii ◽  
High Grade ◽  
Newly Diagnosed ◽  
Factor Viii Activity ◽  
High Grade Gliomas

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

scholarly journals Arterial and Venous Thromboembolic Safety of Bevacizumab in Patients with High Grade Gliomas

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2280-2280
Author(s):  
Inyoung Lee ◽  
Sruthi Adimadhyam ◽  
Edith A. Nutescu ◽  
Karen Sweiss ◽  
Pritesh Patel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Claims Data ◽  
Population Based ◽  
Recurrent Glioblastoma ◽  
Incidence Density ◽  
High Grade ◽  
Increased Risk ◽  
High Grade Gliomas ◽  
Nested Case Control

Abstract INTRODUCTION Bevacizumab, an angiogenesis inhibitor targeting vascular endothelial growth factor A, is used for the treatment of recurrent glioblastoma, the most common primary brain malignancy in adults. Multiple studies demonstrate the efficacy of bevacizumab on progression-free and overall survival of patients with recurrent glioblastoma. However, real world safety data of bevacizumab in patients with glioblastoma is limited on serious adverse outcomes including arterial and venous thrombosis. Our study aimed to evaluate the risk of arterial thromboembolism (ATE) and venous thromboembolism (VTE) in a population-based sample of adult patients with high grade gliomas. METHOD We conducted a nested case-control study within a retrospective cohort of patients receiving treatment for high grade gliomas under the protocol by Stupp, et al. (radiotherapy plus concomitant/adjuvant temezolomide). Patients were sampled from the Truven Health MarketScan® Research Database, containing administrative health claims data of over 40 million commercially insured enrollees and their dependents, between 2009 and 2015. A validated algorithm was used to identify patients with high grade gliomas that underwent craniotomy (index time) with external beam radiation and temozolomide-based treatment occurring within 91 days (cohort entry time). Patients were excluded if they received craniotomy, radiation, temozolomide or bevacizumab during year prior to surgery or had one of our outcomes of interest (ATE or VTE) during the cohort ascertainment period (between index and cohort entry dates). Patients were required to have continuous health plan enrollment during the 12-month baseline and follow up periods (unless died). Surgical procedures and chemotherapy treatments were identified using diagnostic and procedural medical and pharmacy claims data. These data sources were also used to identify VTE risk factors, including medical conditions, procedures and medication use, and to calculate modified Charlson comorbidity index scores at baseline. Cases of ATE and VTE were each identified in the overall cohort using a validated algorithm for administrative claims data. For ATE and VTE separately, each case was matched to up to ten controls on sex, age group, index time and follow-up duration using incidence density sampling with replacement. Exposure to bevacizumab was characterized as any use (yes vs. no) and recent use (last bevacizumab infusion within 30 days prior event or control censoring). We estimated relative risk of ATE and VTE associated with bevacizumab in separate models using conditional logistic regression models to calculate adjusted odds ratios (aOR) and 95% confidence interval (CI). All multivariable models were adjusted for sex, age, and comorbidity index scores; models for risk of VTE were also adjusted for number of baseline VTE risk factors and VTE prophylaxis received. RESULTS Our final study cohort included 2157 patients undergoing treatment for high grade gliomas. We identified 25 ATE cases and 99 VTE cases and matched incidence density-sampled controls (n=170 for ATE; n=819 for VTE) for our nested case-control analysis. A higher proportion of ATE cases received bevacizumab during follow up compared to the controls (28% vs. 17%). In multivariable analyses, no statistically significant increase in ATE risk was observed with bevacizumab overall (aOR 1.51, 95% CI 0.54-4.24), although confidence intervals were wide given the few events observed. Compared to controls in the VTE analysis, cases had a slightly higher proportion of baseline VTE risk factors (2 or more: 17% vs. 13%) and treatment with bevacizumab (13% vs. 9%). However, we found no significant increased risk of VTE associated with bevacizumab overall (aOR 1.40, 95% CI 0.71-2.75) or recent infusion of bevacizumab (aOR 1.40, 95% CI 0.65-3.01). CONCLUSIONS Our findings from this large retrospective cohort of patients undergoing treatment for high grade glioma provide little evidence in support of the increased risk of ATE and VTE reported with use of bevacizumab in other cancer sites. Our study was limited by an overall small number of ATE events observed, and further research is needed to confirm safety of bevacizumab with respect to arterial thrombosis. These population-based estimates show no significant increase in risk of VTE associated with bevacizumab and suggest its safe use in the treatment of high grade gliomas. Disclosures Lee: AbbVie Inc.: Research Funding. Patel:Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Honoraria.

scholarly journals ABO blood group and risk of renal cell cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 371-371
Author(s):  
Eunyoung Cho ◽  
Hee-Kyung Joh ◽  
Toni K. Choueiri
Keyword(s):  
Risk Factors ◽  
Blood Group ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Smoking Status ◽  
Statistical Tests ◽  
Cell Cancer ◽  
Health Study ◽  
Abo Blood Group

371 Background: The genetic determinants of sporadic renal cell cancer (RCC) are largely unknown. Previous studies have suggested associations between the ABO blood group and risk of various cancers, however, its relationship to RCC remains unclear. Methods: We prospectively evaluated the association between the ABO blood group and risk of RCC in two large independent cohorts of women (the Nurses’ Health Study) and men (the Health Professionals Follow-up Study) from 1996 to 2008. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models with adjustment for other risk factors for RCC including obesity, smoking, and hypertension. All statistical tests were two-sided. Results: During 12 years of follow-up of 77 242 women and 29 548 men, 163 cases of incident RCC were documented in women and 84 cases in men. After multivariate adjustment, non-O blood group (combined group of A, AB, and B) was associated with a 1.5-fold elevated risk of RCC (95% CI 1.09–2.09) than O blood group in women. In contrast, no significant associations were observed between the ABO blood group and risk of RCC in men. The associations between the ABO blood group and RCC were consistent across strata of known risk factors including obesity, smoking status, and history of hypertension (Pinteraction≥ 0.58) in both cohorts. Conclusions: We show for the first time that non-O blood group is significantly associated with a higher risk of RCC compared with blood group O in women. Further studies that elucidate the biological mechanisms underlying this association are warranted.

Risk factors for venous thromboembolism in women under combined oral contraceptive

2016 ◽  
Vol 115 (01) ◽  
pp. 135-142 ◽  
Author(s):  
Agathe Henneuse ◽  
Manal Ibrahim ◽  
Dominique Brunet ◽  
Marie-Christine Barthet ◽  
Marie-Françoise Aillaud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Family History ◽  
Blood Group ◽  
Public Health Issue ◽  
Abo Blood Group ◽  
Inherited Thrombophilia ◽  
Thrombophilia Screening ◽  
History Of ◽  
The Impact

SummaryIdentifying women at risk of venous thromboembolism (VTE) is a major public health issue. The objective of this study was to identify environmental and genetic determinants of VTE risk in a large sample of women under combined oral contraceptives (COC). A total of 968 women who had had one event of VTE during COC use were compared to 874 women under COC but with no personal history of VTE. Clinical data were collected and a systematic thrombophilia screening was performed together with ABO blood group assessment. After adjusting for age, family history, and type and duration of COC use, main environmental determinants of VTE were smoking (odds ratio [OR] =1.65, 95 % confidence interval [1.30–2.10]) and a body mass index higher than 35 kg.m-2 (OR=3.46 [1.81–7.03]). In addition, severe inherited thrombophilia (OR=2.13 [1.32–3.51]) and non-O blood groups (OR=1.98 [1.57–2.49]) were strong genetic risk factors for VTE. Family history poorly predicted thrombophilia as its prevalence was similar in patients with or without first degree family history of VTE (29.3 % vs 23.9 %, p=0.09). In conclusion, this study confirms the influence of smoking and obesity and shows for the first time the impact of ABO blood group on the risk of VTE in women under COC. It also confirms the inaccuracy of the family history of VTE to detect inherited thrombophilia.

Venous Thrombosis Following the Use of Intermediate Purity FVIII Concentrate to Treat Patients with Von Willebrand’s Disease

2002 ◽  
Vol 88 (09) ◽  
pp. 387-388 ◽  
Author(s):  
B. Colvin ◽  
V. Gupta ◽  
M. L. Shields ◽  
M. P. Smith ◽  
M. Makris
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Factor Viii ◽  
Surgical Procedures ◽  
Factor Viii Activity ◽  
Physiological Basis ◽  
Von Willebrand's Disease ◽  
Additional Risk ◽  
Von Willebrand’S Disease

SummaryWe describe four patients with von Willebrand’s disease (VWD) who experienced venous thrombosis after treatment with an intermediate purity factor VIII (FVIII) concentrate (Haemate P®) was used to cover invasive or surgical procedures. Most patients had additional risk factors for venous thromboembolism (VTE) and it is difficult to be certain of the contribution of the concentrate to the VTE. In view of the recognised association between high factor VIII activity (FVIII:C) levels and VTE there is a physiological basis for this complication and it is important to consider this when administering FVIII containing concentrates to VWD patients.

Venous Thromboembolism - A Manifestation of the Metabolic Syndrome?.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1499-1499
Author(s):  
Cihan Ay ◽  
Theres Tengler ◽  
Rainer Vormittag ◽  
Ralph Simanek ◽  
Wolfgang Dorda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Factor Viii ◽  
Factor V Leiden ◽  
High Risk Population ◽  
Factor Viii Activity ◽  
The Metabolic Syndrome ◽  
Increased Risk

Abstract There is accumulating evidence for an association between atherosclerosis and venous thrombosis, which may share common risk factors. The metabolic syndrome (MetSyn), a cluster of interrelated risk factors comprising abdominal obesity, elevated blood pressure, high triglycerides, reduced high-density lipoprotein cholesterol and elevated fasting glucose plasma levels is associated with atherosclerotic disease and type 2 diabetes mellitus. It induces a proinflammatory and prothrombotic state. Despite its high prevalence, data on the association with venous thromboembolism (VTE) are scarce. Therefore, we aimed to investigate the association of the MetSyn with the risk for VTE and conducted a case-control study to evaluate the prevalence of the MetSyn according to guidelines of the National Cholesterol Education Program in a high-risk population of patients with objectively confirmed recurrent VTE, who had at least one unprovoked event of deep venous thrombosis or pulmonary embolism. Age and sex-matched healthy individuals served as controls. Finally, a total of 116 patients (53 female, mean age +/−SD: 56 years +/−12) and 129 controls (66 female, mean age +/−SD: 53 years +/−11) were recruited between January 2005 and November 2005. The prevalence of the MetSyn was statistically significantly higher in patients (40/116, 35%) than in controls (26/129, 20%, p=0.012). The unadjusted odds ratio (OR) of the MetSyn for VTE was 2.1 (95% CI [1.2–3.7], p=0.012) and remained statistically significant after adjustment for factor V Leiden, prothrombin G20210A variation and elevated factor VIII activity, sex and age (OR=2.2, 95% CI [1.1–4.2], p=0.024). Furthermore, individuals with the MetSyn (n=66) had significantly higher hs-CRP (median, [interquartile range]: 0.312 mg/dL, [0.142–0.751] vs. 0.153 mg/dL, [0.073–0.330], p<0.001), fibrinogen (390 mg/dL, [342–432] vs. 343 mg/dL, [310–394], p<0.001) and factor VIII activity (182%, [157–216] vs. 159%, [133–199], p=0.005) compared to those without (n=179). In conclusion, the MetSyn was statistically significantly overrepresented in patients with VTE compared to control subjects without a history of venous or arterial thrombosis. Our data suggest that the MetSyn may contribute to the development of VTE as it was associated with a 2-fold increased risk for VTE.

scholarly journals Laser Ablation of Newly Diagnosed Malignant Gliomas

Neurosurgery ◽  
2016 ◽  
Vol 79 (suppl_1) ◽  
pp. S17-S23 ◽  
Author(s):  
Michael E. Ivan ◽  
Alireza M. Mohammadi ◽  
Nicoleta De Deugd ◽  
Joshua Reyes ◽  
Gregor Rodriguez ◽  
...  
Keyword(s):  
Overall Survival ◽  
Minimally Invasive ◽  
Progression Free Survival ◽  
Small Sample ◽  
Invasive Technique ◽  
High Grade ◽  
Newly Diagnosed ◽  
Free Survival ◽  
High Grade Gliomas

Abstract BACKGROUND: Magnetic resonance-guided laser-interstitial thermotherapy (MR-LITT) is a minimally invasive technique that shows promise in neuro-oncology because of its superiority in delivering precise minimally invasive thermal energy with minimal collateral damage. OBJECTIVE: In this analysis, we investigate initial data on the use of MR-LITT in the treatment of newly diagnosed high-grade gliomas. METHODS: With the use of the PubMed, OVID, and Google-scholar database systems, a comprehensive search of the English literature was performed. Eighty-five articles were identified plus 1 that is pending publication. Four articles were accounted for in this review, including 25 patients with newly diagnosed high-grade gliomas who underwent MR-LITT treatment. We evaluated safety, progression-free survival, and overall survival. RESULTS: Twenty-five patients with a mean age of 53.8 years underwent LITT treatments. On average, 82.9% of the pretreatment lesion volume was ablated. The average tumor volume treated was 16.5 cm3. The mean follow-up time was 7.6 months. Median overall survival was found to be 14.2 months (range 0.1-23 months). The median progression-free survival was 5.1 months (range 2.4-23 months); however, these data are limited by the relatively short follow-up of the patients reviewed and small sample size of only 25 patients. There was 1 (3.4%) major perioperative complication, which was a central nervous system infection. CONCLUSION: MR-LITT is a promising technology for the treatment of small, yet difficult-to-treat newly diagnosed high-grade gliomas. This study demonstrates that MR-LITT is safe, and future randomized studies are needed to evaluate its role as a treatment adjunct for newly diagnosed high-grade gliomas.

Sign in / Sign up

Export Citation Format

Share Document