Standardized Thromboprophylaxis Increases Compliance and Reduces Venous Thrombotic Events (VTE) in Hospitalized Cancer Patients

Abstract Background: Venous thromboembolism (VTE) remains a major cause of morbidity and mortality in hospitalized patients with cancer. In 2007, both ASCO and the NCCN developed clinical practice guidelines to help prevent and treat thrombosis in patients with cancer. Adherence to these guidelines has led to successful reduction of VTE in hospitalized patients. Because noncompliance with anticoagulant prophylaxis was an ongoing problem at our institution, a standardized order set for thromboprophylaxis (TP) utilizing anticoagulant therapy was developed and implemented for patients with cancer diagnoses. Methods: All patients admitted to the inpatient oncology unit with a cancer diagnosis were screened for VTE prophylaxis utilizing a standardized order set. Cancer diagnosis and other risk factors for VTE were recorded on the TP order set along with choice of anticoagulant TP. Treatment options included Lovenox 40 mg once subcutaneous (sc)daily for patients with normal renal function, lovenox 30 mg sc daily for creatinine clearance <30cc/min, heparin(h) 5000 units sc every 8 hours. Pneumatic compression devices were utilized in patients who had contraindications to anticoagulation. Exclusion criteria included patients already on therapeutic anticoagulation, active bleeding, and platelet count (plt) <50,000. TP was instituted upon admission and continued until discharge. Patients were clinically monitored for VTE for 4 weeks post discharge and if symptomatic, venous Dopplers, VQ and/or Spiral CT scans were performed. Retrospective review of all VTE events in hospitalized cancer patients occurring in the previous quarter prior to initiation of the standardized order set was performed and number of VTE events and length of stay (LOS) were compared to the treatment group. Results: 100 cancer patients were admitted to the inpatient oncology unit from 4/08–7/08 with use of the standardized TP order set for all patients. 89 patients received TP as follows: 79 received lovenox 40 mg sc daily, 2 lovenox 30mg sc daily, 5 h 5000 units sc q 8 hours, and 3 flowtron boots. 11 patients did not receive TP for the following reasons: 6 were on therapeutic anticoagulation for previous VTE, 4 had a plt < 50,000, 1 had brain metastases with surrounding edema. Of those who did receive TP, no VTE occurred during hospitalization and for 1 month post discharge. No bleeding complications were seen. As compared to those patients treated with the TP order set, 20/207 (9.6%) non-surgical hospitalized patients with cancer developed VTE during their hospitalization in the previous quarter (p<0.01). Of these patients, 11 did not receive TP, and 9 patients received TP: 5 with flowtron boots, 2 short term TP lovenox which was discontinued prematurely, 2 h 5000 units sc 8 hours. The average LOS of patients managed utilizing the TP order set was 7.1 days compared to 19.0 days (p<0.0001) in hospitalized cancer patients with VTE events prior to use of the TP order set. Conclusion: Hospitalized cancer patients are at significant risk for the development of VTE. The implementation of a standard order set ensures compliance with TP and significantly reduces VTE events. LOS is significantly reduced in hospitalized cancer patients by preventing VTE.

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Predicting recurrences or major bleeding in cancer patients with venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th08-02-0125 ◽

2008 ◽

Vol 100 (09) ◽

pp. 435-439 ◽

Cited By ~ 105

Author(s):

Javier Trujillo-Santos ◽

José Nieto ◽

Gregorio Tiberio ◽

Andrea Piccioli ◽

Pierpaolo Micco ◽

...

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Major Bleeding ◽

Bleeding Complications ◽

Vein Thrombosis ◽

Recurrent Pulmonary Embolism ◽

Acute Venous Thromboembolism ◽

Deep Vein

SummaryCancer patients with acute venous thromboembolism (VTE) have an increased incidence of recurrences and bleeding complications while on anticoagulant therapy. Methods RIETE is an ongoing registry of consecutive patients with acute VTE. We tried to identify which cancer patients are at a higher risk for recurrent pulmonary embolism (PE), deep vein thrombosis (DVT) or major bleeding. Up to May 2007, 3, 805 cancer patients had been enrolled in RIETE. During the first three months of follow-up after the acute, index VTE event, 90 (2.4%) patients developed recurrent PE, 100 (2.6%) recurrent DVT, 156 (4.1%) had major bleeding. Forty patients (44%) died of the recurrent PE,46 (29%) of bleeding. On multivariate analysis, patients aged <65 years (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.9–4.9), with PE at entry (OR: 1.9; 95% CI: 1.2–3.1), or with <3 months from cancer diagnosis to VTE (OR: 2.0; 95% CI: 1.2–3.2) had an increased incidence of recurrent PE. Those aged <65 years (OR: 1.6; 95% CI: 1.0–2.4) or with <3 months from cancer diagnosis (OR: 2.4; 95% CI: 1.5–3.6) had an increased incidence of recurrent DVT. Finally, patients with immobility (OR: 1.8; 95% CI: 1.2–2.7), metastases (OR: 1.6; 95% CI: 1.1–2.3), recent bleeding (OR: 2.4; 95% CI: 1.1–5.1), or with creatinine clearance <30 ml/ min (OR: 2.2; 95% CI: 1.5–3.4), had an increased incidence of major bleeding. With some variables available at entry we may identify those cancer patients withVTE at a higher risk for recurrences or major bleeding.

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A case-control study examining the role of recent chemotherapy in causing Clostridium difficile infection among cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19563 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19563-19563

Author(s):

P. Thapaliya ◽

A. Donato ◽

K. Curl

Keyword(s):

Cancer Patients ◽

Case Control Study ◽

Case Control ◽

Hospitalized Patients ◽

Retrospective Case ◽

Chi Square ◽

Patients With Cancer ◽

Toxin Assay ◽

Chemotherapy Agents ◽

Control Study

19563 Background: Clostridium difficle infection is a major cause of morbidity and mortality in hospitalized patients. The recent use of cancer chemotherapy agents is a frequently cited risk factor but there is a paucity of evidence to this regard. Objective: To determine if an association exists between C. difficile infection requiring hospitalization and recent chemotherapy in patients with cancer. Design: A retrospective case control study. Setting: Community Teaching Hospital Participants: 357 cancer patients admitted with diarrhea or developed diarrhea during their hospital stay that were tested for C. difficile diarrhea via toxin assay over a 2 year period. Outcome Measurements: C. difficile infection using tests for toxin A and or B in stool. Results: Eighty-nine cases had stool positive for C. difficile toxin whereas 267 controls were negative. 30/89 (33%) cases and 90/268 (33%) controls were found to have chemotherapy in the six weeks before collection of stool for toxin assay (Odds Ratio (OR) 1.09, p=1.0 using Pearson Chi square). Factors associated with infection on logistic regression analysis included recent antibiotic usage (OR 1.99, 95% CI 1.01- 3.93),hospitalization in preceding 2 wks with OR 4.1 (95%CI 2.39–7.05) and institutionalization with OR 2.13 (95 % CI 1.03–4.39). Conclusions: C .difficile infection in cancer patients is more likely in recently institutionalized or hospitalized patients who have received recent antibiotics, but not patients with recent chemotherapy. No significant financial relationships to disclose.

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Incidence, Characteristics and Outcomes of Patients with Cancer-Associated Venous Thromboembolism: A Retrospective Matched-Pair Analysis

Blood ◽

10.1182/blood-2018-99-113420 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 2516-2516

Author(s):

Piyanuch Kongtim ◽

Dhosaporn Charoenjit ◽

Supawee Saengboon ◽

Hataiwan Ratanabunjerdkul

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Cumulative Incidence ◽

Hematologic Malignancies ◽

Matched Pair ◽

Advanced Stage ◽

Vein Thrombosis ◽

Patients With Cancer

Abstract Introduction Cancer and its treatments are well-recognized risk factors for the development of venous thromboembolism (VTE). The occurrence of VTE has been associated with an increased mortality in patients with cancer. Here we retrospectively reviewed the incidence and characteristics of cancer-associated thrombosis (CAT) in a large cohort of cancer patients treated at our institution as well as compared treatment outcomes of this group of patients with a 1:1 matched pair group of cancer patients without CAT. Methods Data of consecutive patients, 18 years of age or older, with a newly diagnosis of both hematologic malignancies or solid tumors who diagnosed and treated either as an inpatient or outpatient setting at our institution between 2011 to 2015 were included in this analysis. Patients who received anticoagulants for the purpose of either prophylaxis or treatment within 2 weeks before cancer diagnosis and who did not have a histologically confirmed a cancer diagnosis or complete follow up data were excluded from the study. To compare the outcomes of cancer patients with and without CAT, cancer patients who did not experience CAT were randomly selected from the same database and were matched individually (1:1) to cancer patients with CAT based on age, sex, cancer type and stage (limited or advanced) to form a matched cohort of patients as control. Primary outcome was cumulative incidence of CAT at 6 months and 1 year after cancer diagnosis, while incidence of recurrent VTE, major and minor bleeding, relapse, non-relapse mortality (NRM), overall survival (OS) and progression-free survival (PFS) were analyzed as secondary outcomes. CAT was defined as at least 1 site of venous thrombosis confirmed by imaging results, which occurred anytime after the initial diagnosis, during the treatment or follow-up. Results Total 2,291 newly diagnosed cancer patients (633 patients with hematologic malignancies and 1,658 patients with solid cancers) with a median age of 58 years (range 18-93 years) were included in the analysis. CAT was developed in 83 patients (52 females and 31 males) with a median age of 61 year (range 20-85 years). The cumulative incidence of CAT at 6 months and 1 year was 2.7% and 3.4%, respectively. The median time from cancer diagnosis to the diagnosis of CAT was 3.2 months (range 1- 62 months). Sites of VTE were deep vein thrombosis in extremities (N=46; 55.4%), pulmonary embolism (N=6; 7.2%), splanchnic vein thrombosis (N=9; 10.8%) and cerebral venous sinus thrombosis (N=5, 6%). Seventeen patients (20%) developed more than 1 site of VTE. Sixty-nine (83%) cases with CAT were diagnosed in patients with hematologic malignancies including 35, 22 and 12 cases with lymphoma, acute leukemia and myeloproliferative neoplasms, respectively. Overall the incidence was 10.9% in hematologic malignancies and 0.8% in solid tumors. The majority of the CAT cases occurred in advanced stage cancers (66 patients; 79.5%) while 13 cases (15.7%) were diagnosed during ambulatory chemotherapy treatment. None of the patients with CAT received prophylaxis anticoagulant during cancer treatment or follow up period. Characteristics of patients with CAT are summarized in Table 1. Of 83 patients with CAT, 66 patients were treated with anticoagulants, while inferior vena cava filter was used in 8 patients (9.6%). The cumulative incidence of total bleeding events at 1 year was 21.1% whereas cumulative incidence of major bleeding was 6.8%. The cumulative incidence of recurrent thrombosis at 1 year was 8.3%. Cancer patients who developed CAT had both a significantly higher NRM (26.2% vs. 13% at 1 year, p=0.004) (Figure 1A) and relapse rate (63.3% vs. 43.5% at 5 years, p=0.002) (Figure 1B) when compared with control group, which resulted in a significantly lower 5-year OS (24.9% vs. 62.7%; p<0.0001) (Figure 1C) and PFS (16.9% vs. 46%; p<0.0001) (Figure 1D). Advanced stage cancer and development of CAT were associated with poor OS in a multivariable analysis with HR of 6.9 (95%CI 2.7-17.7) and 3.9 (95%CI 2.2-7.0), respectively. Both factors also independently predicted risk of relapse with HR of 4.6 (95%CI 1.8-11.6, p=0.001) and 3.4 (95%CI 1.7-6.8, p<0.0001), respectively. Conclusions Development of CAT is associated with an increased NRM, relapse rate and poor survival in patients with cancer. Effective strategies to prevent CAT especially in high-risk cancer patients are needed to help improve outcomes. Disclosures No relevant conflicts of interest to declare.

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Social toxicity among patients with cancer diagnosis in Saudi Arabia: A descriptive phenomenological qualitative study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.151 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 151-151

Author(s):

Abdul-Rahman Jazieh ◽

Hoda Jradi ◽

Omar B. Da'ar ◽

Mohammad Alkaiyat ◽

Ashwaq Alolayan

Keyword(s):

Saudi Arabia ◽

Qualitative Study ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Hair Loss ◽

Financial Burden ◽

Holistic Approach ◽

The Elderly ◽

Positive Feeling ◽

Patients With Cancer

151 Background: The objective of this study was to describe the social and financial experience of cancer patients throughout the continuum of their disease. Methods: A descriptive phenomenological qualitative study was conducted in the Oncology Department in King Abdulaziz Medical City in Saudi Arabia. Four focus groups, including 15 cancer patients (9 women and 6 men) and 11 care givers (5 females and 6 males), and face-to-face interviews among 29 healthcare workers including physicians, nurses, social workers, and health educators were conducted. All discussions were transcribed verbatim and entered into NVIVO software and themes were extracted and examined. Results: Focus group discussions and interviews revealed a range of social and financial themes such as experiencing fear of spousal abandonment, concerns of becoming a social and financial burden to the family, poor physical appearance, and hair loss for females. Experiencing depression, social isolation, fear of infertility, and fear of job loss for both genders. Males were mostly affected by facial hair loss and sexual dysfunction. An emerging theme regarding the elderly patient was neglect by family members and isolation from society with the intention of protecting them. Acceptability of disease and submission as an act of religiosity was a general positive feeling. Conclusions: This descriptive phenomenological qualitative study characterized the significant social and financial toxicities among patients with cancer diagnosis in Saudi Arabia. Such phenomena and context are expected to enable a deeper understanding of oncology professionals’ experiences in order to better deliver patient-centered care as a component of a holistic approach.

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Morbidity, Mortality and Costs Associated with Venous Thromboembolism in Hospitalized Patients with Cancer

Blood ◽

10.1182/blood.v128.22.4751.4751 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4751-4751

Author(s):

Gary H. Lyman ◽

Eva Culakova ◽

Marek S. Poniewierski ◽

Nicole M. Kuderer

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Cancer Patients ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Hospitalized Patients ◽

Annual Rate ◽

Patients With Cancer ◽

Time Period

Background: Venous thromboembolism (VTE) represents a leading cause of morbidity and mortality among hospitalized patients with cancer. Methods: Hospitalization data reported on adult cancer patients at US academic medical centers and affiliated hospitals between 1995 and 2012 were analyzed. Cancer diagnosis, presence of VTE, comorbidities and complications were based on ICD-9-CM codes. Major comorbidities considered were diabetes, and cerebrovascular, peripheral-vascular, heart, liver, and lung renal disease. In patients with multiple hospitalizations during the time period, a randomly selected hospitalization was utilized in the analysis. Hospitalization cost estimates were inflation adjusted to 2015 US dollars. Results: Nearly 6 million hospitalizations of 3,146,388 individual patients with cancer from more than 200 institutions were evaluated. VTE was reported in 8.4% of patients when all admissions are considered during the time period. When a single selected hospitalization is considered for each patient, VTE was reported in 166,547 (5.3%) of individual patients including 56,125 (1.8%) with pulmonary embolism (PE). The annual rate of VTE increased progressively from 3.5% in 1995 to over 6.5% in 2012 with the rate of PE nearly tripling from 0.8% in 1995 to 2.3% in 2012. For hospitalized patients receiving cancer chemotherapy, the annual rate of VTE more than doubled from 3.6% in 1995 to 8.3% in 2012. VTE was reported in 5.2%, 5.8% and 5.4% of patients with solid tumors, lymphoma, and leukemia, respectively (Table). Rates of VTE were greatest among patients with pancreatic (10.2%), gastric (7.1%) or other abdominal malignancies except colorectal cancer (9.2%) as well as those with ovarian (7.1%), lung (6.8%) and esophageal cancers (6.3%). The risk of VTE increased progressively from 2.3% in those with no comorbidities to over 11% for patients with 4 or more comorbid conditions. The strongest risk factors for VTE were infectious complications including sepsis (14%), invasive candidiasis (16%), pneumonia (11%) and IV line infections (14%).During this same time period, imaging related to VTE actually decreased with significantly lower rates of CT, vascular ultrasound and ventilation perfusion lung scans reported. In-hospital mortality was reported in 5.5% of cancer patients without VTE and in 15.0% of those with VTE including 19.4% of those with pulmonary embolism. In-hospital mortality during this time period decreased by approximately one-third in cancer patients both with and without VTE. While reported rates of VTE increased, the length of hospital stay shortened for patients with as well as without VTE during this period. Average costs per hospitalization adjusted to 2015 dollars for patients with and without VTE were $37,352 and $19,994, respectively. The estimated average inflation adjusted daily cost of hospitalization for patients with cancer and VTE increased nearly 50% between 1995 ($2,256) and 2012 ($3,297). Conclusions: VTE reported among hospitalized patients with cancer has increased significantly during the period of observation along with the cost of hospitalization while in-hospital mortality and imaging rates have decreased. However, patients with additional major medical comorbidities are at exceptionally high risk of serious complications including in-hospital mortality. Disclosures Lyman: Amgen: Research Funding. Kuderer:Janssen Scientific Affairs, LLC: Consultancy, Honoraria.

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Effectiveness of a diabetes focused electronic discharge orderset and post-discharge nursing support among poorly controlled hospitalized patients: A randomized controlled trial (Preprint)

10.2196/preprints.33401 ◽

2021 ◽

Author(s):

Audrey White ◽

David Bradley ◽

Elizabeth Buschur ◽

Cara Harris ◽

Jacob LaFleur ◽

...

Keyword(s):

Diabetes Management ◽

Hospitalized Patients ◽

Post Discharge ◽

Discharge Data ◽

Phone Calls ◽

Discharge Outcomes ◽

Long Term Follow Up ◽

Order Set

BACKGROUND While electronic order sets have become standard practice for inpatient diabetes management, there is limited decision support at discharge. OBJECTIVE This study assessed whether an electronic discharge order set (DOS) plus nurse follow up calls improves discharge orders and post-discharge outcomes among hospitalized patients with type 2 diabetes (T2D). METHODS This is a randomized open label single center study comparing an electronic DOS and nurse phone calls to enhanced standard care (ESC) in hospitalized insulin-requiring patients with T2D. The primary outcome was change in HbA1c at 24 weeks post-discharge. Secondary outcomes included completeness and accuracy of discharge prescriptions related to diabetes. RESULTS The study was stopped early due to feasibility concerns related to long-term follow-up. However a total of 158 subjects were enrolled (DOS=82, ESC=76), 155 of whom had discharge data. The DOS group had a greater frequency of prescriptions for bolus insulin (81% vs 44%; P=0.01), needles/syringes (95% vs 63%; P=0.03), and glucometers (86% vs 36%; P=0.0002). Clarity of orders was similar. HbA1c was available in 27 subjects in each arm at 12 weeks, and 20/21 subjects in the DOS/ESC arms at 24 weeks. The adjusted difference in change in HbA1c (DOS-ESC) was -0.5 ± 0.4% at 12 weeks (P = 0.20) and -0.7 ± 0.4% at 24 weeks (P= 0.09). Achievement of individualized HbA1c target was greater in the DOS group at 12 weeks but not 24 weeks. CONCLUSIONS A DOS resulted in more complete discharge prescriptions. Assessment of post-discharge outcomes was limited due to loss of long-term follow-up but suggests possible benefit in glucose control. CLINICALTRIAL NCT03455985 Effectiveness of a Diabetes Focused Discharge Order Set Among Poorly Controlled Hospitalized Patients Transitioning to Glargine U300 Insulin

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Real-World Analysis of Venous Thromboembolism Rates and Thromboprophylaxis Prescribing In US Patients with Cancer.

Blood ◽

10.1182/blood.v116.21.3802.3802 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3802-3802

Author(s):

Alpesh N Amin ◽

Jay Lin ◽

Stephen Thompson ◽

Daniel Wiederkehr

Keyword(s):

Cancer Patients ◽

Hospital Discharge ◽

Real World ◽

Research Funding ◽

Outpatient Setting ◽

Index Hospitalization ◽

Post Discharge ◽

Pharmacological Prophylaxis ◽

Mechanical Prophylaxis ◽

Patients With Cancer

Abstract Abstract 3802 Background: Deep-vein thrombosis (DVT) is a frequent complication of cancer and treatment of cancer. Among clinical guidelines, there is broad consensus regarding the importance of thromboprophylaxis in hospitalized cancer patients, including prolonged prophylaxis in high-risk patients. The objective of this analysis was to assess the real-world use of prophylaxis for DVT, as well as symptomatic rates of DVT and pulmonary embolism (PE) in cancer patients, both during hospitalization and after hospital discharge. Methods: Data were extracted from the US Premier Perspective(tm)-i3 Pharma Informatics linked database for non-surgical cancer patients who were admitted to hospital from January 2005 to November 2007. Included patients were aged ≥ 18 years and had ≥ 6 months' continuous plan enrollment. Patients were excluded if they were discharged to an acute-care facility, had length of hospital stay ≤ 0 or > 30 days, had missing/unknown gender or age data, or if they were diagnosed with atrial fibrillation during index hospitalization. Clinical rates of DVT/PE, as well as thromboprophylaxis status and duration were evaluated for during hospitalization and post-discharge. Results: Of the 3,759 cancer patients analyzed, 51.9% received inpatient pharmacological and/or mechanical prophylaxis, and 2.8% received outpatient pharmacological prophylaxis in the 14 days following discharge. During index hospitalization 40.0% of patients received mechanical prophylaxis and 21.1% pharmacological prophylaxis, with 9.3% of patients receiving a combination of mechanical and pharmacological prophylaxis. Mean (± standard deviation) duration of prophylaxis was 1.3 (± 2.3) days for inpatients and 0.7 (± 4.5) days post-discharge among all cancer patients. Symptomatic DVT/PE occurred in 2.4% of patients during hospitalization. In the 30 days following hospital discharge, 1.7% of patients was either rehospitalized for DVT/PE or treated for DVT/PE in the outpatient setting. Conclusions: This real-world analysis demonstrates considerable symptomatic rates of DVT/PE in hospitalized cancer patients, with approximately half of patients not receiving any thromboprophylaxis. The risk of DVT/PE persisted into the outpatient setting, but few patients received anticoagulants post-discharge. Further efforts are needed to ensure that patients with cancer receive appropriate thromboprophylaxis and that it is of adequate duration to reduce the large burden of DVT/PE. Acknowledgment: This study was funded by sanofi-aventis U.S., Inc. The authors received editorial/writing support in the preparation of this abstract provided by Tessa Hartog, PhD of Excerpta Medica, funded by sanofi-aventis U.S., Inc. Disclosures: Amin: sanofi-aventis US Inc.: Honoraria, Speakers Bureau. Lin:sanofi-aventis US Inc.: Employment, Research Funding. Thompson:sanofi-aventis US Inc.: Employment. Wiederkehr:sanofi-aventis US Inc.: Research Funding.

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P1571Atrial fibrillation is an independent predictor of mortality in hospitalized cancer patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0331 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A H Malik ◽

S Shetty ◽

S Malik

Keyword(s):

Atrial Fibrillation ◽

Colon Cancer ◽

Risk Factor ◽

Hospital Mortality ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Independent Risk Factor ◽

Attributable Mortality ◽

Patients With Cancer ◽

Hospitalised Patients

Abstract Background Atrial fibrillation (AF) is prevalent in patients with cancer. We performed a study to evaluate the outcomes associated with hospitalised cancer patients with AF. Methods The Nationwide Inpatient Sample was used to identify patients with a cancer diagnosis, who were found to have atrial fibrillation from the years 2002–2014. Descriptive statistics for mortality were calculated using univariate and multivariate model for each cancer, and we identified the type of cancer associated with the highest inpatient mortality. We also calculated the percentage of hospital mortality attributable to AF. Results 12,410,290 (nationwide estimate) patients with a cancer diagnosis were identified, and 8.2% of them had AF. In a multivariate adjusted model for various relevant comorbidities, age, gender and race, AF was also found to be an independent risk factor for higher in-hospital mortality in cancer patients, odds ratio (OR) 1.25 (95% CI 1.23, 1.28, p<0.0001). Colon cancer was found to be associated with the worst outcomes and the highest mortality. In cancer patients, the incident percentage of hospital mortality attributed to AF was 46.7%, population attributable mortality risk of was 7.17%, and number needed to harm was 21 (p<0.0001). Conclusion AF conferred significant morbidity and was found to be an independent risk factor for increased mortality in hospitalised patients with cancer. Colon cancer was found to have the strongest association of worst outcomes in hospitalized patients with AF. Acknowledgement/Funding None

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Comparison between the Khorana prediction score and Caprini risk assessment models for assessing the risk of venous thromboembolism in hospitalized patients with cancer: a retrospective case control study

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa137 ◽

2020 ◽

Vol 31 (4) ◽

pp. 454-460

Author(s):

Yuehong Hu ◽

Xiaoqian Li ◽

Haixia Zhou ◽

Ping Lin ◽

Jiarui Zhang ◽

...

Keyword(s):

Risk Assessment ◽

Venous Thromboembolism ◽

High Risk ◽

Cancer Patients ◽

Case Control Study ◽

Case Control ◽

Hospitalized Patients ◽

Retrospective Case ◽

Patients With Cancer ◽

Control Study

Abstract OBJECTIVES This study aimed to evaluate the optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in hospitalized patients with cancer. We examined and compared the VTE predictive ability of the Khorana score (KS) and the Caprini RAM in hospitalized cancer patients. METHODS We performed a retrospective case–control study among hospitalized cancer patients admitted to a comprehensive hospital in China from January 2015 to December 2016. A total of 221 cases were confirmed to have VTE during hospitalization and 221 controls were selected randomly. The Caprini RAM and KS were implemented and the individual scores of each risk factor were summed to generate a cumulative risk score. Meanwhile, the sensitivity, specificity, areas under curve of the receiver operating characteristic curve and calibration of these 2 models were analysed. RESULTS Significant differences were observed in risk factors between VTE and non-VTE hospitalized cancer patients and the VTE risk increased significantly with an increase in the cumulative KS or Caprini RAM score. A classification of ‘high risk’ according to KS and Caprini RAM was associated with 2.272-fold and 3.825-fold increases in VTE risk, respectively. However, the Caprini RAM could identify 82.4% of the VTE cases that required preventive anticoagulant therapy according to American College of Chest Physicians guidelines, whereas the KS could only identify 35.3% of the VTE cases. In addition, the areas under curve of Caprini RAM were significantly higher than those of the KS (0.705 ± 0.024 vs 0.581 ± 0.025, P < 0.001), with a best cut-off value of 5 score, which happened to be the cut-off value for high risk of VTE in Caprini RAM. Both Caprini RAM and KS showed an excellent calibration curve (0.612 vs 0.141, P > 0.05), but the risk of VTE events predicted by Caprini seemed closer to the observed risk of VTE events. CONCLUSIONS The Caprini RAM was found to be more effective than the KS in identifying hospitalized patients with cancer at risk of VTE.

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High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study

Thrombosis Journal ◽

10.1186/s12959-021-00265-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Abdulrahman Al Raizah ◽

Ahmed Al Askar ◽

Naila Shaheen ◽

Khalid Aldosari ◽

Mohamed Alnahdi ◽

...

Keyword(s):

Multicenter Study ◽

Anticoagulation Therapy ◽

Significant Risk ◽

Hospitalized Patients ◽

High Rate ◽

Bleeding Complications ◽

Controlled Study ◽

Bleeding Events ◽

Composite Event ◽

D Dimer

Abstract Background Several observational studies have reported the rate of venous and arterial thrombotic events in patients infected with COVID-19, with conflicting results. The aim of this study was to estimate the rate of thrombotic and bleeding events in hospitalized patients diagnosed with Coronavirus disease 2019 (COVID-19). Methods This was a multicenter study of 636 patients admitted between 20 March 2020 and 31 May 2020 with confirmed COVID-19 in four hospitals. Results Over a median length of stay in the non-ICU group of 7 days and of 19 days in the ICU group, twelve patients were diagnosed with Venous thromboembolism (VTE) (1.8 %) (95 % CI, 1.1–3). The rate in the non-ICU group was 0.19 % (95 % CI, 0.04–0.84), and that in the ICU group was 10.3 % (95 % CI, 6.4–16.2). The overall rate of arterial event is 2.2 % (95 % CI, 1.4–3.3). The rates in the non-ICU and ICU groups were 0.94 % (95 % CI, 0.46–0.1.9) and 8.4 % (95 % CI, 5.0–14.0). The overall composite event rate was 2.9 % (95 % CI, 2.0–4.3). The composite event rates in the non-ICU and ICU groups were 0.94 % (95 % CI, 0.46–0.1.9) and 13.2 % (95 % CI, 8.7–19.5). The overall rate of bleeding is 1.7 % (95 % CI, 1.0–2.8). The bleeding rate in the non-ICU group was 0.19 % (95 % CI, 0.04–0.84), and that in the ICU group was 9.4 % (95 % CI, 5.7–15.1). The baseline D-dimer level was a significant risk factor for developing VTE (OR 1.31, 95 % CI, 1.08–1.57, p = 0.005) and composite events (OR 1.32, 95 % CI, 1.12–1.55, p = 0.0007). Conclusions In this study, we found that the VTE rates in hospitalized patients with COVID-19 might not be higher than expected. In contrast to the risk of VTE, we found a high rate of arterial and bleeding complications in patients admitted to the ICU. An elevated D-dimer level at baseline could predict thrombotic complications in COVID-19 patients and may assist in the identification of these patients. Given the high rate of bleeding, the current study suggests that the intensification of anticoagulation therapy in COVID-19 patients beyond the standard of care be pursued with caution and would best be evaluated in a randomized controlled study.

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