Contemporary Estimates of the Incidence of Venous Thromboembolism: A Population-Based Cohort Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1143-1143
Author(s):  
Vicky Tagalakis ◽  
Valerie Patenaude ◽  
Susan R. Kahn ◽  
Samy Suissa
Keyword(s):  
Venous Thromboembolism ◽  
General Population ◽  
Incidence Rate ◽  
Conflicts Of Interest ◽  
Public Health Problem ◽  
Incidence Rates ◽  
Future Research ◽  
Public Healthcare ◽  
Source Population

Abstract Abstract 1143 Background: Venous thromboembolism (VTE) is a growing public health problem due largely to the aging population and the increasing prevalence of known risk factors such as surgery and cancer-related treatments. As a result, the true burden of VTE is not fully known and more contemporary estimates of incidence are needed. Objectives: We estimated the incidence of a first VTE event in a general population. Methods: This retrospective, observational study used the linked administrative healthcare databases of the province of Québec, Canada, including the province-wide hospitalization database (MED-ÉCHO) and the healthcare services database of RAMQ which oversees all physician reimbursement claims for services provided to Québec residents. From a source population of all RAMQ beneficiaries with a physician visit or a hospitalization associated with an ICD-9-CM or ICD-10-CA diagnosis code for deep vein thrombosis (DVT) or pulmonary embolism (PE) recorded between January 1, 2000 and December 31, 2009 and without a DVT or PE code prior to January 1, 2000, we identified a cohort of Québec residents with definite incident VTE and a cohort with definite or probable incident VTE. We used a priori determined diagnostic algorithms using RAMQ and MED-ÉCHO data to identify definite and probable cases of VTE. Subjects were followed forward in time from first-time VTE occurrence until the earliest of either death or end of study period (December 31, 2009). Incidence rates of first VTE, DVT alone, and PE with or without DVT were calculated by dividing the number of new cases by the total person-years at risk in the population of Québec residents eligible for RAMQ between 2000 and 2009. Age-specific incidence rates and associated 95% confidence intervals (CI) were calculated using achieved age during follow-up, and as a result patients contributed person-time in different age categories while aging during follow-up. Crude and age-adjusted incidence rate ratios (IRR) were reported comparing rates among women and men. Results: From the 245 452 Québec residents between 2000 and 2009 with at least 1 VTE diagnosis in RAMQ or MED-ÉCHO (source population), we identified 67 410 cases with definite VTE and 35 123 cases with probable VTE. The incidence rate of definite VTE was 0.91 per 1000 person-years (95% CI: 0.90–0.91). For DVT alone, the incidence was 0.53 per 1000 person-years (95% CI: 0.52–0.52) and for PE with or without DVT it was 0.38 per 1000 person-years (95% CI: 0.38–0.38). The incidence rates increased with age, and rates in patients 70 years of age and older were more than 4 times higher than rates in patients who were 40–69 years of age (Table 1). The VTE incidence rate was 0.99 per 1000 person-years (95% CI: 0.98–1.00) in women as compared to 0.82 per 1000 person-years (95% CI: 0.81–0.83) in men. The IRR was 1.19 (95% CI: 1.17–1.22) but this sex difference was no longer seen when adjusted for age (IRR 0.98; 95% CI: 0.96–1.01). The corresponding VTE, DVT alone, and PE incidence rates per 1000 person-years for definite or probable VTE were 1.24 (95% CI: 1.23–1.24), 0.79 (95% CI: 0.78–0.79), and 0.45 (95% CI: 0.45–0.46), respectively. Conclusion: Our study provides real-world contemporary estimates of VTE incidence. The risk in the general population is about 0.9 to 1.2 per 1000 person-years and is highest in the elderly. These data may help inform public healthcare planning and future research. Disclosures: No relevant conflicts of interest to declare.

The Economic Burden of Acute Venous Thromboembolism During One Year Following Diagnosis: A Population-Based Cohort Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1152-1152
Author(s):  
Vicky Tagalakis ◽  
Valerie Patenaude ◽  
Susan R. Kahn ◽  
Samy Suissa
Keyword(s):  
Venous Thromboembolism ◽  
Direct Cost ◽  
Economic Burden ◽  
Conflicts Of Interest ◽  
Ambulatory Setting ◽  
Fiscal Year ◽  
Total Direct Cost ◽  
Source Population ◽  
Physician Visits

Abstract Abstract 1152 Background: Although venous thromboembolism (VTE) is the third most common cardiovascular condition after myocardial infarct and stroke, few data exist on the economic burden associated with this condition. Objective: We aimed to quantify the economic burden of acute VTE in direct medical costs in the general population. Methods: Using the linked administrative healthcare databases of the province of Québec, Canada, including the provincial hospitalization database (MED-ÉCHO) and the healthcare claims databases of RAMQ which is a government agency that administers the provincial universal healthcare program, we determined a source population of all RAMQ beneficiaries with a physician visit or a hospitalization associated with an ICD-9-CM or ICD-10-CA diagnosis code for deep vein thrombosis (DVT) or pulmonary embolism (PE) between January 1, 2000 and December 31, 2009 and without a DVT or PE code prior to January 1, 2000. From the source population, we identified a cohort of Québec residents with a definite VTE and a cohort with a definite or probable VTE. We used a priori determined diagnostic algorithms using RAMQ and MED-ÉCHO data to identify definite and probable VTE cases. Subjects were followed forward in time from first VTE until the earliest of either death or end of study period (December 31, 2009). We determined the total direct cost per year for VTE by applying unit costs to the patient resource use profile in the year after diagnosis of VTE. Resource costs included hospitalizations, physician visits, and prescription medications. Resources were valued by the use of individual patient-level information from RAMQ and MED-ÉCHO. All costs were standardized to the 2009–2010 fiscal year costs, and are reported in Canadian dollars (year 2010 average US exchange rate 1.04). The RAMQ Manuel de Facturation and Manuel des Services de laboratoire en établissement was used to determine fees physician acts associated with a VTE diagnosis. The RAMQ List des médicaments contains information on drugs covered by the provincial drug insurance plan and was used to determine VTE-related drug costs. Because hospital costs are not available in Québec, we used the Ontario Case Costing Initiative to obtain hospital cost data. Hospitalizations for VTE–related outcomes were identified. The mean cost per person-years of follow-up was calculated as the sum of all costs during the year after VTE diagnosis divided by the total person-time of follow-up during that year. Results: From the 245 452 Québec residents between 2000 and 2009 with at least 1 VTE diagnosis in RAMQ or MED-ÉCHO, we identified 40 776 cases with definite VTE, and 14 027 cases with probable VTE. The average direct cost per person-year for VTE is $4,449.13 in the year following a definite VTE (Table 1) and $3,418.83 in the year following a definite or probable VTE. In both cohorts, the majority of cost was incurred by hospitalization for the initial VTE, and average cost after PE was higher than cost following DVT. Conclusions: The economic burden of VTE is large, and is mainly due to the initial VTE hospitalization. Use of measures favouring the safe out-patient treatment of VTE and the development of management strategies to identify patients with acute PE who can safely be treated in the ambulatory setting have the potential to decrease cost. Disclosures: No relevant conflicts of interest to declare.

Temporal Incidence Trends of Pediatric Venous Thromboembolism: A Population-Based Cohort Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1138-1138
Author(s):  
Christine A. Sabapathy ◽  
Susan R. Kahn ◽  
Robert W Platt ◽  
Vicky Tagalakis
Keyword(s):  
Sex Differences ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Conflicts Of Interest ◽  
Age Groups ◽  
Incidence Rates ◽  
Age Group ◽  
Incidence Trends ◽  
Incident Cases ◽  
Temporal Incidence

Abstract Abstract 1138 Background: Pediatric venous thromboembolism (VTE), although rare, is associated with significant morbidity and mortality. Published incidence rates in this age group vary from 0.07 to 0.49 VTE per 10 000 children/year and there is currently a paucity of studies evaluating temporal incidence trends. Objectives: To describe the age-adjusted incidence rates of pediatric VTE and its trend over time in a large pediatric cohort. Methods: A retrospective cohort of all children (ages 1–17 inclusive) with a first time diagnosis of VTE in the province of Quebec, Canada over an eleven-year period, from January 1st, 1994 to December 31st, 2004, was obtained from a comprehensive administrative hospital database (Med-Echo). Quebec census estimates were used to calculate age-standardized incidence rates (IR) of pediatric VTE. The incidence rate trend was then analyzed over the eleven-year study period using Poisson linear regression. Sex differences in incidence rates at the population level stratified by age group as a confounder as well as baseline characteristics of the cases were also evaluated. Results: In total, 487 incident cases of VTE in children 1–17 years of age were documented during the study period. Based on the estimated provincial census person-years during the study period, the age-standardized IR was 0.29 VTE per 10 000 person-years (95% confidence interval (CI) 0.26–0.31). Females overall had a statistically significant higher VTE incidence rate with an incidence rate ratio of 1.75 (95% CI 1.46–2.11) when controlled for age groups, as compared to males. When analyzed by age group, the age-standardized IRs were as follows: 1–5 year olds 0.04 VTE per 10 000 person-years (95% CI 0.03–0.05); 6–10 year olds 0.03 VTE per 10 000 person-years (95% CI 0.02–0.04); 11–14 year olds 0.06 VTE per 10 000 person-years (95% CI 0.05–0.07); 15–17 year olds 0.16 VTE per 10 000 person-years (95% CI 0.14–0.18). Trend analysis of the age-standardized IRs over the 11-year period showed no significant change in incidence rates whether using time as a continuous (yearly) or categorical variable (time-periods). Conclusions: Pediatric VTE is more frequent than previously described, however the rate is stable. As shown by others, children in their late-teen years have a higher risk of VTE than primary school-aged children. Unlike prior studies, females were more prone to VTE than males. Future studies that address sex differences in the incidence of pediatric VTE are needed to help determine effective primary thromboprophylaxis strategies in children at high risk for VTE. Disclosures: No relevant conflicts of interest to declare.

Secondary Malignancies in CML Patients – Data From the German CML Study IV

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3746-3746 ◽  
Author(s):  
Manuel Barreto Miranda ◽  
Michael Lauseker ◽  
Ulrike Proetel ◽  
Annette Schreiber ◽  
Benjamin Hanfstein ◽  
...  
Keyword(s):  
General Population ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Interferon Alpha ◽  
Research Funding ◽  
Incidence Rates ◽  
Primary Cancer ◽  
Secondary Malignancies

Abstract Abstract 3746 Introduction: The increase of overall survival in chronic myeloid leukemia (CML) requires closer long-term observation in the face of a potential carcinogenicity of tyrosine kinase inhibitors (TKIs). Preclinical studies with imatinib in rats showed neoplastic changes in kidneys, urinary bladder, urethra, preputial and clitoral glands, small intestine, parathyroid glands, adrenal glands, and nonglandular stomach. Two epidemiologic studies on patients with chronic myeloproliferative neoplasms (CMPN) and CML (Frederiksen H et al., Blood 2011; Rebora P et al., Am J Epidemiol 2010) found an increased risk of secondary malignancies compared with the general population independent of treatment. In contrast, in a recent analysis of patients with CML and CMPN treated with TKI (Verma D et al., Blood 2011) a decreased risk of secondary malignancies was reported. Aims: To further elucidate the risk of TKI treated CML patients for the development of secondary malignancies we analysed data of the CML study IV, a randomized 5-arm trial (imatinib 400 mg vs. imatinib 800 mg vs. imatinib 400 mg in combination with interferon alpha vs. imatinib 400 mg in combination with AraC vs. imatinib 400 mg after interferon failure). Patients and methods: From February 2002 to April 2012, 1551 CML patients in chronic phase were randomized, 1525 were evaluable. Inclusion criteria allowed the history of primary cancer if the disease was in stable remission. Forty-nine malignancies were reported in 43 patients before the diagnosis of CML. If relapses occurred within 5 years after diagnosis of primary cancer they were not considered for further analysis. Median follow-up was 67.5 months. Age-standardized incidence rates were calculated from the age-specific rates using the European standard population (1976). Results: In total, 67 secondary malignancies in 64 patients were found in CML patients treated with TKI (n=61) and interferon alpha only (n=3). Twelve of these patients developed neoplasms after diagnosis of a primary cancer before diagnosis of CML, 5 patients with metastases or recurrence of the first malignancy (range of diagnosis 5–19 years after primary cancer). Median time to secondary malignancy was 2.5 years (range 0.1–8.3 years). The types of neoplasms were: prostate (n=9), colorectal (n=6), lung (n=6), non Hodgkin's lymphoma (NHL; n=7), malignant melanoma (n=5), skin tumors (basalioma n=4 and squamous cell carcinoma n=1), breast (n=5), pancreas (n=4), kidney (n=4), chronic lymphocytic leukemia (n=3), head and neck (n=2), biliary (n=2), sarcoma (n=2), and esophagus, stomach, liver, vulva, uterus, brain, cancer of unknown origin (each n=1). With these numbers the age-standardized incidence rates of secondary malignancies in CML patients were calculated: 534 cases per 100,000 for men (confidence interval [350;718]), and 582 for women (confidence interval [349;817]). The incidence rates of the general population in Germany were 450 and 350 cases, respectively (“Krebs in Deutschland 2007/2008”, 8th ed., Robert Koch Institute, 2012). The incidence rate of NHLs was higher for CML patients than for the general population but this is not significant. Conclusions: In our cohort, the incidence rate of secondary neoplasms in CML patients was slightly increased compared to the general population. The most common secondary malignancies in CML patients under treatment were cancers of the skin, prostate, colon, lung and NHL. Since the occurrence of secondary neoplasia increases over time, long-term follow-up of CML patients is warranted. Disclosures: Müller: Novartis, BMS: Consultancy, Honoraria, Research Funding. Hochhaus:Novartis, BMS, MSD, Ariad, Pfizer: Consultancy Other, Honoraria, Research Funding. Hehlmann:Novartis: Research Funding.

Epidemiology of first and recurrent venous thromboembolism in patients with active cancer

2017 ◽  
Vol 117 (01) ◽  
pp. 57-65 ◽  
Author(s):  
Anja Katholing ◽  
Stephan Rietbrock ◽  
Luke Bamber ◽  
Carlos Martinez ◽  
Alexander T. Cohen
Keyword(s):  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Source Population ◽  
Recurrence Rates ◽  
Recurrent Vte ◽  
Active Cancer

SummaryPopulation studies on the incidence of venous thromboembolism (VTE) in patients with active cancer are limited. An observational cohort study was undertaken to estimate the incidence of first and recurrent VTE. The source population consisted of all patients in the UK Clinical Practice Research Datalink, with additional information on hospitalisation and cause of death, between 2001 and 2011. A cancer-related clinical diagnosis or therapy within the 90 days before or after a VTE constituted an active-cancer-associated VTE. Incidence rates of first VTE among patients with active cancer and incidence rates of recurrent VTE during the 10-year observational period after a first VTE event were estimated. Incidence rates of all-cause mortality and age- and gender-specific mortality were also calculated. There were 6,592 active-cancer-associated VTEs with a total of 112,738 cancer-associated person-years of observation. The incidence rate of first VTE in patients with active cancer was 5.8 (95 % confidence interval 5.7–6.0) per 100 person-years. A first VTE recurrence was observed in 591 patients. The overall incidence rate for recurrence was 9.6 (95 % confidence interval 8.8–10.4) per 100 person-years, with a peak at 22.1 in the first six months. Recurrence rates were similar after initial pulmonary embolism and after initial deep-vein thrombosis. The mortality risk after VTE was considerable, with 64.5 % mortality after one year and 88.1 % after 10 years. VTE in patients with active cancer is common and associated with high recurrence and mortality rates. Efforts are needed to prevent VTE and reduce recurrence, especially in the first year after VTE diagnosis.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Recurrence Risk after Limited Duration of Anticoagulant Treatment for Late Second Venous Thromboembolism

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 591-591
Author(s):  
T van der Hulle ◽  
M Tan ◽  
P L den Exter ◽  
M JG van Roosmalen ◽  
F JM van der Meer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Recurrence Risk ◽  
Incidence Rates ◽  
Anticoagulant Treatment ◽  
Duration Of Treatment ◽  
Patients At Risk ◽  
Limited Duration

Abstract Introduction Patients with a second venous thromboembolism (VTE) generally receive anticoagulant treatment for indefinite duration, although it is known that the recurrence risk diminishes over time while the risk of hemorrhage persists with continued anticoagulation and increases with age. Based on these arguments and the limited evidence for indefinite duration of treatment, the Dutch guideline recommends to consider limited duration of treatment (i.e. 12-month) for a 'late' second VTE, defined as a second VTE diagnosis >1 year after discontinuing treatment for a first VTE. It is hypothesized that the risk of continued anticoagulation might outweigh the benefits in those patients. We evaluated this management in daily practice. Methods Since 2003, a limited duration of treatment was systematically considered in consecutive patients with a late second VTE at a single academic hospital in The Netherlands. Incidence rates and cumulative incidence rates for a third VTE were calculated in patients who were treated for a limited duration and for an indefinite duration separately. For patients who were treated for a limited duration, hazard ratios (HR) for a third VTE were calculated for unprovoked versus provoked second VTE and DVT or PE as second VTE diagnosis. HR were adjusted for age, sex and where possible for type of second VTE and whether the second VTE was provoked or unprovoked. Results Of 132 patients with a late second VTE, 77 patients were treated for limited duration, of whom 26 developed a symptomatic third VTE after treatment cessation during a cumulative follow-up of 277 years, resulting in an incidence rate of 9.4/100 patient-years (95%CI 6.1-14). Cumulative incidence rates were 15% (95%CI 6.1-14) and 33% (95%CI 18-49) after 1 and 5 years of follow-up (Figure 1). In patients who were treated for an indefinite duration, the incidence rate was 1.2/100 patient-years (95%CI 0.33-3.1). The incidence rates in patients with an unprovoked VTE and a VTE related to a transient provoking factor were 12 per 100 patient-years (95%CI 7.4-19) and 5.6 per 100 patient-years (95%CI 2.2-12) respectively with a HR of 2.8 (95%CI 1.1-7.2) (Figure 2). No difference was observed for patients with deep vein thrombosis as second VTE compared to patients with pulmonary embolism as second VTE, HR 0.65 (95%CI 0.29-1.5). Conclusion The incidence rate of 9.5/100 patient-years for a third VTE after a limited duration of treatment for a second VTE largely exceeds the risk of major hemorrhage associated with long-term anticoagulant treatment, which has been estimated to be 2.7/100 patient-years. Therefore, these findings strongly suggest that identifying patients with a relatively low recurrence risk based on the interval between first and second VTE is not an appropriate strategy. Only in patients with a second VTE in the presence of a transient provoking factor the recurrence risk approaches the risk of major bleeding associated with long-term anticoagulant treatment and a limited duration of treatmentmay still be considered in these patients. Follow-up started at the time of the second venous thromboembolism diagnosis for both categories. Figure 1: Figure 1:. Cumulative incidence rate of a third venous thromboembolism in patients treated for a limited duration and patients treated for an indefinite duration. Note: nrVTE: number of recurrent VTE; PAR: patients at risk Follow-up started at the time of cessation anticoagulant treatment. Figure 2: Figure 2:. Cumulative third venous thromboembolism event rate in patients with a provoked second VTE versus an unprovoked second VTE, treated for a maximum of 12 months. Note: nrVTE: number of recurrent VTE; PAR: patients at risk Disclosures No relevant conflicts of interest to declare.

The incidence of venous thromboembolism in patients with overt hyperthyroidism

2012 ◽  
Vol 107 (03) ◽  
pp. 417-422 ◽  
Author(s):  
Danka J. F. Stuijver ◽  
Olaf M. Dekkers ◽  
Bregje van Zaane ◽  
Eric Fliers ◽  
Suzanne C. Cannegieter ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
General Population ◽  
Incidence Rate ◽  
Multinodular Goiter ◽  
Primary Outcome ◽  
Incidence Rates ◽  
Clinical Implications ◽  
Toxic Adenoma ◽  
Increased Risk ◽  
Overt Hyperthyroidism

SummaryHyperthyroidism is associated with several changes in the haemostatic system resulting in a hypercoagulable state. It is uncertain at this stage whether this leads to an increased risk of venous thromboembolism (VTE). The aim of this retrospective cohort study was to determine the risk of VTE in all patients with overt hyperthyroidism and to compare this to the risk of VTE in the general population. In three hospitals in the Netherlands, patients with biochemically confirmed hyperthyroidism caused by Graves’ disease, multinodular goiter or toxic adenoma were included. All available electronic and handwritten records were examined. Primary outcome was the occurrence of VTE within six months before and until six months after the diagnosis of hyperthyroidism. We included a total of 587 patients. Five patients experienced a VTE during the study period, resulting in an incidence rate of 8.7 (95% CI 2.8 – 20.2) per 1,000 person-years. Three of these five patients had a first VTE (incidence rate for first VTE was 5.3 [95% CI 1.1 – 15.6] per 1,000 person-years). Incidence rates of VTE in the general population are between 0.6 and 1.6 per 1,000 person-years for first VTE and 0.7 and 1.8 per 1,000 person-years for all VTE. In conclusion, the incidence rate of VTE in patients with hyperthyroidism appears to be high. Future prospective studies are needed to further explore this possible association and to address its clinical implications.

scholarly journals A web-based prospective cohort study of home, leisure, school and sports injuries in France: a descriptive analysis

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Madelyn Yiseth Rojas Castro ◽  
Ludivine Orriols ◽  
Dunia Basha Sakr ◽  
Benjamin Contrand ◽  
Marion Dupuy ◽  
...  
Keyword(s):  
General Population ◽  
Injury Severity ◽  
Sport Activity ◽  
Public Health Problem ◽  
Incidence Rates ◽  
Major Public Health Problem ◽  
Severe Injuries ◽  
Web Based ◽  
Entire Cohort

Abstract Background Home and leisure injuries (HLIs) are a major public health problem. Cohort studies among general population are needed for targeted preventive actions but remain scarce. We quantify and qualify the HLIs collected prospectively in the MAVIE (Mutualists against Home and Leisure Injuries) observatory, a web-based cohort among volunteers of the French general population. Methods Participants reported HLIs from November 2014 to December 2019. We calculated crude and standardized incidence rates (SIRs) on the entire cohort, for each of the selected socio-demographic variables and each of the injury circumstances (place and activity), mechanisms, and injury severity levels. We also described other HLIs characteristics and consequences. Results Out of the 29,931 household members enrolled in the cohort, 12,419 participants completed the questionnaires. Among them, 8640 participants provided follow-up data, leading to a follow-up of 6302 persons for 5.2 years and 2483 HLIs were reported. We obtained a SIR of 85.0 HLIs per 1000 persons-years. Most reported injuries did not require emergency department attendance or hospitalization (64%). SIRs were higher in children (< 15 years of age) (109.1 HLIs per 1000 persons-years; 95% CI, 78.2–140.1) and adults aged 70 years and older (123.7 HLIs per 1000 persons-years; 95% CI, 79.2–168.3). Struck or hit by fall was the most frequent injury mechanism (52%) and also among the most severe injuries (73% of Struck or hit by fall HLIs ending with hospitalization). Sport (without contact with nature), and leisure and play activities were the injury circumstances with higher SIRs, 15.2 HLIs per 1000 persons-years (95% CI, 14.6–15.8) and 11.2 HLIs per 1000 persons-years (95% CI, 10.7–11.6), respectively. Outdoor sport activity (in contact with nature) was the circumstance with the highest proportion of hospitalizations (18% of outdoor sports HLIs ending with hospitalization). Conclusion The incidences, causes, and consequences of HLI differ by age group and are mainly related to the performance of certain activities. Although the participants in the MAVIE cohort were not representative of the French population. Our study identified potential sub-populations and specific types of HLIs that should be targeted by future studies concerning risk factors and prevention programs.

Post Discharge Clinically Overt Venous Thromboembolism in Orthopaedic Surgery Patients with Negative Venography -an Overview Analysis

1996 ◽  
Vol 76 (06) ◽  
pp. 0887-0892 ◽  
Author(s):  
Serena Ricotta ◽  
Alfonso lorio ◽  
Pasquale Parise ◽  
Giuseppe G Nenci ◽  
Giancarlo Agnelli
Keyword(s):  
Venous Thromboembolism ◽  
Orthopaedic Surgery ◽  
Diagnostic Methods ◽  
Future Research ◽  
Post Discharge ◽  
Pharmacological Prophylaxis ◽  
Vein Thrombosis ◽  
Overview Analysis ◽  
Major Orthopaedic Surgery

SummaryA high incidence of post-discharge venous thromboembolism in orthopaedic surgery patients has been recently reported drawing further attention to the unresolved issue of the optimal duration of the pharmacological prophylaxis. We performed an overview analysis in order to evaluate the incidence of late occurring clinically overt venous thromboembolism in major orthopaedic surgery patients discharged from the hospital with a negative venography and without further pharmacological prophylaxis. We selected the studies published from January 1974 to December 1995 on the prophylaxis of venous thromboembolism after major orthopaedic surgery fulfilling the following criteria: 1) adoption of pharmacological prophylaxis, 2) performing of a bilateral venography before discharge, 3) interruption of pharmacological prophylaxis at discharge in patients with negative venography, and 4) post-discharge follow-up of the patients for at least four weeks. Out of 31 identified studies, 13 fulfilled the overview criteria. The total number of evaluated patients was 4120. An adequate venography was obtained in 3469 patients (84.1%). In the 2361 patients with negative venography (68.1%), 30 episodes of symptomatic venous thromboembolism after hospital discharge were reported with a resulting cumulative incidence of 1.27% (95% C.I. 0.82-1.72) and a weighted mean incidence of 1.52% (95% C.I. 1.05-1.95). Six cases of pulmonary embolism were reported. Our overview showed a low incidence of clinically overt venous thromboembolism at follow-up in major orthopaedic surgery patients discharged with negative venography. Extending pharmacological prophylaxis in these patients does not appear to be justified. Venous thrombi leading to hospital re-admission are likely to be present but asymptomatic at the time of discharge. Future research should be directed toward improving the accuracy of non invasive diagnostic methods in order to replace venography in the screening of asymptomatic post-operative deep vein thrombosis.

scholarly journals Lymphoproliferative malignancies in patients with neurofibromatosis 1

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Christina Bergqvist ◽  
François Hemery ◽  
Arnaud Jannic ◽  
Salah Ferkal ◽  
Pierre Wolkenstein
Keyword(s):  
General Population ◽  
Medical History ◽  
Hodgkin Lymphoma ◽  
Incidence Rate ◽  
Population Based ◽  
Neurofibromatosis 1 ◽  
Population Based Study ◽  
Non Hodgkin Lymphoma ◽  
History Of

AbstractNeurofibromatosis 1 (NF1) is an inherited, autosomal-dominant, tumor predisposition syndrome with a birth incidence as high as 1:2000. A patient with NF1 is four to five times more likely to develop a malignancy as compared to the general population. The number of epidemiologic studies on lymphoproliferative malignancies in patients with NF1 is limited. The aim of this study was to determine the incidence rate of lymphoproliferative malignancies (lymphoma and leukemia) in NF1 patients followed in our referral center for neurofibromatoses. We used the Informatics for Integrated Biology and the Bedside (i2b2) platform to extract information from the hospital’s electronic health records. We performed a keyword search on clinical notes generated between Jan/01/2014 and May/11/2020 for patients aged 18 years or older. A total of 1507 patients with confirmed NF1 patients aged 18 years and above were identified (mean age 39.2 years; 57% women). The total number of person-years in follow-up was 57,736 (men, 24,327 years; women, 33,409 years). Mean length of follow-up was 38.3 years (median, 36 years). A total of 13 patients had a medical history of either lymphoma or leukemia, yielding an overall incidence rate of 22.5 per 100,000 (0.000225, 95% confidence interval (CI) 0.000223–0.000227). This incidence is similar to that of the general population in France (standardized incidence ratio 1.07, 95% CI 0.60–1.79). Four patients had a medical history leukemia and 9 patients had a medical history of lymphoma of which 7 had non-Hodgkin lymphoma, and 2 had Hodgkin lymphoma. Our results show that adults with NF1 do not have an increased tendency to develop lymphoproliferative malignancies, in contrast to the general increased risk of malignancy. While our results are consistent with the recent population-based study in Finland, they are in contrast with the larger population-based study in England whereby NF1 individuals were found to be 3 times more likely to develop both non-Hodgkin lymphoma and lymphocytic leukemia. Large-scale epidemiological studies based on nationwide data sets are thus needed to confirm our findings.

Atrial fibrillation associated with increased risk of venous thromboembolism

2015 ◽  
Vol 113 (01) ◽  
pp. 185-192 ◽  
Author(s):  
Chun-Cheng Wang ◽  
Cheng-Li Lin ◽  
Guei-Jane Wang ◽  
Chiz-Tzung Chang ◽  
Fung-Chang Sung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Incidence Rates ◽  
Vein Thrombosis ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Deep Vein

SummaryWhether atrial fibrillation (AF) is associated with an increased risk of venous thromboembolism (VTE) remains controversial. From Longitudinal Health Insurance Database 2000 (LHID2000), we identified 11,458 patients newly diagnosed with AF. The comparison group comprised 45,637 patients without AF. Both cohorts were followed up to measure the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Univariable and multivariable competing-risks regression model and Kaplan-Meier analyses with the use of Aelon-Johansen estimator were used to measure the differences of cumulative incidences of DVT and PE, respectively. The overall incidence rates (per 1,000 person-years) of DVT and PE between the AF group and non-AF groups were 2.69 vs 1.12 (crude hazard ratio [HR] = 1.92; 95 % confidence interval [CI] = 1.54-2.39), 1.55 vs 0.46 (crude HR = 2.68; 95 % CI = 1.97-3.64), respectively. The baseline demographics indicated that the members of the AF group demonstrated a significantly older age and higher proportions of comorbidities than non-AF group. After adjusting for age, sex, and comorbidities, the risks of DVT and PE remained significantly elevated in the AF group compared with the non-AF group (adjusted HR = 1.74; 95 %CI = 1.36-2.24, adjusted HR = 2.18; 95 %CI = 1.51-3.15, respectively). The Kaplan-Meier curve with the use of Aelon-Johansen estimator indicated that the cumulative incidences of DVT and PE were both more significantly elevated in the AF group than in the non-AF group after a long-term follow-up period (p<0.01). In conclusion, the presence of AF is associated with increased risk of VTE after a long-term follow-up period.

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