Obesity Is a Risk Factor for Recurrent Venous Thrombosis in Young and Middle-Aged Women. Results From Tehs-Follow up, a Nested Cohort Study On 1394 Women with VTE.

Abstract Abstract 2250 Introduction: Venous thromboembolism (VTE) is a multifactorial disease with a high risk of recurrence. The risk of recurrence is highest during the first year with an incidence of 10–15%, thereafter recurrence occurs in 3 to 5 % per year. The risk of recurrence is associated with age, gender and whether the first VTE was provoked by a transient risk factor or not. Obesity increases the risk of a first event of VTE but its role for a recurrent event is unclear. Methods: We performed a nested cohort study and included 1394 women 18 to 64 years of age with a previous first episode of deep vein thrombosis (DVT) located in the leg or pelvis or with a pulmonary embolism (PE). All women had taken part in TEHS, a population based case-control study on risk factors for VTE. Information on risk factors was obtained by interviews and DNA-analyses immediately after the VTE and information of recurrent VTE was obtained from a follow-up questionnaire or from data recorded in the Swedish Patient Register. Only women who were not on continues anticoagulant treatment were included for assessment of recurrent VTE. Women with a BMI ≥ 30 were considered obese. Risks of recurrence were calculated in Cox regression models and are presented as hazard ratios (HRs) with 95% confidence intervals. Results: A total of 964 women (mean age 46 ± 13 years) with a median follow-up of 76 months accepted participation in the nested cohort study. The recurrence rate was 10.3% and 221 women (23%) were obese when diagnosed with their first VTE. At follow up 240 women (25%) were obese. The recurrence rate was higher in obese than in non-obese women (15.8% vs. 8.6%, p=0.002). The HR for recurrence was 1.9 (p=0.02, 95% CI 1.3–2.9) for obese women compared to non-obese. The HR was unchanged in a multivariate analysis, adjusting for age, index VTE (provoked or unprovoked by cast/surgery or hormonal treatment) and presence of factor V Leiden or prothrombin gene mutation. Conclusion: Obesity is a strong independent risk factor for recurrent VTE in women. Obese women with a first VTE might benefit from long time treatment with anticoagulants and consultation on weight reduction. Disclosures: No relevant conflicts of interest to declare.

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P3850Impact of sex and risk factors for venous thromboembolism on the clinical course of first acute venous thromboembolism. Insights from the PREFER in VTE

European Heart Journal ◽

10.1093/eurheartj/ehz745.0690 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Giustozzi ◽

S Barco ◽

L Valerio ◽

F A Klok ◽

M C Vedovati ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thromboembolism ◽

Baseline Risk ◽

Major Surgery ◽

First Episode ◽

Risk Of Recurrence ◽

Recurrent Vte ◽

The Impact

Abstract Introduction The interaction between sex and specific provoking risk factors for venous thromboembolism (VTE) may influence initial presentation and prognosis. Purpose We investigated the impact of sex on the risk of recurrence across subgroups of patients with first VTE classified according to baseline risk factors. Methods PREFER in VTE was an international, non-interventional registry (2013–2015) including patients with a first episode of acute symptomatic objectively diagnosed VTE. We studied the risk of recurrence in patients classified according to baseline provoking risk factors for VTE consisted of i) major transient (major surgery/trauma, >5 days in bed), ii) minor transient (pregnancy or puerperium, estroprogestinic therapy, prolonged immobilization, current infection or bone fracture/soft tissue trauma); iii) unprovoked events, iv) active cancer-associated VTE. Results A total of 3,455 patients diagnosed with first acute VTE were identified, of whom 1,623 (47%) were women. The percentage of patients with a major transient risk factor was 22.2% among women and 19.7% among men. Minor transient risk factors were present in 21.3% and 12.4%, unprovoked VTE in 51.6% and 61.6%, cancer-associated VTE in 4.9% of women and 6.3% of men, respectively. The proportions of cases treated with Vitamin-K antagonists (VKAs) and direct oral anticoagulants (DOACs) were similar between sexes. Median length of treatment of VKAs was 181.5 and 182.0 days and of DOACs was 113.0 and 155.0 days in women and men, respectively. At 12-months of follow-up, VTE recurrence was reported in 74 (4.8%) women and 80 (4.5%) men. Table 1 shows the sex-specific proportion of recurrences by VTE risk factor categories. Table 1 Major Transient (n=722) Minor transient (n=573) Cancer-associated (n=195) Unprovoked (1965) Women (361) Men (361) OR (95% CI) Women (346) Men (227) OR (95% CI) Women (79) Men (116) OR (95% CI) Women (837) Men (1128) OR (95% CI) One-year follow-up, n (N%) Recurrent VTE, 21 (6.2) 10 (2.9) 0.46 (0.2; 0.9) 9 (2.7) 12 (5.4) 2.09 (0.9; 5.0) 6 (8.0) 5 (4.5) 0.54 (0.2; 1.9) 38 (4.7) 53 (4.7) 1.03 (0.7; 1.6) Major bleeding, 6 (1.8) 5 (1.5) 0.83 (0.3; 2.7) 5 (1.5) 1 (0.5) 0.30 (0.1; 2.6) 1 (1.3) 3 (2.7) 2.07 (0.2; 20) 10 (1.2) 15 (1.4) 1.11 (0.6; 2.4) All-cause death, 37 (10.2) 31 (8.5) 0.82 (0.5; 1.4) 10 (2.9) 14 (6.2) 2.21 (0.9; 5.1) 26 (32.9) 49 (42.2) 1.49 (0.8; 2.7) 33 (3.9) 30 (2.7) 0.66 (0.4; 1.1) Conclusions The proportion of patients with recurrent VTE events after first acute symptomatic VTE provoked by transient risk factors was not negligible during the first year of follow-up during in both women and men. These results may have implications on the decision whether to consider extended anticoagulant therapy in selected patients with provoked events. Acknowledgement/Funding This study was funded by Daiichi Sankyo.

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D-Dimer Levels and Risk of Recurrence Following Provoked Venous Thromboembolism: Findings from the Riete Registry

Blood ◽

10.1182/blood-2018-99-111190 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3810-3810

Author(s):

Martin Ellis ◽

Martin Mar ◽

Monreal Manuel ◽

Orly Hamburger-Avnery ◽

Alessandra Bura-Riviere ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thromboembolism ◽

Anticoagulant Therapy ◽

Conflicts Of Interest ◽

Hazard Ratio ◽

Increased Risk ◽

Risk Patients ◽

Recurrent Vte ◽

D Dimer

Abstract Background. Patients with venous thromboembolism (VTE) secondary to transient risk factors or cancer may develop VTE recurrences after discontinuing anticoagulant therapy. Identifying at-risk patients could help to guide the ideal duration of anticoagulant therapy in these patients. Methods. We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. The proportion of patients with raised d-dimer levels was determined and the hazard ratio (HR) for VTE recurrences compared to those with normal levels was calculated. Univariate and multivariate analyses of factors associated with VTE recurrence were performed. Results. 3 606 patients were identified in the database in April 2018: 2 590 had VTE after a transient risk factor and 1016 had a cancer. D-dimer levels were measured after discontinuing anticoagulation in 1 732 (67%) patients with transient risk factors and 732 (72%) patients with cancer-associated VTE and these patients formed the cohort in which recurrent VTE rate was calculated. D-dimers and were elevated in 551 (31.8%) of patients with a transient risk factor and were normal in 1181 (68.2%). In the cancer-associated group, d-dimers were elevated in 398 (54.3%) and normal in 334 (45.7%) patients. The adjusted hazard ratio for recurrent VTE was: 2.32 (95%CI: 1.55-3.49) in patients with transient risk factors and 2.23 (95%CI: 1.50-3.39) in those with cancer. Conclusions. Patients with raised d-dimer levels after discontinuing anticoagulant therapy for provoked or cancer-associated VTE are at increased risk for recurrent VTE and death. Future studies could target these patients for extended anticoagulation. Disclosures No relevant conflicts of interest to declare.

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Post-Anticoagulation Cessation D-Dimer Testing and VTE Recurrence in Real-World Australian Audit

Blood ◽

10.1182/blood-2018-99-118661 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1227-1227

Author(s):

Julie Wang ◽

Rowena Brook ◽

Alison Slocombe ◽

Lisa Hong ◽

Prahlad Ho

Keyword(s):

Risk Factor ◽

Significant Risk ◽

Significant Risk Factor ◽

Risk Of Recurrence ◽

Increased Risk ◽

Recurrent Vte ◽

Residual Thrombus ◽

Repeat Imaging ◽

D Dimer

Abstract Aim Elevated D-dimer post-anticoagulation cessation is a recognised risk factor for recurrent venous thromboembolic events (VTE). In particular, raised D-dimer post cessation has been associated with increased risk of recurrence in unprovoked major VTE. Currently in Australia, D-dimer has not been widely used in practice to stratify the risk of VTE recurrence. This study aims to retrospectively analyse the effect of routine D-dimer testing and it's association with VTE recurrence. Methods A retrospective evaluation was performed on 1024 patients with a diagnosis of VTE at a tertiary hospital in Australia between January 2013 and December 2016. Data collected included demographics, results and timing of D-dimer testing and serial imaging results. Results 1024 patients were reviewed with a total median follow up of 12 months (range 0-59 months). D-dimer was tested in 189 patients (18.5%) within 90 days after cessation of anticoagulation. Of these patients, median age was 58 (18-92) and 55.3% (n=105) were female. 33.3% (n=63) had isolated distal deep vein thrombosis (IDDVT), 66.3% (n=126) had above knee DVT (AKDVT)/pulmonary embolus (PE), 54.5% (n=103) of VTE were provoked. Abnormal post cessation D-dimer (>500) was found in 72 patients (37.9%). Of these, 25 patients were restarted on anticoagulation; one had recurrent VTE whilst on low dose apixaban 2.5mg BD and one had recurrence after cessation of anticoagulation at a later date. Patients with elevated D-dimer post cessation had a higher rate of recurrence with the highest risk in patients with D-dimer >1000 (RR 7.38, p=<0.01) outlined in Table 1. Of the 164 patients with post cessation D-dimer testing who remained off anticoagulation there were a total of 24 (12.6%) episodes of recurrent VTE. Elevated D-dimer post anticoagulation cessation was a significant risk factor for recurrence in both provoked VTE (RR 4.21, p=0.01) and unprovoked VTE cohorts (RR 4.55, p=0.008) outlined in Table 2. When provoked VTE were sub-categorised, raised D-dimer demonstrated the most statistical significance in VTE provoked by travel (RR 13.5 p=0.06). Of the patients with post anticoagulation cessation D-dimer testing 170 patients (89.9%) had repeat imaging to assess for residual thrombus. In the subgroup of patients with no residual thrombus, elevated D-dimer was a significant risk factor for VTE recurrence (RR 6.4, p=<0.01). Patients with normal D-dimer and no residual thrombus had the lowest rate of recurrence 5.4% (n=4) see Table 3. When stratified by type of VTE, elevated D-dimer post anticoagulation cessation was significantly related to risk for recurrence in the overall IDDVT sub-cohort (RR 4.09, p=0.007). This was not significant for the AKDVT/PE sub cohort (RR 3.24, p=0.079). However, for patients with unprovoked AKDVT or PE, having D-dimer tested post anticoagulation, regardless of result, was associated with lower rates of VTE recurrence RR 0.30 (p=0.02) compared to those who had no D-dimer testing as part of follow-up. Conclusion Post treatment D-dimer testing may have a clinical role in stratifying the risk of VTE recurrence along with repeat imaging to detect residual thrombus. Elevated D-dimer post anticoagulation cessation is associated with increased risk of VTE recurrence for both provoked and unprovoked VTE with highest risk in patients with D-dimer >1000. Patients with no residual thrombus and a negative D-dimer post anticoagulation cessation had the lowest rate of recurrence. In the subgroup of patients with provoked VTE and IDDVT a positive D-dimer post cessation was associated with 4.21 and 4.09 relative risk of recurrence respectively, suggesting that the role of D-dimer testing can be extended to these subpopulations. Interestingly, in patients with unprovoked AKDVT or PE, having post-cessation D-dimer testing performed, regardless of result, was associated with a significantly lower rate of VTE recurrence compared to patients without D-dimer testing, which may be related to specialist review and recommencement of anticoagulation in high-risk patients. Disclosures No relevant conflicts of interest to declare.

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Relationship between classic vascular risk factors and cumulative recurrent cardiovascular event burden in patients with clinically manifest vascular disease: results from the UCC-SMART prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038881 ◽

2021 ◽

Vol 11 (3) ◽

pp. e038881

Author(s):

Tamar Irene de Vries ◽

Jan Westerink ◽

Michiel L Bots ◽

Folkert W Asselbergs ◽

Yvo M Smulders ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cohort Study ◽

Cardiovascular Event ◽

Prospective Cohort ◽

Cardiovascular Events ◽

Recurrent Events ◽

Hdl Cholesterol ◽

Recurrent Event

ObjectiveThe aim of the current study was to assess the relationship between classic cardiovascular risk factors and risk of not only the first recurrent atherosclerotic cardiovascular event, but also the total number of non-fatal and fatal cardiovascular events in patients with recently clinically manifest cardiovascular disease (CVD).DesignProspective cohort study.SettingTertiary care centre.Participants7239 patients with a recent first manifestation of CVD from the prospective UCC-SMART (Utrecht Cardiovascular Cohort - Second Manifestations of ARTerial disease) cohort study.Outcome measuresTotal cardiovascular events, including myocardial infarction, stroke, vascular interventions, major limb events and cardiovascular mortality.ResultsDuring a median follow-up of 8.9 years, 1412 patients had one recurrent cardiovascular event, while 1290 patients had two or more recurrent events, with a total of 5457 cardiovascular events during follow-up. The HRs for the first recurrent event and cumulative event burden using Prentice-Williams-Peterson models, respectively, were 1.36 (95% CI 1.25 to 1.48) and 1.26 (95% CI 1.17 to 1.35) for smoking, 1.14 (95% CI 1.11 to 1.18) and 1.09 (95% CI 1.06 to 1.12) for non-high-density lipoprotein (HDL) cholesterol, and 1.05 (95% CI 1.03 to 1.07) and 1.04 (95% CI 1.03 to 1.06) for systolic blood pressure per 10 mm Hg.ConclusionsIn a cohort of patients with established CVD, systolic blood pressure, non-HDL cholesterol and current smoking are important risk factors for not only the first, but also subsequent recurrent events during follow-up. Recurrent event analysis captures the full cumulative burden of CVD in patients.

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Evaluating a cardiovascular disease risk management care continuum within a learning healthcare system: a prospective cohort study

BJGP Open ◽

10.3399/bjgpopen20x101109 ◽

2020 ◽

Vol 4 (5) ◽

pp. bjgpopen20X101109

Author(s):

T Katrien J Groenhof ◽

A Titia Lely ◽

Saskia Haitjema ◽

Hendrik M Nathoe ◽

Marlous F Kortekaas ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Risk Management ◽

Risk Factor ◽

Cohort Study ◽

Cardiovascular Risk ◽

Health Data ◽

Data Sources ◽

Learning Healthcare System

BackgroundMany patients now present with multimorbidity and chronicity of disease. This means that multidisciplinary management in a care continuum, integrating primary care and hospital care services, is needed to ensure high quality care.AimTo evaluate cardiovascular risk management (CVRM) via linkage of health data sources, as an example of a multidisciplinary continuum within a learning healthcare system (LHS).Design & settingIn this prospective cohort study, data were linked from the Utrecht Cardiovascular Cohort (UCC) to the Julius General Practitioners' Network (JGPN) database. UCC offers structured CVRM at referral to the University Medical Centre (UMC) Utrecht. JGPN consists of electronic health record (EHR) data from referring GPs.MethodThe cardiovascular risk factors were extracted for each patient 13 months before referral (JGPN), at UCC inclusion, and during 12 months follow-up (JGPN). The following areas were assessed: registration of risk factors; detection of risk factor(s) requiring treatment at UCC; communication of risk factors and actionable suggestions from the specialist to the GP; and change of management during follow-up.ResultsIn 52% of patients, ≥1 risk factors were registered (that is, extractable from structured fields within routine care health records) before UCC. In 12%–72% of patients, risk factor(s) existed that required (change or start of) treatment at UCC inclusion. Specialist communication included the complete risk profile in 67% of letters, but lacked actionable suggestions in 86%. In 29% of patients, at least one risk factor was registered after UCC. Change in management in GP records was seen in 21%–58% of them.ConclusionEvaluation of a multidisciplinary LHS is possible via linkage of health data sources. Efforts have to be made to improve registration in primary care, as well as communication on findings and actionable suggestions for follow-up to bridge the gap in the CVRM continuum.

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F11 is associated with recurrent VTE in women

Thrombosis and Haemostasis ◽

10.1160/th15-06-0459 ◽

2016 ◽

Vol 115 (02) ◽

pp. 406-414 ◽

Cited By ~ 4

Author(s):

Maria Bruzelius ◽

Maria Ljungqvist ◽

Matteo Bottai ◽

Annica Bergendal ◽

Rona J. Strawbridge ◽

...

Keyword(s):

Recurrence Rate ◽

Genetic Variants ◽

Recurrent Events ◽

Recurrent Event ◽

Genetic Associations ◽

Risk Alleles ◽

Common Genetic Variants ◽

Recurrent Vte ◽

First Time

SummaryGenetic associations for the reoccurrence of venous thromboembolism (VTE) are not well described. Our aim was to investigate if common genetic variants, previously found to contribute to the prediction of first time thrombosis in women, were associated with risk of recurrence. The Thromboembolism Hormone Study (TEHS) is a Swedish nationwide case-control study (2002–2009). A cohort of 1,010 women with first time VTE was followed up until a recurrent event, death or November 2011. The genetic variants in F5 rs6025, F2 rs1799963, ABO rs514659, FGG rs2066865, F11 rs2289252, PROC rs1799810 and KNG1 rs710446 were assessed together with clinical variables. Recurrence rate was calculated as the number of events over the accumulated patient-time. Cumulative recurrence was calculated by Kaplan-Meier curve. Cox proportional-hazard model was used to estimate hazard ratios (HR) and 95 % confidence intervals (95 % CI) between groups. A total of 101 recurrent events occurred during a mean follow-up time of five years. The overall recurrence rate was 20 per 1,000 person-years (95 % CI; 16-24). The recurrence rate was highest in women with unprovoked first event and obesity. Carriers of the risk alleles of F5 rs6025 (HR=1.7 (95 % CI; 1.1–2.6)) and F11 rs2289252 (HR=1.8 (95 % CI; 1.1–3.0)) had significantly higher rates of recurrence compared to non-carriers. The cumulative recurrence was 2.5-fold larger in carriers of both F5 rs6025 and F11 rs2289252 than in non-carriers at five years follow-up. In conclusion, F5 rs6025 and F11 rs2289252 contributed to the risk of recurrent VTE and the combination is of potential clinical relevance for risk prediction.Supplementary Material to this article is available online at www.thrombosis-online.com.

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Venous Thromboembolism (VTE) in Patients with Hematologic and Non-Hematologic Malignancies: Incidence and Risk Factors for Recurrent VTE

Blood ◽

10.1182/blood.v118.21.2303.2303 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2303-2303

Author(s):

Saroj Vadhan-Raj ◽

Xiao Zhou ◽

Jatin J Shah ◽

Robert S Benjamin ◽

Gregory Gladish

Keyword(s):

Risk Factors ◽

Recurrent Events ◽

Conflicts Of Interest ◽

Hematologic Malignancies ◽

Cancer Center ◽

Index Event ◽

Independent Risk Factors ◽

Recurrent Vte ◽

One Year

Abstract Abstract 2303 The incidence of VTE and risk for recurrence is known to be higher in patients (pt) with malignancy than in other patients. However, the exact incidence and risk factors predictive of recurrent VTE in patients with hematologic malignancies (Hem) and solid tumors (ST) are not well defined. A retrospective study was conducted to evaluate the incidence of VTE and the recurrent events during one year period at MD Anderson Cancer Center. The medical records of all patients with VTE confirmed by the radiologic studies in 2006 were reviewed. The data were collected for the incidence and type of VTE, the recurrent events during a one year follow-up from the time of primary event, and the risk factors for recurrent events, including, the pt demographics, diagnosis, prior history of VTE, transfusions, use of erythropoiesis-stimulating agents, and the laboratory parameters at the time of the index VTE event. Cox proportional hazard models were established to determine the independent predictive factors for recurrent VTE. There were 24,806 unique patients (each patient counted once) in active treatment at the Cancer Center between January 2006 and December 2006. Of the 980 pts diagnosed with VTE (480 DVT, 477 PE, and 23 DVT/PE) during this period, there were 770 ST, 208 Hem, and 2 benign conditions. The incidence of VTE was higher in Hem pts than in ST pts [208/3603 (6%) vs. 770/20212 (4%), p<0.0001]. Among Hem pts, the incidence was significantly higher in myeloma as compared to lymphoma and leukemia (9%, 6%, and 4%, respectively, p<0.0001). The proportion of VTE pts with PE was significantly higher among ST pts compared with Hem pts (55% vs 37%, p<0.0001). The incidence of recurrent VTE, as defined by any new event or progression of the index event, was 14% (140/978 pts) during one year follow-up period, and it was not different for Hem (16%) vs. ST (14%). Among Hem pts, the recurrence was higher for myeloma (19%) than lymphoma (16%) and leukemia (13%). Majority of the recurrent events (100/140, 71%) were seen during the initial 3 month period from the index event. The independent risk factors for recurrent VTE during 3 months, 6 months and 1 year were summarized in the following table:3 months6 months1 yearRisk factorsHazard ratio (95% CI)PHazard ratio (95% CI)PHazard ratio (95%CI)PPE vs. non-PE1.86 (1.20–2.88)0.0051.67 (1.12–2.42)0.0061.74 (1.20–2.51)0.003Age (<60 vs. ≥60 years)2.05 (1.34–3.15)0.0011.55 (1.08–2.23)0.0171.62 (1.14–2.32)0.008Men vs. women1.70 (1.10–2.63)0.0181.44 (0.994–2.07)0.054PE, pulmonary embolism; CI, confidence interval. Conclusions: The incidence of VTE is higher in Hem pts, especially in myeloma. Younger age (<60 years) and PE are independent risk factors predictive of recurrence during 3 month, 6 month and 1 year period. Disclosures: No relevant conflicts of interest to declare.

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Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors

TH Open ◽

10.1055/s-0039-1683374 ◽

2019 ◽

Vol 03 (01) ◽

pp. e58-e63 ◽

Cited By ~ 4

Author(s):

Luca Valerio ◽

Chiara Ambaglio ◽

Marisa Barone ◽

Mariella Ciola ◽

Stavros Konstantinides ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Deep Vein Thrombosis ◽

Baseline Risk ◽

Prognostic Impact ◽

Risk Of Recurrence ◽

Vein Thrombosis ◽

Recurrent Vte ◽

Deep Vein ◽

The Impact

Background It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently associated with a lower risk of recurrence in all patients, or represents a marker of the presence and severity of provoking factors for venous thromboembolism (VTE). Methods We investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent VTE, including proximal DVT and PE. Results A total of 205 (24.7%) patients presented with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03–0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28–1.78]). Conclusions The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.

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A Six-Year Retrospective Follow-up of 502 Patients with Laparoscopic Cholelithotomy for Gallstone Recurrence: Success or Prospect

10.21203/rs.2.11013/v1 ◽

2019 ◽

Author(s):

Garba Seydou Aliou ◽

Gang Zhao ◽

An Hua Huang ◽

An An Xu ◽

Jing Li Cai ◽

...

Keyword(s):

Risk Factors ◽

Recurrence Rate ◽

The Body ◽

Gallbladder Contraction ◽

Risk Of Recurrence ◽

Contraction Function ◽

Gallstone Recurrence ◽

Tongji University ◽

Better Than

Abstract Background This research was designed to explore the risk factors for gallstone recurrence after laparoscopic cholelithotomy. Methods A total of 502 patients who were diagnosed with gallstones using ultrasonography underwent laparoscopic cholelithotomy between January 2011 and December 2017 at the Shanghai-East Affiliated Hospital of Tongji University. Results Our retrospective study revealed that the gallstone recurrence rate of patients taking tauro-ursodeoxycholic acid (TUDCA) was significantly lower (P<0.05) than that of patients not taking TUDCA. The recurrence rate of gallstones in patients with an incision at the fundus of the gallbladder was significantly lower than that of the patients with an incision on the body of the gallbladder. The risk of recurrence in patients with gallstones combined with polyps was significantly higher than that in patients without polyps; the risk of recurrence of gallstones in patients with gallbladder contraction function < 50% was significantly higher than that in patients with gallbladder contraction function ≥ 50%. Additionally, the prognosis of patients without gallbladder adhesions to the peritoneum was better than that of patients with adhesions. Conclusion During the 6-year follow-up period of this study, the recurrence rate of gallstones after laparoscopic gallbladder-preserving cholelithotomy (LGPC) was 22.91%. Factors related to gallstone recurrence were use of TUDCA, location of the incision, presence of gallstones combined with polyps, gallbladder contraction function and presence of gallbladder adhesions to the peritoneum. The main cause of gallstone recurrence needs further investigation, and laparoscopic cholelithotomy remains promising for treatment of gallstone recurrence but requires thorough follow-up.

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Chinese primary knee osteoarthritis progression cohort (CPKOPC) to evaluate the progression of knee osteoarthritis in the Beijing population: a prospective cohort study protocol

BMJ Open ◽

10.1136/bmjopen-2019-029430 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029430 ◽

Cited By ~ 1

Author(s):

Minwei Zhao ◽

Yupeng Liang ◽

Xinguang Wang ◽

Lin Zeng ◽

Hua Tian

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cohort Study ◽

Knee Osteoarthritis ◽

Study Protocol ◽

Occupational Exposures ◽

Beijing Area ◽

Knee Oa ◽

The Impact

IntroductionMillions of patients are currently suffering from pain and dysfunction caused by osteoarthritis (OA), and billions of dollars have been invested into treatment. Because there is no effective treatment that can reverse the progression of knee OA, it is important to determine the risk factors that may influence the progression. However, although there are many studies that examine risk factors for progression, there are only a few that specifically focus on the impact of each risk factor for predicting progression of knee OA. This study aimed to develop a cohort of patients with primary knee OA in the Beijing area to establish models that identify the influence of each risk factor on the prediction of knee OA progression.Methods and analysisThis is a prospective, multicentre, hospital-based cohort study. The study population comprises 2000 patients with primary knee OA from the Beijing area. The recruitment and baseline visits started in December 2017 and will finish in November 2018. After baseline visits, the patients will be followed for 3 years or until the occurrence of primary outcomes. Demographic variables will be collected during the baseline visit. Influencing factors including occupational exposures, family history and treatment will be collected at baseline and each follow-up visit. The primary outcome measure is a comprehensive index which will be combined with clinical WOMAC score, imaging K-L grade and clinical outcomes. These data will also be collected at baseline and each follow-up visit.Ethics and disseminationThis study protocol has been approved by Peking University Third Hospital Medical Science Research Ethics Committee. All the eligible participants will give written informed consent. The findings will be published in peer-reviewed journals and presented at national or international conferences. Besides, the results will be disseminated to all participants via the social software ‘WeChat’.Trial registration numberChiCTR-ROC-17013790; preresults.

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