scholarly journals Risk Factors for Venous Thromboembolism Induced by Prolonged Bed Rest during Interstitial Brachytherapy for Gynecological Cancer: A Retrospective Study

2021 ◽  
Author(s):  
Keiko Murofushi ◽  
Tetsuya Tomita ◽  
Kayoko Ohnishi ◽  
Kei Nakai ◽  
Azusa Akiyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Gynecological Cancer ◽  
Oral Anticoagulants ◽  
Univariate Analysis ◽  
Management Strategies ◽  
Bed Rest ◽  
Intermittent Pneumatic Compression ◽  
Interstitial Brachytherapy ◽  
Group 3

Abstract Background: Screening and management of venous thromboembolism (VTE) after surgery is important in preventing sublethal VTE. However, the risk factors for VTE during interstitial brachytherapy (ISBT) remain unknown, and appropriate screening and management strategies are yet to be established. This study therefore aimed to evaluate the risk factors for VTE resulting from requisite bed rest during ISBT for gynecologic cancers.Methods: We retrospectively analyzed 47 patients. For patients without definitive preceding radiotherapy, whole pelvic irradiation (30-50 Gy) followed by ISBT of 12-30 Gy/2-5 fx/1-3 days was administered to CTV D90. For patients with preceding radiotherapy, 36-42 Gy/6-7 fx/3-4 days was delivered by ISBT alone. D-dimer (DD) was measured at initial presentation, 1 week before ISBT, pre-ISBT, on the day of, and the day following needle removal. Patients were divided into three groups according to the risk of VTE and were managed accordingly. Group 1: DD was not detected (negative) before ISBT. Group 2: VTE was not detected on venous ultrasound imaging, although DD was positive before ISBT. Group 3: VTE was detected (positive) before ISBT. An intermittent pneumatic compression device was used during ISBT; for this, patients without VTE before ISBT required to remain in the supine position. Heparin or oral anticoagulants were administered to patients with VTE before ISBT.Results: Overall, the median values of DD pre-ISBT, on the day of, and on the day following needle removal were 1.0 (0.4-5.8), 1.1 (0.5-88.9), and 1.5 (0.7-40.6) μg/mL, respectively. After ISBT, no patients had deep vein thrombosis (DVT) in groups 1 and 2. In group 3, 7 of 14 patients experienced worsening of VTE but remained asymptomatic. In univariate analysis, DVT diagnosed before ISBT, Caprini score ≥5, and difference in DD values between pre-ISBT and the day of or the day following needle removal ≥1 were associated with the incidence or worsening of VTE.Conclusion: DD should be measured before and after ISBT to detect the incidence or worsening of VTE in patients with DVT. The Caprini score may help in the prediction of VTE during or after ISBT.

scholarly journals Risk factors for venous thromboembolism induced by prolonged bed rest during interstitial brachytherapy for gynecological cancer: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Keiko Nemoto Murofushi ◽  
Tetsuya Tomita ◽  
Kayoko Ohnishi ◽  
Kei Nakai ◽  
Azusa Akiyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Gynecological Cancer ◽  
Oral Anticoagulants ◽  
Univariate Analysis ◽  
Management Strategies ◽  
Bed Rest ◽  
Intermittent Pneumatic Compression ◽  
Interstitial Brachytherapy ◽  
Group 3

Abstract Background Screening and management of venous thromboembolism (VTE) after surgery is important in preventing sublethal VTE. However, the risk factors for VTE during interstitial brachytherapy (ISBT) remain unknown, and appropriate screening and management strategies are yet to be established. Therefore, this study aimed to evaluate the risk factors for VTE resulting from requisite bed rest during ISBT for gynecologic cancers. Methods We retrospectively analyzed 47 patients. For patients without definitive preceding radiotherapy, whole pelvic irradiation (30–50 Gy) followed by ISBT of 12–30 Gy/2–5 fx/1–3 days was administered to CTV D90. For patients with preceding radiotherapy, 36–42 Gy/6–7 fx/3–4 days was delivered by ISBT alone. The supine position was required during ISBT. D-dimer (DD) was measured at initial presentation, 1 week before ISBT, pre-ISBT, on the day of, and the day following needle removal. Patients were divided into three groups according to the risk of VTE and were managed accordingly; Group 1: DD was not detected (negative) before ISBT, Group 2: VTE was not detected on venous ultrasound imaging, although DD was positive before ISBT, and Group 3: VTE was detected (positive) before ISBT. An intermittent pneumatic compression device was used during ISBT; for the patients without VTE before ISBT. Heparin or oral anticoagulants were administered to patients with VTE before ISBT. Results Overall, the median values of DD pre-ISBT, on the day of, and on the day following needle removal were 1.0 (0.4–5.8), 1.1 (0.5–88.9), and 1.5 (0.7–40.6) μg/mL, respectively. After ISBT, no patients had deep vein thrombosis (DVT) in groups 1 and 2. In group 3, 7 of 14 patients experienced worsening of VTE but remained asymptomatic. In univariate analysis, DVT diagnosed before ISBT, Caprini score ≥ 7, and difference in DD values between pre-ISBT and the day of or the day following needle removal ≥ 1 were associated with the incidence or worsening of VTE. Conclusion DD should be measured before and after ISBT to detect the incidence or worsening of VTE in patients with DVT. The Caprini score may help in the prediction of VTE during or after ISBT.

scholarly journals Venous Thromboembolism and Its Risk Factors in Children with Acute Lymphoblastic Leukemia in Israel: A Population-Based Study

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2759
Author(s):  
Shlomit Barzilai-Birenboim ◽  
Ronit Nirel ◽  
Nira Arad-Cohen ◽  
Galia Avrahami ◽  
Miri Ben Harush ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Univariate Analysis ◽  
Population Based ◽  
Population Based Study ◽  
Inherited Thrombophilia ◽  
Severe Hypertriglyceridemia

Venous thromboembolism (VTE) is a serious complication of acute lymphoblastic leukemia (ALL) therapy. The aim of this population-based study was to evaluate the rate, risk factors, and long-term sequelae of VTE in children treated for ALL. The cohort included 1191 children aged 1–19 years diagnosed with ALL between 2003–2018, prospectively enrolled in two consecutive protocols: ALL-IC BFM 2002 and AIEOP-BFM ALL 2009. VTEs occurred in 89 patients (7.5%). Long-term sequelae were uncommon. By univariate analysis, we identified four significant risk factors for VTEs: Severe hypertriglyceridemia (p = 0.005), inherited thrombophilia (p < 0.001), age >10 years (p = 0.015), and high-risk ALL group (p = 0.039). In addition, the incidence of VTE was significantly higher in patients enrolled in AIEOP-BFM ALL 2009 than in those enrolled in ALL-IC BFM 2002 (p = 0.001). Severe VTE occurred in 24 children (2%), all of whom had at least one risk factor. Elevated triglyceride levels at diagnosis did not predict hypertriglyceridemia during therapy. In a multivariate analysis of 388 children, severe hypertriglyceridemia and inherited thrombophilia were independent risk factors for VTE. Routine evaluation for these risk factors in children treated for ALL may help identify candidates for intervention.

A Risk-Prediction Model For Identifying Venous Thromboembolism In Hospitalized Pediatric Patients: A Single Institution Retrospective Case-Control Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2957-2957
Author(s):  
Ruchika Goel ◽  
Jessy Dhillon ◽  
Craig Malli ◽  
Kishen Sahota ◽  
Prabhjot Seehra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Venous Thromboembolism ◽  
Risk Prediction ◽  
Research Funding ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Case Control ◽  
Control Analysis ◽  
Multivariable Logistic Regression

Abstract Introduction Venous thromboembolism (VTE) is increasing in children, especially in the tertiary care setting. Hospital-associated VTE (HA-VTE) is a potentially preventable cause of major morbidity and mortality. However, the incidence of HA-VTE VTE is low in children Risk stratification tools may aid in identification of hospitalized high risk pediatric patients who may benefit from VTE prophylaxis. Methods We conducted a case-control study of pediatric patients with HA-VTE (21 years or younger at the time of diagnosis) admitted to the Johns Hopkins Hospital from 2008-2010. Cases were identified using ICD-9 codes for DVT and PE and verified by reviewing hospital records and radiologic imaging reports. HA-VTE was defined as: 1) VTE was diagnosed ≥48 hours after hospital admission without signs/symptoms of VTE on admission, or 2) VTE was diagnosed within 90 days of hospital discharge. Two contemporaneous controls matched for age, sex and admission unit were selected for each case. Records of cases and controls were reviewed for presence of a priori identified putative VTE risk factors at admission. Univariate and conditional multivariable logistic regression analyses with backward elimination were used to develop risk-prediction models. Based on results of univariate analysis, we sought to evaluate two multivariable models, one without length of stay (LOS) with relevance to assessment at admission, and one in which LOS was included with relevance to re-assessment after several days of hospitalization. All variables selected for the multivariable model were tested for interaction with a significance threshold level of p<0.2. Except for this, all hypothesis testing was two tailed and a p value of <0.05 was considered significant. Receiver operator curves (ROC) were constructed using risk factors on multivariate analysis. Results Table 1 lists the results putative risk factors by univariate analysis with a) significantly higher odds of VTE and b) higher odds of VTE but not statistically significant. In multivariable logistic regression analysis, central venous catheter (CVC), VTE predisposition and immobility or LOS >5 days were independently associated with HA-VTE. The combination of CVC and VTE predisposition with either immobility or LOS was predictive of HA-VTE (area under the curve for ROC of 76.6% and 80.6%, Table 2). Conclusion We found independently associated risk factors with that may potentially be used in a predictive model of HA-VTE in children. Further prospective validation studies of these and other risk factors may serve as the basis of future risk-stratified randomized control trials of primary prevention of pediatric HA-VTE. Disclosures: Streiff: Bristol Myers Squibb: Research Funding; Sanofi: Consultancy, Honoraria; Eisai, Daiichi-Sankyo, Boehringer-Ingelheim, Janssen HealthCare: Consultancy. Strouse:NIH: Research Funding; Doris Duke Charitable Foundation: Research Funding; Masimo Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding. Takemoto:Novonordisk: Research Funding.

scholarly journals Risk assessment and prevention of venous thromboembolism among hospitalized patients: Results of the regional multicenter study

2021 ◽  
pp. 26-40
Author(s):  
A. B. Sugraliyev ◽  
Sh. S. Aktayeva ◽  
Sh. B. Zhangelova ◽  
S. A. Shiller ◽  
Zh. M. Kussymzhanova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Multicenter Study ◽  
Bed Rest ◽  
Primary Objective ◽  
Hospitalized Patients ◽  
Public Health Issue ◽  
Medical Patients ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis

Introduction. Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multicenter study was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the regions of Kazakhstan.Materials and methods. Standardized case report forms were filled by trained medical doctors on one predefined day in selected hospitals. Data were analyzed by independent biostatistician. Risk of VTE was categorized according to Caprini score which was recommended by 2004 American College of Chest Physicians (ACCP) guidelines.Results. 432 patients from 4 regions of Kazakhstan; 169 (39.10%) medical patients and 263 (60.9%) surgical patients were eligible for the study. Patients were at low (10%), moderate (19.2%), high (33.6%) and very high risk (37.3%) for VTE. The main risk factors (RF) of VTE among hospitalized patients were heart failure (HF), obesity, prolonged bed rest, and the presence of acute non-infective inflammation. From total number of hospitalized patients with RF with indications to VTE prophylaxis, 58.1% of patients received pharmacological prophylaxis and only 24.6% of them received VTE prophylaxis according ACCP. On the other hand, 23.5% patients with the risk of VTE but who were not eligible for it received pharmacological prophylaxis.Conclusion. These results indicate the existence of inconsistency between eligibility for VTE prophylaxis on one hand and its application in practice (p < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.

scholarly journals Current Recommendations for the Management of Cancer-Associated Venous Thromboembolism

2021 ◽  
Vol 7 (2) ◽  
pp. 27-38
Author(s):  
Katalin Makó
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Term Treatment ◽  
Long Term Treatment ◽  
High Bleeding Risk ◽  
Cancer Associated Thrombosis

Abstract Cancer-associated thrombosis (CAT) is a major cause of death in oncological patients. The mechanisms of thrombogenesis in cancer patients are not fully established, and it seems to be multifactorial in origin. Also, several risk factors for venous thromboembolism (VTE) are present in these patients such as tumor site, stage, histology of cancer, chemotherapy, surgery, and immobilization. Anticoagulant treatment in CAT is challenging because of high bleeding risk during treatment and recurrence of VTE. Current major guidelines recommend low molecular weight heparins (LMWHs) for early and long-term treatment of VTE in cancer patients. In the past years, direct oral anticoagulants (DOACs) are recommended as potential treatment option for VTE and have recently been proposed as a new option for treating CAT. This manuscript will give a short overview of risk factors involved in the development of CAT and a summary on the recent recommendations and guidelines for treatment of VTE in patients with malignancies, discussing also some special clinical situations (e.g. renal impairment, catheter-related thrombosis, and thrombocytopenia).

scholarly journals Thromboembolism and antithrombotic management in pregnancy

2011 ◽  
Vol 152 (21) ◽  
pp. 815-821 ◽  
Author(s):  
Attila Pajor
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Individual Risk ◽  
Low Molecular Weight ◽  
Pregnancy And Delivery ◽  
Individual Risk Factors ◽  
In Pregnancy

Venous thromboembolism occurs approximately in 1 of 1000 pregnancies. It is one of the leading causes of maternal mortality. Physiologic changes associated with pregnancy and delivery favor for developing venous thromboembolism, and there are individual risk factors, too, contributing to its manifestation. The most frequent risk factors of venous thromboembolism developing during pregnancy are the previous venous thromboembolism and the thrombophilias, furthermore, some other diseases and some unique complications of pregnancy and delivery. Beyond mechanical prevention only heparin preparations can be used for preventing and treating venous thromboembolism in pregnancy and among them the low-molecular-weight heparins are preferred for applying. Dosage of low-molecular-weight heparin preparations is determined by the type and strength of thrombophilia. For treatment of venous thromboembolism presented during pregnancy subcutaneous 100 IU/kg low-molecular-weight heparin is generally used at every 12 hours. Postpartum the oral anticoagulants can be safely applied, too. Orv. Hetil., 2011, 152, 815–821.

Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women

2007 ◽  
Vol 98 (12) ◽  
pp. 1237-1245 ◽  
Author(s):  
Joachim Dudenhausen ◽  
Andree Faridi ◽  
Thorsten Fischer ◽  
Samson Fung ◽  
Ulrich Geisen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Management Strategies ◽  
Prospective Trial ◽  
High Risk Group ◽  
Group I ◽  
Increased Risk ◽  
History Of ◽  
Heparin Prophylaxis

SummaryWomen with a history of venous thromboembolism (VTE), thrombophilia or both may be at increased risk of thrombosis during pregnancy, but the optimal management strategy is not well defined in clinical guidelines because of limited trial data. A strategy of risk assessment and heparin prophylaxis was evaluated in pregnant women at increased risk of VTE. In a prospective trial (Efficacy of Thromboprophylaxis as an Intervention during Gravidity [EThIG]), 810 pregnant women were assigned to one of three management strategies according to pre-defined risk factors related to history of VTE and thrombophilic profile. Low-risk women (group I), received 50–100 IU dalteparin/ kg body weight/ day for 14 days postpartum, or earlier when additional risk factors occurred. Women at high (group II) or very high risk (group III) received dalteparin from enrolment until six weeks postpartum (50–100 IU and 100–200 IU/ kg/ day, respectively). Objectively confirmed, symptomatic VTE occurred in 5/810 women (0.6%; 95% confidence interval [CI], 0.2 to 1.5%) (group I, 0 of 225; II, 3/469; III, 2/116). The rate of serious bleeding was 3.0% (95 % CI, 1.9 to 4.4%); 1.1% (95 % CI, 0.5 to 2.2%) was possibly dalteparin-related. There was no evidence of heparin- induced thrombocytopenia, one case of osteoporosis, and rates of miscarriage and stillbirth were similar to previous, retrospective studies. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic VTE and few clinically important adverse events. Antepartum heparin prophylaxis is, therefore, warranted in pregnant women with idiopathic thrombosis or symptomatic thrombophilia.

scholarly journals Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism

2019 ◽  
Vol 4 (1) ◽  
pp. e000367 ◽  
Author(s):  
Patrick F Walker ◽  
Seth Schobel ◽  
Joseph D Caruso ◽  
Carlos J Rodriguez ◽  
Matthew J Bradley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Scoring System ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Trauma Patients ◽  
Military Trauma ◽  
Support Tools ◽  
Combat Casualties

IntroductionClinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE. The purpose of this study was to evaluate the utility of TESS in predicting VTE in military trauma patients.MethodsA retrospective cohort study of 549 combat casualties from October 2010 to November 2012 admitted to a military treatment facility in the USA was performed. TESS scores were calculated through data obtained from the Department of Defense Trauma Registry and chart reviews. Univariate analysis and multivariate logistic regression were performed to evaluate risk factors for VTE. Receiver operating characteristic (ROC) curve analysis of TESS in military trauma patients was also performed.ResultsThe incidence of VTE was 21.7% (119/549). The median TESS for patients without VTE was 8 (IQR 4–9), and the median TESS for those with VTE was 10 (IQR 9–11). On multivariate analysis, Injury Severity Score (ISS) (OR 1.03, p=0.007), ventilator days (OR 1.05, p=0.02), and administration of tranexamic acid (TXA) (OR 1.89, p=0.03) were found to be independent risk factors for development of VTE. On ROC analysis, an optimal high-risk cut-off value for TESS was ≥7 with a sensitivity of 0.92 and a specificity of 0.53 (area under the curve 0.76, 95% CI 0.72 to 0.80, p<0.0001).ConclusionsWhen used to predict VTE in military trauma, TESS shows moderate discrimination and is well calibrated. An optimal high-risk cut-off value of ≥7 demonstrates high sensitivity in predicting VTE. In addition to ISS and ventilator days, TXA administration is an independent risk factor for VTE development.Level of evidenceLevel III.

Factors associated with diagnosis and operability of chronic thromboembolic pulmonary hypertension

2013 ◽  
Vol 110 (07) ◽  
pp. 83-91 ◽  
Author(s):  
Gérald Simonneau ◽  
Joanna Pepke-Zaba ◽  
Eckhard Mayer ◽  
David Ambrož ◽  
Isabel Blanco ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Univariate Analysis ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Factors Associated ◽  
Thromboembolic Pulmonary Hypertension ◽  
History Of ◽  
Acute Venous Thromboembolism

SummaryChronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary hypertension (IPAH) share a similar clinical presentation, and a differential diagnosis requires a thorough workup. Once CTEPH is confirmed, patients who can be safely operated have to be identified. We investigated risk factors associated with CTEPH and IPAH, and the criteria for the selection of operable CTEPH patients. This case-control study included 436 consecutive patients with CTEPH and 158 with IPAH in eight European centres, between 2006 and 2010. Conditions identified as risk factors for CTEPH included history of acute venous thromboembolism (p < 0.0001), large size of previous pulmonary embolism (p = 0.0040 in univariate analysis), blood groups non-O (p < 0.0001 in univariate analysis), and older age (p = 0.0198), whereas diabetes mellitus (p = 0.0006), female gender (p = 0.0197) and higher mean pulmonary artery pressure (p = 0.0103) were associated with increased likelihood for an IPAH diagnosis. Operability of CTEPH patients was associated with younger age (p = 0.0108), proximal lesions (p ≤ 0.0001), and pulmonary vascular resistance below 1200 dyn.s.cm-5 (p = 0.0080). Non-operable CTEPH patients tended to be less differentiable from IPAH patients by risk factor analysis than operable patients. This study confirmed the association of CTEPH with history of acute venous thromboembolism and blood groups non-O, and identified diabetes mellitus and higher mean pulmonary artery pressure as factors suggesting an IPAH diagnosis. Non-operable CTEPH is more similar to IPAH than operable CTEPH regarding risk factors.

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