scholarly journals Estimating the risk of thrombotic events in people with congenital hemophilia A using US claims data

2021 ◽  
Author(s):  
Imi Faghmous ◽  
Francis Nissen ◽  
Peter Kuebler ◽  
Carlos Flores ◽  
Anisha M Patel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Ischemic Stroke ◽  
Hemophilia A ◽  
Incidence Rates ◽  
Thrombotic Risk ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Similar Incidence

Aim: Compare thrombotic risk in people with congenital hemophilia A (PwcHA) to the general non-hemophilia A (HA) population. Patients & methods: US claims databases were analyzed to identify PwcHA. Incidence rates of myocardial infarction, pulmonary embolism, ischemic stroke, deep vein thrombosis and device-related thrombosis were compared with a matched cohort without HA. Results: Over 3490 PwcHA were identified and 16,380 individuals matched. PwcHA had a similar incidence of myocardial infarction and pulmonary embolism compared with the non-HA population, but a slightly higher incidence of ischemic stroke and deep vein thrombosis. The incidence of device-related thrombosis was significantly higher in PwcHA. Conclusion: This analysis suggests that PwcHA are not protected against thrombosis, and provides context to evaluate thrombotic risk of HA treatments.

Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism: A 35-Year Population-Based Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1488-1488 ◽  
Author(s):  
John A. Heit ◽  
Tanya M. Petterson ◽  
Sara A. Farmer ◽  
Kent R. Bailey ◽  
L. Joseph Melton
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Incidence Rates ◽  
Age And Gender ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
And Gender ◽  
Age Adjusted Rates ◽  
Deep Vein ◽  
Age And Sex

Abstract Background: Recent trends in the incidence of venous thromboembolism (VTE), including idiopathic vs. non-idiopathic VTE, have not been well described. Objective: To estimate the incidence of deep vein thrombosis (DVT) and pulmonary embolism with or without DVT (PE), and describe trends in incidence. Methods: Using the resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN residents with an incident DVT and PE over the 35-year period, 1966–2000 (n=3342). For all cases, the complete medical records in the community were reviewed for demographic and baseline characteristics previously identified as risk factors for VTE. Generalized linear models assuming a Poisson error structure, and using a log link function, and a log (population) offset will be used to assess the relationship of crude incidence rates to gender, year of diagnosis and age at diagnosis. Results: The overall average age- and sex-adjusted annual VTE incidence was 122 per 100,000 person-years (DVT, 56 per 100,000; PE, 66 per 100,000), with higher age-adjusted rates among men than women (134 versus 115 per 100,000, respectively). VTE incidence rates increased exponentially with age for both genders, ranging from 4 to 1110 per 100,000 for age groups 0–19 to 90–110 years. Compared to the 5-year period, 1981–85 (when non-invasive diagnostic testing became routinely available), the overall VTE incidence through 2000 remains unchanged. However, the DVT incidence and the PE incidence significantly increased and decreased, respectively, adjusting for age and gender (p<0.001 for both). The overall age- and sex-adjusted annual incidence of idiopathic VTE was 11.7 per 100,000 person-years (DVT, 6.6 per 100,000; PE, 5.1 per 100,000), with age-adjusted rates also higher among men than women (15.1 vs. 9.1 per 100,000). Interestingly, again compared to 1981–85, idiopathic VTE incidence decreased for 1991–95 (p=0.001) and 1996–2000 (p=0.32), adjusting for age and gender. Idiopathic DVT incidence decreased for 1991–95 (p=0.09), and idiopathic PE incidence decreased for both 1991–95 (p=0.004) and 1996–2000 (p=0.03). The overall age- and sex-adjusted annual incidence of non-idiopathic VTE was 109.4 per 100,000 (DVT, 48.4 per 100,000; PE, 60.7 per 100,000), again, with age-adjusted rates higher in men than women (115.1 vs. 106.8 per 100,000). Non-idiopathic DVT incidence increased steadily since 1981–85 (p=0.006, p<0.001, and p<0.001 for increasing DVT incidence for 1986–1990–1991–1995–1996–2000, respectively, adjusting for age and gender). Non-idiopathic PE incidence, however, remained unchanged for 1986–2000. Conclusions: VTE remains a major national health problem, especially among the elderly. Despite improved VTE prophylaxis efficacy and utilization, the overall incidence of VTE remains unchanged. However, the decreasing incidence of idiopathic DVT, and particularly idiopathic PE (with its associated poor survival) raises the possibility that the total number of VTE(PE)-related deaths may also be decreasing, albeit slightly. This hypothesis requires formal testing. The increasing or steady incidence of non-idiopathic DVT and PE, respectively, suggests the need for more widespread, effective VTE prophylaxis.

scholarly journals ROLE OF PROPHYLACTIC ANTI COAGULANTS AND ANTI PLATELETS TO REDUCE THE INCIDENCE OF THROMBOSIS, STROKE, MYOCARDIAL INFARCTION IN ASYMPTOMATIC PATIENTS OF COVID19

2021 ◽  
pp. 14-16
Author(s):  
J Mariano Anto Brunomascarenhas
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
The Body ◽  
Vein Thrombosis ◽  
Asymptomatic Patients ◽  
Embolism And Thrombosis ◽  
Deep Vein ◽  
Serial Evaluation

BACKGROUND: As we are in the middle of the second year of the COVID19 Pandemic,we are observing an increased incidence of conditions like Cerebrovascular Accidents, Ischemic Heart Disease, Myocardial Infarction, Deep Vein Thrombosis,Pulmonary Embolism,and Thrombosis of Other Vessels. MATERIALS AND METHODS: Literature Review and Analysis of Coagulation Profiles of Patients in the past 1 year treated by the author was done. RESULTS AND CONCLUSIONS: 1. COVID19 is not just an infectious disease, but also an Immune Disease. The Immune Part can also happen in Asymptomatic Patients and those who got the vaccine. 2. Most of the disease processes in the body start after the virus has been cleared from the throat. The vigil against complications must not stop when the Throat Swab becomes negative or even when the patient is discharged but must continue for months till all the disease processes stop. 3.It is recommended that: a.Initial Evaluation with PT, aPTT, INR is done for: I.Those suffering from COVID 19 who have not undergone D Dimer evaluation ii.Those recovering from COVID 19. iii.Those likely to have had COVID 19 (based on the symptoms),but the infection was not documented. iv.Those likely to have had asymptomatic COVID 19 (contacts of COVID19 infected patients) v.Those planning to take Vaccines for COVID19. b.An Abnormal Value in PT,aPTT,INR may be managed with appropriate Drugs like Aspirin,Clopidogrel,Dipyridamole, Ticlopidine, Rivaroxaban, Dabigatran, Apixaban, Edoxaban, Heparin, Low Molecular Weight Heparin, Warfarin, and other drugs. c. Serial Evaluation of PT, aPTT, INR be done after 1 month, 3 months, 6 months (and even at more frequent intervals if indicated) and the drugs are added or removed,the dosage of the drugs is increased or reduced based on the results. d.Standard Indication of IVC Filter may be followed. 4.It is the knowledge of the pathogenesis of Thrombosis that is crucial in the prevention and management of Stroke, Heart Attack, Deep Vein Thrombosis, and Pulmonary Embolism rather than fancy gadgets, expensive tests, and exotic drugs.

Postoperative Deep Vein Thrombosis, Pulmonary Embolism, and Myocardial Infarction

Spine ◽  
2018 ◽  
Vol 43 (13) ◽  
pp. E766-E772 ◽  
Author(s):  
Brian Shiu ◽  
Elizabeth Le ◽  
Ehsan Jazini ◽  
Tristan B. Weir ◽  
Timothy Costales ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Postoperative Deep Vein Thrombosis ◽  
Deep Vein

scholarly journals Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Post operative Cardiovascular and Thromboembolic Complications

2015 ◽  
Vol 06 (03) ◽  
pp. 565-576 ◽  
Author(s):  
M. Tien ◽  
R. Kashyap ◽  
G. A. Wilson ◽  
V. Hernandez-Torres ◽  
A. K. Jacob ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Knee Arthroplasty ◽  
Search Algorithm ◽  
Cardiovascular Complications ◽  
Data Abstraction ◽  
Vein Thrombosis ◽  
Electronic Search ◽  
Deep Vein

Summary Background: With increasing numbers of hospitals adopting electronic medical records, electronic search algorithms for identifying postoperative complications can be invaluable tools to expedite data abstraction and clinical research to improve patient outcomes. Objectives: To derive and validate an electronic search algorithm to identify postoperative thromboembolic and cardiovascular complications such as deep venous thrombosis, pulmonary embolism, or myocardial infarction within 30 days of total hip or knee arthroplasty. Methods: A total of 34 517 patients undergoing total hip or knee arthroplasty between January 1, 1996 and December 31, 2013 were identified. Using a derivation cohort of 418 patients, several iterations of a free-text electronic search were developed and refined for each complication. Subsequently, the automated search algorithm was validated on an independent cohort of 2 857 patients, and the sensitivity and specificities were compared to the results of manual chart review. Results: In the final derivation subset, the automated search algorithm achieved a sensitivity of 91% and specificity of 85% for deep vein thrombosis, a sensitivity of 96% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 95% for myocardial infarction. When applied to the validation cohort, the search algorithm achieved a sensitivity of 97% and specificity of 99% for deep vein thrombosis, a sensitivity of 97% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 99% for myocardial infarction. Conclusions: The derivation and validation of an electronic search strategy can accelerate the data abstraction process for research, quality improvement, and enhancement of patient care, while maintaining superb reliability compared to manual review. Citation: Tien M, Kashyap R, Wilson GA, Hernandez-Torres V, Jacob AK, Schroeder DR, Mantilla CB. Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Postoperative Thromboembolic and Cardiovascular Complications. Appl Clin Inform 2015; 6: 565–576http://dx.doi.org/10.4338/ACI-2015-03-RA-0026

scholarly journals Background rates of hospitalizations and emergency department visits for selected thromboembolic and coagulation disorders in Ontario, Canada, 2015 to 2020, to inform COVID-19 vaccine safety surveillance

2021 ◽  
Author(s):  
Sharifa Nasreen ◽  
Andrew Calzavara ◽  
Maria Sundaram ◽  
Shannon E. MacDonald ◽  
Christiaan Righolt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Emergency Department Visits ◽  
Coagulation Disorders ◽  
Idiopathic Thrombocytopenia ◽  
Vein Thrombosis ◽  
Deep Vein

AbstractObjectiveThe objective of this study was to estimate background rates of selected thromboembolic and coagulation disorders in Ontario, Canada.DesignPopulation-based retrospective observational study using linked health administrative databases. Records of hospitalizations and emergency department visits were searched to identify cases using diagnostic codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA).ParticipantsAll Ontario residents.Primary outcome measuresIncidence rates of stroke, deep vein thrombosis, pulmonary embolism, idiopathic thrombocytopenia, disseminated intravascular coagulation, and cerebral venous thrombosis during five pre-pandemic years (2015–2019, annually, averaged, and monthly average) and 2020.ResultsThe average annual population was 14 million with 51% female. The mean annual rates during 2015–2019 were 127.1/100,000 population (95% confidence interval [CI], 126.2, 127.9) for ischemic stroke, 22.0/100,000 (95%CI, 21.6, 22.3) for intracerebral haemorrhage, 9.4 (95%CI, 9.2, 9.7) for subarachnoid haemorrhage, 86.8/100,000 (95%CI, 86.1, 87.5) for deep vein thrombosis, 63.7/100,000 (95%CI, 63.1, 64.3) for pulmonary embolism, 6.1/100,000 (95%CI, 5.9, 6.3) for idiopathic thrombocytopenia, 1.6/100,000 (95%CI, 1.5, 1.7) for disseminated intravascular coagulation, and 1.5/100,000 (95%CI, 1.4, 1.6) for cerebral venous thrombosis. Rates were lower in 2020 than during the pre-pandemic years for ischemic stroke, deep vein thrombosis, and idiopathic thrombocytopenia. Rates were generally consistent over time, except for pulmonary embolism, which increased from 57.1 to 68.5 per 100,000 between 2015 and 2019. Rates were higher for females than males for subarachnoid haemorrhage, pulmonary embolism, and cerebral venous thrombosis, and vice versa for ischemic stroke and intracerebral haemorrhage. Rates increased with age for most of these conditions, but idiopathic thrombocytopenia demonstrated a bimodal distribution with incidence peaks at 0–19 years and ≥60 years.ConclusionsOur estimated background rates help to contextualize observed events of these potential adverse events of special interest and to detect potential safety signals related to COVID-19 vaccines.Strengths and limitations of this study➢Recent background rates of selected thromboembolic and coagulation disorders that are potential adverse events special interest related to COVID-19 vaccine are estimated.➢Background rates during five pre-pandemic (2015–2019) years and 2020 will provide context for these events to identify vaccine safety signals.➢We used recorded diagnostic codes in administrative data without information on clinical and/or diagnostic confirmation, and the validity of these data are imperfect, which may result in under or overestimation.

scholarly journals Proximal Deep Vein Thrombosis and Pulmonary Embolism in COVID-19 Patients: A Systematic Review and Meta-Analysis Short Tittle: Venous Thromboembolism in COVID-19 Patients

2020 ◽  
Author(s):  
Gregoire Longchamp ◽  
Sara Manzocchi-Besson ◽  
Alban Longchamp ◽  
Marc Righini ◽  
Helia Robert-Ebadi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Meta Analysis ◽  
Proximal Deep Vein Thrombosis ◽  
Primary Analysis ◽  
Thrombotic Risk ◽  
Medically Ill ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract BACKGROUNGCOVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODSThis meta-analysis included original articles in English published from 01/01/2020 to 06/15/2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTSIn 33 studies (n=4’009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2=92.5) overall, and 21% (95%CI 14-28%, I2=87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2= 87.0%) and 8% (95%CI 3-14%, I2=87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2=92.1%) and 17% (95%CI 11-25%, I2=89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%).CONCLUSIONSThe risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATIONThe review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020193369).

Factor XI in Clinical Bleeding and Thrombotic Disorders

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. SCI-21-SCI-21
Author(s):  
Uri Seligsohn ◽  
Ophira Salomon
Keyword(s):  
Myocardial Infarction ◽  
Deep Vein Thrombosis ◽  
Ischemic Stroke ◽  
Allele Frequencies ◽  
Bleeding Disorders ◽  
Expected Number ◽  
Factor Xi ◽  
Similar Frequency ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Abstract SCI-21 Severe inherited bleeding disorders have served as models for unraveling the role of specific coagulation factors in hemostasis and thrombosis and for design of antithrombotic agents. Factor XI (FXI) deficiency, was described in 1953 as a mild to moderate autosomal dominant bleeding disorder. Later studies indicated that inheritance is autosomal recessive with homozygotes or compound heterozygotes having a major deficiency of FXI and heterozygotes exhibiting a minor deficiency. FXI deficiency is the most frequent entity among rare inherited bleeding disorders; in worldwide surveys and registries, its relative frequency ranged between 24–60%. The prevalence of heterozygous FXI deficiency is very high in Ashkenazi Jews (1:11) in whom two predominant mutations, Glu117X and Phe283Leu, of similar frequency were described, with allele frequencies of 0.0217 and 0.0254, respectively. The Glu117X is also found in Iraqi Jews, Arabs and Italians at decreasing prevalences. A Cys38Arg mutation is prevalent in French Basques, and a Cys128X is prevalent in Britons with allele frequencies of 0.005 and 0.009, respectively. More than 185 additional mutations have been described usually in individual patients (www.factorXI.org). The common presentation of severe FXI deficiency is injury related bleeding, e.g. tooth extractions. Alternatively, a pronged aPTT in a routine examination leads to the diagnosis. Surgery or trauma at sites with increased fibrinolytic activity can be associated with excessive bleeding in 53–67% of untreated patients (Salomon et al. Haemophilia 2006, 12:490). The frequency of bleeding in heterozygotes with partial FXI deficiency is substantially lower than in patients with a severe deficiency. An additional hemostatic abnormality in such instances is likely. The procoagulant and antifibrinolytic effects of FXI mediated by augmented thrombin generation and activation of thrombin activatable fibrinolysis inhibitor could imply that elevated FXI levels confer an increased risk of thrombosis. This was indeed found in patients with deep vein thrombosis and ischemic stroke but is controversial in acute myocardial infarction suggesting that low levels of FXI might be protective at least against ischemic stroke and deep vein thrombosis. This assumption is also supported by animal models of venous and arterial thrombosis in which severe FXI deficiency confers protection against thrombosis yet without causing bleeding. In a cohort of 115 patients older than 45 years with severe FXI deficiency, we recently showed that 19 have had a myocardial infarction, implying a frequency that was expected in the Israeli population. In contrast, only 1 patient had an ischemic stroke, whereas the expected number of ischemic strokes in an Israeli health survey of 9509 subjects was 8.56 (p=0.0037) after adjustment for ischemic stroke risk factors (Salomon et al. Blood 2008, 111:4113). In another cohort of 219 patients with severe FXI deficiency, the expected number of subjects with deep vein thrombosis derived from a population based study was 4.65, whereas the observed number was 0 (p=0.019). These data suggest that severe FXI deficiency provides protection against deep vein thrombosis and ischemic stroke but not against myocardial infarction. These variable manifestations probably stem from differences in the aforementioned vascular beds. Collectively, these observations warrant development of means to induce FXI deficiency for potential use as new antithrombotic treatment modalities. Disclosures: Seligsohn: ISIS Pharmaceuticals, U.S.A.: Membership on an entity's Board of Directors or advisory committees.

The incidence of pulmonary embolism during deep vein thrombosis

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 29-33 ◽  
Author(s):  
J D Nielsen
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Major Trauma ◽  
Major Surgery ◽  
Vein Thrombosis ◽  
High Age ◽  
Deep Vein

Among life-threatening cardiovascular diseases, pulmonary embolism (PE) is the third most common after myocardial infarction and stroke. PE is a manifestation of venous thromboembolism (VTE). PE shares risk factors with deep vein thrombosis (DVT) and is regarded as a consequence of DVT rather than a separate clinical entity. Risk factors for VTE include major surgery, major trauma, high age, myocardial infarction, chronic heart failure, prolonged immobility, malignancy, thrombophilia and prior VTE. It is, however, important to recognize that these factors are not equally important and not equally common in patients with PE and DVT, respectively. Compared with DVT, PE is more often associated with major surgery, major trauma, high age, myocardial infarction and chronic heart failure, whereas malignancy and thrombophilia primarily are clinical predictors of DVT. In patients with prior VTE the initial clinical manifestation strongly predicts the manifestation of recurrent episodes, i.e. patients with previous PE are more likely to develop recurrent PE than DVT while patients with DVT predominantly are at risk of recurrent DVT.

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