Incidence and associated factors of venous thromboembolism in patients with gastric cancer across treatment settings after diagnosis: a systematic review and meta-analysis.

Abdominal surgery and chemotherapy are well-established risk factors for venous thromboembolism (VTE) in patients with cancer, but their specific contribution in patients with esophageal and gastric cancer is unclear. We aim to quantify the risk of VTE, identify risk factors associated with VTE, and determine the association between VTE and survival in patients undergoing surgery for esophageal or gastric cancer. A retrospective, population-based cohort study was conducted using linked administrative healthcare databases. We used the Ontario Cancer Registry to identify patients with esophageal or gastric cancer between January 1, 2007 and December 31, 2016 who underwent surgical resection. Incidence of first VTE event was identified using International Classification of Diseases 9 and 10 codes. VTE incidence was calculated at clinically relevant time points 180 days before and after surgery. Logistic regression was used to identify factors associated with VTE with odds ratios (OR) and 95% confidence intervals (CI) reported. Cox proportional hazards regression models were used to estimate associations between covariates and survival. Kaplan-Meier method was used to compare overall (OS) and cancer-specific survival (CSS) by VTE status. A total of 4894 patients had esophagectomy or gastrectomy, of which 8% (n = 383/4894) had VTE. VTE risk was 2.5% (n = 123/4894) 180 days before surgery, 2.8% (n = 138/4894) within 30 days of surgery, and 2.5% (n = 122/4894) from 31 to ≤ 180 days after surgery. Of the patients with VTE within 30 days of surgery, 34% (n = 47/138) were diagnosed after discharge from hospital. Receipt of preoperative chemotherapy was associated with VTE 180 days before surgery (odds ratio [OR] 3.84, 95% confidence interval [CI] 2.41, 6.11). Increased hospital length of stay (LOS) was associated with VTE 30 days after surgery (OR 1.08, 95% CI 1.02, 1.14, per week). Patients with VTE had inferior median OS and CSS (2.2 vs. 3.7 years; 2.3 vs. 4.4 years, respectively). In adjusted models VTE was associated with inferior OS (HR 1.36, 95% CI 1.13, 1.63) and CSS (HR 1.42, 95% CI 1.16, 1.75). The highest risk of VTE is within 30 days of surgery with one third of patients diagnosed after discharge from hospital. Longer hospital LOS and receipt of preoperative chemotherapy are associated with increased risk of VTE. VTE is an independent risk factor for inferior survival in patients with esophageal or gastric cancer.

To the Editor: I read with interest the recent report by Shamsuzzaman et al1 of elevated C-reactive protein (CRP) in patients with obstructive sleep apnea (OSA). Although the patients and control subjects were matched for body mass index (BMI), 36±4 kg/m2 versus 34±4 kg/m2, all were very obese (upper normal BMI=25 kg/m2). Several recent studies have indicated that CRP levels are elevated in obese patients.2–4 Adiposity, in particular visceral adipose tissue, is a key promoter …

The use of warfarin sodium for treating venous thromboembolism in patients with cancer is associated with a significant risk of recurrence and bleeding. The use of low-molecular-weight heparin sodium for secondary prevention of venous thromboembolism in cancer patients may reduce the complication rate. To determine whether a fixed dose of subcutaneous low-molecular-weight heparin is superior to oral warfarin for the secondary prophylaxis of venous thromboembolism in patients with cancer and venous thromboembolism. In a randomized, open-label multicenter trial performed between April 1995 and March 1999, we compared subcutaneous enoxaparin sodium (1.5 mg/kg once a day) with warfarin given for 3 months in 146 patients with venous thromboembolism and cancer. A combined outcome event defined as major bleeding or recurrent venous thromboembolism within 3 months. Of the 71 evaluable patients assigned to receive warfarin, 15 (21.1%; 95% confidence interval [CI], 12.3%-32.4%) experienced one major outcome event compared with 7 (10.5%) of the 67 evaluable patients assigned to receive enoxaparin (95% CI, 4.3%-20.3%; P =.09). There were 6 deaths owing to hemorrhage in the warfarin group compared with none in the enoxaparin group. In the warfarin group, 17 patients (22.7%) died (95% CI, 13.8%-33.8%) compared with 8 (11.3%) in the enoxaparin group (95% CI, 5.0%-21.0%; P =.07). No difference was observed regarding the progression of the underlying cancer or cancer-related death. These results confirm that warfarin is associated with a high bleeding rate in patients with venous thromboembolism and cancer. Prolonged treatment with low-molecular-weight heparin may be as effective as oral anticoagulants and may be safer in these cancer patients.

An overview of venous thromboembolism prophylaxis

Increased risk of preoperative venous thromboembolism in patients with renal cell carcinoma and tumor thrombus: reply

ObjectiveThis study examines the clinical features and risk factors for postoperative venous thromboembolism in craniotomy patients with intracranial tumors.MethodsIn this study, we conducted an analysis using clinical data extracted from the Medical Information Mark for Intensive Care (MIMIC) database. Clinical data from the first day of ICU admission were utilized for our analysis. We employed univariate and multivariate logistic regression analyses to examine the factors influencing the outcome. A nomogram, constructed using the R software, was developed to predict the risk of secondary thromboembolism.ResultsA total of 728 eligible patients were included in this study, among whom the incidence of postoperative venous thromboembolism after craniotomy was found to be 19.2%. The age of the patients, along with their initial Glasgow Coma Scale score and prothrombin time, were identified as independent potential risk factors for the occurrence of venous thromboembolism in patients with intracranial tumors. These risk factors were incorporated into the predictive model, and a nomogram was constructed using the R software. By further conducting receiver operating characteristic curve analysis, the model exhibited an area under the curve of 0.7463 (95% CI 0.7056-0.7932). Simultaneously, we employed repeated sampling to construct a calibration curve, which demonstrated excellent model fit.ConclusionPatient age, Glasgow Coma Scale score, and prothrombin time have been identified as potential independent risk factors that may influence the occurrence of venous thromboembolism in patients with intracranial tumors.

AMA Serejko-Banaś K, Ciałkowska-Rysz A. Prevention is better than cure, or what we know about venous thromboembolism in patients with advanced cancer Part I. Risk factors and epidemiology of venous thromboembolism in patients with advanced cancer. Medycyna Paliatywna/Palliative Medicine. 2022;14(4):183-188. doi:10.5114/pm.2022.127090. APA Serejko-Banaś, K., & Ciałkowska-Rysz, A. (2022). Prevention is better than cure, or what we know about venous thromboembolism in patients with advanced cancer Part I. Risk factors and epidemiology of venous thromboembolism in patients with advanced cancer. Medycyna Paliatywna/Palliative Medicine, 14(4), 183-188. https://doi.org/10.5114/pm.2022.127090 Chicago Serejko-Banaś, Katarzyna Ewa, and Aleksandra Ciałkowska-Rysz. 2022. "Prevention is better than cure, or what we know about venous thromboembolism in patients with advanced cancer Part I. Risk factors and epidemiology of venous thromboembolism in patients with advanced cancer". Medycyna Paliatywna/Palliative Medicine 14 (4): 183-188. doi:10.5114/pm.2022.127090. Harvard Serejko-Banaś, K., and Ciałkowska-Rysz, A. (2022). Prevention is better than cure, or what we know about venous thromboembolism in patients with advanced cancer Part I. Risk factors and epidemiology of venous thromboembolism in patients with advanced cancer. Medycyna Paliatywna/Palliative Medicine, 14(4), pp.183-188. https://doi.org/10.5114/pm.2022.127090 MLA Serejko-Banaś, Katarzyna Ewa et al. "Prevention is better than cure, or what we know about venous thromboembolism in patients with advanced cancer Part I. Risk factors and epidemiology of venous thromboembolism in patients with advanced cancer." Medycyna Paliatywna/Palliative Medicine, vol. 14, no. 4, 2022, pp. 183-188. doi:10.5114/pm.2022.127090. Vancouver Serejko-Banaś K, Ciałkowska-Rysz A. Prevention is better than cure, or what we know about venous thromboembolism in patients with advanced cancer Part I. Risk factors and epidemiology of venous thromboembolism in patients with advanced cancer. Medycyna Paliatywna/Palliative Medicine. 2022;14(4):183-188. doi:10.5114/pm.2022.127090.

Accumulating evidence suggests that low-molecular-weight heparins are the drug of choice for the prevention and treatment of venous thromboembolism in patients with cancer. For prophylaxis in the surgical setting, once-daily subcutaneous injections of low-molecular-weight heparin are as effective and safe as multiple doses of unfractionated heparin. Extending prophylaxis with low-molecular-weight heparins beyond hospitalization was recently found to reduce safely the risk of postoperative thrombosis after abdominal surgery for cancer. For the long-term treatment of deep vein thrombosis and in select patients with pulmonary embolism, recently completed clinical trials have shown that secondary prophylaxis with low-molecular-weight heparin is feasible and more effective than oral anticoagulant therapy in preventing recurrent venous thromboembolism in cancer patients. There is also evidence that low-molecular-weight heparins are effective in cancer patients who develop recurrent thrombosis while on warfarin therapy. Lastly, the potential antineoplastic effects of low-molecular-weight heparins make these agents an attractive option in patients with cancer. Although the management of cancer patients with venous thromboembolism remains challenging, low-molecular-weight heparins have simplified and improved the prevention and treatment of venous thromboembolism in these high-risk patients.

Optimal timing of starting thromboprophylaxis for patients with acute spinal cord injury: A survey of Canadian spine surgeons

Incidence of Venous Thromboembolism in Patients Hospitalized with Cancer

The present study employed the integrative literature review methodology to examine the risks of deep vein thrombosis and venous thromboembolism in patients with liver cirrhosis. Different data sets were collected, all related to this specific theme. The discussion addressed and analyzed the risks of developing deep vein thrombosis and venous thromboembolism in patients with different degrees of liver cirrhosis, the occurrence of thrombotic events in these patients was also analyzed, it was also observed that deep venous thrombosis and thromboembolism are less common in alcoholic cirrhosis than in non-alcoholic cirrhosis. It is concluded that the understanding of these risks is still limited and there is a lack of more in-depth and complete studies and research, since there is a general reluctance to use anticoagulation for fear of hemorrhagic complications when there is an indication for the use of anticoagulants, such as venous thromboembolism (VTE) and deep vein thrombosis (DVT), which makes it impossible to carry out clinical trials to understand these risks and make use of an effective therapy.

Timing, Incidence and Risk Factors for Venous Thromboembolism in Patients Undergoing Radical Cystectomy for Malignancy: A Case for Extended Duration Pharmacological Prophylaxis

The risk of venous thromboembolism in patients with mental illness has been insufficiently addressed. This study aimed to assess the correlation between hyperhomocysteinemia and venous thromboembolism prevalence among this population. Patients with a diagnosis of mental illness and concurrent venous thromboembolism, admitted to Sir Run Run Shaw Hospital at Zhejiang University School of Medicine between January 2014 and December 2021, were included in the venous thromboembolism group. The control group, approximately twice the size, comprised individuals with mental illness but without venous thromboembolism. Basic clinical data were gathered for both cohorts. In psychiatric patients, elevated D-dimer levels(OR=5.60,95% CI 3.28-10.00), hyperhomocysteinemia (OR=2.37,95% CI 1.10-5.14), and hyperprolactinemia(OR= 2.68,95% CI 1.12-6.42)were significant risk factors for venous thromboembolism. According to further subgroup analyses, hyperhomocysteinemia is a significant risk factor associated with pulmonary embolism, with an OR of 5.08 (95% CI 1.20-21.48). An interaction effect between gender and homocysteine level was found, with a p-interaction of 0.022.A subsequent analysis confirmed the association between hyperhomocysteinemia and venous thromboembolism in female psychiatric patients, with an OR of 3.34 (95% CI 1.68-6.65), indicating that hyperhomocysteinemia is a significant risk factor for venous thromboembolism in women. Patients with psychiatric disorders were found to have an elevated risk of venous thromboembolism, which was associated with increased levels of D-dimer, hyperprolactinemia, and hyperhomocysteinemia. A strong correlation between hyperhomocysteinemia and pulmonary embolism was identified in patients with mental illnesses. Furthermore, the study revealed that female psychiatric patients with hyperhomocysteinemia constituted a high-risk group for venous thromboembolism. This finding holds significant clinical implications, suggesting that early preventative measures could be implemented for this high-risk population to reduce the incidence of thromboembolic events during hospitalization for psychiatric patients.

Background:Deep sternal wound infection and mediastinitis following sternotomy are associated with significant morbidity and mortality, and often require sternal reconstruction by plastic surgeons. Despite this patient population having a substantial risk of venous thromboembolism, there are no reports of the incidence of venous thromboembolism in patients undergoing sternal reconstruction. The authors sought to evaluate the incidence of venous thromboembolism in sternal reconstruction patients and to identify common risk factors for venous thromboembolism in this patient population.Methods:A single-center retrospective review was completed of all patients who underwent sternal reconstruction by plastic surgeons between January 2012 and July 2020. Demographic data, antiplatelet and anticoagulant use, 2005 Caprini score, operative time, bleeding events, and postoperative venous thromboembolism events were recorded.Results:A total of 44 patients were identified for analysis. The average 2005 Caprini score for the cohort was 10.9. In total, 93.2% of patients received perioperative antiplatelet and anticoagulant therapy (either chemoprophylaxis or systemic). Two patients developed postoperative venous thromboembolism events, for a total venous thromboembolism rate of 4.6%. Four patients had bleeding events requiring reoperation. No deaths were reported from either of these complications.Conclusions:Patients undergoing sternal reconstruction are at a high risk for venous thromboembolism and postoperative bleeding events. Despite the growing body of literature on venous thromboembolism in various surgical populations, the optimal management of thromboembolic risk in patients with high Caprini scores undergoing sternal reconstruction requires additional investigation.

Cancer-related venous thromboembolism is one of the leading causes of mortality and morbidity in cancer patients. Lung cancer is the second most common cancer in the world and is closely related to venous thromboembolism. Venous thromboembolism affects survival in patients with cancer and it is important to be able to predict the possibility of thrombosis in patients with cancer. It was aimed to evaluate the predictive performance of the Khorana risk score in patients with lung cancer. The medical data of the patients followed up with lung cancer were analyzed retrospectively. Venous thromboembolism events in lung cancer patients were described. The relationship between the Khorana risk score and the risk of venous thromboembolism was investigated using the cumulative incidence function with compared risk models. Eight hundred fourteen lung cancer patients were included in the study. Venous thromboembolism was detected in 79 (9.7%) of the patients. Sixty one (77.2%) of the patients had pulmonary embolism, 15 (19%) had peripheral deep vein thrombosis and three (3.8%) had venous thrombosis of other sites. The cumulative incidences of venous thromboembolism for high and intermediate Khorana risk scores were 10.1% and 9.7%, respectively (p= 0.09). The cumulative incidences of venous thromboembolism at 3, 6, 12, and 24 months were 4.7%, 5.8%, 6.4%, and 9.6% for the high-grade Khorana risk score; 4.6%, 5.7%, 6.3% and 7.8% for the intermediate Khorana risk score (p= 0.11). The Khorana risk score was not found useful in the risk stratification of venous thromboembolism (intermediate or high risk) in patients with lung cancer. New scoring systems are needed to calculate the risk of venous thromboembolism in patients with lung cancer.