Annual Incidence Of Venous Thromboembolism Research Articles

Venous thromboembolism and amyotrophic lateral sclerosis: the Venous Thrombo-Embolism and Sclerosis Lateral Amyotrophic study

BackgroundAmyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease. Given the inflammatory nature of ALS and the high number of ALS-related clinical circumstances (eg, prolonged immobilization and infections), patients with ALS may have a high risk of venous thromboembolism (VTE). ObjectivesTo determine the annual incidence rate of VTE and the predictors of VTE in patients with ALS. MethodsWe analyzed a prospective cohort of patients with ALS diagnosed between 2009 and 2019 followed in the Brest University Hospital ALS Centre. ResultsAmong 227 patients with ALS, VTE occurred in 19 patients during a median follow-up period of 717 days (IQR, 488-1308), yielding an annual incidence rate of 2.93% (95% CI, 1.88%-4.53%). Predictors for VTE were a family history of VTE (hazard ratio [HR], 15.24; 95% CI, 1.72-134.84; P = .01), the presence of noninvasive ventilation at ALS diagnosis (HR, 6.98; 95% CI, 1.09-44.59; P = .04) and a short time (ie, <213 days) between first symptoms and ALS diagnosis (HR, 5.48; 95% CI, 1.57-19.11; P = .01). Recurrent VTE occurred within 3 months after stopping anticoagulation in 5 patients (26.3%). ConclusionThe annual incidence of VTE in patients with ALS is high. Predictive factors of VTE were a VTE history, noninvasive ventilation, and a short time between first symptoms of ALS and ALS diagnosis.

Diagnostic performance of natural language processing in detection of acute cancer VTE.

e19062 Background: The annual incidence of venous thromboembolism (VTE) is roughly 50-fold increased post allogeneic hematopoietic cell transplant (HSCT). Timely detection of VTE events has a significant impact on morbidity and mortality from these events. Manual chart review is commonly used for detection of VTE events; however, this is labor intensive and often not feasible. The International Classification of Diseases, 10th revision (ICD-10) has attempted to codify VTE more easily but has high false positive and false negative rates. Natural language processing (NLP) algorithms have been designed to improve detection of VTE events in electronic medical record systems over the past several years. This study aims to compare the accuracy of our institution’s NLP algorithm to the ICD-10 in detecting extremity VTE/pulmonary embolism (PE) events in hematopoietic stem cell transplant (HSCT) patients. Methods: This study was a retrospective analysis of adult patients who had allogeneic HSCT at MD Anderson between 2016-2020. Patient charts were assessed by three different methods for acute VTE events within 100 days of HSCT (index date). ICD-10 codes and our institution’s NLP algorithm were used separately to identify these VTE events. Afterwards, manual chart review was performed for confirmation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the ICD-10, NLP, and the NLP+ICD combination. Results: A total of 1,391 patient charts were analyzed in our study. There were 129 (9.3%) VTE events detected via manual chart review. Three methodologies were used for comparison: the NLP algorithm alone, the ICD code alone, and detection by NLP or ICD. The NLP algorithm alone had the best specificity (98.9%) and PPV (89.4%) of the three methods. The ICD-10 code had a statistically significant decrease in ability to detect acute VTE events compared to the NLP (p&lt;0.001) (Table). Of the 19 VTE events not identified by NLP, all were found in radiology or vascular laboratory reports. Conclusions: Our study shows the overall superior performance of the NLP algorithm, as it had higher sensitivity, specificity, PPV, and NPV compared to the ICD-10, as well as a better specificity and PPV compared to the combination of both methods. Future refinement of the NLP algorithm and combination with other detection methodologies will allow for more accurate detection of VTE in large cohorts. [Table: see text]

Clinico-pathological correlation between deep vein thrombosis and malignancy

Background: Cancer is one of the risk factors with estimates suggesting annual incidence of venous thrombo-embolism (VTE) is 0.5% in cancer patients compared to 0.1% in the general population. VTE is the second most common cause of death from cancer. Cancer associated thrombosis (CAT) is the target of intense interest in recent medical literature, including its epidemiology, pathophysiology, challenges in diagnosis, prophylaxis and treatment. Cancer types, stages, treatment and comorbidities are among the risk factors for developing VTE. Methods: This was a retrospective study based on patient hospital records from May 2017 to Dec 2021. About 50 patient records reportedly having CAT were studied to meet research objectives. Data pertaining to patient age, gender and comorbidity was collected for study purpose. Patients having confirmed diagnosis for deep venous thrombosis (DVT) (Duplex scan) and malignancy (Biopsy) were considered to ensure data completeness for analysis and reporting. Results: Our study showed that there was no correlation between different types of cancer with deep venous thrombosis, neither with different approach of treatment had it showed any significant results nor with any comorbidity. But we found out a correlation between different cancer with various comorbidity. Conclusions: Our study aimed at exploring clinical and pathological correlation between DVT and malignancy. Our study was a sincere effort to study clinic-pathological correlation among cancer patients with known cases of venous thrombosis. Further studies are warranted with large sample and more extensive case record format, and preferably long-term follow-up to understand patient outcome.

Pediatric Spontaneous Heparin-Induced Thrombocytopenia and Thrombosis Resulting in Thrombotic Storm

Background: The annual incidence of venous thromboembolism in pediatric patients is approximately 6 out of 1000 in the United States. In rare cases, rapid progression of multifocal thrombosis occurs despite therapeutic anticoagulation with heparin or low molecular weight heparin. Heparin-induced thrombocytopenia (HIT) is a pro-thrombotic disorder caused by an IgG-mediated immune response against platelet factor 4 resulting in platelet activation and risk of thrombosis, classically associated with prior exposure to heparin. The literature reports rare cases of adult patients developing HIT and thrombosis (HITT) without prior exposure. Objective: Aim to describe a case of spontaneous HITT in a pediatric patient which has never previously been published in the literature. Design/Method: Single subject case report developed with literature review. Results: 2-year-old male with no past medical history who presented with 5 days of frontal headaches and irritability. Neuroimaging, including CT, MRI, and MRV demonstrated extensive sinus venous thrombosis requiring initial anticoagulation with heparin. However, within 48 hours of initiation, the patient developed significant thrombocytopenia concerning for HIT. Lab testing was positive for both heparin-induced antibody and serotonin release assay, despite no prior heparin exposure. The remainder of the hypercoagulability workup was negative. Heparin was discontinued and the patient subsequently showed inadequate response to initial treatment with first-generation1 direct thrombin inhibitor (DTI) (Argatroban). Due to ongoing severe progressive symptomatic thrombocytopenia and thrombosis concerning for HIIT with thrombotic storm, the patient was treated with DTI (Bivalirubin), high dose methylprednisolone, and anti-CD20 therapy (Rituximab). This resulted in an improved clinical, laboratory, and neuroimaging response, and the patient was able to be gradually weaned off steroid therapy, and transitioned to anticoagulation with warfarin, with plans to remain on long-term anticoagulation. Conclusion: This is the first reported case in the literature of spontaneous HIIT in a pediatric patient. Spontaneous HITT is the primary explanation due to fulminant thrombosis and positive heparin-induced antibody and serotonin release assay with no prior heparin exposure, thrombocytopenia without immediate improvement upon heparin discontinuation, and blood smear showing normal red blood cell and platelet morphology. Spontaneous HIIT is a rare but important differential to consider in patients presenting with thrombosis and thrombocytopenia as the treatment differs from that of classic HIT, requiring heparin discontinuation, alternative anticoagulation, and immunomodulation.

Cancer-Associated Thrombosis: Implications toward Health-Related Quality of Life.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a severe health problem associated with high morbidity and mortality among cancer patients. The annual incidence of VTE is estimated at around 1% in the general population.[1] Due to the hypercoagulable state in cancer patients, there is a fourfold to sevenfold increased risk of thrombosis.[1] VTE is also an independent risk factor for mortality in patients with cancer.[2] Cancer-associated thrombosis (CAT) is increasingly important due to the rising number of individuals living with cancer.

KNOWLEDGE AND PREVALENCE OF RISK FACTORS FOR DEEP VEIN THROMBOSIS AMONG ADULT SAUDI POPULATION

While the reported annual incidence of venous thrombo-embolism varies widely, ranging from 43.7 to 145 per 100 000, the true incidence in the Kingdom of Saudi Arabia (KSA) remains unknown. Deep Vein Thrombosis (DVT) is a term that refers to blood clots inside a deep vein in the body, most commonly in lower extremities (usually calf or thigh); in rare cases, it can be in upper extremities. The main aim of this study was to assess the public knowledge and extent of DVT and to assess the influence of socio-demographic factors. The objectives were:&#x0D; &#x0D; To test the association between gender and the prevalence of DVT.&#x0D; To test the association between body mass index (BMI) and the prevalence of DVT.&#x0D; To test whether recent or current pregnancy and DVT are significantly associated.&#x0D; To test the significance of a family history of DVT and the prevalence of DVT among members of the same family.&#x0D; To fit binary logistic models that flag the important factors for DVT&#x0D; &#x0D; Methods&#x0D; The study was cross-sectional and it involved the adult population in Saudi Arabia. The total enumeration method was used to include male and female that agreed to answer the questionnaire in this study. The questionnaire included demographic information and knowledge and attitudes towards the symptoms, and risk factors measures.&#x0D; Results&#x0D; The ages of 317 of the 484 respondents who agreed to fill out the questionnaire were between 19 and 30 years. Males were 35.8% and females 64.2%, while 21.8% of the respondents reported having an incidence of DVT. DVT was statistically significantly associated with gender and pregnancy condition p&lt;.05 in both cases while the highest risk factor was gender where females were 2.205 more times likely to have DVT than males [95%CI;1.85,2.63, p &lt; .000].&#x0D; Conclusions&#x0D; There is a general increase in knowledge for DVT and also a general increase in incidences of DVT in Saudi Arabia compared to previous literature. BMI, gender, and pregnancy condition are the main risk factors of DVT.&#x0D; Keywords: Deep vein thrombosis, risk factors, Surgery, Saudi Arabia

Epidemiology of Venous Thromboembolism and Treatment Pattern of Oral Anticoagulation in Korea, 2009-2016: a Nationwide Study Based on the National Health Insurance Service Database.

BACKGROUNDThe annual incidence of venous thromboembolism (VTE) is increasing, and the treatment pattern of oral anticoagulants (OACs) has changed with introduction of new oral anticoagulants (NOACs). The aims of this study were to assess the annual incidence of VTE in a Korean population and the change of treatment pattern with availability of NOACs using a population-based database.METHODSUsing the Korean National Health Insurance Services database, we identified patients diagnosed with VTE between 2009 and 2016. The annual prevalence of VTE and clinical characteristics and treatment pattern were investigated. The annual incidence of VTE was calculated using direct and indirect methods using the estimated Korean population in 2009 as the reference.RESULTSThe annual incidence of VTE in Korean has increased yearly from 23.9 per 100,000 in 2009 to 42.2 in 2016. The overall rate of OAC prescription for VTE treatment increased from 55.9% to 68% in the same time period. The rate of initiation of NOAC treatment greatly increased, particularly from 2013 onwards, with a 20-fold increase from 2009 to 2016 (2.1% vs. 54.3%).CONCLUSIONSThe annual incidence of VTE in Korea increased by almost two-fold from 2009 to 2016. The rate of initiation of NOAC treatment has increased substantially since 2013, and these agents have surpassed VKAs as the anticoagulant of choice for VTE. This temporal pattern of OAC prescription is consistent with the current clinical guidelines, which indicate NOACs over the warfarin in patients with VTE.

Venous thromboembolic events in hand surgery

The risks of venous thromboembolism (VTE) following total hip and knee arthroplasty have been widely published. Our aim was to investigate the recorded incidence of VTE events at the time of elective and trauma hand surgery. The UK National Hospital Episode Statistics (HES) data linking VTE events with hand surgery for the financial years 2010–2012 were analysed. The local VTE rates following hand surgical procedures were also analysed. Finally, a cost assessment of VTE thromboprophylaxis was performed according to the British Society for Surgery of the Hand (BSSH) guidelines. 334,211 hand surgical procedures were performed throughout England of which there were 13 DVT and 27 PE events. These events were seen in patients with pre-existing comorbidities. The annual incidence of VTE is 0.006% at most in hand surgical patients in England. The cost of implementing mechanical VTE thromboprophylaxis to all patients having hand surgery would amount to £6,336,641 over 2 years. The cost of treatment for all VTE events would amount to £20,418. VTE prophylaxis is probably not necessary in patients undergoing isolated elective or trauma hand surgical procedures.

Perioperative Transfusions and Venous Thromboembolism.

Annual incidence of venous thromboembolism (VTE) including postoperative VTE in hospitalized children is rising significantly. A growing body of evidence supports the role of red blood cells (RBCs) in pathologic thrombosis. In this study, we examined the association of perioperative RBC transfusion with postoperative VTE in pediatric patients. The pediatric databases of the American College of Surgeons' National Surgical Quality Improvement Project from 2012 to 2017 were used. Multivariable logistic regression was used to examine the association between perioperative RBC transfusion status and the development of new or progressive VTE within 30 days of surgery. The analyses were age stratified, as follows: neonates (≤28 days), infants (>28 days and <1 year), and children (≥1 year). In this study, we included 20 492 neonates, 79 744 infants, and 382 862 children. Postoperative development of VTE was reported in 99 (0.48%) neonates, 147 (0.2%) infants, and 374 (0.1%) children. In all age groups, development of VTE was significantly more common among patients with a perioperative RBC transfusion than patients without a perioperative RBC transfusion (neonates: adjusted odds ratio [aOR] = 4.1, 95% confidence interval [CI] = 2.5-6.7; infants: aOR = 2.4, 95% CI = 1.7-3.6; children: aOR = 2.2, 95% CI = 1.7-2.9). Among children who received an intra- or postoperative transfusion, the weight-based volume of RBCs (mL/kg) transfused was associated with postoperative VTE in a dose-dependent manner: second tertile (odds ratio = 2.3, 95% CI = 1.3-4.1) and third tertile (odds ratio = 4.1, 95% CI = 2.3-7.4) versus first tertile. Perioperative RBC transfusions are independently associated with development of new or progressive postoperative VTE in children, infants, and neonates. These findings need further validation in prospective studies and emphasize the need for evidence-based perioperative pediatric blood transfusion decisions.

Incidence of VTE Among Patients with a Cancer Diagnosis in Oklahoma County

Background: Patients with cancer are at elevated risk for venous thromboembolism (VTE). Active cancer contributes a 4-7 fold increased risk for VTE; however, the incidence of VTE stratified by subpopulations of patients diagnosed with cancer, especially race/ethnicity, is uncertain. Objective: Describe the incidence of VTE among adult patients (age ≥ 18 years) with a cancer diagnosis in Oklahoma County, OK according to age, gender, race, and cancer type. Methods: In collaboration with the Centers for Disease Control and Prevention, we established a population-based surveillance system for VTE in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Patients were linked to the Oklahoma Central Cancer Registry. Any patient with a cancer diagnosis since 1997, excluding basal or squamous cell carcinoma, were included in the population-at-risk. Active cancer was defined as metastatic or a diagnosis ≤6 months before their VTE diagnosis. Poisson regression was used to estimate incidence rates (IRs) and 95% confidence intervals (CIs), which are reported per 1,000 person years (PY). Estimates with &amp;lt;10 events were suppressed. Results: Among all patients aged ≥18 years with a cancer diagnosis since 1997, 1.5% (n = 881) had a VTE event during the 2-year surveillance period. The overall annual age-adjusted incidence of VTE among those with cancer was 6.8 per 1,000 PY (95% CI: 5.81, 7.95). The demographic-specific incidence rates are summarized in Table 1. The VTE incidence did not significantly differ by sex. When stratified by age, annual VTE incidence was similar among those aged 18-39 years (6.1/1,000 PY, 95% CI: 4.35, 8.61), 40-59 years (6.2/1,000 PY, 95% CI: 5.4, 7.14), and 60-79 years (7.2/1,000 PY, 95% CI: 6.55, 7.90), however, the incidence was significantly higher (p&amp;lt;0.05) in those aged 80+ years (10.1/1,000 PY, 95% CI: 8.77, 11.61). When patients with a cancer diagnosis were stratified by race/ethnicity, non-Hispanic blacks had the highest VTE incidence (11.7/1,000 PY, 95% CI: 10.00, 13.59), followed by Hispanics (8.0/1,000 PY, 95% CI: 5.66, 11.44), non-Hispanic whites (6.9/1,000 PY, 95% CI: 6.41, 7.48), other non-Hispanic/unknown (5.8/1,000 PY, 95% CI: 3.45, 9.85), and non-Hispanic Native Americans (2.6/1,000 PY, 95% CI: 1.39, 4.79). VTE incidence was highest among those with active cancer or a history of cancer within the past three years, after which it appeared to decrease. When stratified by primary cancer type, VTE incidence was highest among those with brain cancer (16.6/1,000 PY, 95% CI: 11.06, 25.04) and lowest among those with prostate cancer (5.2/1,000 PY, 95% CI: 4.20, 6.44). As shown in Table 2, when stratified by cancer type, the incidence of VTE was higher (non-overlapping CIs) among those with active cancer compared to those with a history of cancer &amp;gt;6 months for several tumor types. Discussion: The incidence of VTE among those with cancer differs by race/ethnicity, with non-Hispanic blacks bearing the highest burden of disease. The risk of VTE persists and is particularly elevated up to three years after a cancer diagnosis. Disclosures Raskob: Eli Lilly: Consultancy; Pfizer: Consultancy, Honoraria; Portola: Consultancy; Novartis: Consultancy; BMS: Consultancy, Honoraria; Janssen R&amp;D, LLC: Consultancy, Honoraria; Tetherex: Consultancy; Daiichi Sankyo: Consultancy, Honoraria; Anthos: Consultancy; Bayer Healthcare: Consultancy, Honoraria; Boehringer Ingelheim: Consultancy.

The risk factors, outcomes, and costs associated with venous thromboembolism after traumatic brain injury: a nationwide analysis

ABSTRACTObjective: We sought to identify risk factors for VTE following traumatic brain injury (TBI) and determine how venous thromboembolism (VTE) affects outcomes and costs using a national database.Methods: The Nationwide Inpatient Sample (NIS) was used to identify patients with TBI between 2002 and 2014. VTE was identified as any occurrence of deep venous thrombosis or pulmonary embolism. We investigated putative risk factors for VTE and determined the effect of VTE on outcomes including mortality and disposition.Results: 424,929 patients met the inclusion criteria. There were 16,690 (3.9%) patients who developed a VTE. The annual incidence of VTE increased from 2.2% in 2002 to 5.4% in 2014 (R2 = 0.992, p < .001). Older age, increasing number of comorbidities, craniotomy or craniectomy, and more severe injuries were associated with increased odds of developing VTE (p < .001 for all). Patients with VTE had decreased odds of in-hospital mortality (OR 0.53; 95% CI 0.50–0.57) and increased odds of non-routine disposition (OR 2.05; 95% CI 1.97–2.14), tracheostomy, and gastrostomy.Conclusion: To our knowledge, we provide the largest analysis of VTE in TBI. This entity appears to be increasing in frequency, which may merit new strategies for prevention.

Cancer-associated thrombosis: the when, how and why.

Cancer-associated thrombosis (CAT) is a condition in which relevance has been increasingly recognised both for physicians that deal with venous thromboembolism (VTE) and for oncologists. It is currently estimated that the annual incidence of VTE in patients with cancer is 0.5% compared to 0.1% in the general population. Active cancer accounts for 20% of the overall incidence of VTE. Of note, VTE is the second most prevalent cause of death in cancer, second only to the progression of the disease, and cancer is the most prevalent cause of deaths in VTE patients. Nevertheless, CAT presents several peculiarities that distinguish it from other VTE, both in pathophysiology mechanisms, risk factors and especially in treatment, which need to be considered. CAT data will be reviewed in this review.

Venous Thromboembolism in Children and Young Adults in Korea: Analysis of the Korean Health Insurance Review and Assessment Service Database.

BackgroundVenous thromboembolism (VTE) is very rare in childhood. Nevertheless, its incidence has increased recently. This study aimed to identify risk factors for developing thrombosis in childhood cancers and other childhood diseases through the Korean Health Insurance Review and Assessment Service database.MethodsData were extracted from the Korean Health Insurance Review and Assessment Service database. Children and young adults from 1 month to 29 years of age were eligible, and 21,747 cases of VTE between January 2008 and December 2016 were identified.ResultsThe VTE incidence was high in children younger than 1 year of age. After 1 year of age, its incidence decreased rapidly and gradually increased. The VTE incidence for children between 0 and 1 year of age was 10.23-fold higher than that for those between 1 and 5 years of age. Annual VTE incidence increased by year. The age-standardized annual incidence rates were 9.98 per 100,000 population in 2008 and 22.53 per 100,000 population in 2016. The age-standardized annual incidence rate increased 2.25-fold during the 8 years. The lower extremity was the most common site of venous thrombosis.ConclusionThe incidence of VTE in a population younger than 30 years was 13.11 per 100,000 persons in Korea. We found a bimodal age distribution of the VTE incidence with peaks at infancy and again after 16 years. The incidence of portal vein thrombosis was high in infants, and infection and malignancy were the most common comorbidities in patients with VTE.

β-Antithrombin, subtype of antithrombin deficiency and the risk of venous thromboembolism in hereditary antithrombin deficiency: A family cohort study

Hereditary antithrombin deficiency is associated with a high incidence of venous thromboembolism (VTE), but VTE risk differs between families. Beta-antithrombin is reported to be the most active isoform of antithrombin in vivo. Whether β-antithrombin activity and subtypes in antithrombin deficiency have impact on VTE risk has not been investigated outside the proband setting.We performed a retrospective family cohort study to investigate whether subtypes of antithrombin deficiency or β-antithrombin levels are associated with the risk of first or recurrent VTE.Eighty-one subjects from 21 families were included, of which 52 were antithrombin deficient. Βeta-antithrombin levels were decreased in most type I and type IIPE subjects, but normal levels were found in all subtypes of antithrombin deficiency.The annual incidence of VTE in antithrombin-deficient family members was 1.24%, 95%CI: 0.72–1.99%, in low β-antithrombin 1.36% (95%CI: 0.76–2.25%) and in normal β-antithrombin 0.79% (95%CI: 0.10–2.77). The annual incidence of recurrence in family members was 3.1% (95%CI: 0.9–7.1%). Duration of anticoagulation had an impact on recurrence risk: In family members annual recurrence with fixed duration was 10% (95%CI: 2.1–29.2%), with indefinite duration 1.5% (95%CI: 0.2–5.4%), p < 0.05. Beta-antithrombin levels were not associated with the risk for first or recurrent VTE in antithrombin deficient subjects. ConclusionsIn this high-risk antithrombin-deficient population, both subjects with low and normal plasma β-antithrombin activity had high risks of first and recurrent VTE. This puts the importance of β-antithrombin into question. Long-term anticoagulation is warranted in antithrombin-deficient VTE patients.

Application of an antithrombotic prophylaxis protocol in patients with multiple myeloma treated with Lenalidomide-Dexamethasone in our center. Thrombosis incidence

Introduction: The annual incidence of venous thromboembolism (VTE) is particularly high in patients with Multiple Myeloma (MM) treated with lenalidomide (LEN) and low doses of dexamethasone (DEX) (12%). Thrombotic risk factors (TRF) include age, high dose of DEX, cardiovascular risk factors (CVRF), use of EPO, immobilization and history of previous thrombotic events. In 2015, we analyzed 53 patients with MM treated with LEN-DEX and the influence of the associated risk factors. The rate of VTE was 13%, with a median onset of the thrombotic event of 4 months after the start of treatment. At that time we applied the recommendations of the International Working Group on Myeloma (IMWG) which consisted of prophylaxis with aspirin (ASA) for patients with ≤ 1 TRF and low molecular weight heparin (LMWH) or warfarin for those with> 1 TRF. As a result, we changed to a more intensive protocol of initial prophylaxis with LMWH a minimum of 4 months from the beginning, re-evaluation and according to the presence or absence of TRF, it was considered a change to ASA or maintenance of LMWH/antivitamins K (AVK).

Pharmacoeconomic study on rivaroxaban vs conventional venous thromboembolism prophylaxis following elective total hip or knee replacement surgery in Serbia: Single centre study

Introduction: Venous thromboembolism (VTE) is often clinically unobservable, showing the first symptoms only after the patient has been discharged from the hospital, owing to which symptoms may not be recognized in time and serious complications may arise after hip or knee replacement surgery. The outcome for a patient who has had a symptomatic episode of VTE may be bad due to a risk of recurrent VTE and the development of postthrombotic syndrome. The annual incidence of VTE is around 80-180 cases in 100.000, based on population studies. Worldwide, orthopaedists and anaesthesiologists mostly refer to ACCP guidelines from America, or guidance from NICE and Scottish Medicines Consortium in Europe. All the guidelines include rivaroxaban as a therapy of choice for the prevention of VTE following elective arthroplasty as the therapy with rivaroxaban has shown both effectiveness and cost-savings. Many countries have included rivaroxaban as a medicine of first choice in the therapy for the above described indication. Aim: The objective of this analysis is to demonstrate cost-effectiveness of the new therapy with rivaroxaban versus conventional in VTE prophylaxis for patients undergoing elective hip or knee replacement surgery. Methodology: This paper is a part of the academic IV phase pharmacoecconomic study using extrapolation datas (RECORD 1, RECORD 2, RECORD 3) done in Serbia as single center expirience of Institute for Orthopaedic Surgery 'Banjica', in 2015. Information on drug prices, basic pharmacological characteristics, and on services of health institutions, are taken from the List of Drugs and Pricelist of the Republic Health Insurance Fund, as well as the Thromboembolism Prophylaxis Guide of the Institute 'Banjica'. The Incremental cost-effectiveness ratio (ICER) and Cost-utility analysis (CUA) have also been used in relation to the Quality-adjusted life-year (QALY). Furthermore, in the calculation the proposed price of a defined daily dose (DDD) of rivaroxaban was 3.36 EUR. Results: Total savings obtained annually through the application of rivaroxaban instead of usual prophylaxis (6,900 surgeries) could lead to cost savings of EUR 511,248.35 with the ICER value shows that therapy with rivaroxaban is dominant. Conclusions: The introduction of rivaroxaban in the therapy will enable patients to receive more conformable oral therapy with the same amount of health insurance resources spent, while on the other hand significant savings will be obtained owing to a decrease in the number of inpatient days in hospitals, as well as owing to the fact that regular control examinations of INR and number of blood platelets will not be necessary, which otherwise may amount to EUR 511,248.35annually for the said indication. The authors suggest support for the IV phase of the investigator initiated academic clinical trials with the intention of gaining security and personal experiences of doctors who use rivaroxaban in clinical practice.

Reasons for the persistent incidence of venous thromboembolism.

Reasons for trends in venous thromboembolism (VTE) incidence are uncertain. It was our objective to determine VTE incidence trends and risk factor prevalence, and estimate population-attributable risk (PAR) trends for each risk factor. In a population-based cohort study of all residents of Olmsted County, Minnesota from 1981-2010, annual incidence rates were calculated using incident VTE cases as the numerator and age- and sex-specific Olmsted County population estimates as the denominator. Poisson regression models were used to assess the relationship of crude incidence rates to year of diagnosis, age at diagnosis, and sex. Trends in annual prevalence of major VTE risk factors were estimated using linear regression. Poisson regression with time-dependent risk factors (person-years approach) was used to model the entire population of Olmsted County and derive the PAR. The age- and sex-adjusted annual VTE incidence, 1981-2010, did not change significantly. Over the time period, 1988-2010, the prevalence of obesity, surgery, active cancer and leg paresis increased. Patient age, hospitalisation, surgery, cancer, trauma, leg paresis and nursing home confinement jointly accounted for 79 % of incident VTE; obesity accounted for 33 % of incident idiopathic VTE. The increasing prevalence of obesity, cancer and surgery accounted in part for the persistent VTE incidence. The PAR of active cancer and surgery, 1981-2010, significantly increased. In conclusion, almost 80 % of incident VTE events are attributable to known major VTE risk factors and one-third of incident idiopathic VTE events are attributable to obesity. Increasing surgery PAR suggests that concurrent efforts to prevent VTE may have been insufficient.

Incidence and Risk Factors of Venous Thromboembolism in Patients with Multiple Myeloma Receiving Immunomodulatory Agents

Multiple myeloma (MM) is an incurable plasma cell disorder representing 10% of all hematologic malignancies. Cancer is a known risk factor for venous thromboembolism (VTE). Patients with MM are at a particularly high risk of developing VTE owing to patient characteristics (e.g. previous history of VTE), disease characteristics, and treatment characteristics including use of the immunomodulatory agents (IMIDs). Unfortunately, standard criteria to identify the patients most at risk for developing VTE in MM while receiving IMIDs are unknown. We sought to assess the incidence of VTE and its associated risk factors in MM patients receiving IMID therapy.A retrospective cohort study including 1680 consecutive patients with multiple myeloma treated at our centre between January 01, 1995 and January 26, 2016 was conducted. The annual incidence of VTE on immunomodulatory agents including thalidomide, lenalidomide, and pomalidomide was derived. Univariate incidence ratio analyses of VTE for different risk factors was performed including: previous history of VTE, concomitant use of dexamethasone, and ≥/< 6 months after IMID initiation.A total of 309 MM patients treated with an immunomodulatory agent were identified. Nineteen patients were excluded (incomplete data, lost to follow). Of the remaining 290 patients, the mean age was 67.9 and 42.4% were female. Twenty-seven VTE events were recorded. The overall risk ratio was 6.1 for the development of VTE. Patients with a personal history of VTE had an increased risk of suffering a VTE while on IMID therapy (IRR 5.4; CI, 1.9-13.6). The time from the initiation of the IMID therapy (less than 6 months) also increased the risk of developing a VTE (IRR 51.7; CI,19.4-160.1). The concomitant use of dexamethasone was not associated with a statistically significant increased risk (IRR 1.7; CI, 0.3-69.5). Incidence risk ratios for these risk factors are depicted in Table 1.Our results suggest that a personal history of VTE and the time from the initiation of the IMID (less than 6 months) are associated with an increased risk of VTE in MM patients receiving IMID therapy. This may be helpful in determining which multiple myeloma patients treated with an IMID agent warrant more aggressive thromboprophylaxis. Further prospective studies are needed to determine the optimal agent, intensity, and duration of thromboprophylaxis in patients with MM on IMID therapy. [Display omitted] DisclosuresMcCurdy:Celgene: Honoraria.

Incidence of venous thromboembolism in France: a retrospective analysis of a national insurance claims database.

BackgroundData estimating the annual incidence of venous thromboembolism (VTE) in France, taking into account both hospital and community settings, are very lacking.This study aimed to estimate the annual incidence of VTE (pulmonary embolism (PE) and deep vein thrombosis (DVT)) in France in 2011 in “real world” population.MethodsThis was a longitudinal insurance claims study of the incidence of VTE in France over 2 years (2010 and 2011). The data analysis was performed using the EGB (Echantillon Généraliste des Bénéficiaires) database, a randomly selected sample of the French national insurance database (CNAMTS) which covers 77 % of the population. All adult patients experiencing a VTE event during the study period were analysed. Recurrence rate of VTE and all-cause mortality rate were also estimated over a 12-month follow-up period.ResultsThe estimated annual incidence of VTE in France was 184.0 per 100 000 subjects, corresponding to a total of 119 670 events countrywide. The estimated incidence of DVT and PE were respectively 119.8 and 64.2 per 100 000 subjects. Annual recurrence of VTE was reported in 5.5 % (n = 99) patients, with a significantly higher recurrence rate in patients with PE than those with DVT (p = 0.02). Overall, 6.2 % (n = 112) of patients had died over the 12-month follow-up (respectively 10.2 and 7.7 % of patients with DVT and PE).DiscussionTo our knowledge, this analysis is the first to estimate the annual incidence of VTE in France using exhaustive data from the EGB database. This has allowed the incidence of DVT in the community to be documented, which to date has not been characterised. Previous studies in France have been limited to the hospital setting and have yielded incidence rates comparable to ours.ConclusionsThis analysis is the first to estimate the annual incidence of VTE in France using exhaustive data from the EGB database. This study showed that the incidence and the burden of the disease remains elevated.

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data

AbstractPatients with breast cancer are at increased risk of venous thromboembolism (VTE), particularly in the peridiagnosis period. However, no previous epidemiologic studies have investigated the relative impact of breast cancer treatments in a time-dependent manner. We aimed to determine the impact of breast cancer stage, biology, and treatment on the absolute and relative risks of VTE by using several recently linked data sources from England. Our cohort comprised 13 202 patients with breast cancer from the Clinical Practice Research Datalink (linked to Hospital Episode Statistics and Cancer Registry data) diagnosed between 1997 and 2006 with follow-up continuing to the end of 2010. Cox regression analysis was performed to determine which demographic, treatment-related, and biological factors independently affected VTE risk. Women had an annual VTE incidence of 6% while receiving chemotherapy which was 10.8-fold higher (95% confidence interval [CI], 8.2-14.4; absolute rate [AR], 59.6 per 1000 person-years) than that in women who did not receive chemotherapy. After surgery, the risk was significantly increased in the first month (hazard ratio [HR], 2.2; 95% CI, 1.4-3.4; AR, 23.5; reference group, no surgery), but the risk was not increased after the first month. Risk of VTE was noticeably higher in the 3 months after initiation of tamoxifen compared with the risk before therapy (HR, 5.5; 95% CI, 2.3-12.7; AR, 24.1); however, initiating therapy with aromatase inhibitors was not associated with VTE (HR, 0.8; 95% CI, 0.5-1.4; AR, 28.3). In conclusion, women receiving chemotherapy for breast cancer have a clinically important risk of VTE, whereas an increased risk of VTE immediately after endocrine therapy is restricted to tamoxifen.