Diagnosis Of Venous Thromboembolic Disease Research Articles

Gadofosveset-Trinatrium-Enhanced MR Angiography and MR Venography in the Diagnosis of Venous Thromboembolic Disease: A Single-Center Cohort Study.

The aim of this single-center combined prospective/retrospective cohort study was to analyze Gadolinium (Gd)-enhanced MRA (magnetic resonance angiography) and MRV (MR venography) for the diagnosis of pulmonary artery embolism and deep venous thrombosis. The gold standard methods result in major exposure to radiation and a high amount of nephrotoxic iodinated contrast media. This is the first larger contrast-enhanced MR imaging study of acute and chronic venous thromboembolic disease of various stages. We prospectively examined 88 patients presenting clinical signs of deep vein thrombosis and/or pulmonary artery embolism. A single-session, one-stop shop Gd-enhanced MRA/MRV at 1.5 Tesla, using gradient echo sequences with very short repetition and echo times as well as low flip angles with subtraction and three-dimensional reconstruction, was performed. A diagnosis was made with the consensus of two experienced radiologists. We observed excellent MRA image quality in 87% and even higher diagnostic image quality of MRV in 90% of our examinations. Pulmonary artery embolism occurred with deep vein thrombosis in 22%. Gd-enhanced MRA/MRV provided excellent image quality for the diagnosis of venous thromboembolic disease in the majority of cases. It may be particularly useful to plan and follow-up filter implantation and retrieval in the inferior caval vein.

Características clínicas y forma de presentación en pacientes con enfermedad tromboembólica venosa y dímero-D negativo o débilmente positivo

IntroductionD-dimer has a high negative predictive value for the diagnosis of venous thromboembolic disease (VTE). However, VTE has been reported in the presence of normal D-dimer values. MethodsThis is a prospective observational study in patients with VTE from Hospital Gregorio Marañón between 2001 and 2022, comparing the characteristics of clinical presentation based on D-dimer levels (<500 ng/mL vs. ≥500 ng/mL). ResultsA total of 2582 patients were found, 333 patients (12.9%) presented negative or weakly positive D-dimer levels. They were significantly younger (57.9 vs. 65.3 years), with a lower prevalence of comorbidities (ischemic heart disease, dementia, and chronic kidney disease), and a greater family history of VTE (8.4% vs. 5.2%) and thrombophilia (11.7% vs. 7.8%). They presented significantly less dyspnea (57.6% vs. 75.4%), syncope (3% vs. 13.5%), less thrombotic load, elevated NT-pro-BNP (22.0% vs. 48.2%), and right ventricle dilatation (8.1% vs. 30.0%). ConclusionPatients with VTE and low D-dimer levels at diagnosis were younger, with milder clinical presentation and lower thrombotic load; but they presented a higher prevalence of thrombophilia and a family history of VTE.

Epidemiological, Clinical and Therapeutic Patterns of Venous Thromboembolic Disease in Cancer Patients Followed up in Two Reference Hospitals in Cameroon

Background: Cancer increases the incidence of venous thromboembolic disease (VTE), which represents a significant cause of morbidity, mortality, and economic burden in cancer patients. Objective: We aimed to describe the epidemiologic, clinical, and therapeutic pattern of VTE in cancer patients followed-up in two reference hospitals in Cameroon over the past ten years. Methods: This was a cross-sectional retrospective study conducted in the oncology department of the General hospitals of Yaoundé and Douala. We included the medical records of all patients aged 18 years and above who had active cancer with a confirmed diagnosis of VTE from 2010 to 2021. Results: We analysed 408 patients’ medical records. The prevalence of VTE was 7.6%. All those having VTE had solid tumours. There were twenty (64.5%) cases of deep venous thrombosis, five (16.1%) cases of pulmonary embolism, and three (9.7%) cases of both. Poor performance status and chemotherapy were independently associated with the development of VTE. Most of the patients were treated with compression stockings and low molecular weight heparin. Conclusion: VTE prevalence is high among cancer patients in Cameroon. It is most frequent in solid tumours originating from the genitourinary system, the lung, the pancreas, and the brain.

Acute pulmonary embolism in times of SARS-CoV-2: Diagnostic and therapeutic management

There is a clear association between novel coronavirus 2 infection and the diagnosis of venous thromboembolic disease, as a cosequence of the development of a systemic inflammatory response syndrome due to the activation of the coagulation cascade. It occurs in 90% of patients with severe forms of the infection, evidencing the presence of pulmonary endovascular micro and macro thrombosis. This suggests a possible clinical benefit of thromboprophylaxis according to the patient’s clinical risk. The suspicion of venous thromboembolic disease in the context of this pandemic represents a diagnostic challenge due to the co-existence of similarities between both conditions in several different aspects. It should be noted that the diagnosis of acute pulmonary embolism does not exclude the possibility of simultaneous viral infection. The evaluation of patients with suspected acute pulmonary embolism in the context of the pandemic should be optimized in order to implement a rapid diagnosis and treatment to reduce the associated morbidity and mortality. This will help reducing infectious risk for health-care professionals and other patients.

VENOUS THROMBOEMBOLIC DISEASE IN PATIENTS WITH CHRONIC LUNG DISEASE

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Venous thromboembolic disease (VTE) is increasing in incidence. Anecdotal evidence suggests a correlation between the presence of chronic lung diseases (CLD) and the incidence of VTE. We aim to describe the incidence of VTE related hospitalizations and outcomes in patients with CLD. METHODS: A descriptive, retrospective study was conducted on the National Inpatient Sample (NIS) database for the years 2005-2014. Admissions with the diagnosis of VTE were selected based on appropriate International Classification of Diseases-Ninth Revisionthe Modification diagnoses codes (ICD-9). Patients were considered to have chronic lung disease (CLD) if appropriate ICD-9 codes were present for Tuberculosis (TB), Malignancy affecting lungs, Sarcoidosis, Cystic Fibrosis (CF), Chronic obstructive pulmonary disease (COPD), Asthma, Interstitial lung disease (ILD) or Pulmonary circulation disorders. All analysis was conducted in patients with VTE as the principal or secondary diagnosis only. RESULTS: From 2005 to 2014, there was an increased incidence of VTE related admissions [8.53 per thousand admissions (pta) to 11.70 pta, annual percentage change (APC) 3.6]. Mean age of patients with VTE was 63.49 + 17.71 years, 53.85% were female and 73.74% were white. A significant proportion of patients with VTE had complications: acute respiratory failure (6.31%), mechanical ventilation (2.58%), thrombolysis (2.69%), vena-cava filter (13.41%) and 3.04% died during hospitalization. Among patients with CLD, the incidence of VTE has increased from 2005 to 2014 [12.18 pta to 16.84 pta, APC 3.3]. In patients with CLD, the adjusted odds of having VTE were higher in patients older than 40 years [Odds ratio (OR) 2.46, Confidence Interval (CI) (2.38-2.54), p<0.001), and lower in patients with weight loss (OR 0.97, CI (0.95-0.99), p<0.001), smokers (OR 0.92, CI (0.91-0.94), p<0.001) and women (OR 0.94, CI (0.93-0.95), p<0.001). In patients with COPD, the incidence of VTE was 1.43%. Compared to patients with COPD, patients with ILD (2.01%), sarcoidosis (1.91%), malignancy (3.17%), TB (1.46%) and pulmonary circulation disorder (2.68%) had higher incidence of VTE while asthma (1.16%) and CF (0.23%) had a significantly lower incidence (p<0.001). In patients with VTE, there was a significant difference among the different chronic lung diseases, in the rates of acute respiratory failure, mechanical ventilation, inpatient mortality and length of stay (p<0.001). CONCLUSIONS: CLD patients have higher odds of VTE if they are above 40 years of age, men, African-Americans and obese. Pulmonary circulation disorders and malignancy, have a higher risk of VTE when compared to patients with other CLDs. CLINICAL IMPLICATIONS: a of VTE is increasing in the general population and the CLD patients.CLDs differ in their risk of VTE and subsequent outcomes. DISCLOSURES: No relevant relationships by Prakash Acharya, source=Web Response No relevant relationships by Momcilo Durdevic, source=Web Response No relevant relationships by Stephen Jesmajian, source=Web Response No relevant relationships by Ashutossh Naaraayan, source=Web Response No relevant relationships by Abhishek Nimkar, source=Web Response No relevant relationships by Seema Singh, source=Web Response

Characteristics and clinical significance of serum D-dimer level before and after delivery in women with advanced maternal age

Objective: To explore the characteristics of serum D-dimer level before and after delivery in women with advanced maternal age (VTE), and to assess the value of the characteristics for the diagnosis of venous thromboembolic disease. Methods: The objects were 785 puerperae with advanced maternal age (AMA) who experienced delivery in Women's Hospital, Zhejiang University School of Medicine during 1(st) Jan 2017 to 31(st) Dec 2017, and 327 puerperae with appropriate maternal age as controls were randomly selected from puerperae who gave birth in the same period. Their serum D-dimer levels before and after delivery were evaluated, and AMAs with high-level postnatal serum D-dimer were specially observed for the prognosis. Besides, puerperae complicated with VTE were retrieved from the medical database during 2014-2018, and their clinical characteristics and dynamic variation of serum D-dimer levels were analyzed. Result: The significant difference of D-dimer levels neither before nor after delivery was not observed between AMAs and controls (antenatal: 1.64(1.19, 2.29) mg/L vs 1.53(1.04, 2.23) mg/L, and postnatal: 2.70(1.71, 2.97) mg/L vs 2.63(1.17, 4.13) mg/L, P<0.05 for both; None of AMAs with high-level serum D-dimer after delivery were complicated with VTE, and most of their serum D-dimer levels decreasedsharply with in four postnatal days (the average decrease was 9.2(7.69,12.74) mg/L, and 96.2% of the sepuerperae's decrease was more than 50%). Eight puerperae complicated with VTE were found in the database from 2014 to 2018, among which five were AMAs. The eight puerperae all received a B ultrasound because of the discomfort of lower limbs or abnormal variation of serum D-dimer levels (a slow decrease or an increase trend), so that a diagnosis of VTE was established; besides, the diagnosis or symptoms all emerged in the 3(rd) to 5(th) day after caesarean. Conclusions: The factor of advanced maternal age has little influence on the serum D-dimer level before or after delivery among pregnant women. It is not a single detection for serum D-dimer level, but the intensive monitoring of clinical symptoms and dynamic change of serum D-dimer level, that helps early diagnosis of VTE.

Fiber-based early diagnosis of venous thromboembolic disease by label-free D-dimer detection

D-dimer is a useful diagnostic biomarker for deep vein thrombosis or pulmonary embolism, collectively referred to as venous thromboembolism (VTE). The ability to detect in real-time the amount of D-dimer with a fast and reliable method is a key step to anticipate the appearance of these diseases. Here, the results of a highly specific and sensitive biosensor for the detection of D-dimer based on lossy mode resonance in fiber optics are presented. The unique features of specialty fibers in light management integrated with microfluidics allow detecting D-dimer in human serum with a detection limit of 100 ng/mL, a value 5-fold below the clinical cutoff value. Comparison of the results achieved with mass-spectrometry-based proteomics, which allows for the identification of beta- and gamma-chains of fibrinogen, demonstrates the ability of our platform to specifically (>90%) recognize D-dimer. Therefore, this technology potentially represents a paradigm shift in the development of a simple, high-specificity and label-free biosensing platform, which can be applied to speed up diagnostic healthcare processes of venous thromboembolism toward an early diagnostic and personalized treatment system.

Validation of New D-Dimer Cutoff Values to Increase Its Diagnostic Utility as Biochemical Marker in Acute Venous Thromboembolic Disease

Background: Diagnosis of venous thromboembolic disease (deep venous thrombosis and pulmonary embolism) is often inaccurate because signs and symptoms are nonspecific. Numerous clinical management trials using D-dimer which is one of the coagulation markers have shown that it has a sufficient specificity to assist in the diagnosis of venous thromboembolic disease. Aim of the work:This study was done to validate the utility of D-dimer as a diagnostic biomarker for DVT using a higher cutoff values which may improve the test specificity. Material and method: In this retrospective chart review study, we reviewed the hospital records of all patients for whom D-dimer assay was done in King Abdul Aziz Specialist Hospital, Al Taif - Saudi Arabia from January 2011 to October 2013. The study involved 141 individuals; 25 who were proved to be normal were chosen to serve as control group (Group I), 61 patients who were positive for DVT by duplex scanning (Group II) and 55 patients who had symptoms of DVT but showed negative results on duplex ultrasound(group III). Results: The demographic data revealed statistically insignificant difference between all studied groups. No significant differences were detected between the studied groups, except for hemoglobin level which was significantly lower in patients of groups II and III than in control group. However, highly significant differences were detected between different studied groups as regards D-dimer. Analysis of the receiver operator characteristic (ROC) curve to establish the cutoff level of the studied marker in the diagnosis of DVT, verified that D-dimer value of 0.92 mg/L can accurately differentiate patients who were positive for DVT on duplex scanning from control group. Level of 2.81 mg/L for D-dimer was considered as a cutoff point that can differentiate patients who were duplex negative and free from thrombosis from those who eventually developed thrombosis. Conclusion: This study suggests the importance of the use of modified D-dimer cut-off values that can safely differentiate patients who are free from venous thromboembolic disease from others who are positive for the disease sparing patients the unnecessary risks of anticoagulation. In addition it can detect the patients who will eventually develop thrombosis regardless their primary duplex ultrasound scanning results, so, they could receive anticoagulation treatment.

Clinical consequences of an indeterminate CT pulmonary angiogram in cancer patients

Our aim was to evaluate clinical management and outcomes in cancer patients who had an indeterminate Computed Tomographic Pulmonary Angiogram (CTPA) for the assessment of pulmonary embolus. We reviewed 1000 CTPA studies and identified 251 limited (indeterminate) CTPA. We examined follow-up imaging and reviewed clinical management decisions and any positive diagnosis of venous thromboembolic disease (VTE) within the subsequent 90days.60 patients (23.9%) had a follow-up imaging study within five days. 8 had a positive study for VTE disease within 5days. 3 patients (1.2%) were placed on anticoagulation therapy based on the limited CT result.

Molecular Analysis Of Patients With Deep Venous Thrombosis

Background Deep venous thrombosis (DVT) refers to the formation of a thrombus within a deep vein that frequently occurs after surgical procedures, trauma, in the presence of cancer and immobilization conditions. DVT is a major health problem that causes high rate of morbidity and mortality in the general population. Hyper coagulation states such as antithrombin-III, protein-C and protein-S deficiencies, contribute to formation of DVT. Congenital and acquired gene mutations are other risk factors that stimulate formation of thrombus. Our aims in this study was to molecularly analyze the patients with DVT and assess the impact of common mutations of MTHFR (C677T) (A1298C), PAI-1, Prothrombin 20210 and FV Leiden mutation on occurrence of deep venous thrombosis. Methods This long-term study was conducted from June 2009 to July 2013 on 221 patients with deep venues thrombosis. Two hundred and twenty-one age and sex matched individuals were also chosen as control group. The diagnosis of venous thromboembolic disease was based on patient’s history, clinical findings and D-dimer test. Finally deep venous thrombosis was confirmed with Doppler ultrasonography. In addition, all participants were asked to complete a standardized questionnaire on acquired risk factors for venous thrombosis. After confirmation of DVT, both groups were assessed molecularly for five mutations including, MTHFR C677T, MTHFR A1298C, PAI-1 4G/5G, Prothrombin 20210 and FV Leiden. The relationship between these mutations and the risk of DVT was calculated using logistic regression and expressed as an OR with a 95% confidence interval (CI). Results The mean age of patients and control group were 38±0.8 and 3.7± 0.7 years. Our results revealed that the MTHFR C677T (OR 2.9, 95% 95% CI 1.1 to 7.5) and MTHFR A1298C in heterozygote manner (OR 4.3, 95% CI 1.4 to 13.7) were each associated with an increased risk of DVT. The OR associated with being a carrier of the PAI-1 4G/5G genotype was 2.9 (95% CI 1.14 to 7.5). There was a 4-fold increased risk of DVT associated with Prothrombin 20210 mutation in heterozygote manner (OR 4.3, 95% CI 1.4 to 13.7). For patients who were heterozygous for FV Leiden mutation OR DVT was 2.6 (95% CI 1.3 to 5.0). Conclusion Our findings suggest that genetic risk factors have a contributory role on occurrence of DVT. Disclosures: No relevant conflicts of interest to declare.

Faisabilité pratique de l’auto-injection des traitements anticoagulants : l’expérience du réseau GRANTED

Injectable anticoagulation therapy is indicated for several months following diagnosis of venous thromboembolic disease (VTE) in a context of active neoplasia. Certain studies have shown an improvement in patient compliance using self-injections. Allow patients to safely make their own injections of anticoagulants after checking their aptitude and motivation. At the prescribing physician's request, the GRANTED network provided patients and/or the resource person with specific education and training. The educational program was proposed to patients with an indication for a treatment for at least 3months. After becoming familiar with the injection material and its manipulation, the patient and/or resource person performed sham injections on test materials. Patients were then allowed to decide for themselves whether or not to participate in the self-injection protocol. The prescribing physician received a report from the training team. From November 2010to July 2012, 39patients participated in the educational program, generally in a context of vitamin K antagonist prescriptions. Sixteen of these patients had a neoplasia. The educational program corrected erroneous or imprecise points of information, particularly concerning syringe purging. The education program proved to be interesting for points other than those initially foreseen and allowed the team to rectify a certain number of erroneous messages unrecognized by the prescribing physicians. This result goes in line with the need for accompanying patients who have a prescription for self-injections and also emphasizes the need for careful follow-up.

Association between periodontal disease and venous thromboembolic disease.

In recent years, periodontal disease has been related to a large number of systemic disorders. The aim of this study was to find a relationship between periodontal disease and venous thromboembolic disease. A total of 197 patients were included in the study, 97 patients with a diagnosis of venous thromboembolic disease and 100 healthy controls, in order to establish an association between these two conditions. All patients were subjected to periodontal examination, with evaluation of the number of teeth, Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Community Periodontal Index of Treatment Needs, Clinical Attachment Level, Probing Pocket Depth, number of pockets >= 4 mm, and number of pockets >= 6 mm. A high prevalence of periodontal disease was detected in patients with thromboembolic disease (P < .001). Bleeding Index, Gingival Index, Simplified Oral Hygiene Index, Clinical Attachment Level, and Probing Pocket Depth were higher in venous thromboembolic disease patients than in the control group (P < .001). A high prevalence of periodontal disease was detected in venous thromboembolic patients. There exists an association between periodontal disease and venous thromboembolic disease.

P-090 Obstetric outcomes in patients with previous venous thromboembolic disease (VTD)

Objective: To ascertain the rate of adverse obstetric outcomes in patients with a previous episode of VTD: miscarriages, severe preeclampsia, Intrauterine Growth Restriction (IUGR) or abruptio placentae (AP). Material and methods: During the period between 2000 and 2012, a total of 136 pregnant women with a previous diagnosis of VTD were followed up. In all cases diagnosis was made by lower Doppler or/and CT scan or pulmonary scintigraphy. 93% of them had a single episode, 4% had two and 3% had four. 73.5% of them took place during gestation or the use of contraceptives (61% of them also had associated thrombophilia). 10.5% appeared to be related to an isolated thrombophilia (84.6% hereditary, 15.4% acquired). 13% of patients had transient thrombotic risk factors. 3% were considered idiopathic. All of them were treated with low-molecular-weight heparin (LMWH), and were recommended to use graduated compressive stockings. The mean gestational age at the time of initiation of treatment was 11.37 weeks gestation (w) ±9.42 weeks. It was maintained throughout pregnancy and up to six weeks postpartum. Results and conclusions: We found a rate of 8% of miscarriages (45% of them occurred in patients who had not yet started treatment with LMWH). We found a rate of 1.5% of severe preeclampsia. 5.8% of pregnancies developed IUGR (20% of them severe IUGR), and 2.2% presented AP, all of them at term and during labor.

Biomarkers for the diagnosis of deep vein thrombosis

Venous thromboembolic disease (VTE) remains a significant source of morbidity and mortality. As non-specific subjective complaints and a paucity of objective clinical examination findings complicate the diagnosis of both deep venous thrombosis (DVT) and pulmonary embolism, diagnostic modalities remain essential. Compression ultrasound remains the gold standard for DVT diagnosis. Reliable imaging is not always available making a serologic diagnosis, or biomarker, highly desirable. While D-dimer, a highly sensitive biomarker, is useful for excluding acute VTE, it lacks the specificity necessary for diagnostic confirmation. As such, ongoing research efforts target and support the utility of alternative plasma biomarkers to aid in the diagnosis of VTE including selectins, microparticles, IL-10 and other inflammatory markers. These molecular markers may also predict recurrence risk, guide length and modality of treatment, and predict which thrombi will resolve spontaneously or recanalize, thus potentially identifying patients who would benefit from more aggressive therapies than standard anticoagulation.

Timing and Perioperative Risk Factors for In-Hospital and Post-Discharge Venous Thromboembolism After Colorectal Cancer Resection

We postulated that the risk of venous thromboembolic disease (VTE) may persist after discharge and tested this hypothesis in patients undergoing colorectal resection for cancer. The American College of Surgeons National Surgery Quality Improvement Program database was queried for patients undergoing colorectal resections for cancer from 2005 to 2009. The outcome analyzed was a 30-day deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Multivariable forward stepwise regression was used to identify independent predictors of VTE. The database contained 21 943 colorectal cancer resections. The 30-day DVT rate was 1.4% (306 of 21 943), 29% (89 of 306) were diagnosed post-discharge. The 30-day PE rate was 0.8% (180 of 21 943), 33% (60 of 180) was diagnosed post-discharge, the combined DVT/PE rate was 2.0% (446 of 21 943). The median time to diagnosis of VTE was 9 days (interquartile range 4-16) after surgery. Post-discharge VTE rates in patients with length of stay (LOS) less than 1 week (0.6%) were similar to patients with LOS greater than 1 week (0.7%, Fisher exact P not significant). Independent risk factors for post-discharge VTE were preoperative steroid use for chronic condition (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.51-5.57, P = .001) and preoperative systemic inflammatory response syndrome (OR 2.26, 95% CI 1.24-4.10, P = .008). Diagnosis of almost one third of postoperative VTE in this patient population occurred after discharge. The duration of the prothrombotic stimulus of surgery is not well defined, and patients with malignancy are at high risk of VTE; thromboprophylaxis after discharge should be considered for these patients.

Comparison of five D-dimer reagents and application of an age adjusted cut-off for the diagnosis of venous thromboembolic disease in emergency department

Comparison of five D-dimer reagents and application of an age adjusted cut-off for the diagnosis of venous thromboembolic disease in emergency department

Plasma Serum Amyloid A Levels Are Increased In Venous Thrombosis Patients and Are Correlated with Blood Coagulability

AbstractAbstract 155Inflammation is well correlated with cardiovascular diseases, but its relationship to venous thromboembolic disease (VTE) is less well established. One well studied inflammatory marker, C-reactive protein (CRP), has been inconsistently linked to VTE and this association is controversial. First, we explored the relationship between serum amyloid A (SAA), an inflammatory biomarker, and VTE because SAA can induce tissue factor (TF) expression and release pro-inflammatory cytokines, activities that might imply a linkage between SAA elevation and thrombotic disease. Second, we probed the influence of SAA on blood coagulability. Plasma SAA levels were determined by ELISA for Scripps VTE registry subjects (113 VTE patients and 113 matched controls). Inclusion criteria for this study included age at thrombosis < 55 years, > 3 months since diagnosis of VTE, a life expectancy of > 3 years, no cancer, and no lipid lowering medications. VTE patients had significantly higher median levels of SAA than controls (3.70 vs. 2.12 μ g/ml, p<0.0001). Odds ratio (OR) calculation based on SAA values > 90th percentile of controls showed that elevated SAA was associated with VTE with an OR value of 6.9 (95% CI: 3.3–14). Since SAA is associated with other inflammation parameters, we measured two other acute-phase inflammatory proteins. SAA was correlated with CRP and fibrinogen (r=0.32, p<0.0001 and r=0.37, p<0.0001, respectively). To test if the association of elevated plasma SAA levels with VTE was primary or, alternatively, only secondary to the association of SAA with other acute-phase proteins (e.g., CRP or fibrinogen), we adjusted the OR value (SAA > 90th percentile of controls) for CRP and fibrinogen. However, even after this adjustment for these two inflammation biomarkers, the OR for association of SAA with VTE was not altered (adjusted OR=6.8, 95%CI: 3.1–15). Thus, elevated plasma SAA (> 90th percentile of controls) is a strikingly strong biomarker for VTE that appears to be independent of two other well studied inflammatory biomarkers. To assess the potential direct relationship between SAA in plasma and blood coagulation reactions, we obtained data using endogenous thrombin potential assays and other coagulation assays. Plasma SAA levels from individual donors were very well correlated with parameters of TF-induced thrombin generation in plasma, showing that endogenous plasma SAA levels were associated with plasma coagulability. When added to plasma, purified recombinant SAA dose-dependently enhanced TF-induced thrombin generation. This procoagulant activity of endogenously added SAA that was seen in TF-induced thrombin generation assays was not affected by corn trypsin inhibitor, a specific inhibitor of factor XIIa, implying that contact activation was not mediating this SAA procoagulant activity. However, the procoagulant activity of purified recombinant SAA added to plasma was not seen when factor XI deficient plasma was used for assays, suggesting that SAA exerts procoagulant effects in plasma that require factor XI, i.e., effects that involve factor XI activation and/or expression of factor XIa activity. Further studies are needed to clarify details for the procoagulant effects of SAA on coagulation pathways. In conclusion, these results show that elevated plasma levels of SAA are strongly linked to VTE in adults (< 55 yrs old) and imply that SAA itself is a potential enhancer of thrombin generation in plasma acting via factor XI and the intrinsic coagulation pathway. Disclosures:No relevant conflicts of interest to declare.

Venous thromboembolism in acutely ill hospitalized medical patients

Background Acute and chronic illness, immobility, and procedural and pharmacologic interventions may predispose patients in the Internal Medicine Wards to venous thromboembolic disease (VTE). The purpose of this study was to determine the incidence of VTE in these patients. Materials and Methods A retrospective chart review of cohort of consecutive patients admitted to Internal Medicine wards in Spain between January 1st 2005 and December 31st 2007 was performed. For each patient, demographic data, risk factors for VTE and the diagnosis of VTE during hospitalization was recorded. Results We analyzed 1,567,659 patients, excluding 28,226 patients who had DVT or PE before admission, and 196,555 who were discharged in the first 48 hours. We identify 12,458 new diagnosed VTE events among 1,344,959 patients (incidence 0.93%) hospitalized more than two days. Hospitalized-acquired VTE risk factors were feminine gender (odds ratio [OR] 1.31; CI95% 1.26-1.35), age > 70 (OR 1.08 CI95% 1.04-1.13), acute infectious disease (OR 1.27 CI95% 1.17-1.38), acute respiratory disease (OR 1.23 CI95% 1.17-1.28), dementia (OR 1.22 CI95% 1.14-1.31), neoplasic disease (OR 2.29, CI95% 2.19-2.49), and hemiplegia (OR 1.49, CI95% 1.31-1.69). Conclusions The number of patients with VTE in an Internal Medicine ward is higher than expected. Several independent risk factors for VTE were identified. Based on the large number of patients who developed a VTE during hospitalization, our data add strength to the argument that VTE prevention should be high on the list of priorities when health care policies are being formed.

Cáncer en pacientes con enfermedad tromboembólica venosa

To study the characteristics of patients with venous thromboembolic disease (VTD) and cancer in our area. Prospective observational study of all patients diagnosed by objective methods of VTD in the only hospital in a rural area from November 2002 to April 2005. Ninety-four patients were diagnosed of VTD. The median age was 71.9 years (range 35-94 years), and 52 (55.3%) were women. The median follow-up with anticoagulant therapy was 7.1 months (range 0-29 months). Seventeen patients (18.1%) had cancer. Eleven cases (64.7%) had an adenocarcinoma, and 7 (41.2%) had distant metastases. Two (2.5%) of 79 cases without prior cancer were diagnosed of cancer after the diagnosis of VTD. The frequency of adverse events (death, major hemorrhage and thromboembolic recurrence) was higher in patients with cancer (64.7 vs. 9.1%, p < 0.001). Almost one fifth of patients with VTD in our area had cancer, more frequently an adenocarcinoma. Cancer is infrequently diagnosed after the diagnosis of VTD. Cancer in VTD is associated to a poor prognosis, with a remarkable frequency of adverse events.

Radiologic diagnoses of patients who received imaging for venous thromboembolism despite negative D-dimer tests

Objective The literature supports a negative D-dimer (−DD) excluding venous thromboembolic disease (VTE) in low-risk patients. We determined the radiologic diagnoses in patients where imaging was ordered despite a −DD. Methods This is a retrospective chart review of patients with a −DD (Tinaquant; Roche Diagnostics, Mannheim, Germany) and a radiologic study within 48 hours, sought to determine radiologic diagnosis (primary outcome), treatment of VTE, and consensus diagnosis of acute VTE. Results Among 3462 DD tests, 1678 met the inclusion criteria. Of 1362 patients with DD values of 350 ng/mL or less, 166 (12.2%) had radiologic studies: 93.4% of the final radiologic diagnoses were negative for VTE, 3.6% were indeterminate, and 3.0% (1.0%-6.9%) were positive; 1.8% ultimately had a consensus diagnosis of acute VTE. In 316 patients with DD values between 351 and 500 ng/mL, 88 (27.8%) had radiologic studies: 95.5% were negative, 1.1% were indeterminate, and 3.4% (0.7%-9.6%) were positive. Conclusions Of patients who receive radiologic studies despite −DD tests, 3.0% have positive radiologic diagnoses for acute VTE; only 1.8% had acute VTE after the review of their hospital course.