Early Venous Thromboembolism Research Articles

Characteristics and Outcomes Among Patients With Early Venous Thromboembolic Events After Lung Transplant

BackgroundDespite several previous studies reporting a high frequency of venous thromboembolism (VTE) after lung transplant (LT), few actionable risk factors have been identified. There are limited data regarding the practice patterns of anticoagulation use among patients with LT. MethodsAll adult patients with single or bilateral LT between 2012 and 2016 were included (n = 324; mean age, 56.3 ± 13.3 years; male, 61.1%). Demographic, clinical, and laboratory variables before and after LT were recorded. Follow-up data included survival up to 3 years post-transplant. Development of VTE during the first 30 days after LT was the primary outcome variable. ResultsThe overall incidence of VTE during the first 30 days after LT was 29.9% (n = 97), among which the majority were upper extremity thromboses. Female sex, personal history of VTE, hospitalization at the time of transplant, and use of 3 or more central venous catheters during index hospitalization were independently associated with VTE. The use of anticoagulants was independently associated with a reduced risk of VTE. Despite increased morbidity, the development of VTE was not associated with worse post-transplant survival. ConclusionsA significant proportion of patients develop early VTE after LT. Limiting the number of central catheters to < 3 during the post-transplant period, along with the early institution of thromboprophylaxis, may lower the risk of VTE.

Current prevalence of perioperative early venous thromboembolism and risk factors in Chinese adult patients with inguinal hernia (CHAT-1)

Venous thromboembolism (VTE) is an important postoperative complication. We investigated and analyzed the current inguinal hernia treatment methods and occurrence of early postoperative VTE in Chinese adults. This study involved data for patients with inguinal hernia hospitalized in 58 general hospitals in mainland China from January 1st, 2017 to December 31st, 2017. Data were retrospectively analyzed using a questionnaire. After data inputting and cleaning, we stratified and statistically analyzed patients' data using Caprini scores to create a high-, middle-, and low-risk group. A total of 14,322 patients with inguinal hernia were admitted to the 58 participating hospitals. After data collation and cleaning, 13,886 patients (97.0%) met our inclusion and exclusion criteria. The percentages of laparoscopic surgery and open surgery were 51.2% and 48.8%, respectively. 16 VTEs occurred during the hospitalization, accounting for 0.1% of all adverse events (95% confidence interval (CI) 0.11–0.13). The incidence of VTE was 0.2% (95% CI 0.18–0.2) in the high-risk group and 0.02% (95% CI 0.01–0.03) in the middle-risk group, based on Caprini scoring, with a significant difference (p < 0.0001). No VTE occurred in the low-risk group. Only 3,250 (23.4%) patients underwent Caprini risk assessment regarding treatment, with 13.2% receiving any prevention and only 1.2% receiving appropriate prevention. The treatment of inguinal hernia in Chinese adults has progressed somewhat; however, the evaluation and prevention of perioperative VTE was seriously neglected, in our study, and the incidence of postoperative VTE was underestimated postoperatively. Risk factors continue to be inadequately considered.

Early Chemoprophylaxis in Severely Injured Trauma Patients Reduces Risk of Venous Thromboembolism.

Venous thromboembolism (VTE) remains a serious complication for trauma patients. While early VTE prophylaxis has gained traction, the timing of prophylaxis remains uncertain. We hypothesized that VTE prophylaxis within 24 hours of admission would have lower VTE rates and similar rates of adverse events in seriously injured patients. Trauma patients were included from 32 American College of Surgeons verified Level 1 and 2 trauma centers over a 10-year period. Patients with injury severity score (ISS) <15, death or discharge within 48 hours of arrival, or who received no prophylaxis were excluded. 14 096 patients received VTE prophylaxis with an ISS of ≥15. Patients given prophylaxis at <24 hours had fewer VTE events and trended toward fewer serious in-hospital complications. Mortality and return to the operating room were similar across groups. Hospital and intensive care unit length of stay in the <24 hours prophylaxis group was significantly shorter when VTE prophylaxis was initiated earlier. In severely injured trauma patients with ISS >15, early VTE prophylaxis within 24 hours significantly reduced the risk of VTE as compared with delayed prophylaxis. Early chemoprophylaxis was found to be efficacious in reducing the incidence of VTE; however, the safety of this practice should be evaluated by future prospective studies.

Chemoprophylaxis and Venous Thromboembolism in Traumatic Brain Injury at Different Trauma Centers

Patients with severe traumatic brain injury (TBI) are at an increased risk of venous thromboembolism (VTE). Because of concerns of worsening intracranial hemorrhage, clinicians are hesitant to start VTE chemoprophylaxis in this population. We hypothesized that ACS Level I trauma centers would be more aggressive with VTE chemoprophylaxis in adults with severe TBI than Level II centers. We also predicted that Level I centers would have a lower risk of VTE. We queried the Trauma Quality Improvement Program (2010-2016) database for patients with Abbreviated Injury Scale scores of 4 and 5 of the head and compared them based on treating the hospital trauma level. Of 204,895 patients with severe TBI, 143,818 (70.2%) were treated at Level I centers and 61,077 (29.8%) at Level II centers. The Level I cohort had a higher rate of VTE chemoprophylaxis use (43.2% vs 23.3%, P < 0.001) and a shorter median time to chemoprophylaxis (61.9 vs 85.9 hours, P < 0.001). Although Level I trauma centers started VTE chemoprophylaxis more often and earlier than Level II centers, there was no difference in the risk of VTE (P = 0.414) after controlling for covariates. Future prospective studies are warranted to evaluate the timing, safety, and efficacy of early VTE chemoprophylaxis in severe TBI patients.

Prevalence of Venous Thromboembolism in Trauma Patients in a Private Tertiary Care Hospital

OBJECTIVES: To study the prevalence of venous thromboembolism (VTE) in trauma patients receiving inpatient care at Bangkok Hospital Headquarters (BHQ). MATERIAL AND METHODS: A retrospective observational study in adult trauma patients (age ≥ 15 years) admitted at BHQ from 2016 to 2018. The collected data were diagnosis of VTE, gender, age, ethnicity, VTE risk score, Injury Severity Score (ISS), the onset of VTE, and patient care modalities including operative or non-operative management, need for intensive care and need for ventilator support. RESULT: A total of 2,548 trauma patients were admitted at BHQ from January 1, 2016 to December 31, 2018. Thirty-one patients developed VTE (1.22%), 29 cases had deep vein thrombosis (DVT) and 2 cases had DVT with pulmonary embolism (PE). There were twenty-one male patients and ten female patients in the VTE group. Fifteen patients in the VTE group were older than 65 years (48%). The prevalence of VTE was 0.54% in Thai patients, and 2.43% in non-Thai patients. Twenty-nine patients in the VTE group had high VTE risk. Four patients had diagnosis of VTE prior to admission at BHQ and 13 cases had been diagnosed within 48 hours of admission. The patients with higher severity of injury (higher ISS) had higher risk for VTE (p < 0.001). Twenty-four cases in the VTE group needed surgical management. Seventeen cases required intensive care and 7 cases needed ventilator support, not related to the presence of PE. Six patients developed VTE despite prevention. CONCLUSION: The prevalence of VTE in adult trauma patients in BHQ is 1.22%. A significant association between VTE and the severity of injury suggests that we should pay attention to this specific groups of patients for early VTE prophylaxis and detection.

57 Risk of Venous Thromboembolism in Acute Necrotizing Pancreatitis: A Population-Based National Study

INTRODUCTION: Studies on the incidence of venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism (PE), in patients with acute pancreatitis (AP) with or without necrosis are scarce. We conducted a population-based national study to evaluate the incidence of VTE and PE in patients with AP using a large database. METHODS: Data were extracted from a large database which incorporates 26 major integrated healthcare systems and over 300 hospitals in the United States (Explorys, Cleveland, OH). Using Systematized Nomenclature of Medicine (SNOMED) codes we identified patients with a diagnosis of acute pancreatitis with and without necrosis in the year 2018. The primary outcome was the incidence of index (first-ever) VTE at 7-days after diagnosis of AP. Patients with a prior history of VTE were excluded. Secondary outcomes included rates of sepsis, mechanical ventilation, intensive care unit admission, acute kidney injury, need for dialysis, and all-cause mortality. Univariate analysis was performed; P value &lt; 0.05 was considered statistically significant. RESULTS: A total of 10,840 cases of acute necrotizing pancreatitis (ANP) and 65,960 cases of AP without necrosis were identified. Cohort demographics and outcomes are shown in Table 1. At 7 days after onset of ANP, VTE occurred at a rate of 18.5%, compared with 5.9% in AP without necrosis (OR 2.75, 95% CI 2.64–2.87, P &lt; 0.01), while PE occurred at a rate of 2.3% in ANP vs. 0.4% in AP without necrosis (OR 6.2, 95% CI 5.20–7.41, P &lt; 0.01) (Figure 1). In the setting of ANP, VTE was associated with a significantly higher all-cause mortality (follow-up 121–485 days) (OR 1.54, 95% CI 1.36–1.73, P &lt; 0.01). In ANP cohort, univariate analysis demonstrated significantly higher associations of VTE with baseline smoking, alcohol consumption, and elevated BMI. Secondary outcomes including sepsis, intensive care unit admission, mechanical ventilation, acute kidney injury, and the need for dialysis, were all significantly associated with the development of VTE in ANP (Table 1). CONCLUSION: Patients with ANP have a near 3-fold risk of VTE, and a 6-fold risk of PE, compared to those with AP without necrosis. The development of VTE in the setting of ANP is associated with higher all-cause mortality. This study was unable to assess whether early pharmacologic VTE prophylaxis would improve outcomes. A large prospective study would aid in investigating the effect of this intervention.

Early Venous Thromboembolism Prophylaxis after Spinal Surgery Does Not Increase Risk of Bleeding Complications: A Single-Study Experience

Early Venous Thromboembolism Prophylaxis after Spinal Surgery Does Not Increase Risk of Bleeding Complications: A Single-Study Experience

Early Venous Thromboembolism Prophylaxis for Isolated High-Grade Blunt Splenic Injury

BackgroundNonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury. MethodsWe utilized the American College of Surgeons Trauma Quality Improvement Program database (2013-2014) to identify adult patients who underwent NOM for isolated high-grade blunt splenic injuries (grades 3-5). The incidence of NOM failure after the initiation of VTE prophylaxis was compared between two groups: VTE prophylaxis <48 h after admission (early prophylaxis group), and ≥48 h (late prophylaxis group). ResultsA total of 816 patients met the inclusion criteria. Of those, VTE prophylaxis was not administered in 525 patients (64.3%), whereas VTE prophylaxis was given <48 h and ≥48 h after admission in 144 and 147 patients, respectively. There was no significant difference in the NOM failure rate after the initiation of VTE prophylaxis between the early and late prophylaxis groups (3.5% versus 3.4%, P = 1.00). In the multiple logistic regression analysis, early initiation of VTE prophylaxis was not significantly associated with NOM failure (OR: 1.32, 95% CI 0.35-4.93, P = 0.68). ConclusionsThe results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.

Early versus late venous thromboembolism: A secondary analysis of data from the PROPPR trial

BackgroundFactors predicting timing of post-traumatic venous thromboembolism (VTE) remain incompletely understood. Because the balance between hemorrhage and thrombosis is dynamic during a patient’s hospital course, early and late VTE may be physiologically discrete processes. This secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial aims to explore whether certain risk factors are associated with early versus late VTE. MethodsThe PROPPR trial investigated post-traumatic resuscitation with platelets, plasma, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. Multinomial regression based on a threshold determined by cubic spline analysis tested the association of clinical variables with early or late VTE, a composite of deep vein thrombosis and pulmonary embolus, adjusting for predetermined confounders. ResultsOf the 87 patients (13%) with VTE, pulmonary embolus was predominant in the first 72 hours. A statistically determined threshold at 12 days corresponded to change in odds of early versus late events. Variables associated with early VTE included plasma transfusion (risk ratio [RR] 1.14; 95% confidence interval, 1.00, 1.30; P = .05), sepsis (RR 0.05; 95% confidence interval, 1.40, 6.64; P = .01), pelvic or femur fracture (RR 2.62; 95% confidence interval, 1.00, 6.90; P = .05). Late VTE was associated with dialysis (RR 7.37; 95% confidence interval, 1.59, 34.14; P = .01), older age (RR 1.02; 95% confidence interval 1.00, 1.04; P = .05), and delayed resuscitation approaching ratios of 1:1:1 among patients randomized to 1:1:2 therapy (RR 2.06; 95% confidence interval, 0.28, 3.83; P = .02). Cyroprecipitate increased risk of early (RR 1.04, 95% confidence interval, 1.00,1.08; P < .03) and late VTE (1.05; 95% confidence interval, 1.01, 1.09; P = .01). Prolonged lagtime (coeffcient 0.06, 95% confidence interval, 0.02, 0.10; P < .01) and time-to-peak thrombin generation (coeffcient 0.04, 95% confidence interval, 0.02, 0.07; P < .01) were associated with increased risk of early VTE. ConclusionEarly and late VTE may differ in their risk factors. Defining temporal trends in VTE may allow for a more individualized approach to thromboprophylaxis.

Podoplanin Expression and IDH-Wildtype Status Predict Venous Thromboembolism in Patients with High-Grade Gliomas in the Early Postoperative Period

Venous thromboembolism (VTE) often is encountered in patients with high-grade gliomas. The underlying mechanisms are unclear, as is the optimal prophylactic protocol. The purpose of the present study was to identify risk factors of VTE and examine the validity of early VTE detection in high-grade gliomas. We reviewed the medical records of 165 patients with newly diagnosed high-grade glioma treated at Niigata University Hospital during the years 2009 to 2016. If the serum D-dimer levels increased to 5.0 μg/mL or more, computed tomography was performed to detect VTE. Furthermore, immunohistochemistry with antibodies against podoplanin was performed on available 101 tumor tissues. Of the 165 patients, 44 (26.7%) developed VTE. Of the 44 patients, 34 (79.5%) developed VTE within 7 days after surgery. No fatal VTE occurred and major complications secondary to anticoagulation occurred in only 2 (1.2%) patients. On multivariate analysis, lower Karnofsky Performance Scale status, podoplanin expression, and isocitrate dehydrogenase-wildtype status were independently associated with the risk of VTE (P < 0.05). We found that most VTEs occurred early in the postoperative period and commonly in patients with lower Karnofsky Performance Scale status and isocitrate dehydrogenase-wildtype gliomas, which expressed podoplanin.

Early Postpartum Venous Thromboembolism: Risk Factors and Predictive Index.

The aim of our study was to quantify risk factors for venous thromboembolism (VTE) during the puerperal period. The case–control study was conducted in Women’s Hospital, Zhejiang University, China, from January 2006 to December 2016; cases of hospitalized VTE within 1 week after delivery were identified according to International Classification of Diseases, Ninth Revision, Clinical Modification codes. Control postpartum women without VTE were randomly selected, matched on birth day, age, delivery mode, and number of fetus with 4:1 ratio. Clinical risk factors for postpartum VTE and coagulation parameters were analyzed. We found independent variables that were significantly related to postpartum VTE (all P < .05) in a binary logistic regression analysis included preeclampsia/eclampsia (odds ratio [OR], 2.89; 95% confidence interval [CI], 1.56-5.37) and postpartum hemorrhage (OR, 4.6; 95% CI, 1.71-12.40). D-dimer was the only biomarker that statistically significant associated with postpartum VTE in 3 days after delivery (all P < .05). These findings showed preeclampsia/eclampsia and postpartum hemorrhage were important risk factors for early VTE during puerperal period. A higher level of D-dimer was more meaningful than other coagulation parameters to suspect early thrombotic disease after delivery.

Полиморфизм гена тканевого активатора плазминогена и риск рецидива венозного тромбоза у пациентов молодого возраста

Introduction. The most frequent clinical manifestations of venous thromboembolism (VTE) — deep vein thrombosis (DVT) and pulmonary embolism (PE) are often complicated by recurrent episodes that lead to an increased risk of severe post-thrombophlebitic syndrome and/or life-threatening PE. The role of hereditary factors in the development of recurrent VTE in young people is still unclear. Aim: identification of genetic risk factors for recurrent VTE in young patients. Materials and methods. We examined 250 patients (117 men and 133 women, mean age — 37.4 years) with early VTE debut (aged up to 45 years inclusive). In 105 (42%) of them, a recurring course of thrombosis was observed. In all patients a molecular genetic study of DNA polymorphism of 9 genes involved in the regulation of hemostasis plasma activity was carried out: α- and β-subunits of factor (F) I (Thr312Ala and –455 G/A, respectively), FII (20210 G/A), FV (1691 G/A), FXII (46 C/T), FXIII A sub- unit (Val34Leu), plasminogen activator inhibitor type I (PAI-1, —675 4G/5G), tissue plasminogen activator (tPA, 311 bp Ins/Del), and the endothelial protein C receptor (EPCR, Ser219Gly). Assessment of statistical significance of differences in genotype distribution between the groups of patients with recurrent VTE and a single episode of thrombosis history was performed us- ing Fisher’s exact method. Results. In the long-term period VTE recurrence was revealed in 105 (42%) patients. The comparison group consisted of 103 (41.2%) patients with a single VTE episode in the anamnesis. In 42 (16.8%) patients the presence or absence of disease recur- rence was not revealed. Genotype «tPA Del Del» met 2 times less frequently in patients with recurrent VTE (14.3% vs 28.2% in individuals with a single episode of VTE; OR = 0.4; 95% CI: 0,2–0,9; p = 0.017) that indicates its possible protective effect on the risk of disease recurrence. For the remaining genes no significant differences in genotypes distribution between the compared groups were found. Study of «gene-gene interactions» of tPA and PAI-1 variants revealed significant differences between groups of patients: the combination «tPA Del/Del + PAI-1 4G5G» was 3.5 times less frequent in the group with recur- rent venous thrombosis (3.8% against 13.6%; OR = 0.3; 95% CI: 0.08–0.8; p = 0.011) while the combination of the genotypes «PAI-1 5G5G + tPA Ins/Del», in contrast, was typical for this group (13.3% vs. 5.8% in individuals with a single episode of VTE; OR = 2.5; 95% CI: 0.9–6.7; p = 0.054). Conclusion. Group of young patients with recurrent VTE is characterized by a significant reduction in the incidence of genotype tPA Del/Del as well as the combination of «tPA Del / Del + PAI-1 4G5G». To clarify the effect of polymorphism of these genes on the risk of developing of VTE recurrent episodes additional studies are needed.

Early venous thromboembolism at the beginning of palliative chemotherapy is a poor prognostic factor in patients with metastatic pancreatic cancer: a retrospective study

BackgroundThis study investigated the prognostic effects of venous thromboembolism (VTE)-related factors in patients with metastatic pancreatic cancer receiving palliative chemotherapy. Predictive factors for VTE were also investigated.MethodsA total of 216 patients diagnosed with metastatic pancreatic cancer who received gemcitabine-based palliative chemotherapy at our institution were retrospectively evaluated.ResultsVTE occurred in 51 (23.6%) patients during treatment and did not affect survival. However, patients who were diagnosed with VTE at the beginning of chemotherapy showed poor prognosis compared with patients diagnosed with VTE during chemotherapy: all patients (hazard ratio [HR] 1.897, p = 0.008); patients diagnosed with VTE (HR = 3.768, p = 0.001). Low serum sodium (Na) (< 135 mmol/L) and high Khorana score (≥3) were strong predictive factors of early VTE (odds ratio [OR] 5.109; 95% confidence interval [95% CI] = 1.010–25.845; p = 0.049 for Khorana score, OR 10.304; 95% CI = 1.036–102.466; p = 0.047) for hyponatremia).ConclusionsOur study demonstrated that occurrence and detection of VTE in the early period of chemotherapy was the most significant VTE-related prognostic factor in patients with metastatic pancreatic cancer receiving chemotherapy. Prediction using the Khorana score and serum Na levels would be helpful in early diagnosis of VTE.

Predictors of Venous Thromboembolism After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis

Venous thromboembolism (VTE) is responsible for many hospital readmissions each year, particularly among postsurgical cohorts. Because early and indiscriminate VTE prophylaxis carries catastrophic consequences in postcraniotomy cohorts, identifying factors associated with a high risk for thromboembolic complications is important for guiding postoperative management. To determine VTE incidence in patients undergoing nonemergent craniotomy and to evaluate for factors that predict 30-day and 90-day readmission with VTE. The 2010-2014 cohorts of the Nationwide Readmissions Database were used to generate a large heterogeneous craniotomy sample. There were 89,450 nonemergent craniotomies that met inclusion criteria. Within 30 days, 1513 patients (1.69%) were readmitted with VTE diagnoses; among them, 678 (44.8%) had a diagnosis of deep vein thrombosis alone, 450 (29.7%) had pulmonary embolism alone, and 385 (25.4%) had both. The corresponding 30-day deep vein thrombosis and pulmonary embolism incidences were 1.19% and 0.93%, respectively. In multivariate analysis, several factors were significantly associated with VTE readmission, namely, craniotomy for tumor, corticosteroids, advanced age, greater length of stay, and discharge to institutional care. Craniotomies for tumor, corticosteroids, advanced age, prolonged length of stay, and discharge to institutional care are significant predictors of VTE readmission. The implication of steroids, coupled with their ubiquity in neurosurgery, makes them a potentially modifiable risk factor and a prime target for VTE reduction in craniotomy cohorts. Furthermore, the fact that dose is proportional to VTE risk in the literature suggests that careful consideration should be given toward decreasing regimens in situations in which use of a lower dose might prove equally sufficient.

Risk factors of early venous thromboembolism based on Caprini model among patients with thoracoscopic lobectomy for lung

Objective To explore the risk factors of early venous thromboembolism (VTE) based on Caprini risk assessment model among patients with thoracoscopic lobectomy for lung. Methods From June 2015 to December 2017, retrospective analysis was used to collect the data of 28 patients with pulmonary embolism one week after thoracoscopic lobectomy for lung of Shanghai Chest Hospital, Shanghai Jiaotong University, in observation group. And we selected 84 patients with the same operation in the same term by convenience sampling in control group according to the ratio of 1: 3. Patients of two groups were scored with the Caprini risk assessment model. Single factor analysis and Logistic regression analysis were used to the risk factors in Caprini risk assessment model and related factors of lung lobectomy. Results The Caprini score of patients group in observation group was higher than that in control group with a significant difference (P<0.01) . The proportion of moderate risk and high risk in patients with VTE was 78.6% in observation group and was 20.2% in control group with a statistical difference in the risk classification (P<0.01) . Logistic regression analysis took patients in case group as dependent variable and 16 risk factors in clinical baseline information as the independent variable showed the body mass index≥25 kg/m2, smoking history, preoperative plasma D-dimer higher than the critical value had positive correlations with the risk of VTE after surgery (OR=13.354, 5.639, 3.084; P<0.05) . Conclusions The Caprini risk assessment model can well determine the risk factors of VTE among patients with thoracoscopic lobectomy for lung. The high risk factors of VTE of these patients may include long-term and heavy smoking, overweight and preoperative plasma D-dimer higher than the critical value. Key words: Venous thrombosis; Pulmonary embolism; Risk factors; Thoracoscopes; Lung lobectomy; Caprini model

Current Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage.

Venous thromboembolism (VTE) is common after intracerebral hemorrhage (ICH). Guidelines recommend early VTE prophylaxis. To determine characteristics associated with early chemoprophylaxis (CP) after ICH in the Get With The Guidelines-Stroke registry. In this observational cohort study, we identified patients with ICH between January 1, 2009 and September 30, 2013, who (1) were non-ambulatory and/or not comfort care measures by hospital day 2; (2) were not transferred to another acute care facility; and (3) had known VTE prophylaxis status at end of hospital day 2. Categories for VTE prophylaxis were as follows: (1) mechanical non-CP or (2) CP with or without mechanical prophylaxis. Early prophylaxis was defined as occurring by hospital day 2. Using multivariable logistic regression, we assessed patient, hospital, and geographic factors independently associated with early CP use. Among 74 283 patients with ICH from 1358 hospitals, 5929 (7.9%) received early CP, 66 444 (89.4%) received early mechanical/non-CP, and 1910 (2.6%) had no prophylaxis, mechanical or CP, within the first 2 days. There was no increase in early CP use over the study period; 60% of hospitals provided early CP to <9% of patients. In multivariable analysis, female sex, atrial fibrillation, diabetes, coronary, carotid, and peripheral artery disease, prior ischemic stroke or transient ischemic attack, hospital size >500 beds, and geographic region were independently associated with early vs no early CP use. Nationwide, the large majority of ICH patients receive early mechanical VTE prophylaxis only, without CP. Patient comorbidities and hospital characteristics such as geographic location are determinants of higher use of early CP.

PD52-09 THROMBOEMBOLIC EVENTS DURING TREATMENT FOR RENAL CELL CARCINOMA: MUST WE PREVENT?

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging III1 Apr 2017PD52-09 THROMBOEMBOLIC EVENTS DURING TREATMENT FOR RENAL CELL CARCINOMA: MUST WE PREVENT? Jamie Olsen, Steven Jubelirer, Samuel Umstot, and Samuel Deem Jamie OlsenJamie Olsen More articles by this author , Steven JubelirerSteven Jubelirer More articles by this author , Samuel UmstotSamuel Umstot More articles by this author , and Samuel DeemSamuel Deem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2197AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal mass detection has been on a steady incline over the past decade and subsequently, surgery for solid renal masses has also increased. 900,000 Americans are diagnosed with a VTE each year with the average cost being $56,000 to treat each incident. VTE is the number two cause of death behind the primary malignancy itself. As quality indicators and outcomes are more frequently being linked with reimbursement, venous thromboembolism (VTE) prevention has gained increased attention. Increasing the number of surgeries will also increase the incidence of VTE. The purpose of this study is to identify the incidence of VTE among renal cell carcinoma patients that have undergone definitive surgical therapy and to see if pharmacological prophylaxis following surgery is warranted. METHODS Over a fourteen year period (2000-2014), all patients who had surgery for renal cell carcinoma were examined. A total of 900 patients had either open, laparoscopic or robotic surgery. This included partial, radical and cytoreductive nephrectomies. All VTE incidents that had occurred up until 2015 were documented. Patient demographics and comorbidities were analyzed for risk factors for VTE. All VTE incidents were documented in adjunct with known risk factors for each patient. RESULTS Of the 900 patients that were evaluated, 10 were documented to have VTE, making the incidence 1.1%. 40% of these patients had a prior history of VTE. 20% of the patients with a VTE had metastatic disease at time of surgery. 90% of patients were obese with a mean BMI of 32.3. 50% of patients with postoperative VTE had tobacco use. 100% of patients with documented VTE had at least 1 risk factor for VTE while 80% of patients had greater than 2 risk factors. CONCLUSIONS VTE incident following renal cell carcinoma surgery was found to be 1.1%. All patients had at least one risk factor in addition to surgery. The rate of significant postoperative bleeding following surgical therapy for renal cell carcinoma requiring transfusion is noted to be 3-6%. Risks of postoperative bleeding and other complications outweigh the benefit pharmacological VTE may have with such a low incidence of VTE. Early ambulation and mechanical VTE prophylaxis are warranted following surgery. Although VTE was a rare event, those with multiple risk factors may warrant special consideration and more aggressive VTE prophylaxis following surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e992-e993 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jamie Olsen More articles by this author Steven Jubelirer More articles by this author Samuel Umstot More articles by this author Samuel Deem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Khorana score and histotype predicts incidence of early venous thromboembolism in non-Hodgkin lymphomas. A pooled-data analysis of 12 clinical trials of Fondazione Italiana Linfomi (FIL).

Current data suggests that the risk of venous thromboembolism (VTE) in patients with non-Hodgkin lymphoma (NHL) is comparable to that observed in patients with solid tumours, although more robust confirmatory analyses are required. With that in mind, we investigated the occurrence of VTE in a pooled analysis of 12 "Fondazione Italiana Linfomi" (FIL) prospective clinical studies. Specifically, we wished to assess the cumulative incidence of VTE in NHL patients, evaluate the predictive value of the Khorana Score (KS), and identify other potential risk factors for VTEs. Data for VTE occurrence were retrieved from study databases and pharmacovigilance reports. Our analysis includes 1717 patients from 12 prospective phase II and III trials, including newly diagnosed NHL. We observed 53 VTEs (any grade) in 46 patients, with 20 severe VTEs in 17 patients. The cumulative incidences for "all-grade" or grade ≥3 VTEs were 2.9 % (95 % CI: 2.1-3.8) and 1.1 % (95 % CI: 0.6-1.6), respectively. KS categories were positively associated with the risk of VTE of any grade, and with severe events (i. e. grade ≥3; Gray's test p-values = 0.048 and 0.012, respectively). Among NHL patients, those with diffuse large B-cell lymphoma (DLBCL) showed a greater risk of (any grade) VTE (HR: 3.42, 95 % CI: 1.32-8.84, p-value = 0.011). Our study indicates that 1) VTE is a relevant complication for NHL patients, 2) KS is predictive of VTE events and 3) DLBCL histotype is an independent risk factor for VTE incidence, for which preventative interventions could be considered.

Timing of Chemical Thromboprophylaxis and Deep Vein Thrombosis in Major Colorectal Surgery: A Randomized Clinical Trial.

To identify the optimal timing of perioperative chemical thromboprophylaxis (CTP) and incidence of occult preoperative deep vein thrombosis (OP-DVT) in patients undergoing major colorectal surgery. There is limited Level 1 data regarding the optimal timing of CTP in major colorectal surgery and the incidence of OP-DVT remains unclear. Both issues influence the occurrence of venous thromboembolism (VTE) and may impact Medicare reimbursement because of penalties for hospital-acquired conditions. Patients undergoing major colorectal surgery underwent preoperative lower extremity venous duplex (LEVD) immediately before surgery. Those without OP-DVT were randomized to preoperative or postoperative CTP with 5000 units of subcutaneous heparin. Patients underwent repeat LEVD in the recovery room and on postoperative day 2. Outcome measures included early (48-hrs) and overall (30-days) postoperative VTE, bleeding complications, and OP-DVT. Eighteen patients (4.2%) had OP-DVT and were excluded. The randomized group included 376 patients (51.6% female) with mean age of 52.7 ± 17.6 years. No pulmonary embolism occurred. There was no significant difference in preoperative versus postoperative CTP with respect to early postoperative DVT [3/184 (1.6%) vs 5/192 (2.6%); P = 0.72], DVT at 30 days (1.6% vs 3.6%; P = 0.34) or bleeding complications requiring reoperation (0.5% vs 1.6%; P = 0.62). The risk of OP-DVT is higher than that of perioperative DVT after colorectal surgery and preoperative screening LEVD should be considered to identify and treat patients at risk for pulmonary embolism. Preoperative and postoperative CTP are equally safe in protecting against VTE. CMS should account for these factors when assigning financial disincentives for perioperative VTE. Clinicaltrials.gov #NCT01976988.

918P - A pooled data analysis of 12 clinical trials of Fondazione Italiana Linfomi (FIL): Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in non-Hodgkin lymphoma (NHL)

VTE in NHL occurs in most cases within 3 months from diagnosis and can have substantial impact on treatment delivery and outcome. However, few data are available on potential predictors. We conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk. From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. Overall, 1717 patients belonging to 12 studies were evaluated. M/F ratio was 1.41, median age was 57. Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25. Median Hb, WBC and platelets counts were : 13 g/dl, 7,1 x 109/l, 224 x 109/l, respectively. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%). None was fatal. Median time from study enrolment to VTE was 63 days . Considering death as a competitive event the 6 months cumulative incidence of VTE was 2.2% in low risk Khorana score, 4.5% in intermediate and 6.6% in high risk (p = 0.012) . The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score and DLCL-B histotype were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE. Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL.