Venous Thromboembolism Factors Research Articles

Factors of venous thromboembolism among COVID-19 patients

Context: Anticoagulants are used to prevent and treat venous thromboembolism (VTE), such as deep-vein thrombosis (DVT) and pulmonary embolism (PE) in COVID-19 for better outcomes. Aim: This study aims to explore clinical outcomes and factors affecting VTE among COVID-19 patients. Settings and Design: The study design involved a retrospective cohort study. Study Methods: Hospitalized COVID-19 patients in a tertiary hospital prescribed subcutaneous (SC) anticoagulants were included. Statistical Analysis Used: Multiple logistic regression was performed to determine factors affecting VTE among subjects. Results: A total of 450 patients were included. Types of anticoagulants include fondaparinux (n = 114, 38.1%), enoxaparin (n = 113, 37.8%), and heparin (n = 72, 24.1%). 423 (94.0%) patients were discharged well, 27 (6.0%) patients were admitted to the intensive care unit (ICU). The primary outcome was the prevalence of VTE, which occurred in 19.3% (n = 87) patients, with 80 (92.0%) reporting DVT and 7 (8.0%) reporting PE. The secondary outcome, which was the average length of hospital stay was 9.9 (±4.7) days. Factors of VTE occurrence were likely in patients not prescribed SC anticoagulants compared to those prescribed with SC anticoagulants (adjusted odds ratio [aOR] 54.330, 95% confidence interval [CI]: 7.086, 416.526), treatment with fondaparinux compared to heparin (aOR 2.502, 95% CI: 1.175, 5.327), and less likely in those discharged well compared to patients in the ICU (aOR 0.139, 95% CI: 0.053, 0.361). Conclusions: Careful monitoring is required to reduce VTE risk in COVID-19 patients.

Venous Thromboembolism in Rheumatoid Arthritis: The Added Effect of Disease Activity to Traditional Risk Factors.

Many epidemiological studies have shown an increased risk of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA). RA and VTE share some background factors, such as increasing age, smoking, and obesity. At the same time, other VTE factors, such as knee replacement and oral contraceptive pills, occur commonly in RA patients. In addition, the chronic inflammatory state of RA might hypothetically lead to endothelial injury and a hypercoagulable state. Two critical pathophysiological pathways lead to VTE. Recently, concerns increased about the increased risk of VTE in patients using Janus Kinase inhibitors. This review aims at reviewing the risk of VTE in RA and the role of traditional risk factors and disease-related inflammation and develops a conceptual framework that describes the interaction between these factors.

Is smoking an independent risk factor for venous thromboembolism?

Is smoking an independent risk factor for venous thromboembolism?

Risk of venous thromboembolism in patients with pancreatic cancer

Venous thromboembolism (VTE) is often diagnosed in patients with pancreatic cancer, resulting in increased morbidity and mortality. Objective: to study the relationship between clinical characteristics and hemostatic disorders in patients with pancreatic cancer and determine their role in predicting VTE. Material and Methods. The study included 246 patients with pancreatic cancer. Pancreatic ductal adenocarcinoma was diagnosed in 91.9 % of patients. In most patients (68.3 %), the tumor was localized in the head of the pancreas; 45.9 % of patients had stage IV disease at diagnosis (T1–4N0–2M1); 31.7 % of patients manifested jaundice at diagnosis. A small proportion of patients (17.5 %) received chemotherapy, and 28 % of patients underwent surgery. Within the 12-month follow-up period, the frequency of VTE was 15.4 %. Clinical characteristics and hemostasis parameters were retrospectively compared in patients with VTE and without VTE diagnosed during the follow-up period. Results. The risk of developing VTE in cancer patients was higher with a larger tumor size and the presence of distant metastases. The initial high level of D-dimers increased the risk of VTE during the frst 12 months of diagnosis. In a multivariate analysis, the elevated level of D-dimers was a signifcant risk factor for VTE. Conclusions. The tumor size, advanced tumor stage (stage IV), and elevated levels of D-dimer in patients with pancreatic cancer are of prognostic signifcance for VTE. The study of hemostasis parameters (D-dimer) can help identify patients at risk of developing VTE, who are advised to take anticoagulant therapy with low hemorrhagic risk.

Assessment of efficacy and validity of Khorana risk assessment model in cancer outpatients at a regional cancer center.

e18689 Background: Malignancy is a known risk factor for venous thromboembolism (VTE). Several risk assessment models have been proposed in the literature. Khorana score (KS) is by far the most favored VTE risk assessment tool in cancer outpatients. The KS incorporates the site of primary cancer, baseline hemoglobin, platelets, white blood cell count, and body mass index into the risk score. Patients are classified into low (KS = 0), intermediate (KS = 1-2) and high (KS≥ 3) risk groups. Low dose prophylactic anticoagulation for up to 6 months is recommended in patients with a KS of 2 or higher. In this study we attempted to validate the efficacy of Khorana risk model in our cancer population. Methods: We identified 270 patients (18 years and older) in 2018 and 2019 from our cancer registry with a new cancer diagnosis who received chemotherapy. All the components of KS including patient’s white blood cell count (WBC), hemoglobin, platelet count, baseline body mass index (BMI), and site of the primary were collected. We reviewed medical records to assess for development of VTE over time following initial cancer diagnosis. To assess the performance of Khorana score in our population, we utilized logistic regression and receiver operating characteristic curve (ROC) analysis. We further evaluated VTE free survival by Khorana score using Cox regression analysis. Results: Among 270 patients, the mean age was 60.4 (SD 14.0). 50.6 % were males (n = 136) and 49.6 % were females (n = 134). The most common cancer site was breast (n = 57) followed by prostate (n = 55), pancreas (n = 24), lymphoma (n = 22), bladder (n = 17), lung (n = 13), colon (n = 11), and acute myeloid leukemia (n = 6). The mean Khorana score was 1.2 (SD 1.1). Prophylactic anticoagulation was indicated in 84 patients (KS ≥ 2) but only 4 patients received prophylactic anticoagulation (1.4%). Using a KS cutoff score of 2 or more, the sensitivity was 55.6% (95% CI 0.31 to 0.78), specificity was 70.6% (95% CI 0.64 to 0.76) with a positive predictive value of 11.9% (95% CI 0.06 to 0.21) and negative predictive value of 95.7% (95% CI 0.91 to 0.98). The area under the ROC curve was 0.66, indicating poor performance of the KS. Using Cox regression, those with a KS of 3 or more were 6.3 times (95% CI 1.7 to 23.5) more likely to develop a VTE compared to those with a KS of zero. However, those with KS of 1 (RH 0.96; 95% CI 0.23 to 3.9) or KS of 2 (RH 1.3; 95% CI 0.28 to 6.1) were no more likely to develop a VTE compared to those with a KS of zero. Conclusions: In our patient population, patients were unlikely to receive prophylactic anticoagulation for VTE despite many meeting KS criteria. Using a KS of 2 or higher did not perform well in predicting the risk of a symptomatic VTE. Some VTE diagnoses may have been missed since only those with suspicion of VTE underwent diagnostic testing, which could influence KS performance. However, routine testing for VTE without symptoms or signs is not considered stand or care.

Molecular and clinical predictors of venous thromboembolism in acute myeloid leukemia and myelodysplastic syndrome.

e19008 Background: Malignancy is a well-described risk factor for venous thromboembolism (VTE). Although widely recognized and studied in solid tumors, VTE is also an appreciable cause of morbidity in patients with hematologic malignancies. Many validated scoring systems exist to predict risk of VTE based on cancer type and other clinical characteristics. However, hematologic malignancies are poorly represented in these models. The purpose of this study was to determine risk factors for the development of VTE in a large cohort of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) with the goal of creating a risk stratification model to predict VTE risk in this patient population. Methods: Patients presenting to the University of Wisconsin-Madison with newly-diagnosed AML or MDS from 1/1/2010 through 12/31/2021 were included. Data were collected retrospectively, including patient demographics, clinical characteristics, molecular data, treatment, and complications. Univariate and multivariable logistic and log-binomial regression was used to assess whether variables of interest had any association with VTE. Poisson regression was used to estimate the mortality rate. Results: 547 patients were included in the analysis, including 304 patients with AML and 243 patients with MDS. The overall prevalence of VTE was 14% (95% CI 11.4-17.2%). Those with AML were more likely to experience VTE compared to those with MDS (19.1% vs. 7.8%, RR = 2.4, 95% CI 1.5-4.1, p < 0.001). Higher body mass index (BMI, p = 0.022), induction chemotherapy (p = 0.001), and younger age (p = 0.001) were also associated with development of VTE. Within a subgroup of patients with molecular data available (154 patients), 18.2% experienced VTE. Harboring a mutation in a chromatin modification gene ( ASXL1/2, EED, EZH2, KMT2A) was associated with an 87% reduction in the risk of developing VTE (RR = 0.13, 95% CI 0.01-0.58, p = 0.002). When adjusted for diagnosis and age, the mortality rate for those who experienced VTE was only half the rate of those who never experienced VTE (95% CI 35-69%, p < 0.001). Conclusions: At our institution, the total incidence of VTE was higher than previously described, which underscores the importance of elucidating risk factors of VTE in order to prevent this complication. AML diagnosis, elevated BMI, younger age, and induction chemotherapy were associated with increased risk of VTE, while mutations in chromatin modification genes were associated with a reduction in risk. Surprisingly, the development of VTE was associated with decreased mortality, perhaps reflecting the association of curative-type chemotherapy regimens with VTE in this cohort. In summary, this study demonstrates interesting associations that can ultimately be used to create a risk prediction model of VTE in myeloid malignancies in order to provide optimal supportive care for this patient population.

Impact of COVID-19 on risk of venous thromboembolism (VTE) in cancer patients: A single institution analysis.

e18732 Background: Cancer is known to increase the risk of VTE when compared to the non-cancer population. Additionally, SARS-CoV-2 infection has been associated with hypercoagulability and VTE. A study by Patell et al noted similar cumulative incidence of thrombotic events (arterial and venous) in patients hospitalized with COVID-19 with active cancer than those without cancer (14.2% vs 18.2%). Data from the COVID-19 and Cancer Consortium (CCC19) Registry reported incidence of VTE of 7.6% in cancer patients within 90 days of hospitalization for COVID-19. However, it is unknown whether patients with cancer are at significantly higher risk for VTE in the setting of COVID-19 compared to cancer patients without COVID-19. Our study objectives were to: 1) determine the overall incidence of VTE in patients with cancer with and without COVID-19, regardless of hospitalization status; 2) assess the relative risk of VTE due to COVID-19 in cancer patients; 3) examine risk for VTE in cancer patients with COVID-19 based on certain demographic characteristics and comorbidities. Methods: An institutional retrospective cohort analysis was performed from March 1, 2020 through July 31, 2021. 228 patients with COVID-19 and cancer were identified and compared to matched controls without COVID-19 (n = 448) during the same study period based on age, gender, and BMI. Results: Incidence of VTE in cancer patients with COVID-19 was significantly higher than in cancer patients without COVID-19 (11% vs 3.1%) [RR 3.45, 95% CI 1.85-6.67]. There was no significantly increased risk of VTE in cancer patients with COVID-19 based on the following characteristics: non-White race, male gender, diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and end-stage renal disease receiving dialysis. However, patients with any history of smoking (including current smokers) had increased risk of VTE compared to never-smokers (RR 2.2756, 95% CI 1.0498-4.9326). Conclusions: COVID-19 further increases the risk of VTE in cancer patients, a population with an independent risk factor for VTE at baseline. Whether the increased risk is additive or synergistic is currently unknown. Demographic factors and comorbidities that have been associated with increased severity of COVID-19 in other studies do not appear to significantly increase risk of VTE in cancer patients with COVID-19, with the exception of smoking status (either current or past). Given the impact on morbidity and mortality, further analyses, including with larger datasets, are warranted.

Venous thromboembolism in COVID-19 patients and prediction model: a multicenter cohort study

BackgroundPatients with COVID-19 infection are commonly reported to have an increased risk of venous thrombosis. The choice of anti-thrombotic agents and doses are currently being studied in randomized controlled trials and retrospective studies. There exists a need for individualized risk stratification of venous thromboembolism (VTE) to assist clinicians in decision-making on anticoagulation. We sought to identify the risk factors of VTE in COVID-19 patients, which could help physicians in the prevention, early identification, and management of VTE in hospitalized COVID-19 patients and improve clinical outcomes in these patients.MethodThis is a multicenter, retrospective database of four main health systems in Southeast Michigan, United States. We compiled comprehensive data for adult COVID-19 patients who were admitted between 1st March 2020 and 31st December 2020. Four models, including the random forest, multiple logistic regression, multilinear regression, and decision trees, were built on the primary outcome of in-hospital acute deep vein thrombosis (DVT) and pulmonary embolism (PE) and tested for performance. The study also reported hospital length of stay (LOS) and intensive care unit (ICU) LOS in the VTE and the non-VTE patients. Four models were assessed using the area under the receiver operating characteristic curve and confusion matrix.ResultsThe cohort included 3531 admissions, 3526 had discharge diagnoses, and 6.68% of patients developed acute VTE (N = 236). VTE group had a longer hospital and ICU LOS than the non-VTE group (hospital LOS 12.2 days vs. 8.8 days, p < 0.001; ICU LOS 3.8 days vs. 1.9 days, p < 0.001). 9.8% of patients in the VTE group required more advanced oxygen support, compared to 2.7% of patients in the non-VTE group (p < 0.001). Among all four models, the random forest model had the best performance. The model suggested that blood pressure, electrolytes, renal function, hepatic enzymes, and inflammatory markers were predictors for in-hospital VTE in COVID-19 patients.ConclusionsPatients with COVID-19 have a high risk for VTE, and patients who developed VTE had a prolonged hospital and ICU stay. This random forest prediction model for VTE in COVID-19 patients identifies predictors which could aid physicians in making a clinical judgment on empirical dosages of anticoagulation.

Moringa Oleifera leaf extract induced pulmonary embolism-a case report

BackgroundM. oleifera leaf extract supplement is famous for its anti-inflammatory, antioxidant, antimicrobial, antifertility, anticancer, antihepatotoxic, and antiulcer properties. However, limited data exist on the coagulation effect of M. oleifera leaf extract in human plasma, which maybe a predisposing factor to venous thromboembolism (DVT and PE); a disorder that is well known to be induced by risk factors such as surgery, trauma, cancer, or prolonged immobility.Case presentationWe report a case of a 63-year-old Hispanic female with past medical history of obesity and type 2 diabetes mellitus who presented to the emergency room with a three-day history of worsening shortness of breath and chest pain. Computerized tomography-pulmonary angiogram (CT-PA) revealed bilateral pulmonary embolism (PE) and right ventricle strain. Based on CT imaging findings, the absence of a major transient risk factor for venous thromboembolism (VTE), no history suggestive of an underlying hypercoagulable disorder, and a medication history that was significant for a recent 5-month use of M. oleifera leaf extract that has been reported to induce clot formation, she was diagnosed as a rare case of sub-massive pulmonary embolism provoked by M. oleifera leaf extract supplement. She received initial anticoagulation (AC) during her hospitalization and was discharged on maintenance AC for 3 months.Discussion and conclusionWe report the first case of PE likely triggered by using Moringa oleifera leaf extract herbal supplement. Cohort studies on the coagulation effect of Moringa oleifera leaf extract in humans are necessary to determine the relationship between Moringa Oleifera leaf extract and VTEs.

Evaluation of the modified Wells score in predicting venous thromboembolic disease in patients with tuberculosis or HIV in a South African setting.

BackgroundThere is paucity of data on the modified Wells score (MWS) utility on patients with venous thromboembolism (VTE) in a South African setting where there is a high burden of HIV and tuberculosis (TB). This study analyses the performance of this score in HIV/TB-infected patients compared with non-infected patients.ObjectivesTo assess the performance of the MWS as an additional risk factor for VTE in hospitalised patients with a high burden of HIV/TB infections.MethodThis study was a retrospective cross-sectional cohort analysis of the utility of the MWS in 156 HIV/TB-infected and non-infected adult patients diagnosed with VTE on compression ultrasonography (CUS) or computed tomography pulmonary angiography (CTPA) in a medical inpatient setting over six months. Patients with HIV and/or TB were assessed as having an additional risk factor (1 point for each), and this was compared with the MWS. A McNeymar’s paired sample chi-squared test was used to compare the sensitivity of this score against the MWS.ResultsOf the 156 patients with VTE who were enrolled, HIV was the commonest risk factor (42.31%) with TB accounting for 10.90% of cases. When the MWS adjusted for HIV/TB was used, the sensitivity increased from 25% to 100% for the HIV–/TB+ category, it increased from 77.36% to 98.11% in the HIV+/TB– category and it increased from 84.62% to 92.95% in the HIV+/TB+ category. These differences were statistically significant at P < 0.05 in all categories.ConclusionThe MWS performs better when the infectivity of HIV/TB is included as an additional risk factor in the score.

Incidence of COVID-19-Associated Venous Thromboembolism Among Hospitalized Patients in McAllen, Texas, USA, in Late 2021

This study investigated the incidence of venous thromboembolism (VTE) in hospitalized COVID-19 patients in a community hospital in McAllen, Texas, USA. Such incidence was reported to be as high as 31% in early 2020, and in the range of 3.1%-13.6% in mid-2020, with no later studies addressing this issue. We identified a total of 47 COVID-19 hospitalized patients during August 2021, among whom four (8.5%) had a documented VTE. They were all on prophylactic anticoagulation from the time of admission, and none of them had disseminated intravascular coagulation (DIC) or a prior history of VTE. The incidence was equal between ICU and non-ICU patients. Pre-existing hypertension and cardiovascular diseases, but not high body mass index (BMI) or diabetes mellitus, appeared to be among risk factors for VTE in these patients. All four VTE patients were of Hispanic ethnicity, while only half of all 47 patients were Hispanic. The study concluded that in late 2021 the rate of VTE remained to be higher in COVID-19 than non-COVID-19 patients in hospitals despite routine and early implementation of prophylactic anticoagulation in this patient population.

A151 RISK FACTORS FOR VENOUS THROMBOEMBOLISM AFTER HOSPITAL DISCHARGE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundInflammatory bowel disease (IBD) is a chronic inflammatory condition which is independently associated with venous thromboembolism (VTE). Although the absolute risk of VTE is greatest during hospitalization, the risk remains elevated in the early post-discharge period. The risk factors for VTE during this vulnerable period remain unknown.AimsWe performed a systematic review and meta-analysis to determine risk factors for VTE in the post discharge period among adult patients with IBD.MethodsWe performed a systematic search of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception through April 29, 2021 for publications that reported risk factors for VTE during the post-discharge period among patients with IBD. Study eligibility was assessed independently in duplicate without age or language restriction. We defined the post-discharge period as within 6 months of discharge. Pooled summary estimates of adjusted hazard/odds ratios, when available, were calculated for individual risk factors using random effects model with 95% confidence intervals. The analysis was performed when a minimum of three studies were available for a given risk factor. Heterogeneity was assessed using I2 statistic. Study quality was assessed using an adapted version of the National Institute of Health criteria.ResultsWe identified 10 studies from a total of 4339 abstracts that met our inclusion criteria: 8 population-based studies, 1 multicenter observational study and 1 single center observational study. Risk factors for post-discharge VTE were assessed at 6 weeks in 1 study, 1 month in 5 studies, 3 months in 2 studies, and 6 months in 2 studies. The variables assessed in our meta-analysis are reported in Table 1. Exposure to corticosteroid (odds ratio [OR], 1.77; 95% CI, 1.53–2.06) but not biologics (OR, 1.21; 95% CI 0.80–1.82) was associated with an increased risk of VTE. Furthermore, greater length of stay (OR 1.49; 95% CI, 1.01–2.20), ulcerative colitis (OR 1.41; 95% CI, 1.19–1.66), history of malignancy (OR 1.35; 95% CI, 1.12–1.62), and surgery during admission (OR 1.26; 95% CI, 1.12–1.42) but not female sex (OR 0.98; 95% CI, 0.88–1.10) or surgery type (OR 1.09; 95% CI, 0.75–1.57) were associated with increased risk of VTE after discharge. Overall, the study quality was rated as fair.ConclusionsIn our meta-analysis, which consisted of moderate quality of evidence, we identified multiple risk factors associated with VTE in the post-discharge period. This work will help inform which factors should be considered for developing point of care clinical predictive models to help guide when extended VTE prophylaxis is required. Funding AgenciesNone

337. SARS-CoV-2 Viral Load Does Not Predict Incident Venous Thromboembolism in COVID-19

BackgroundThe risk factors of venous thromboembolism (VTE) in COVID-19 warrant further study. We leveraged a cohort in the Military Health System (MHS) to identify clinical and virological predictors of incident deep venous thrombosis (DVT), pulmonary embolism (PE), and other VTE within 90-days after COVID-19 onset. MethodsPCR or serologically-confirmed SARS-CoV-2 infected MHS beneficiaries were enrolled via nine military treatment facilities (MTF) through April 2021. Case characteristics were derived from interview and review of the electronic medical record (EMR) through one-year follow-up in outpatients and inpatients. qPCR was performed on upper respiratory swab specimens collected post-enrollment to estimate SARS-CoV-2 viral load. The frequency of incident DVT, PE, or other VTE by 90-days post-COVID-19 onset were ascertained by ICD-10 code. Correlates of 90-day VTE were determined through multivariate logistic regression, including age and sampling-time-adjusted log10-SARS-CoV-2 GE/reaction as a priori predictors in addition to other demographic and clinical covariates which were selected through stepwise regression. Results1473 participants with SARS-CoV-2 infection were enrolled through April 2021. 21% of study participants were inpatients; the mean age was 41 years (SD = 17.0 years). The median Charlson Comorbidity Index score was 0 (IQR = 0 - 1, range = 0 - 13). 27 (1.8%) had a prior history of VTE. Mean maximum viral load observed was 1.65 x 107 genome equivalents/reaction. 36 (2.4%) of all SARS-CoV-2 cases (including inpatients and outpatients), 29 (9.5%) of COVID-19 inpatients, and 7 (0.6%) of outpatients received an ICD-10 diagnosis of any VTE within 90 days after COVID-19 onset. Logistic regression identified hospitalization (aOR = 11.1, p = 0.003) and prior VTE (aOR = 6.2 , p = 0.009) as independent predictors of VTE within 90 days of symptom onset. Neither age (aOR = 1.0, p = 0.50), other demographic covariates, other comorbidities, nor SARS-CoV-2 viral load (aOR = 1.1, p = 0.60) were associated with 90-day VTE.ConclusionVTE was relatively frequent in this MHS cohort. SARS-CoV-2 viral load did not increase the odds of 90-day VTE. Rather, being hospitalized for SARS-CoV-2 and prior VTE history remained the strongest predictors of this complication. Disclosures Simon Pollett, MBBS, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work)) Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) David A. Lindholm, MD, American Board of Internal Medicine (Individual(s) Involved: Self): Member of Auxiliary R&D Infectious Disease Item-Writer Task Force. No financial support received. No exam questions will be disclosed ., Other Financial or Material Support David Tribble, M.D., DrPH, Astra Zeneca (Other Financial or Material Support, HJF, in support of USU IDCRP, funded under a CRADA to augment the conduct of an unrelated Phase III COVID-19 vaccine trial sponsored by AstraZeneca as part of USG response (unrelated work))

Chronic hypersensitivity pneumonitis is associated with an increased risk of venous thromboembolism: a retrospective cohort study

BackgroundIdiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis share commonalities in pathogenesis shifting haemostasis balance towards the procoagulant and antifibrinolytic activity. Several studies have suggested an increased risk of venous thromboembolism in IPF. The association between venous thromboembolism and chronic hypersensitivity pneumonitis has not been studied yet.MethodsA retrospective cohort study of IPF and chronic hypersensitivity pneumonitis patients diagnosed in single tertiary referral center between 2005 and 2018 was conducted. The incidence of symptomatic venous thromboembolism was evaluated. Risk factors for venous thromboembolism and survival among those with and without venous thromboembolism were assessed.ResultsA total of 411 (259 IPF and 152 chronic hypersensitivity) patients were included (mean age 66.7 ± 8.4 vs 51.0 ± 13.3 years, respectively). There were 12 (4.6%) incident cases of venous thromboembolism in IPF and 5 (3.3%) in chronic hypersensitivity pneumonitis cohort. The relative risk (RR) of venous thromboembolism in chronic hypersensitivity pneumonitis was not significantly different to that found in patients with IPF (7.1 vs 11.8/1000 person-years, RR 1.661 95% CI 0.545–6.019, respectively).The treatment with systemic steroids (OR 5.38; 95% CI 1.65–18.8, p = 0.006) and GAP stage 3 (OR 7.85; 95% CI 1.49–34.9; p = 0.037) were significant risk factors for venous thromboembolism in IPF. Arterial hypertension and pulmonary hypertension significantly increased risk of venous thromboembolism in chronic hypersensitivity pneumonitis. There were no significant differences in survival between patients with and without venous thromboembolism.ConclusionsThe patients with chronic hypersensitivity pneumonitis have a marked increase in the risk of venous thromboembolism, similar to the patients with IPF. Venous thromboembolism does not affect the survival of patients with IPF and chronic hypersensitivity pneumonitis.

A case-control study on factor V Leiden: an independent, gender-dependent risk factor for venous thromboembolism

BackgroundActivated protein C resistance (APCR) due to factor V Leiden (FVL) mutation (R506Q) is a major risk factor in patients with venous thromboembolism (VTE). The present study investigated the clinical manifestations and the risk of venous thromboembolism regarding multiple clinical, laboratory, and demographic properties in FVL patients.Material and methodsA retrospective cross-sectional analysis was conducted on a total of 288 FVL patients with VTE according to APCR. In addition, 288 VET control samples, without FVL mutation, were also randomly selected. Demographic information, clinical manifestations, family and treatment history were recorded, and specific tests including t-test, chi-square and uni- and multi-variable regression tests applied.ResultsAPCR was found to be 2.3 times significantly more likely in men (OR: 2.1, p < 0.05) than women. The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in APCR patients was 4.5 and 3.2 times more than the control group, respectively (p < 0.05). However, APCR could not be an independent risk factor for arterial thrombosis (AT) and pregnancy complications. Moreover, patients were evaluated for thrombophilia panel tests and showed significantly lower protein C and S than the control group and patients without DVT (p < 0.0001).ConclusionFVL mutation and APCR abnormality are noticeable risk factors for VTE. Screening strategies for FVL mutation in patients undergoing surgery, oral contraceptive medication, and pregnancy cannot be recommended, but a phenotypic test for activated protein C resistance should be endorsed in patients with VTE.

Effectiveness and safety of apixaban vs warfarin among older venous thromboembolism patients stratified by race

Abstract Background Race has been identified as a risk factor for venous thromboembolism (VTE), with Black individuals having a higher risk of VTE compared to Caucasians. Black patients have been underrepresented in clinical trials evaluating anticoagulants for VTE. There has been limited evidence about the effects of anticoagulants for Black patients with VTE in routine clinical practice. Purpose To evaluate the risk of recurrent VTE, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding among VTE patients initiating apixaban or warfarin stratified by race. Methods Older VTE patients (≥65 years) who initiated apixaban or warfarin were selected from the CMS Medicare database (September 2014–December 2017). Stabilized inverse probability treatment weighting (IPTW) was used to balance the differences between apixaban and warfarin cohorts. After IPTW, subgroup interaction analysis was conducted to evaluate if treatment effects were different between Black and White patients in the Medicare population. Due to small sample size, other races were not included in the interaction analysis. Cox proportional hazard models were used to evaluate if there was significant interaction (p&amp;lt;0.10) between treatment and race on recurrent VTE, MB, or CRNM bleeding. Results A total of 22,135 apixaban and 45,840 warfarin patients with VTE were included in the analysis. Post-IPTW, patient characteristics were balanced between apixaban and warfarin treatment cohorts. Apixaban patients had significantly lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients (Figure). When stratified by race, 57,008 (83.9%) were White, 7,832 (11.5%) Black, and 3,135 (4.6%) other races. For both treatment cohorts, age was similar between Black (77.0–77.2 years) and White (77.4–77.5 years) patients. However, Black patients were more likely to have an inpatient VTE event (77.3–77.8% vs. 63.1–63.3%), a provoked VTE event (78.6–79.5% vs 69.4–69.6%), and a higher comorbidity index score (mean 4.1 vs. 2.7) compared to White patients with VTE. The incidence rates per 100 person-years of recurrent VTE (2.0–3.3 vs 1.4–2.2) and MB (7.4–10.1 vs 3.5–5.3) were also numerically higher for Black patients compared to White patients. Across both race groups, apixaban patients had a lower incidence rate of recurrent VTE, MB and CRNM bleeding compared to warfarin patients. No significant interaction was observed between treatment and race for recurrent VTE, MB, or CRNM bleeding (Figure). The findings within each race group were consistent with those of the overall VTE population. Conclusion Among older VTE patients, disparities were observed in VTE characteristics and clinical outcomes between Black and White patients. Across both race groups, apixaban had lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients. Further studies are needed to identify optimal management strategies for Black patients with VTE. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Pfizer IncBristol-Myers Squibb Company

Incidence of venous thromboembolism in children with primary lymphomas

Cancer increases the risk of venous thromboembolism (VTE) in adults and children. The aim of our study was to evaluate the incidence of VTE in children and adolescents with lymphomas. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. A retrospective analysis based on medical data of 262 children and adolescents (0–18 years) with primary lymphomas (n = 262) who were treated in Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology since 01.01.2013 to 31.12.2019 had been performed. Such parameters as age and sex distribution of patients, the frequency, as well as the cumulative incidence of detection (CI) and differences in localization, the median time of detection of symptomatic (sVTE) and asymptomatic episodes of VT (aVTE), their relationship with central venous catheters (CVC) were analyzed. Statistical processing of the obtained data was carried out using the XLSTAT 2020 program (Addinsoft, France). The median age was 11,1 years (interquartile range (IQR) 6.5–15 years), the ratio of males to females was 2.2:1. There were 71 episodes of VTE in 65 patients (24.8%, 95% confidence interval (CI): 19.6–30). Among all episodes of VTE 31% were defined as sVTE at 400 day CI for sVTE was found to be 8.1% (95% CI: 5.4–12.2) and CI for aVTE – 18.7% (95% CI: 14.4–24.2). The median time to VTE episode was 38 days (IQR 16.5–91.5 days). There was a trend towards an earlier diagnosis of sVTE (median 23.5 days, IQR – 17–42 days) than aVTE (median 62 days, IQR 14–80 days), p = 0.075. VTE was CVC-related in 67.7 of all VTE cases. In one case, asymptomatic thrombosis of right atrium led to pulmonary embolism (PE). VTE is a frequent complication in children and adolescents with lymphomas. Most episodes of VTE were asymptomatic, one of which was the most likely cause of PE in the child. Further research is needed to find risk factors for VTE.

Association of smoking and cancer with the risk of venous thromboembolism: the Scandinavian Thrombosis and Cancer cohort

Smoking is a well-established risk factor for cancer, and cancer patients have a high risk of venous thromboembolism (VTE). Conflicting results have been reported on the association between smoking and risk of VTE, and the effect of smoking on VTE-risk in subjects with cancer is scarcely studied. We aimed to investigate the association between smoking and VTE in subjects with and without cancer in a large population-based cohort. The Scandinavian Thrombosis and Cancer (STAC) cohort included 144,952 participants followed from 1993–1997 to 2008–2012. Information on smoking habits was derived from self-administered questionnaires. Active cancer was defined as the first two years following the date of cancer diagnosis. Former smokers (n = 35,890) and those with missing information on smoking status (n = 3680) at baseline were excluded. During a mean follow up of 11 years, 10,181 participants were diagnosed with cancer, and 1611 developed incident VTE, of which 214 were cancer-related. Smoking was associated with a 50% increased risk of VTE (HR 1.49, 95% CI 1.12–1.98) in cancer patients, whereas no association was found in cancer-free subjects (HR 1.07, 95% CI 0.96–1.20). In cancer patients, the risk of VTE among smokers remained unchanged after adjustment for cancer site and metastasis. Stratified analyses showed that smoking was a risk factor for VTE among those with smoking-related and advanced cancers. In conclusion, smoking was associated with increased VTE risk in subjects with active cancer, but not in those without cancer. Our findings imply a biological interaction between cancer and smoking on the risk of VTE.

The Impact of ABO Blood Type on Developing Venous Thromboembolism in Cancer Patients: Systematic Review and Meta-Analysis.

The impact of ABO blood type in the development of venous thromboembolism in cancer patients remains controversial. To develop a sense of the current opinion in this area, we conducted a systematic review and meta-analysis. In March 2021, we performed a systematic search of PubMed, the Cochrane library, and Scopus for studies that compared cancer patients who had a blood type of either O or non-O (A, B, and AB). Our objective was to use multivariate logistic regression analysis to determine how ABO blood type was associated with the development of venous thromboembolism. Our selection criteria were met by a total of nine studies in 25,884 patients for the systematic review and five studies in 22,777 patients for the meta-analysis. In cancer patients, we found that non-O blood type was associated with a nearly two-fold increase in risk of venous thromboembolism (pooled OR: 1.74, 95% CI: 1.44–2.10). Additionally, among the eligible patients, 21,889 patients were post-operative urological cancer patients. In these patients, the analysis also showed an association between non-O blood type and increasing risk of venous thromboembolism after pelvic surgery for malignancy (pooled OR: 1.73, 95% CI: 1.36–2.20). Our meta-analysis suggested that non-O blood type is a risk factor for venous thromboembolism among patients with cancer. As blood type is routinely determined preoperatively by objective and standardized methods, we anticipate that our results will be useful for managing venous thromboembolism in cancer patients, especially after pelvic surgery for urological cancers.

An incidental finding of testicular seminoma in the context of acute pulmonary embolism: a case report

BackgroundClinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient.Case presentationA 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy.ConclusionsThis case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”