High Risk Of Venous Thromboembolism Research Articles

Plasma tissue factor activity in lung cancer patients predicts venous thromboembolism and poor overall survival

BackgroundBiomarkers to identify lung cancer (LC) patients with high risk of venous thromboembolism (VTE) are needed. ObjectivesTo evaluate the usefulness of plasma tissue factor activity (TFA) and D-dimer levels for the prediction of VTE and overall survival in patients with LC. MethodsIn a prospective multicenter observational cohort of consecutive LC patients, TFA and D-dimer levels were measured at diagnosis before any cancer treatment (V1) and between 8 and 12 weeks after diagnosis (V2). ResultsAmong 302 patients, 38 (12.6%) experienced VTE within the first year after diagnosis. V1-TFA and V1-D-dimer levels were significantly (P = .02) higher in patients who presented VTE within 3 months than in patients without VTE: V1-TFA was 2.02 (25th-75th percentiles, 0.20-4.01) vs 0.49 (0.20-3.09) ng/mL and V1-D-dimer was 1.42 (0.64-4.40) vs 0.69 (0.39-1.53) μg/mL, respectively. Cutoffs of 1.92 ng/mL for TFA and 1.26 μg/mL for D-dimer could discriminate both groups of patients. In multivariate analysis, V1-TFA > 1.92 ng/mL was the only significant predictor of VTE risk at 1 year (hazard ratio, 2.10; 95% CI, 1.06-4.16; P = .03). V2-TFA, quantified in 251 patients, decreased significantly compared with V1-TFA (0.20 vs 0.56 ng/mL, P < .05), but a V2-TFA level > 0.77 ng/mL could predict VTE in the following 3 months. Median overall survival was worse for patients with V1-TFA > 1.92 ng/mL (14.6 vs 23.8 months) and V1-D-dimer > 1.26 μg/mL (13.8 vs 24 months, P < .001). ConclusionHigh plasma TFA levels are associated with the occurrence of VTE within the next 3 months after each visit (V1 or V2) and poor survival.

Does hormone therapy exacerbate other venous thromboembolism risk factors?

Postmenopausal symptoms in women at higher risk for venous thromboembolism (VTE) due to comorbidities are often undertreated because of concerns that hormone therapy (HT) may increase VTE risk; however, it is unclear how much HT impacts risk of VTE when compared with other risk factors. This is a case-control study in a commercial claims database from 2007 to 2019. Women aged 50 to 64 years (n = 223,949) were classified as cases if they had an International Classification of Diseases code indicating an acute VTE plus a filled prescription for an anticoagulant, placement of intravascular vena cava filter, or death within 30 days of diagnosis. Controls were matched 10:1 to each case by index date and age. Risk factors and comorbidities present within the year before index were examined. Exposure was defined as a HT prescription within 60 days before index. There were 20,359 VTE cases and 203,590 matched controls. A conditional logistic regression indicated that the greatest risks for VTE were from metastatic cancer (odds ratio [OR], 13.66; 95% CI, 12.64-14.75), hospitalization/surgery (OR, 8.51; 95% CI, 8.09-8.96), trauma (OR, 3.52; 95% CI, 3.32-3.73), comorbidity burden (OR, 3.51; 95% CI, 3.34-3.69), history of hypercoagulable condition (OR, 3.10; 95% CI, 2.87-3.36), and varicose veins (OR, 2.87; 95% CI, 2.56-3.22). Regarding hormone exposure, we observed ORs of 1.51 (95% CI, 1.43-1.60) for any recent hormone exposure; 1.13 (95% CI, 1.04-1.23; number needed to harm, 4,274) for unopposed estrogen menopausal HT; 1.23 (95% CI, 1.10-1.38; number needed to harm, 2,440) for combined menopausal HT; and 5.22 (95% CI, 4.67-5.84) for combined hormonal contraceptives compared with no recent HT exposure. Hormone therapy exposure did not appear to adversely influence other risk factors, and exposure generally played a minor role in VTE risk. Contraceptives, however, were a strong risk factor.

Clinical and molecular determinants of bleeding-related adverse outcomes in high-grade glioma.

Cancer is an independent risk factor for the development of venous thromboembolism (VTE). However, patients with high-grade glioma (HGG) including glioblastoma (GBM) are at a particularly high risk of VTE with an incidence up to 20-30% per year. Patients are often placed on anticoagulation if they are found to have VTE. However, patients with primary brain tumors such as HGG are at increased risk for intracerebral hemorrhage (ICH) even without the administration of anticoagulation. The combination of risk factors for ICH with anticoagulation and HGG complicates decision-making. Currently it is not known which of the direct oral anticoagulants (DOACs) are safest for patients with HGG in terms of adverse bleeding-related outcomes such as ICH. Furthermore, a deeper understanding of the clinical and molecular determinants of bleeding-related adverse outcomes in HGG is not fully characterized. In this retrospective study, we identified and gathered data on 75 consecutive patients with pathology-confirmed HGG with hospital encounters at two academic medical center hospitals in Austin between July 1, 2017 and June 30, 2022. We compared clinical and treatment-related factors among cohorts who had received various forms of anticoagulation or no anticoagulation. Patients who were on rivaroxaban (3/7 (43%)) had a statistically significant association with more bleeding-related adverse events compared to those on apixaban (0/12 (0%)) or enoxaparin (0/5 (0%), p = 0.022) even though the groups were similar in characteristics including total time on the respective anticoagulation. Patients on anticoagulation vs those never on anticoagulation did not differ in terms of their studied demographic and clinical characteristics. Intriguingly, logistic regression analysis revealed that patients Astrocytoma, isocitrate dehydrogenase (IDH) mutant, grade 4 had a significant association with more adverse bleeding-related events even when controlling for other relevant factors (Odds Ratio compared to reference GBM: 49.4, 95% CI: 2.8, 2084.7; p = 0.013). In this study we found that the use of rivaroxaban was associated with more bleeding-related events compared to apixaban and enoxaparin in patients with high-grade glioma. In this study we also found that the diagnosis of astrocytoma, IDH mutant, grade 4 was associated with more bleeding events. However, this is based on a small study and there is a need for larger studies to further evaluate these results.

Elevated levels of citrullinated fibrinogen in patients with cancer.

Neutrophil released peptidyl arginine deiminase 4 (PAD4) converts arginine residues on plasma proteins into citrulline. Here, we developed an assay to quantify citrullinated fibrinogen. We employed a biotin-conjugated phenylglyoxal (biotin-phenylglyoxal (PG)) compound that selectively labels citrulline. Patient samples were derived from a multicenter prospective cohort study that aimed to identify cancer patients at high risk for venous thromboembolism (VTE). Our data show that cancer patients have higher (median 2-fold increased) citrullinated fibrinogen levels when compared to normal human plasma and a cohort of healthy donors. Our results show that citrullination of fibrinogen is a common posttranslational modification in patients with cancer.

Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin

Background/Objective: Patients undergoing inflatable penile prosthetic (IPP) surgery are at an increased risk for cardiovascular complications such as venous thromboembolism (VTE) following surgery due to pre-existing comorbidities associated with erectile dysfunction. The use of perioperative subcutaneous heparin (SqH) along with a surgical drain has been shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively. In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain.&#x0D; Methods: This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or explant and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, and 90-day postoperative complications, including hematoma formation, were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not.&#x0D; Results: We reviewed data for 240 patients; 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, and no VTE was recorded in the group receiving SqH. There was no statistical significance in hematoma formation betweengroups (SqH 5.5% vs. non-SqH 6.2% p=.898). Beyond hypertension prevalence (SqH 74.8% vs. non-SqH 62.8% p=.045), there was no difference between comorbidities or Caprini risk factor scores (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups (Table 1). 94% of thepatients in this study were considered high risk for VTE.&#x0D; Conclusions: Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.

Effectiveness and safety of anticoagulants among patients with venous thromboembolism and common cancers or cancers with high venous thromboembolism risk.

Aim: Treatment effects among anticoagulant-treated patients with venous thromboembolism (VTE) and cancer across tumor types were evaluated. Methods: Patients initiating an anticoagulant within 30days after VTE were identified. After inverse probability treatment weighting, patients were stratified by tumor type. Interactions between treatment and tumor type on recurrent VTE, major bleeding and clinically relevant non-major bleeding were assessed using Cox proportional hazard models. Results: Treatment effects were generally not significantly different among patients with or without the following cancer types: prostate, breast, lung, pancreatic or multiple myeloma. Few significant interactions were observed for lung and pancreatic cancer. Conclusion: Anticoagulant treatment effects were generally consistent across tumor types. The significant interactions may indicate tumor-specific effects of anticoagulants, but further research is needed.

Thromboprophylaxis in lower limb amputation surgery.

Lower limb amputation surgery is associated with a high risk of venous thromboembolism. There is evidence that pharmacological thromboprophylaxis is not widely prescribed to patients undergoing this type of procedure. To investigate the profile of the thromboprophylaxis practices of angiologists and vascular surgeons in Brazil during the perioperative period of lower limb amputation surgery and conduct a descriptive analysis of the findings. This is a cross-sectional, descriptive study, with simple probabilistic sampling, carried out with angiologists and vascular surgeons working in Brazil. Data were collected through electronic questionnaires, from February to June 2023. There were 237 respondents, 58.6% of whom conduct thrombotic risk stratification. Of these, 86.3% use the Caprini score. Only 27% of participants stratify patients' bleeding risk. Low molecular weight heparin is the medication of choice for 85.7% of study participants, 78.9% of whom use a dosage of 40 IU per day. Around 46.8% use direct oral anticoagulants in addition to low molecular weight heparin and rivaroxaban is the drug they most often prescribe (94.6%). A little more than half (51.15%) routinely recommend pharmacological thromboprophylaxis until hospital discharge. The study revealed the heterogeneous nature of conduct related to prescription of pharmacological thromboprophylaxis, highlighting the need for more studies to support prophylaxis decision-making in this patient population.

THromboprophylaxis In Sickle Cell Disease with central venous catheters (THIS): an internal pilot randomised controlled trial protocol

IntroductionIndividuals with sickle cell disease (SCD) and central venous catheters (CVC) are at high risk for venous thromboembolism (VTE). Minimal data exist regarding the use of anticoagulation as thromboprophylaxis of...

Multiple risk factors are associated with an incremental increase in acute venous thromboembolism risk after total joint arthroplasty: A pearldiver cohort study.

Several risk factors are associated with acute venous thromboembolism (VTE) after total joint arthroplasty (TJA). However, there is a lack of literature regarding the cumulative impact of multiple risk factors. To address this gap, we utilized the PearlDiver database, an insurance billing claims database containing de-identified data from 91 million orthopedic patients. The PearlDiver database was queried for records of patients who underwent total hip and knee arthroplasty from 2010 to 2019 using ICD-10 and CPT codes. Twelve persistent and two transient risk factors were analyzed for their association with the occurrence of acute VTE within three months after surgery. Univariate and logistic regression analyses with odds ratios (ORs) and confidence intervals (CIs) were conducted to determine the odds associated with each risk factor and the impact of multiple concurrent risk factors. A total of 988,675 patients who underwent hip and knee arthroplasty met the inclusion criteria, of whom 1.5% developed acute VTE after three months. The prevalence of VTE risk factors ranged from 0.2 to 38.6%. Individual, persistent risk factors demonstrated 14-84% increased odds of VTE compared to a 1.2% increase for a transient risk factor (acute myocardial infarction). Three or more persistent risk factors were associated with a higher risk of VTE. Persistent risk factors were associated with a higher incidence of postoperative VTE than transient risk factors. An incremental increase in risk was noted if three or more persistent risk factors were present.

Prevalence of and Risk Factors for Venous Thromboembolism in Patients With Lymphoma: A Meta-Analysis.

The risk of venous thromboembolism (VTE) in patients with lymphoma may be overlooked because patients often experience thrombocytopenia from the disease or chemotherapy. A meta-analysis was conducted to identify the prevalence of and risk factors for VTE in patients with lymphoma. A systematic search of Embase®, Web of Science, PubMed®, and Cochrane Library databases was conducted to identify relevant studies investigating VTE in patients with lymphoma. The methodologic quality of the eligible observational studies was assessed using the Newcastle-Ottawa Scale. Stata, version 12.0, was used to perform the meta-analysis. Female sex, older age, history of VTE, a diagnosis of diffuse large B-cell lymphoma, Ann Arbor stage III-IV disease, a higher performance status score, bulky disease, central nervous system involvement, a white blood cell count greater than 11 × 109/L, a D-dimer level greater than 0.5 mg/L, central venous catheterization, and treatment with doxorubicin were significant risk factors for VTE. This meta-analysis identified risk factors for VTE, which may provide a theoretical foundation for clinical staff to conduct early assessment and identification of high-risk VTE groups, allowing for timely intervention.

Nomogram for predicting venous thromboembolism after spinal surgery

PurposeThis study aimed to establish a nomogram to predict the risk of venous thromboembolism (VTE), identifying potential risk factors, and providing theoretical basis for prevention of VTE after spinal surgery.MethodsA retrospective analysis was conducted on 2754 patients who underwent spinal surgery. The general characteristics of the training group were initially screened using univariate logistic analysis, and the LASSO method was used for optimal prediction. Subsequently, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative VTE in the training group, and a nomogram for predict risk of VTE was established. The discrimination, calibration, and clinical usefulness of the nomogram were separately evaluated using the C-index, receiver operating characteristic curve, calibration plot and clinical decision curve, and was validated using data from the validation group finally.ResultsMultivariate logistic regression analysis identified 10 independent risk factors for VTE after spinal surgery. A nomogram was established based on these independent risk factors. The C-index for the training and validation groups indicating high accuracy and stability of the model. The area under the receiver operating characteristic curve indicating excellent discrimination ability; the calibration curves showed outstanding calibration for both the training and validation groups. Decision curve analysis showed the clinical net benefit of using the nomogram could be maximized in the probability threshold range of 0.01–1.ConclusionPatients undergoing spinal surgery with elevated D-dimer levels, prolonger surgical, and cervical surgery have higher risk of VTE. The nomogram can provide a theoretical basis for clinicians to prevent VTE.

Oncogenes and cancer associated thrombosis: what can we learn from single cell genomics about risks and mechanisms?

Single cell analysis of cancer cell transcriptome may shed a completely new light on cancer-associated thrombosis (CAT). CAT causes morbid, and sometimes lethal complications in certain human cancers known to be associated with high risk of venous thromboembolism (VTE), pulmonary embolism (PE) or arterial thromboembolism (ATE), all of which worsen patients' prognosis. How active cancers drive these processes has long evaded scrutiny. While "unspecific" microenvironmental effects and consequences of patient care (e.g., chemotherapy) have been implicated in pathogenesis of CAT, it has also been suggested that oncogenic pathways driven by either genetic (mutations), or epigenetic (methylation) events may influence the coagulant phenotype of cancer cells and stroma, and thereby modulate the VTE/PE risk. Consequently, the spectrum of driver events and their downstream effector mechanisms may, to some extent, explain the heterogeneity of CAT manifestations between cancer types, molecular subtypes, and individual cases, with thrombosis-promoting, or -protective mutations. Understanding this molecular causation is important if rationally designed countermeasures were to be deployed to mitigate the clinical impact of CAT in individual cancer patients. In this regard, multi-omic analysis of human cancers, especially at a single cell level, has brought a new meaning to concepts of cellular heterogeneity, plasticity, and multicellular complexity of the tumour microenvironment, with profound and still relatively unexplored implications for the pathogenesis of CAT. Indeed, cancers may contain molecularly distinct cellular subpopulations, or dynamic epigenetic states associated with different profiles of coagulant activity. In this article we discuss some of the relevant lessons from the single cell "omics" and how they could unlock new potential mechanisms through which cancer driving oncogenic lesions may modulate CAT, with possible consequences for patient stratification, care, and outcomes.

A comprehensive deep venous thrombosis prophylaxis regimen in isolated coronary artery bypass grafting

ObjectivesDeep venous thrombosis (DVT) is a known surgical complication that can lead to pulmonary embolism with subsequent morbidity and mortality. The incidence of DVT following coronary artery bypass grafting is unclear. Prophylaxis regimens vary and some guidelines advocate against use of routine chemoprophylaxis in patients at low-moderate risk for venous thromboembolism. We utilized postoperative lower extremity venous ultrasound to determine the incidence of DVT following coronary artery bypass grafting in patients with low- to moderate-risk of venous thromboembolism receiving aggressive postoperative DVT prophylaxis. MethodsThis is a single-center, retrospective study of all patients who underwent coronary artery bypass grafting between April 2022 and January 2023. All patients who completed postoperative venous ultrasound of the bilateral lower extremities were initially included. Patients who underwent concurrent valve or aortic surgery, were at high risk of venous thromboembolism, or were receiving anticoagulation therapy for nonvenous thromboembolism indications were excluded. The primary outcome was in-hospital incidence of DVT. Secondary outcomes were rates of mortality, postoperative bleeding, and thromboembolic events from discharge to 30 days postoperatively and from 30 days to 3 months postoperatively. ResultsNo DVTs were observed in 211 included patients. In hospital, there were 3 significant bleeding events and 1 stroke. Following discharge there were 3 additional bleeding events, 1 death, 1 transient ischemic attack, and 1 pulmonary embolism. ConclusionsWe observed a 0% rate of DVT in low- to moderate-risk patients undergoing isolated coronary artery bypass grafting and receiving a comprehensive DVT prophylaxis regimen. In hospital bleeding and other thromboembolic event rates were 2.84% and 0.47% respectively.

Perioperative hemorheological status of oncological patients with primary knee replacement

Introduction. Endoprosthesis of large joints is associated with high risk of venous thromboembolism. Researchers focus on biochemical characteristics of homeostasis, blood clotting in particular, as the main reason for abnormal blood flow. At the same time, biophysical condition of homeostasis, namely decreased blood fluidity, is rarely considered. Study of rheological behavior of blood after primary oncological endoprosthesis of large joints in patients can potentially affect the selection of perioperative thromboprophylaxis and patient rehabilitation approach.Aim. To study the indicators of the hemorheological status of patients with tumours of long bones in the preand postoperative periods of primary oncological knee replacement.Materials and methods. The study included 36 patients (26 men and 10 women, mean age 46 years) without cardiovascular diseases and pathology of the veins of the lower limb admitted to the Russian Scientific Center of Roentgen Radiology for oncological endoprosthesis of the knee joint. All patients were prescribed: an antiplatelet agent (acetylsalicylic acid) and an anticoagulant (enoxaparin sodium 40 mg daily). Distal resection of the femur (on average 14 cm) was performed in 28 patients, and proximal resection of the tibia (on average 12 cm) in 8 patients, followed by knee replacement. Before the operation, on the 1st and 6th days after the operation, the hemorheological status and the state of the hemostasis system were evaluated in all patients. To determine the reference values, 24 healthy people were examined, comparable in gender and age. Statistical analysis using Statistica 10.0.Results. During the preoperative examination, integral assessment showed the differences in the severity of hemorheological disorders between patients, and two groups were identified: Group 1 – 21 (61 %) patients whose hemorheological disorders were classified as severity degree I, and Group 2 – 14 (39 %) patients with severity degree II d. On day 1 after the surgery, both patient groups showed negative dynamics: hemorheological disorders in group 1 worsened from grade I to II d., and in group 2 to III d. (critical) (p &lt;0.05). On day 6, the parameters did not change significantly in all patients. Similar dynamic changes were observed in the haemostasis system.Conclusion. Activation of the blood coagulation system and deterioration of hemorheology occurred after surgery during administration of anticoagulant and antiplatelet therapy. None of the patients had venous thromboembolic complications, however the risk of their development remained high. A differential model describing hemorheological status can be useful for selection of thromboprophylaxis and rehabilitation methods which include physical factors that improve the hemorheological profile: low-frequency magnetic and/or laser therapy in patients.

Risk-stratified thromboprophylaxis effects of aspirin versus low-molecular-weight heparin in orthopedic trauma patients: A secondary analysis of the PREVENT CLOT trial.

The PREVENT CLOT trial concluded that thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin (LMWH) in preventing death after orthopedic trauma. However, it was unclear if these results applied to patients at highest risk of thrombosis. Therefore, we assessed if the effect of aspirin versus LMWH differed based on patients' baseline risk of venous thromboembolism (VTE). The PREVENT CLOT trial enrolled 12,211 adult patients with fractures. This secondary analysis stratified the study population into VTE risk quartiles: low (<1%) to high (>10%) using the Caprini score. We assessed stratum-specific treatment effects using the win ratio method, in which each patient assigned to aspirin was paired with each assigned to LMWH. In each pair, we compared outcomes hierarchically, starting with death, then pulmonary embolism, deep vein thrombosis, and bleeding. The secondary outcome added patients' medication satisfaction as a fifth composite component. In the high-risk quartile (n = 3052), 80% had femur fracture, pelvic, or acetabular fractures. Thoracic (47%) and head (37%) injuries were also common. In the low risk quartile (n = 3053), most patients had a tibia fracture (67%), 5% had a thoracic injury, and less than 1% had head or spinal injuries. Among high risk patients, thromboembolic events did not differ statistically between aspirin and LMWH (win ratio, 0.94; 95% confidence interval [CI], 0.82-1.08, p = 0.42). This result was consistent in the low (win ratio, 1.15; 95% CI, 0.90-1.47, p = 0.27), low-medium (win ratio, 1.05; 95% CI, 0.85-1.29, p = 0.68), and medium-high risk quartiles (win ratio, 0.94; 95% CI, 0.80-1.11, p = 0.48). When medication satisfaction was considered, favorable outcomes were 68% more likely with aspirin (win ratio, 1.68; 95% CI, 1.60-1.77; p < 0.001). Thromboembolic outcomes were similar with aspirin or LMWH, even among patients at highest risk of VTE. Aspirin was favored if medication satisfaction was also considered. Therapeutic/Care Management; Level II.

While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension

This study aims to determine the overall incidence of venous thromboembolism (VTE) following shoulder arthroscopy and to define potential risk factors associated with its development that may help define guidelines for the use of thromboprophylaxis. A systematic review was performed using PubMed, Embase, Web of Science, CINAHL, and Cochrane databases per PRISMA guidelines. The search terms consisted of variations of "Venous Thromboembolism" and "Shoulder Arthroscopy." Information regarding arthroscopy indication, risk factors, outcomes, and patient demographics was recorded and analyzed, and pooled odds ratios were reported for each variable. Six hundred eighty-five articles were identified in the initial search, and 35 articles reported DVT, PE, or VTE incidence following shoulder arthroscopy. Seventeen nonoverlapping articles with a unique patient population incidence rates. Four articles were thenused for subgroup meta-analysis. The incidence rate of VTE was 0.24%, ranging from 0.01% to 5.7%. BMI >30 (OR= 1.46; 95% CI= [1.22, 1.74]; I2= 0%) and hypertension (OR= 1.64; 95% CI= [1.03, 2.6]; I2= 75%) were significant risk factors (P < .05) for developing VTE following shoulder arthroscopy. Diabetes (OR= 1.2; 95% CI=[0.97, 1.48]; I2= 0%), insulin-dependent diabetes (OR= 5.58; 95% CI= [0.12, 260.19]; I2= 85%), smoking (OR= 1.04; 95% CI= [0.79, 1.37]; I2= 12%), male sex (OR= 0.95; 95% CI= [0.49, 1.85]; I2= 86%) and age over 65 (OR= 4.3; 95% CI= [0.25, 72.83]; I2= 85%) were not associated with higher VTE risk. The VTEincidence following shoulder arthroscopy is low at 0.24%. Patients with BMI >30 and hypertension are at a higher risk for VTE after shoulder arthroscopy. Level IV, systematic review and meta-analysis of Level I-IV studies.

#113 : Transdermal Oestrogen (GEL) for Endometrial Preparation in Frozen-Thawed Embryo Transfer

Background and Aims: Frozen-thawed embryo transfer (FET) requires a synchronization between endometrium and embryo. Pregnancy and live birth rates are proven to be significantly higher with FET due to better endometrial receptivity. In this study, we look at effectiveness oftwo oestrogen preparations in hormone replacement therapy (HRT) FET cycle on the pregnancy outcomes. Method: This is a retrospective analysis of 200 HRT FET cycles from 1st Jan 2020-31st December 2021, divided into 2 groups. Group 1 (n=100) received T Progynova 6 mg/day and Group 2 (n=100) received Oestrogel 6 mg/day (17B oestradiol 0.06% gel Besins France) starting on day 1 of menses, without GnRH agonist pituitary downregulation. The oestrogen dose was adjusted accordingly to achieve endometrial thickness (ET) of minimum 8 mm, prior to initiation of vaginal progesterone. The pregnancy outcomes (biochemical pregnancy, clinical pregnancy, ongoing pregnancy, early pregnancy loss and ectopic pregnancy rates), duration of oestrogen usage and endometrial thickness measurement prior to embryo transfer were analysed. Results: The biochemical pregnancy rate in this study was 39%, with a clinical pregnancy rate of 31%. Comparing both preparations, the biochemical pregnancy rate (p=0.562), clinical pregnancy rate (p=0.705), ongoing pregnancy rate (p=0.623), and early pregnancy loss rate (p=0.705) were not statistically significant. The duration required to achieve optimal endometrial thickness (p=0.212), and endometrial thickness measurement prior to vaginal progesterone commencement (p=0.335) were comparable. Conclusion: Oestrogel is a non-inferior option to oestradiol valerate for endometrial preparation in HRT FET cycles, especially for patients with high risk of venous thromboembolism due to its safety profile.

The effect of the Ankle Pump Exercise (APE) counter system assisted ankle pump motion in patients after femoral neck fracture

ObjectiveTo explore the effect of the Ankle Pump Exercise (APE) counter system on moderate to high-risk Venous thromboembolism (VTE) after femoral neck fracture surgery.MethodsFrom June 2021 to June 2022, a total of 140 patients with moderate and high-risk VTE after femoral neck fracture surgery treated at the Department of Orthopedics of a tertiary hospital in Zhejiang were included and divided into observation (70 cases) and control (70 cases) groups according to whether APE counter system was used or not. The control group was given routine oral propaganda, and the observation group was given a comprehensive nursing intervention with APE counter system on the basis of the control group’s treatment. The compliance rates of the two groups on the postoperative 3st, 5rd, and 7th days were compared. Moreover, the General self-efficacy scale (GSES) was used to evaluate self-efficacy before and after exercise.ResultsThe compliance rates of the control group and the observation group on the postoperative 3st, 5rd, and 7th days were 74.3% vs. 85.7%, 67.1% vs. 85.7%, and 61.4% vs. 82.9%. On the 5rd and 7th days, the compliance of the observation group was obviously higher than that of the control group. Moreover, the mean postoperative GSES score was also significantly higher than that in the control group (23.20 ± 3.516 vs. 25.31 ± 4.583, P < 0.05, values are expressed in mean ± standard).ConclusionAPE counter system can significantly improve the compliance and self-efficacy of patients with moderate and high-risk VTE after lower limb fracture surgery.

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

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

Event rates and risk factors for venous thromboembolism and major bleeding in a population of hospitalized adult patients with acute medical illness receiving enoxaparin thromboprophylaxis

BackgroundWe aimed to describe the event rates and risk-factors for symptomatic venous thromboembolism (VTE) and major bleeding in a population of hospitalized acutely ill medical patients. MethodsPatients ≥40 years old and hospitalized for acute medical illness who initiated enoxaparin prophylaxis were selected from the US Optum research database. Rates of symptomatic VTE and major bleeding at 90-days were estimated via the Kaplan-Meier (KM) method. Risk factors were identified via the Cox proportional hazards model. ResultsA total of 123,022 patients met the selection criteria. The KM rates of VTE and major bleeding at 90-days were 3.5 % and 2.2 %, respectively. Among subgroups, the risk of VTE varied from 3.0 % in patients with ischemic stroke to 6.9 % in patients with a cancer-related hospitalization, and the risk of major bleeding varied from 1.9 % in patients with inflammatory conditions to 3.6 % in patients with ischemic stroke. Key risk factors for VTE were prior VTE (HR=4.15, 95 % confidence interval [CI] 3.80–4.53), cancer-related hospitalization (HR=2.35, 95 % CI 2.10–2.64), and thrombophilia (HR=1.64, 95 % CI 1.29–2.08). Key risk factors for major bleeding were history of major bleeding (HR=2.17, 95 % CI 1.72–2.74), history of non-major bleeding (HR=2.46, 95 % CI 2.24–2.70), and hospitalization for ischemic stroke (2.42, 95 % CI 2.11–2.78). ConclusionThere is substantial heterogeneity in the event rates for VTE and major bleeding in acute medically ill patients. History of VTE and cancer related hospitalization represent profiles with a high risk of VTE, where continued VTE prophylaxis may be warranted.