Incidence Of Thromboembolism In Patients Research Articles

Correlation Between Statin Use and Symptomatic Venous Thromboembolism Incidence in Patients With Ankle Fracture: A Machine Learning Approach.

Identifying factors that correlate with the incidence of venous thromboembolism (VTE) has the potential to improve VTE prevention and positively influence decision-making regarding prophylaxis. In this study, we aimed to investigate the correlation between statin consumption and the incidence of VTE in patients who sustained an ankle fracture. In this retrospective, case-controlled study, cases were those who developed VTE and controls were those who had no VTE, and the ratio was 1:4. Patients' demographics, history of hyperlipidemia, and reported statins use were obtained. A random forest classifier (RFC) model was used to predict whether statin consumers were at risk of VTE after ankle fracture regardless of VTE prophylaxis administration based on statin consumption, body mass index (BMI), age, and biological sex. Of the 1175 patients with ankle fractures, 238 had confirmed VTE (case group), and 937 had no symptomatic VTE (control group; ratio 1:4). Fifty (21%) cases and 407 (43%) controls were on a statin. Statin users had a significantly lower incidence of VTE after ankle fracture, odds ratio (OR) = 0.35, 95% CI: 0.25, 0.49, P < .001. Our model showed an area under the receiving operator curve (AUROC) of 78%, a sensitivity of 73%, and a specificity of 83% in predicting the risk of VTE. The importance of the predictors of VTE, other than the use of statins (model importance = 0.1), were age (model importance of 0.72), BMI (model importance of 0.24), and biological sex (model importance of 0.02). Statins were significantly associated with a lower rate of VTE in our population of patients who sustained an ankle fracture. 3.

The Incidence of Venous Thromboembolism in Dengue Viral Infections: A Systematic Review

BACKGROUND Dengue infection has become a major public health problem with significant socioeconomic burden to the increasing geographical extension, number of cases, and severity of the disease. One of the neglected complications in dengue is venous thromboembolism (VTE) which could also be as fatal is often overlooked in the overall management of dengue. OBJECTIVE This study aimed to provide a perspective on the incidence of thromboembolism in patients with dengue infection. METHODS The search strategy was conducted through PubMed and LinkSpringer. About 182 articles were retrieved using ‘vein thrombosis’ and ‘dengue’ keywords. Further, screening was carried out and resulted in 15 articles. In the end, five articles were included. To be eligible, the articles should be published from 2011-2121 and published in English. RESULTS This review found that VTE can occur in dengue patients of all ages, genders, and severities. VTE is more common in dengue shock syndrome patient rather than dengue haemorrhagic fever or least likely in dengue fever. Administering Anticoagulants is still the preferred option in managing VTE in dengue patients with caution of the thrombocyte count of patients. CONCLUSIONS The likeliness of VTE occurrence is linear with the severity of the dengue infection and the patient’s length of stay in hospitals. Preventive measures could be taken to prevent VTE in high-risk dengue patients, thus it is important to do risk scoring in high-risk patients. Thrombocytopenia must be taken into account when realizing said preventive measure, i.e., administering anticoagulant as prophylaxis.

Rationale and design of a prospective, multicenter, cohort study on the evaluation of postoperative Venous ThromboEmbolism incidence in patients with ColoRectal Cancer (CRC-VTE trial).

BackgroundVenous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication after abdominal surgery. The incidence of VTE after colorectal malignancy is higher than that after general surgery. Although more attention has been paid to the prevention of VTE, there is still a large gap between clinical practice and guideline recommendation.MethodsThe Venous ThromboEmbolism incidence in patients with ColoRectal Cancer (CRC-VTE trial) will be a prospective, multicenter, cohort study to determine the current status of the incidence, diagnosis, treatment, and prevention of VTE after colorectal cancer surgery in China, as well as to further improve the level of prevention and treatment of VTE events in these fragile patients. In this study, 1,217 patients will be enrolled at 40 centers in China and evaluated on VTE events and adverse events related to VTE prevention at 5–9 and 21–28 days after surgery. The primary outcome is the incidence of VTE events during the follow-up, and secondary outcome is the incidence of adverse events associated with VTE prevention.DiscussionThis study will comprehensively evaluate the incidence and prevention of VTE after colorectal cancer surgery in China, balance the relationship between VTE prevention and bleeding adverse events, and the formulate a guideline for the prevention of VTE after colorectal surgery that might suitable for national conditions.Trial RegistrationClinical trial registration number NCT04588805 (The CRC-VTE trial).

Carbamazepine, phenytoin, and oral anticoagulants: Drug‐drug interaction and clinical events in a retrospective cohort

BackgroundCarbamazepine and phenytoin are potent inducers of enzymes that metabolize oral anticoagulants. ObjectivesTo determine the clinical impact of drug‐drug interactions between these anticonvulsants and oral anticoagulants, and whether they affect the treatment with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Material and methodsData on patients cotreated with carbamazepine or phenytoin and an oral anticoagulant were retrospectively retrieved from medical records from 2011 to 2020. Outcomes were time in therapeutic range (TTR), DOAC levels, thromboembolic events, major bleeding, and all‐cause mortality. ResultsAmong 85 patients (37% female, median age 68 years) treated with carbamazepine (n = 43 [51%]) or phenytoin (n = 42 [49%]), 53 (62%) were initially treated with VKAs and 32 (38%) with DOACs. TTR in VKA patients was 63%, which improved in year 2. Four of seven trough and five of 12 peak DOAC plasma levels were lower than expected. The incidence rate (95% confidence interval) per 100 person‐years for thromboembolism was 3.6 (3.1‐4.2) for VKA patients and 4.4 (3.5‐5.6) for DOAC patients; for major bleeding 1.8 (1.5‐2.1) and 1.5 (1.2‐1.9), and for all‐cause mortality 3.6 (3.1‐4.2) and 1.5 (1.2‐1.9), respectively. Incidence rates between VKAs and DOACs and between carbamazepine and phenytoin were similar. ConclusionThere was a high incidence of thromboembolism in patients cotreated with anticoagulants and carbamazepine or phenytoin. The incidence rates of thrombotic and bleeding events were similar between VKA and DOAC patients. DOAC levels were lower than expected in 47% of cases tested, without correlation with clinical outcomes.

Risk of Venous Thromboembolism in Patients with Lung Cancer Treated with Immune Checkpoint Inhibitors

Background: Thromboembolism (TE) in cancer significantly contributes to morbidity and mortality. Cancer immunotherapy is linked to several inflammatory immune mediated adverse events. Inflammation plays a key role in thrombosis but the association between immunotherapy and venous thromboembolism (VTE) has not been thoroughly investigated. Here, we report the incidence of thromboembolism in patients with lung cancer treated with immune checkpoint inhibitors (ICIs).Methods: A single institution retrospective cohort of 514 adult patients with lung cancer who received ICIs (pembrolizumab, nivolumab, atezolizumab, ipilumab, avelumab) between 2013 and 2017 was included. Diagnosis of VTE (deep vein thrombosis and/or pulmonary embolism, and visceral vein thrombosis “VVT”) was confirmed by imaging. Overall survival (OS) was estimated by Kaplan-Meier and compared using log rank test. Cumulative incidence rate of VTE was estimated and compared using Gray's method.Results: Of 514 patients (pts), 58.75% were males, 83.27% were white with a median age of 67 (range 22-91). Nivolumab was most commonly used (52.14%), followed by Pembrolizumab (30.16%), Atezolizumab (10.89%), combination of ipilimumab plus nivolumab (6.61), ipilimumab (2.33%), Avelumab (1.17%). 88.52% had stage 4 disease at treatment initiation. VTE events occurred in 62 pts (12%) (3.5% DVT, 4.47% PE, 2.72% both, 0.97 VVT, 0.19 VVT + PE, 0.19% VVT+DVT+PE). The cumulative incidence rate of VTE of all pts at 6-month and 1-year post IO was 7.6% (95% CI:5.3-9.9%) and 11.6% (95% CI:8.7-14.6%) respectively. The rate of survival without VTE at 6 months after IO treatment was 91% (95% CI: 89-94%). None of the following factors (age, gender, race, cancer staging, IO type or line) were significantly associated with time-to-VTE (TTVTE) survival post treatment (P >0.05). Median OS of all pts was 12.6 months (95% CI: 11.0-16.7 months), with 2-year OS rate of 35% (95% CI: 31-41%).Conclusion: ICIs in lung cancer are associated with higher VTE risk within six months and a year of initiation of treatment. Further studies are needed to investigate the risk factors for ICIs-associated VTE. DisclosuresPennell: Astrazeneca: Consultancy, Honoraria; Merck: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; G1 therapeutics: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Genentech: Consultancy, Honoraria; Mirati Therapeutics, Inc.: Consultancy, Honoraria; Viosera Therapeutics: Consultancy, Honoraria; Eli Lilly: Consultancy, Honoraria; BMS: Consultancy, Honoraria. McCrae: Sanofi, Novartis, Alexion, and Johnson & Johnson: Consultancy, Honoraria; Dova, Novartis, Rigel, and Sanofi Genzyme: Consultancy. Khorana: Pfizer: Consultancy, Honoraria; Anthos: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Bayer: Consultancy, Honoraria.

Patients with mild congenital heart defects and atrial arrhythmias: anticoagulate all or follow the CHA2DS2-VASc score?

Abstract Purpose Clinical practice used to anticoagulated all patients with mild congenital heart defects (CHD) and atrial arrhythmias (AA) because of the presence of structural abnormalities. Current guidelines on adult congenital heart disease indicate that in these patients, as per general, the CHA2DS2-VASc score should be followed when deciding upon thromboprophylaxis in case AA. To validate this recommendation, we aimed to assess the incidence of thromboembolism in patients with mild CHD according to CHA2DS2-VASc score using non-vitamin K oral anticoagulants (NOACs) for AA. Methods Data are retrieved from the multinational NOTE-registry, which follows ACHD patients on NOACs for several indications since 2014. Patients in whom NOAC was prescribed for atrial arrhythmias were included in this study. The primary endpoint was the incidence of thromboembolism (TE) and major bleeding (MB). Secondary outcomes were minor bleeding and mortality. Risk stratification was performed using CHA2DS2-VASc score at baseline. Results The NOTE registry has up to date engaged leading ACHD-centers of up to 14 different countries throughout the world, thereby demonstrating a significant effort to fill the gap in science regarding the efficacy and safety of NOACs in the ACHD population. Out of a total of 638 patients, 72 patients had mild congenital defects and NOACs prescribed for AA. The mean age at baseline was 57 (±12) years and 56% was female. Patients were followed up to a maximum of 7 years (202 patient-years; median 2.5, IQR 1.2–4.0). In all patients with a CHA2DS2-VASc score of 0 (n=24), no TE occurred (annualized TE-rate 0%), while 2 patients suffered a MB (annualized MB-rate 3.3%; Figure 1). In patients with a CHA2DS2-VASc score of 1 (n=8) or ≥2 (n=40) the annualized eventrates were 0% and 0.8% for TE, and 0% and 1.7% for MB, respectively. Conclusion These reassuring results demonstrated that the annualized eventrate for TE in patients with mild CHD and a CHA2DS2-VASc score of 0 under treatment with NOACs is very low, at the cost of major bleedings. Following the guidelines seems justified: similar to patients with acquired heart disease the prescription of oral anticoagulant therapy can be refrained from in patients with CHA2DS2-VASc score of 0 and in those with CHA2DS2-VASc score 1 it can be debated weighing the risks and benefits. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Heart Institute Figure 1. Eventrates of TE and MB

Association of left ventricular end-diastolic diameter with incidence of thromboembolism in patients with non-valvular atrial fibrillation: the Fushimi AF Registry

Abstract Background Atrial fibrillation (AF) is a common arrhythmia and a risk factor for thromboembolism including ischemic stroke (IS) and systemic embolism (SE). Thrombus formation mainly occurs in the left atrium (LA), but we reported that relative wall thickness (RWT) of left ventricle (LV) was independently associated with IS/SE among patients with non-valvular AF. Little is known about the impact of LV size on thromboembolism in patients with AF. We investigated the relationship between left ventricular end-diastolic diameter (LVDd) and incidence of IS /SE, using data from the Fushimi AF Registry. Methods The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in the community. Follow-up data were available for 4,472 patients as of November 2020, and the median follow-up period was 1,820 days. Of them, we excluded 226 patients with mitral stenosis or prior cardiac valve surgery. Among 4,246 non-valvular AF patients, follow-up data including LVDd at the baseline from echocardiography were available for 3,311 patients. We divided these patients into three groups according to LVDd tertile (T1:&amp;lt;44.0 mm; n=1,091, T2: 44.0–48.5; n=1,112, T3: 48.5 or above; n=1,108), and compared the clinical characteristics and outcomes. Results Percentage of female (T1 vs. T2 vs T3; 56.5 vs. 37.5 vs. 34.1%; p&amp;lt;0.01), age (76.2±9.9 vs. 72.8±10.7 vs. 71.9±11.1 years; p&amp;lt;0.01), height (156.3±9.9 vs. 160.4±9.4 vs. 163.7±9.5 cm; p&amp;lt;0.01), BMI (21.8±3.9 vs. 23.3±3.6 vs. 24.2±4.4 kg/m2; p&amp;lt;0.01), prevalence of hypertension (58.8 vs. 64.1 vs. 67.7%; p&amp;lt;0.01), vascular disease (7.4 vs. 8.8 vs. 15.2%; p&amp;lt;0.01), CHA2DS2-VASc score (3.59±1.68 vs. 3.27±1.70 vs. 3.31±1.73; p&amp;lt;0.01) and the prescription of oral anticoagulants (OACs) were different among groups. LV ejection fraction (65.9±8.7 vs. 65.0±9.1 vs. 57.7±14.4%; p&amp;lt;0.01), LA diameter (40.7±7.9 vs. 42.8±7.3 vs. 45.8±7.6 mm; p&amp;lt;0.01), LVRWT (0.471±0.090 vs. 0.411±0.064 vs. 0.366±0.063; p&amp;lt;0.01) and LV mass index (79.6±21.4 vs. 93.5±20.4 vs. 117.6±30.3 g/m2; p&amp;lt;0.01) were different. Prevalence of prior stroke/SE and prior major bleeding were comparable among groups. In Kaplan-Meier analysis, the incidence of IS/SE was different among the groups during the median follow-up period of 1,826 days (T1 vs. T2 vs T3; 2.1 vs. 1.9 vs. 1.1 per 100 person-years; p&amp;lt;0.01, by log-rank test) (Figure). LVDd (All age, hazard ratio [95% confidential interval]: T1/T3 1.57 [1.09–2.29]; p=0.02, T2/T3 1.55 [1.11–2.17]; p&amp;lt;0.01: less than 75 years, T1/T3 2.27 [1.24–4.22]; p&amp;lt;0.01, T2/T3 1.54 [0.89–2.70]; p=0.12: 75 years or above, T1/T3 1.33 [0.83–2.14]; p=0.08, T2/T3 1.57 [1.04–2.40]; p=0.03) was an independent predictor of the incidence of IS/SE after adjustment by the components of CHA2DS2-VASc score, LA diameter, LVRWT, type of AF and the prescription of OACs (Table). Conclusion LVDd was independently associated with IS/SE among Japanese patients with non-valvular AF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Practical Research Project for Life-Style-related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development

Venous thromboembolism in women with ovarian cancer undergoing neoadjuvant chemotherapy prior to cytoreductive surgery: A retrospective study

Ovarian cancer is associated with a venous thromboembolism risk of at least 7.2% by 2years from diagnosis, and although patients undergoing surgery benefit from routine thromboprophylaxis, those undergoing neoadjuvant chemotherapy do not. This study aims to determine the venous thromboembolism incidence in patients with ovarian cancer undergoing neoadjuvant chemotherapy, and explore whether any subset is at higher risk, in order to evaluate whether thromboprophylaxis is justified in some or all of these patients. This was a retrospective review of all women undergoing neoadjuvant chemotherapy for FIGO radiological stages III and IV primary ovarian, fallopian tube, and primary peritoneal cancer, between 2000 and 2015, in a London tertiary cancer center. The primary outcome was venous thromboembolism rate among women undergoing neoadjuvant chemotherapy. The secondary outcomes were patient or treatment factors associated with venous thromboembolism risk, including age, body mass index, smoking status, performance status, and tumor stage. We identified 278 eligible women from the ovarian cancer database. Fifty-eight women (20.9%) developed venous thromboembolism between initial presentation and the immediate postoperative period, of which 45 (77.6%) developed a pulmonary embolism. In all, 15.1% of women developed venous thromboembolism from the start of neoadjuvant chemotherapy. Age, body mass index, smoking, or other comorbidities were not significantly associated with venous thromboembolism risk. One woman died from massive pulmonary embolism, 27 women underwent inferior vena cava filter insertion, and 10 had surgery delayed. This study demonstrates an unacceptably high rate of avoidable venous thromboembolism including pulmonary embolism in these women, which complicates and delays treatment. Thromboprophylaxis during neoadjuvant chemotherapy should now be assessed prospectively.

Incidence of venous thromboembolism in patients with solid cancers in Japan: retrospective study of 2735 patients.

The incidence of cancer-associated venous thromboembolism (CA-VTE) in Japan has not been fully investigated. Clinicopathological information from patients with solid malignancies who first visited our department between November 2011 and March 2018 were retrospectively reviewed from medical records. The primary outcome was incidence of CA-VTE, defined as deep-vein thrombosis (DVT) and/or pulmonary embolism (PE). On median follow-up of 187days, 91 of 2735 patients (3.3%) developed CA-VTE during their clinical course, giving an incidence rate of 40.7 per 1000 person-years. Of the 91 patients, 75 (82%) were diagnosed with DVT alone, 6 (7%) with PE alone, and 10 (11%) with both DVT and PE. CA-VTE was most frequent in non-small cell lung cancer (10.8%), followed by cancer of unknown origin (5.8%). Forty-four patients (48%) had one or more symptoms at the initial diagnosis of VTE. Five patients (6%) had a normal D-dimer level (≤ 1.0µg/mL); of these, 2 were asymptomatic. In this retrospective study, the incidence of CA-VTE in Japanese patients with cancer was equivalent to that in Western populations. Approximately half of CA-VTE patients were asymptomatic and 6% had normal D-dimer levels, indicating the need for closer attention to occult CA-VTE.

High incidence of thromboembolism in patients with chronic GVHD: association with severity of GVHD and donor-recipient ABO blood group

Chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) is associated with systemic inflammation and endothelial dysfunction, increasing risk for thromboembolic events (TEE). In 145 adult recipients who developed cGVHD after a matched sibling or umbilical cord blood donor HCT from 2010 to 2018, 32(22%) developed at least 1 TEE event, and 14(10%) developed 2 TEE events. The 5-year cumulative incidence of TEE was 22% (95% CI, 15–29%) with a median time from cGVHD to TEE of 234 days (range, 12–2050). Median time to the development of LE DVT or PE was 107 (range, 12–1925) compared to 450 days (range, 158–1300) for UE DVT. Cumulative incidence of TEE was 9% (95% CI, 0–20%), 17% (95% CI, 9–25%), and 38% (95% CI, 22–55%) in those with mild, moderate, and severe GVHD, respectively. Higher risk for TEE was associated with cGVHD severity (hazard ratio [HR] 4.9, [95% CI, 1.1–22.0]; p = 0.03), non-O-donor to recipient ABO match compared to O-donor to O-recipient match (HR 2.7, [95% CI, 1.0–7.5]; p = 0.053), and personal history of coronary artery disease (HR 2.4, [95% CI, 1.1–5.3]; p = 0.03). TEE was not associated with 2-year non-relapse mortality or 5-year overall survival.

Decreased Mortality of COVID-19 with Anticoagulants and Antiplatelet Therapy in Patients with High Risk of Thromboembolism a Meta-Analysis

BACKGROUND: The clinical presentation of patients with COVID-19 varied considerably, ranging from asymptomatic infection to severe pneumonia that may lead to coagulation abnormality and pulmonary thromboembolism. Targeted antithrombotic therapy may be beneficial to reduce the incidence of thromboembolism in patients with COVID-19. METHODS: We will conduct a systematic review based on searches of major databases (PUBMED, Web of Science and EMBASE) and clinical trial registries from inception to present. The search strategy included clinical date published until Aug 12, 2020. All published randomized retrospective, control and quasi-randomized trials, and observational studies related to antiplatelet/anticoagulant therapy for COVID-19 patients with high risk of thromboembolism will be included. The primary outcome was death events, secondary outcome was disease severity of COVID-19. We used Review Manager 5.3 software to calculate the odds ratio and corresponding 95% CI. The χ2 test (assessing the P) and the I2 statistic were performed to estimate the heterogeneity. RESULTS: Compared with non-antiplatelet/anticoagulant therapy, antiplatelet/anticoagulant therapy was not associated with disease severity (odds ratio, 0.70 [95% CI, 0.41–1.21], P=0.20, I2=52%) but was related to lower mortality of COVID-19 in patients with high risk of embolism (odds ratio, 0.33 [95% CI, 0.24–0.47], P&lt;0.001, I2=8%). CONCLUSION: Current evidence suggested that antiplatelet/anticoagulant therapy should be continued in COVID-19 patients with high risk of thromboembolism. the majority of patients with severe COVID‐19 should have received similar supportive treatment after admission.

Incidence of thromboembolism in patients with melanoma on immune checkpoint inhibitor therapy and its adverse association with survival

BackgroundThromboembolism (TE) in cancer significantly contributes to morbidity and mortality. Little is known about the incidence of arterial TE (ATE) and venous TE (VTE) in patients with melanoma on immune...

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

BackgroundSince the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization.MethodsMedline, Embase, Scopus, and grey literature were searched until June 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model.ResultsA total of 36 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 28% (95% CI, 22–34%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (32% [95% CI, 18–45%] vs. 6% [95% CI, 4–9%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2–5%). In the non-ICU setting, the pooled incidence of VTE was 10% (95% CI, 6–14%,).ConclusionsThe incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19.

Pathogenic Mechanisms of Venous Thromboembolism in Ovarian Tumor Patients

Venous thromboembolism (VTE) is a serious complication of ovarian cancer. However, the mechanism of thrombus formation in ovarian cancer has not been sufficiently clarified. We aimed to examine the pathogenic mechanism of thromboembolism in patients with ovarian tumors before surgery using the activated protein C sensitive ratio (APC-sr) and endogenous thrombin potential (ETP) measurements in plasma. The incidence of thromboembolism in patients with ovarian tumors was determined. APC-sr and ETP were measured from plasma samples obtained from ovarian tumor patients before surgery at our hospital. There were 60 enrolled patients. Thrombosis was found in 10 patients, of which 9 had ovarian cancer and 1 had borderline malignancy. The incidence of thromboembolism was significantly higher in cases of ovarian cancer than in cases of benign and borderline tumors (p < 0.001). However, APC-sr and ETP did not differ between patients with and without thromboembolism (p = 0.681, 0.796). APC-sr and ETP may not be involved in the pathogenic mechanism of thromboembolism in patients with ovarian tumors before surgery. Thus, other approaches should be considered for detecting the pathogenic mechanism of thromboembolism in this population.

Association of relative wall thickness of left ventricle with incidence of thromboembolism in patients with non-valvular atrial fibrillation: The Fushimi AF Registry.

Atrial fibrillation (AF) increases the risk of thromboembolism, such as ischaemic stroke or systemic embolism (SE). The aim of this study was to investigate the relationship between left ventricular relative wall thickness (RWT) and the risk of thromboembolism in patients with non-valvular AF. The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Japan. Analyses were performed on 3067 non-valvular AF patients, in which RWT values determined by transthoracic echocardiography were available at the baseline. The high-RWT group (RWT above the median) was more often female, older, and had higher systolic blood pressure, CHADS2 and CHA2DS2-VASc scores, as compared with low-RWT group. During the median follow-up period of 1309 days, there was a higher incidence of ischaemic stroke/SE in the high-RWT group [unadjusted hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.42-2.59]. On multivariate Cox regression analysis, including the components of CHA2DS2-VASc score, left atrial diameter, oral anticoagulant prescription at baseline, and type of AF, high RWT was independently associated with ischaemic stroke/SE (adjusted HR, 1.81; 95% CI, 1.34-2.47). Stratified analysis demonstrated no significant interaction for any subgroups. In Kaplan-Meier analysis, ordinal RWT quartiles stratified the incidence of ischaemic stroke/SE. Finally, addition of RWT to CHA2DS2-VASc score increased the performance of risk stratification for the incidence of stroke/SE. Relative wall thickness was independently associated with ischaemic stroke/SE among Japanese patients with non-valvular AF, suggesting the importance of left ventricular morphology in contributing to adverse outcomes, particularly thromboembolism.

Hyperuricemia: risk factor for thromboembolism in hypertrophic cardiomyopathy patients.

Hyperuricemia has been regarded as a risk factor for various cardiovascular diseases. However, few studies have evaluated its influence on thromboembolism in hypertrophic cardiomyopathy (HCM) patients. The purpose of the present study is to investigate the association between hyperuricemia and thromboembolism in a retrospective HCM cohort. A total of 447 adult HCM patients were enrolled in this study from December 2008 to May 2016. Uric acid levels were measured at baseline. Hyperuricemia was defined as blood uric acid level > 360µmol/L for female patients and > 420µmol/L for male patients, respectively. The association between hyperuricemia and thromboembolism was analyzed. During the follow-up period of 1786.8 person-years, 31 patients (6.9%) developed thromboembolic events. There was a higher thromboembolism incidence in patients with hyperuricemia than those with normouricemia (8.9% vs. 5.6%; unadjusted HR 2.35, 95% CI 1.16-4.78, P = 0.018). The association slightly increased after adjusting for potential confounders (HR 2.67, 95% CI 1.24-5.76, P = 0.013). Atrial fibrillation (AF) and left ventricular outflow tract obstruction played an interactive role in the relationship between hyperuricemia and thromboembolism with P for interaction of 0.011 and 0.007, respectively. Adjusted HRs of hyperuricemia were 8.99 (95% CI 2.23-36.29, P = 0.002) for thromboembolism in HCM patients with AF and 6.89 (95% CI 2.23-21.24, P = 0.001) in non-obstructive HCM patients. The association lost statistical significance among patients without AF and obstructive ones. Hyperuricemia significantly predicts future thromboembolism in HCM patients, especially in HCM patients with AF and non-obstructive HCM patients. Future studies are warranted for further evaluation.

Prospective Registry of Rivaroxaban Management of Cancer-Associated Venous Throboembolism (PRIMECAST) Study

Background: The incidence of thromboembolism in patients with cancer is approximately 11%, and the risk of thrombosis in patients with malignant tumors is 6-fold higher than that in healthy persons. Thrombosis not only disrupts the treatment of cancer but also induces deterioration of quality of life (QOL). Knowledge about thrombus treatment is limited, and evidence is scarce. Clarification of the status and safety of venous thromboembolism (VTE) treatment in patients with cancer will contribute to active intervention and improvement of prognosis and QOL. In this study, the therapeutic effects of a non-vitamin K antagonist oral anticoagulant for VTE and the prognosis of cancer after treatment will be examined to establish a therapeutic method for VTE in patients with cancer.Methods and Results: A multicenter, non-interventional, observational study will be conducted in patients with cancer who developed VTE and underwent anticoagulant therapy with rivaroxaban (group A) or warfarin (group B) for 24 weeks. The primary endpoint will be the recurrence/aggravation of symptomatic VTE or occurrence/aggravation of deep vein thrombosis. Registration of 500 patients is needed in order to calculate the 95% confidence interval of the event rate at ±1% precision.Conclusions: The investigation period will run from January 2019 to December 2023 with ongoing selection of patients. Trial registration: no. 5-18-32 (approved 1 August 2018).

Does Tranexamic Acid Increase the Incidence of Thromboembolism After Spinal Fusion Surgery?

This was a retrospective analysis of prospectively collected data. To investigate the incidence of thromboembolism in patients who received tranexamic acid (TXA) after lumbar spine fusion and determine the diagnostic value of lower limb duplex sonography as a screening test. TXA is effective in reducing blood drainage in spine fusion surgery but some studies have reported increased incidence of venous thromboembolism associated with TXA. One hundred twenty-two patients who underwent lumbar fusion for degenerative spinal disease received intravenous TXA in doses equivalent to 10 mg/kg for 48 hours after surgery. As a control group, 85 patients received intravenous administration of the same amount of normal saline. D-dimer levels were checked on the day of admission and the seventh postoperative day (POD#7). All patients underwent duplex sonography on POD#7, and patients with abnormal results were further evaluated with computed tomography angiography and pulmonary arterial angiography. None of the patients showed symptoms of deep vein thrombosis (DVT). Suspicious signs of DVT were observed in 5 patients in the TXA group and 4 patients in the control group in lower limb duplex sonography. Finally, DVT was confirmed by computed tomography angiography in one of 122 patients (0.8%) in the TXA group and in one of 85 patients (1.2%) in the control group. D-dimer levels on POD#7 were higher in the patients with DVT than in patients without DVT. Average postoperative blood drain was 421.3±133.1 mL in the TXA group and 635.2±151.2 mL in the control group (P<0.001), which showed TXA was effective to reduce postoperative hemorrhage. The incidence of thromboembolism after using TXA in lumbar fusion surgery was 0.8%, as comparable as the incidence of thromboembolism in the control group. Lower limb duplex sonography is not recommended for screening test of DVT because of high false-positive rate. Level III.

Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study.

The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE. We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year. A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups. Long-term HCQ appears to have no vascular protective effect in patients with SLE.

259P Thromboembolism incidence in patients with pancreatic cancer receiving chemotherapy: A single-institutional retrospective cohort analysis

259P Thromboembolism incidence in patients with pancreatic cancer receiving chemotherapy: A single-institutional retrospective cohort analysis