Incidence Of Venous Thromboembolic Disease Research Articles

Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study

ObjectiveOur objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM). DesignRetrospective cohort study (2014–2022). SettingMedic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center. PatientsAdult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy. InterventionsNone. Main variables of interestWe analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU. ResultsWe included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary. ConclusionsIn this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%. Clinical Trial RegistrationNCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).

Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study

ObjectiveOur objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM). DesignRetrospective cohort study (2014–2022). SettingMedic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center. PatientsAdult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy. InterventionsNone. Main variables of interestWe analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU. ResultsWe included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary. ConclusionsIn this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%. Clinical Trial RegistrationNCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).

Clinical Characterization of Patients with Venous Thromboembolic Disease in 2 Reference Centers in El Salvador

Introduction. During the last decade, venous thromboembolic disease (VTE) has become increasingly important due to its high impact on morbidity and mortality in patients. Suspicion scores together with the diversification of diagnostic methods have allowed rapid and timely diagnosis. Although the annual incidence of VTE is estimated to be approximately 1 in 1,000 people, the risk in certain groups is significantly higher. For the United States, the statistics do not vary significantly. It is estimated that DVT and PE affect between 350,000 and 600,000 people a year, causing between 100,000 and 300,000 deaths. For El Salvador, there are no clinical data related to risk and development factors. Aim. To describe the clinical characteristics of patients with venous thromboembolic disease in 2 reference centers of the Salvadoran Social Security Institute in 2020. Methods. This study is retrospective, observational, cross-sectional and descriptive. All patients with a first-time or recurrent diagnosis that were documented by venous Doppler of the lower and/or upper limbs, computed tomography angiography, magnetic resonance imaging and/or venography at the General Hospital, Medical Surgical and Oncological Hospital of Social Security were included. diagnosed in the internal medicine hospitalization area and in outpatient consultation for the first time in the Hematology Service during the period established between January and December 2020. Results. Of the total of 138 registered patients, the final study population that met all the inclusion criteria was 88, of which the majority corresponded to the female gender in 56.8% (n=50), with a mean age for all of them. the cases of 55 years (range 23 to 88 years). Regarding the associated comorbidities, the 2 main ones were arterial hypertension 52.3% (n=46) and diabetes mellitus 25% (n=22), the most prevalent risk factor being the use of OACs with 9.1% (n=8 ). The most frequent anatomical location was the left lower limb with 45.2% (n=46) of the cases and at the time of diagnosis the initial treatment of all patients with thrombosis was with low molecular weight heparins in 51.1% (n=45). ). VTE in any of its entities continues to be a disease predominantly in adults and women, which is favored by various modifiable and sometimes preventable risk factors. Conclusions. VTE in any of its entities continues to be a disease predominantly in adults and women, which is favored by various modifiable and sometimes preventable risk factors. The main anatomical location of thrombosis is in the lower limbs, mainly on the left side, and in the lungs in main branches. Regardless of the location, mortality is similar in deep vein thrombosis and pulmonary embolism.

Biosimilar versus branded enoxaparin to prevent postoperative venous thromboembolism after surgery for digestive tract cancer: Randomized trial.

Cancer and/or major surgery are two factors that predispose to post-operative thrombosis. The annual incidence of venous thromboembolic disease (VTED) in cancer patients was estimated at 0.5%-20%. Surgery increases the risk of VTED by 29% in the absence of thromboprophylaxis. Enoxaparin is a low molecular weight heparin that is safe and effective. Branded Enoxaparin and biosimilar Enoxaparin are two enoxaparin treatments. This study aimed to compare Branded Enoxaparin with biosimilar Enoxaparin in patients operated on for digestive cancer regarding the prevention of postoperative thrombosis event, to compare the tolerance of the two treatments and to identify independent predictive factors of thromboembolic incident. A randomized controlled trial conducted in a single-centre, surgical department B of Charles Nicolle Hospital, over a 5-year period from October 12th, 2015, to July 08th, 2020. We included all patients over 18 who had cancer of the digestive tract newly diagnosed, operable and whatever its nature, site, or stage, operated on in emergency or elective surgery. The primary endpoint was any asymptomatic thromboembolic event, demonstrated by systematic US Doppler of the lower limbs on postoperative day 7 to day 10. The sonographer was unaware of the prescribed treatment (Branded Enoxaparin [BE] or biosimilar Enoxaparin [BSE]). Of one hundred sixty-eight enrolled patients, six patients (4.1%) had subclinical venous thrombosis. Among those who had subclinical thrombosis, four patients (5.6%) were in the Branded Enoxaparin group and two patients (2.7%) in the Biosimilar Enoxaparin group without statistically significant difference (p = 0.435). Analysis of the difference in means using Student's t test demonstrated the equivalence of the two treatments. Our study allowed us to conclude that there was no statistically significant difference between Branded Enoxaparin and Biosimilar Enoxaparin regarding the occurrence of thromboembolic accidents postoperatively. BE and BSE are equivalent. Trial registration. Trial registration: The trial was registered on CLINICALTRIALS.GOV under the number NCT02444572.

Characteristics and Effect of Rivaroxaban on Venous Thromboembolism in Korean Patients Compared to Western Population: A Subgroup Analysis from XALIA(-LEA) Study.

This study aimed to compare the characteristics of venous thromboembolic disease (VTE) in Korean to Caucasian population. XALIA-LEA and XALIA were phase IV non-interventional prospective studies with identical designs that investigated the effect of rivaroxaban versus standard anticoagulation for VTE. Koreans accounted for the largest proportion of the overall enrolled population of XALIA-LEA. However, in the XALIA study, most patients were Caucasian. Therefore, Korean data from XALIA-LEA and Caucasian data from XALIA were used in this study. This study compared the clinical characteristics and primary outcomes of the XALIA program, including major bleeding, recurrent VTE, and all-cause mortality. The Korean population was older, was less obese, and had more active cancer at baseline than the Caucasian population. Provoked VTE was more common in the Korean population. Interestingly, Koreans showed less accompanying thrombophilia than Caucasians, and factor V Leiden mutations were not detected. Korean analyses comparing the effects of rivaroxaban and standard anticoagulation with primary outcomes showed a lower incidence of major bleeding, recurrent VTE, and all-cause mortality with rivaroxaban. Similar results were obtained in the propensity score matching analysis. Characteristic differences were found between Korean and Caucasian VTE patients. Despite these ethnic differences, the effectiveness and safety of rivaroxaban therapy in these patients were consistent.

COVID-19 associated coagulopathy and thrombosis in cancer

Cancer patients are at risk for a more severe COVID-19 infection as well as an adverse outcome of such infection. This may be caused by the cancer itself (e.g haematological malignancies and lung cancer) or due to immune suppression caused by anti-cancer treatment. Severe COVID-19 infections are often complicated by a coagulopathy that clinically results in a high incidence of venous thromboembolic disease. Cancer itself is associated with a hypercoagulable state and a markedly increased incidence of thromboembolic complications, hence the combination of cancer and COVID-19 may amplify this risk. COVID-19 vaccination seems safe and effective in most cancer patients although adapted and bespoke vaccination schemes may increase the seroconversion rate and immune response in selected patients. Specific management strategies to improve outcomes of cancer patients in COVID-19 (e.g. higher intensity antithrombotic prophylaxis) are lacking and should be evaluated in clinical studies simultaneously focusing on efficacy and safety.

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

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

1688P Impact of immunotherapy on the risk of thromboembolic disease in patients with melanoma

Although melanoma is not associated with a high incidence of venous thromboembolic disease (VTE) and arterial thrombosis (AT), it is unknown whether immune checkpoint inhibitors (ICI) increase the risk of VTE/AT.

VENOUS THROMBOEMBOLIC DISEASE IN PATIENTS WITH CHRONIC LUNG DISEASE

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

Incidence of venous thromboembolic disease (VTE) in a cohort of patients with colorectal cancer (CRC) according to KRAS, NRAS and BRAF status.

e15136 Background: A recent study has suggested that KRAS mutation could increase the risk of VTE in patients with CRC. The role of others biomarkers, such as BRAF, in this setting is unknown. The aim of this study is to analyze the incidence of cancer-associated thrombosis in a cohort of patients with CRC based on KRAS, NRAS and BRAF status. Methods: We performed a retrospective review of patients with metastatic CRC and KRAS/NRAS/BRAF status known, attended in the Medical Oncology Department of the Hospital General Universitario Gregorio Marañón (Madrid, Spain) between January 2010 and January 2018. Results: 194 patients were identified and included in the analysis. The median age was 64 years (18-86). Most were metastatic at diagnosis (58.1%). Khorana’s predictive model: low-risk 67.7%, intermediate-risk 31.0%, high-risk 2.3%. The median follow-up was 35 months (2-240). 41 patients (21.1%) experienced VTE (11 pulmonary embolism, 15 lower extremity deep-vein thrombosis, 12 visceral vein thrombosis, 2 catheter-related thrombosis, 1 unknown). Most had metastatic disease at the moment of VTE (90.2%). 40% of the events occurred at the time of diagnosis or within the first 6 months. 65% were incidental events. Khorana’s predictive model in VTE patients: low-risk 63.4%, intermediate-risk 24.5%, high-risk 7.3%. According to biomarkers, the incidence was 19.1% (13/68) in KRAS/NRAS mutated patients, 28.6% (6/21) in BRAF mutated patients and 21% (22/105) in triple-wild-type patients. 6/38 patients (15.8%) developed recurrent thrombosis. In the univariate analysis, the presence of chronic kidney disease (p = 0.022), ECOG ≥ 2 (p = 0.038) and high-risk Khorana score (p = 0.011) were significantly associated with increased risk of VTE. Metastatic disease showed a trend towards the statistical significance (p = 0.053). In the multivariate model, including this variables, age, sex and biomarkers, only ECOG ≥ 2 remained independent predictor of VTE (OR 8.73; CI 95% 1.32-57.82; p = 0.025). Conclusions: The biomarkers have not been associated with the risk of VTE. We have observed a high incidence of VTE in BRAF mutated patients that should be investigated in further studies.

Incidence of hospital-acquired venous thromboembolic disease.

There is limited knowledge of the incidence of venous thromboembolic disease (VTE) during hospitalization, since most of these are community-based data. To estimate the incidence rate (IR) of VTE developed during hospitalization. Prospective cohort of all inpatients admitted in a university tertiary hospital, in Argentina. The inclusion criteria were defined as: adult patients consecutively admitted from July/2006 to August/2013, for any cause. Patients admitted for VTE were excluded; all patients at the time of admission were free of event. Each person was followed contributing time at risk, from admission to event, discharge or death. VTE incident cases were captured from the Institutional Registry of Thromboembolic Disease (ClinicalTrials.gov Identifier NCT01372514). Incidence rate was calculated with 95% confidence intervals. The crude incidence rate of VTE for clinical patients was 0.49 (95%CI 0.45-0.55) per 1,000 cases person-days, and IR adjusted for WHO was 0.23 (95%CI 0.19-0.26). The crude IR of VTE for surgical patients was 0.25 (95%CI 0.23-0.27), and IR adjusted for WHO was 0.13 (95%CI 0.10-0.17). The incidence rate ratio (IRR) for VTE shows that surgical admission reduces the IRR and age categories increases the thrombosis rate risk, after adjustment for age category, sex and surgical admission. This study suggests that there is a high risk of VTE in hospitalized patients and is still a frequent problem.

Antithrombotic treatment in neonates and children.

Despite the increasing incidence of venous thromboembolic disease in pediatric patients, it remains a rare complication in childhood. Particularly neonates and adolescents are at risk for development of venous thrombosis. Spontaneous thrombotic events are sporadic, the majority of children have multiple coexisting risk factors, including central venous catheter, asphyxia, congenital heart disease, infection, malignancy, surgery and hypovolemia. Most thrombi are diagnosed by ultrasonography. Recommendations for management of pediatric thrombosis are typically extrapolated from adult studies, despite many differences between adults and children, including developmental hemostasis. This review will focus on the management of venous thrombosis in neonates and children, and discuss the use of the available antithrombotic agents in both age categories with reference to those differences.

Hospital incidence and annual rates of hospitalization for venous thromboembolic disease in France and the USA.

Objective The study was designed to describe the hospital incidences and annual hospitalization rates for venous thromboembolic disease by age and sex in France and the United States on the closest possible methodological bases. Methods French statistics are from the PMSI MCO (Programme de médicalisation des système d'information de médecine, chirurgie et obstétrique (French national hospital discharge register)) national database. These are compiled for each calendar year by collating résumé de sortie anonymisé (RSA, anonymous discharge summary) files forwarded and validated by health establishments with admissions in medicine, surgery, obstetrics, and odontology. They are compared to the data issued from the US National Hospital Discharge Survey which is equivalent to the PMSI in France and uses the International Classification of Diseases-9 for encoding the data. These data were published in the Morbidity, Mortality Weekly Report of the Centre for Disease Control. Results In the US, 547,996 hospital stays involve venous thromboembolic diseases, 348,558 deep venous thrombosis (DVT), and 277,549 pulmonary embolism (PE). Of these 78,511, or 14%, include a diagnosis of both DVT and PE. The hospital incidence of venous thromboembolic disease is 1.4%, DVT 0.9%, and PE 0.7%. In France, of the 26,658,228 annual hospital stays, 273,931 include venous thromboembolic disease, 179,286 DVT, and 139,345 PE while 44,700, i.e. 16.3%, include both DVT and PE. The hospital incidence of venous thromboembolic disease is thus 1.0%, DVT 0.6%, and PE 0.5%. The overall annual hospitalization rates for venous thromboembolic disease, DVT, and PE are respectively 274, 179, and 139 per 100,000 inhabitants in France and 239, 146, and 121 per 100,000 inhabitants in the US. Conclusion Venous thromboembolic diseases occur in France and the US in 1% of all hospital stays and are responsible for an annual hospitalization rate that exceeds 200 per 100,000. The scale of these annual incidences should prompt us to question the quality of prevention put in place and/or its efficacy.

Thrombophilia and Thrombotic Disorders in Newborns

incidence in children is estimated at about 0.7 cases of venous thrombosis per 100,000 population, 1.0 of stroke and 0.1 of myocardial infarction, while in adults the incidence reported is 74.2, 45.4 and 175.6 cases respectively. The lower incidence of venous thromboembolic disease (VTE) in children compared to adults is mainly due to the integrity of the vessels and the enhanced anticoagulant activity of the endothelium, and additionally to the reduced capacity of thrombin generation, inactivation of thrombin by a2-macroglobulin, the increased concentration of which, counterbalances the physiological deficiency of antithrombin and protein C / S, to the decreased levels of tissue factor in cord blood and concentration of eicosanoids and proteoglycans, depending on age [2,3]. The incidence of thromboembolic events (VTE) is higher in infants than in older children. About 10% of VTE occur in the first four weeks of life, frequently in critically ill neonates (2.4 symptomatic VTE cases per 1000 admissions in Neonatal Intensive Care Units-NICU). The incidence of symptomatic venous thrombosis (VTE) in newborns is 5.1/100,000 live births [4]. Although it is considered that the thromboembolic events are under diagnosed, newborns are nearly 40 times more likely to suffer a VTE than during the entire childhood, but certainly the above probability is significantly less than that referred in adults [5,6]. The hemostatic system both in preterm and full-term newborns differs significantly from that of older children and much more than that of adults, however, normally in newborns there is a balance in between bleeding or thrombosis diathesis. The increased incidence of VTE in critically ill infants is attributed to the derangement of equilibrium of the hemostatic mechanism, because of the lower concentrations of natural inhibitors and impaired fibrinolytic activity and also due to elevated levels of factor von Willebrand [7]. The combination of the above with both the high viscosity of blood due to the high hematocrit and the small vascular diameter of newborns results in low capillary flow, especially on coexistence of dehydration or hypercoagulable state because of infection or prematurity. Furthermore, the use of venous or arterial catheters is one of the major risk factors for thrombosis in neonatal period. Nowadays, 15% of infants in NICU and at least 50% of preterm infants of birth weight 90% of cases) or congenital risk factors. For the manifestation of VTE in neonates, several coincidental risk factors (variety of underlying diseases or triggering events of the child or maternal) are required. Studies so far, have not revealed thrombophilic factors contributing to the occurrence of asymptomatic or symptomatic VTE [8]. Genetic factors are related to the risk of VTE in children and newborns but no causal relationship is established for most of them [9]. The frequency of presence of thrombophilic factors in children with VTE is reported 13-79% in several studies. The huge discrepancy is attributed mainly to variation in the design of the trials, the difficulty in the definition of related prothrombotic disorders, and also to the small number and different patient populations. Regarding thromboembolic events of central venous system (CNS) [10], and although the high frequency of idiopathic arterial ischemic events (AIS) [11], the prevalence of thrombophilic factors varies in different studies from 20 to 50%, while increased appears the possibility of the presence of congenital thrombophilia in neonates with renal, hepatic or portal vein thrombosis [12]. Furthermore, maternal thrombophilia has been associated with the occurrence of perinatal AIS, venous sinus thrombosis or renal vein thrombosis [13]. However, in neonates there is scepticism about the interpretation of results of the various studies due to the complexity of the mechanism of hemostasis and the interaction of several acquired factors. Thrombosis in neonates is generally a multifactorial process [14]. Future studies may clarify both causative background and therapeutic choices in this group of patients.

Seasonality of occurrence of deep vein thrombosis of the lower limbs

Published data concerning increased incidence of venous thromboembolic disease (VTE) in different seasons of the year are divergent. In the 12-month period lasting from 1st December 2007 to 30th November 2008, 48 cases of deep vein thrombosis (DVT) of the lower limbs were diagnosed in the population of Bemowo, a district of Warsaw. The analysis of the incidence of DVT of the lower limbs occurrence at particular times of the year was performed. During the winter time, 11 episodes of DVT were diagnosed and, respectively, 16 episodes during the spring, 11 during the summer and 10 episodes of DVT during autumn. Using the Chi-square test, the authors revealed no statistically significant differences in the incidence of DVT of the lower extremities in different seasons.

Multicentric Study Evaluating Venous Thrombosis Among Patients with Haemophilia Undergoing Major Orthopaedic Surgery

▪Deep venous thrombosis (DVT) is a common postoperative complication in patients undergoing major orthopaedic surgery of the lower limbs, such as total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery (HFS). In the absence of thromboprophylaxis, subclinical venous thrombosis rates as high as 60% have been reported when using systematic bilateral phlebography after orthopaedic surgery. As a result, routine pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) or a new oral anticoagulant agent is strongly recommended in patients undergoing these procedures.With the availability of efficient and safe clotting factor concentrates, THR, TKR, as well as ankle arthrodesis are frequently performed in subjects with haemophilia suffering from chronic haemophilic arthropathy. Yet, pharmacological prophylaxis of venous thromboembolism (VTE) in this patient group remains controversial. With the exception of retrospective case reports and small series, the incidence of VTE disease in haemophilic patients after major orthopaedic surgery is still unclear. Surveys suggest that more than half of hemophilia treatment centers in the United States and Europe use thromboprophylaxis in patients with haemophilia (PWH) who require major orthopedic surgery. However, this is not supported by evidence or surgical practice guidelines, and simply increases the risk of bleeding in such patients. Given the aging nature of the haemophilia population and the incidence of joint disease, the question of the thrombotic risk associated with major orthopaedic surgery and joint replacement surgery in particular is highly relevant. Few studies have addressed this issue and more information is needed on which to base optimal preventive strategies for venous thrombosis in patients with haemophilia undergoing elective major orthopedic surgery.We here report the results of 2 parallel and independent prospective studies from Belgium and Norway currently evaluating by systematic US-Doppler imaging the incidence of subclinical deep venous thrombosis in consecutive haemophilic patients referred for major orthopaedic surgery. In Belgium, the study has so far included 36 different patients (32 HA, 4HB) undergoing 50 major orthopaedic procedures of the lower limbs. In Norway, the study has involved 29 patients (26 HA, 3 HB, all with severe haemophilia) undergoing 29 orthopaedic procedures, most of the lower limbs. In both countries, most patients were treated with continuous infusion of clotting factor concentrates and none of them did receive antithrombotic pharmacological prophylaxis.In the 2 studies that included in total 65 patients undergoing 79 major orthopaedic procedures, no case of clinically patent DVT or PE was detected (Table 1). In total there were 5 cases of DVT evidenced by US imaging which were all distal, not complicated by PE and treated with a short course of low-molecular weight heparin in most cases. The overall incidence of subclinical DVT calculated on the whole population was 6%.In conclusion, these data provide for the first time multicentric and imaging-based evidence that the risk of DVT following major orthopaedic surgery among patients with haemophilia undergoing major orthopaedic surgery is very low and that systematic pharmacological thromboprophylaxis in this specific population is for most patients not required. The two studies are still ongoing and should include a larger number of participants in the future. Table 1Characteristics of patients with haemophilia undergoing major orthopaedic surgeryHTC BrusselsHTCOsloTotalPatients362965Haemophilia A322658Haemophilia B437Severe252954Moderate909Mild202Procedures502979Knee301141Ankle81220Hip729Femur404Lumbar101Elbow044Venous thrombosis415HTC: Haemophilia Treatment Center DisclosuresNo relevant conflicts of interest to declare.

Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period

Venous thromboembolic disease (TED), although rare, is a major cause of maternal mortality and morbidity, hence methods of prophylaxis are often used for women at risk. This may include women delivered by caesarean section, those with a personal or family history of TED and women with inherited or acquired thrombophilias (conditions that predispose people to thrombosis). Many methods of prophylaxis carry a risk of side effects, and as the risk of TED is low, it is possible that the benefits of thromboprophylaxis may be outweighed by harm. Current guidelines for clinical practice are based on expert opinion only, rather than high quality evidence from randomised trials.To determine the effects of thromboprophylaxis in women who are pregnant or have recently delivered and are at increased risk of TED on the incidence of venous TED and side effects of treatment.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).Randomised trials comparing one method of thromboprophylaxis with placebo or no treatment, and randomised trials comparing two (or more) methods of thromboprophylaxis.Two review authors extracted data independently and resolved any discrepancies by discussion.Sixteen trials met the inclusion criteria but only 13 trials, involving 1774 women, examining a range of methods of thromboprophylaxis, contributed data for the outcomes of interest. Four of them compared methods of antenatal prophylaxis: low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) (two studies), and heparin versus no treatment (two studies). Eight studies assessed postnatal prophylaxis after caesarean section; one compared hydroxyethyl starch with unfractionated heparin; four compared heparin with placebo; and the other three compared UFH with LMWH. One study examined prophylaxis in the postnatal period.The small number of statistically significant findings in this review are largely derived from trials which are not of high methodological quality. It was not possible to assess the effects of any of these interventions on most outcomes, and especially on rare outcomes such as death, TED and osteoporosis, because of small sample sizes and the small number of trials making the same comparisons.There was some evidence of side effects associated with thromboprophylaxis.There is insufficient evidence on which to base recommendations for thromboprophylaxis during pregnancy and the early postnatal period. Large scale randomised trials of currently-used interventions should be conducted.

Incidence of Venous Thromboembolism in Otolaryngology–Head and Neck Surgery

To examine the incidence of venous thromboembolic disease in the otolaryngology-head and neck surgery (OTO-HNS) patient population. Review of medical records for all patients undergoing a surgical procedure during fiscal years 2008 to 2011 (July 1, 2008, through June 30, 2011) at an academic tertiary care medical center. A total of 59 884 total surgical procedures among all the surgical services. The incidence of deep venous thrombosis and pulmonary embolism. There were 5616 otolaryngology procedures performed during the study period. Clinically evident deep venous thrombosis developed in 3 patients; 2 of these patients also developed a pulmonary embolism. The overall incidence of deep venous thrombosis and pulmonary embolism in OTO-HNS was 0.05% and 0.035%, respectively. All patients who developed deep venous thrombosis or a pulmonary embolism in the OTO-HNS population were inpatients being treated for cancer. There were no deep venous thromboses or pulmonary emboli in patients undergoing same-day or overnight surgery or in patients without an active cancer. The OTO-HNS service had significantly lower rates of venous thromboembolism than did most other surgical specialties despite lower rates of adherence to venous thromboembolism prophylaxis guidelines. The incidence of deep venous thrombosis and pulmonary embolism among the OTO-HNS patient population at our academic center is lower than the incidence reported in previous studies (range, 0.1%-0.3%) and is significantly lower than the incidence observed in other surgical specialties. It is likely that patient- and specialty-specific factors as well as the more aggressive use of venous thromboembolism prophylaxis during recent years are at least partially responsible for the decreased incidence in our population.

Incidence rate of symptomatic venous thromboembolic disease in patients from a medical care program in Buenos Aires, Argentina: a prospective cohort

BackgroundThe incidence of venous thromboembolic disease (VTED) is estimated to be, on average, 1–2 cases per 1,000 individuals per year worldwide. There are few data concerning the incidence rate (IR) of VTED in the Argentinean population at large.Our aim was to estimate the IR of VTED at the Italian Hospital Medical Care Program (IHMCP) in Buenos Aires, the most populous city in Argentina.MethodsThis prospective cohort study evaluated all consecutive incident cases of pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) confirmed in patients over the age of 17 who were members of the IHMCP from June 2006 to May 2012. Any patient who had an initial confirmed VTED episode and was a member of the IHMCP at the time of diagnosis was considered an incident case.ResultsThere were 1,138 cases of VTED for 687,871 person-years of follow-up. The crude IR of VTED was 1.65 (95% CI: 1.56 to 1.75) per 1,000 person-years. The highest IR was found in subjects >80 years old (5.92 per 1,000 person years; 95% CI: 5.41 to 6.49).The IRs adjusted to the population of the city of Buenos Aires were 0.90 (95% CI: 0.84 to 0.95) for VTED, 0.71 (95% CI: 0.66 to 0.76) for DVT, and 0.34 (95% CI: 0.31 to 0.37) for PTE.ConclusionsVTED is a common health problem with a high IR in members of the IHMCP, especially the elderly. This is the first paper to report prospectively the cumulative incidence of VTED in Latin America.

Invited commentary

Venous thromboembolic disease (VTE), the term given when deep venous thrombosis (DVT) and pulmonary embolism (PE) present together, is a national health hazard. VTE accounts for an estimated 900,000 cases yearly, resulting in approximately 300,000 deaths annually. Thrombus in the vein leads to vein wall fibrotic injury and sets the stage for post-thrombotic syndrome, one of the major complications of DVT, or chronic thrombotic pulmonary hypertension, one of the major complications of PE. Although many thrombotic events are spontaneous in the absence of malignancy, patients with tumors have a high incidence and risk of VTE in the early months after diagnosis, and these risks are further augmented with metastatic disease. VTE is a leading cause of death in cancer patients—the prothrombotic state of malignancy is complex and multifactorial. In the current article, De Martino et al establish that different malignancies have different thrombotic potential by using administrative data from the American College of Surgeons-National Surgical Quality Improvement Program and an analysis of >43,000 cancer patients. Although this fact has been known, the unique feature of the current article is defined by the statement in the discussion that “variation in VTE risk among patients undergoing surgical resection may differ not only by cancer, but also by the associated resection magnitude.” Patients who underwent breast surgery, gastrectomy, lung resection, prostatectomy, colectomy, pancreatectomy, esophagectomy, hysterectomy, hepatectomy, cystectomy, and nephrectomy were evaluated. Compared with breast resection, the authors found prostatectomy, colectomy, esophagectomy, hysterectomy, and hepatectomy had a greater than twofold odds ratio for DVT. Every operation evaluated, except esophagectomy, had increased odds for PE (with hysterectomy and cystectomy at very high risk, 5.5-fold and 6.4-fold odds ratio), and prostatectomy, esophagectomy, hysterectomy, and hepatectomy were associated with the development of VTE. One interesting finding was the difference among those procedures associated with DVT and not PE, and vice versa. Multivariate analysis also identified factors associated with DVT, PE, and VTE, with prolonged length of stay and wound infection associated with all three conditions. As with any study based on administrative data, some of the details necessary for a full analysis are not available, and certain factors, such as prophylaxis use, are not available from the National Surgical Quality Improvement Program database. Nonetheless, this important study sets the stage for the development of further “prospective cohort studies … to validate risk of VTE in patients undergoing various cancer surgeries” and also suggests that studies to determine best prophylaxis use are indicated, potentially with different cancer resections requiring different prophylaxis strategies. Variation in thromboembolic complications among patients undergoing commonly performed cancer operationsJournal of Vascular SurgeryVol. 55Issue 4PreviewThere is widespread evidence that cancer confers an increased risk of deep venous thrombosis (DVT). This risk is thought to vary among different cancer types. The purpose of this study is to better define the incidence of thrombotic complications among patients undergoing surgical treatment for a spectrum of prevalent cancer diagnoses in contemporary practice. Full-Text PDF Open ArchiveCorrectionJournal of Vascular SurgeryVol. 56Issue 2PreviewIn the April 2012 issue of the Journal of Vascular Surgery, the first sentence of the invited commentary by Dr Wakefield (Wakefield TW. Invited commentary. J Vasc Surg 2012;55:1041) should read as follows: Full-Text PDF Open Archive