Incidence Of VTE Research Articles

PB1488 Risk of Venous Thromboembolic Disease and Adequacy of Thromboprophylaxis at a Teaching Hospital and Incidence of VTE in the Three Months after Admission

PB1488 Risk of Venous Thromboembolic Disease and Adequacy of Thromboprophylaxis at a Teaching Hospital and Incidence of VTE in the Three Months after Admission

PB0082 VTE Incidence and Risk Factors among Hospitalized COVID-19 Patients in Salvador -Brazil

PB0082 VTE Incidence and Risk Factors among Hospitalized COVID-19 Patients in Salvador -Brazil

Obstructive Shock Pulmonary Embolism: Catheter Directed Thrombolysis

Venous thromboembolism is one of the most frequently encountered condition for which patients need intensive care admission often. Most of the time patients presents with shock and hemodynamic instability if it is massive pulmonary embolism. Incidence of Vte is comparable to western population in India, studies conducted by Ayyapan et all say it around 20/10,000 admission. Studies showed higher mortality of around 50% in high risk (massive) and mortality of around 14% in intermediate risk (sub-massive) PE which necessitating more aggressive approach in high-risk groups. Rapid administration of systemic thrombolytic agents is indicated in massive pulmonary embolism patients who presents with hemodynamic instability but systemic thrombolytic therapy is associated with risk of major bleeding around 20% and haemorrhagic stroke of 2% to 5% . During systemic thrombolysis shunting of thrombolytic agents away from clot into the systemic circulation which makes it failed lysis sometimes along with major bleeding.

647 VTE Prophylaxis Protocol Compliance Post Elective Lower Limb Arthroplasty

Abstract Aim Venous thromboembolism (VTE) is a common post-operative complication, and it is essential for surgical departments to ensure adequate prophylaxis is provided. A single centre DGH introduced a new proforma to be filled out at the time of operation. This audit aims to evaluate compliance with the proforma and its correlation to prophylactic prescription and postoperative VTE rates. Method A retrospective study was conducted for 524 patients undergoing elective lower limb arthroplasty between August 2020 and August 2022. Clinical notes were reviewed for of a) presence and completeness of proforma and b) clear documentation of prophylaxis. 30-day post-operative re-admission rates, associated complications, incidence of VTE, and deaths within 90 days of surgery were also reviewed. Results 335 patients underwent an elective lower limb arthroplasty after the proforma was implemented in August 2021 of which 321 (95.8%) had the proforma in their clinical care forms. Of these, 56/321 (17.4%) forms were filled. All patients had documented VTE prophylaxis prescriptions and 438/524 (83.6%) were clearly described/'complete'. Of those incomplete, 74/86 (86%) were recorded after August 2021. There was 1 confirmed incidence of VTE within 30 days which occurred after proforma implementation. 9/18 surgeons (50%) practiced completing the proforma but 0/18 used it consistently. Conclusions There was poor compliance with the proforma but low incidence of VTE rates. Overall, the proforma did not affect VTE rates. In fact, there is the impression that reliance on the proforma worsened quality of documentation of VTE prescription required in operation notes. This suggests implementation of this proforma was negative.

1011 Chemical VTE Prophylaxis for Adults with Abdominal Trauma: A Systematic Review

Abstract Aim The increased incidence of VTE following blunt and penetrating abdominal trauma is well documented due to trauma induced coagulopathy and immobility. Whilst guidance often advocates early chemical thromboprophylaxis with low molecular weight heparin, clinical practice varies. This systematic review aims to evaluate evidence regarding VTE chemical prophylaxis in the adult trauma population (16+) presenting with blunt and penetrating abdominal trauma. Method A search of MEDLINE, EMBASE and PubMed databases was conducted, and additional references were identified from a review of literature citations. Search results were limited to English language and human studies. Co-existing severe head injuries defined as AIS>3 was excluded. Data was summarised in data extraction tables, along with level of evidence and bias scores for each study. Results A total of 9 retrospective trials exploring the timings of VTE chemoprophylaxis were included. All but 3 studies showed late VTE chemoprophylaxis initiation (>48hrs) was linked with a higher incidence of VTE, with significant results in 4 studies. Early VTE chemoprophylaxis was not associated with increased risk of NOM failure. Early VTE chemoprophylaxis was also not found to be associated with an increased risk in bleeding in most studies, with non-significant differences in blood transfusion requirements. Conclusions Research favours early initiation of VTE chemoprophylaxis in the abdominal trauma population, without significant risk of complications and supports results from other trauma populations. Further prospective studies are needed in the abdominal trauma population, as well as its sub-populations, to directly compare VTE agents and dosing regimens and provide higher quality evidence to support chemical thromboprophylaxis.

584 Extended VTE Prophylaxis in Patients Undergoing Oesophagogastric Cancer Surgery

Abstract Aim Venous thromboembolism (VTE) is a life-threatening complication in cancer patients undergoing surgery. NICE recommends VTE-prophylaxis to 28days for patients undergoing major abdominal cancer surgery. The efficacy of in-hospital VTE-prophylaxis is well-documented, but the optimal duration of postoperative VTE-prophylaxis remains controversial. Patients undergoing oesophagogastric cancer surgery have a higher risk of VTE due to suboptimal oral intake, dehydration, need for adjuvant and neoadjuvant chemotherapy. Hence in 2014, extended VTE-prophylaxis to 28days from hospital discharge (HD) was adopted as a departmental policy. This study aims to evaluate its effectiveness, prescribing compliance and safety. Method This is a 10-year retrospective study from July 2012-2022. All patients who underwent cardio-oesophagectomy or gastrectomy for oesophagogastric cancers were included. Patients who died during the index admission, benign oesophagogastric surgery including excision of GIST, and central line associated VTE were excluded. The primary outcome is prescribing compliance with 28-day VTE prophylaxis from HD. The secondary outcome includes the incidence of VTE and bleeding complications requiring hospital readmission within 28days from HD. Results 582 patients were included in our study. Since 2014, 423/490patients (86.3%) have been discharged with 28days VTE-prophylaxis from HD compared to pre-2014 (13/92patients,14.1%). There was a statistically significant difference in improving prescribing compliance following the introduction of this policy (p<0.05). No patient was readmitted due to bleeding complications. Only 1 patient (1/582,0.17%) developed VTE within 28days from HD. Conclusions We recommend extending VTE-prophylaxis for 28days from hospital discharge for all patients undergoing oesophagogastric cancer surgery. This improves prescribing compliance, reduces the incidence of post-discharge VTE and is safe.

1201 A Systematic Review and Meta-Analysis of Venous Thromboembolism Risk in Surgical Patients with Recent Air Travel

Abstract Aim Venous thromboembolism (VTE) is associated with recent surgery; additionally, long-haul air-travel increases VTE risk. As surgical tourism increases, more patients are flying long distances seeking surgical intervention. This meta-analysis aimed to estimate post-operative VTE risk in the context of recent air-travel. Method Embase, Ovid MEDLINE, Cochrane and Scopus databases were accessed from 1947 to May 2022. Inclusion criteria were any study design with adults undergoing surgical intervention with recent air-travel, reporting VTE incidence. PRISMA guidelines were followed with a registered protocol (PROSPERO:CRD42022323561). Data was extracted independently by two reviewers and pooled using fixed and random effects. Primary outcome was pooled VTE rate; secondary outcomes were pooled rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). ROBINS-I tool was used to assess risk of bias. Results Seven retrospective studies were included, totalling 24,975 patients. Overall odds of VTE in the flying plus surgery group was 1.96 (95%CI 0.54-7.08). For surgery with post-operative flight odds ratio (OR) of VTE was 1.31 (95%CI 0.63-2.71), whilst for surgery with pre-operative flight OR was 7.86 (95%CI 0.23–265.26). Three studies reported DVT/PE incidence specifically. DVT: for surgery and air-travel DVT rate was 0.67% (95%CI 0.31%-1.51%) versus 0.45% (95%CI 0.10%-2.00%) in surgery alone. PE: for surgery and air travel, PE rate was 0.41 (95%CI 0.00%-1.29%) versus 0.55% (95%CI 0.31%-0.86%) for surgery alone. Conclusions Whilst meta-analysis demonstrates that air-travel confers no additional VTE risk for surgical patients, it does not account for confounding factors. Future research should risk score then propensity match participants to generate higher quality evidence.

Delayed surgery after hip fracture affects the incidence of venous thromboembolism

BackgroundVenous thromboembolism (VTE) is one of the most common complications of hip fracture surgeries, and it is unclear whether delayed surgery affects the incidence of VTE. This study aimed to examine the association between delayed surgery and VTE incidence by statistically adjusting for factors that may influence VTE incidence.MethodsWe included 862 patients ≥ 65 years with hip fractures who underwent surgery between October 2010 and December 2020. We examined the effect of surgical delay 48 h after injury on postoperative VTE. Patients with and without VTE were assigned to groups V and NV, respectively. Those with and without proximal deep venous thrombosis (DVT) were assigned to PD and NPD groups, respectively. Univariate analysis was performed to identify factors that might influence DVT development. Risk factors for developing VTE and proximal DVT were analyzed using logistic regression analysis to determine whether delayed surgery was a risk factor.ResultsVTE was observed in 436 patients (40%) and proximal DVT in 48 patients (5.6%). Univariate analysis showed significant differences in the time from trauma to surgery between the V and NV groups and between the PD and NPD groups. In multivariate analysis, surgery 48 h later was also a risk factor for developing VTE and proximal DVT.ConclusionA delay in surgery beyond 48 h after a hip fracture injury is a risk factor for developing VTE and proximal DVT.

Venous thrombosis following endovenous laser ablation with and without thromboprophylaxis

ObjectiveVenous thromboembolism (VTE) occurs infrequently after endovenous laser ablation (EVLA). The purpose of this study was to assess the incidence of VTE after EVLA with and without pharmacologic prophylaxis. MethodsFrom October 2019 to March 2020, a series of consecutive patients from the prospectively maintained VEINOVA (vein occlusion with various techniques) registry was retrospectively analyzed. All the patients underwent EVLA with and without postoperative thromboprophylaxis. A 1470-nm laser wavelength with a radial fiber was used for EVLA. Concomitant phlebectomy or sclerotherapy of insufficient tributaries was allowed. Perivenous tumescence was applied with 1% Rapidocaine (lidocaine hydrochloride monohydrate; Sintetica SA). Ablation of varicose veins was performed by continuously drawing back the laser fiber at a power of 10 W, aiming for a linear endovenous energy delivery of 60 to 90 J/cm. Compression stockings were applied postoperatively, and the patients were advised to wear them for 1 week. Duplex ultrasound was performed at the 1- and 4-week follow-up visits to determine the occlusion rate and the occurrence of EHIT and VTE. ResultsOverall, 249 patients were identified from the registry. Of the 249 patients, 26 were omitted because of treatment of recurrent varicose veins. Finally, 223 consecutive patients with 223 legs and 227 saphenous veins (159 great saphenous veins, 49 small saphenous veins, and 19 anterior accessory saphenous veins) were included in the final analysis. Their mean age was 58.1 ± 13.8 years, and 167 patients (73.1%) were women. The clinical CEAP (clinical, etiology, anatomy, pathophysiology) classification was C2 for 11 legs (4.9%), C3 for 123 legs (55.2%), C4a or C4b for 86 legs (38.6%), and C5 to C6 for 3 legs (1.4%). Thromboprophylaxis was given to 132 patients (59.2%) for 3 days (rivaroxaban 10 mg once daily to 130 patients [98.5%] and low-molecular-weight heparin to 2 patients [1.5%]). No thromboprophylaxis was administered to 91 patients (40.8%) after EVLA. The average treatment length was 34.2 ± 19.3 cm and the average diameter was 5.0 ± 1.3 mm. At 1 week of follow-up, no thrombotic event had occurred in either group. At 4 weeks of follow-up, one case of EHIT class 2 (1.1%) and one case of pulmonary embolism (1.1%) had occurred in the group without thromboprophylaxis. In the thromboprophylaxis group, one deep vein thrombosis (0.8%) event had occurred (adjusted P = .135). At 1 and 4 weeks of follow-up, the treated varicose veins remained occluded in both groups. ConclusionsEndovenous ablation of truncal varicose veins appears to be safe with a low thrombotic event rate with or without pharmacologic thromboprophylaxis. However, more data are needed before a final recommendation regarding the best thromboprophylaxis treatment option can be given.

Incidence of bleeding and recurrence in isolated distal deep vein thrombosis: findings from the Venous Thrombosis Registry in Østfold Hospital

BackgroundIsolated distal deep vein thrombosis (IDDVT) is a common presentation of deep vein thrombosis. There are limited data on the long-term risk of recurrence after IDDVT. ObjectivesWe aimed to determine the short- and long-term incidence of venous thrombosis (VTE) recurrence after cessation of anticoagulation and the 3-month incidence of bleeding during anticoagulant treatment in patients with IDDVT. MethodsBetween January 2005 and May 2020, 475 patients with IDDVT and without active cancer were identified from the Venous Thrombosis Registry in Østfold Hospital, which is an ongoing registry of consecutive patients with VTE at Østfold Hospital, Norway. Major and clinically relevant, nonmajor bleeding as well as recurrent VTE were registered, and the cumulative incidences of these events were assessed. ResultsThe median age of the patients was 59 years (IQR, 48-72 years), 243 (51%) patients were women, and 175 events (36.8%) were classified as unprovoked. The 1-, 5-, and 10-year cumulative incidences of recurrent VTE were 5.6% (95% CI, 3.7-8.4), 14.7% (95% CI, 11.1-19.4), and 27.2% (95% CI, 21.1-34.5), respectively. The recurrence rates were higher for unprovoked IDDVT than for provoked IDDVT. Among the recurrent events, 18 (29%) were pulmonary embolisms and 21 (33%) were proximal deep vein thromboses. The 3-month cumulative incidence of major bleeding was 1.5% (95% CI, 0.7-3.1) overall and 0.8% (95% CI, 0.2-3.1) when restricted to patients treated with direct oral anticoagulants. ConclusionDespite initial treatment, the long-term risk of VTE recurrence after first-time IDDVT is high. The bleeding rates during anticoagulation, particularly with direct oral anticoagulants, were acceptably low.

High rates of venous thromboembolism among deliveries complicated by cancer

BackgroundVenous thromboembolism (VTE) risk is increased independently by both cancer and pregnancy. ObjectivesTo estimate VTE risk in the postpartum period among patients delivering with a cancer diagnosis, stratified by cancer type and delivery route. MethodsWe performed a retrospective cohort study utilizing the large, all-payer Nationwide Readmissions Database from October 2015 through December 2020. We identified delivery hospitalizations, cancer diagnoses, and VTE using patient demographics and diagnosis codes. The primary outcome was VTE incidence at 42 and 330 days from delivery admission date, comparing patients with and without cancer diagnoses. A secondary analysis included VTE risk stratified by cancer diagnosis and delivery route. Outcomes were compared using inverse probability-weighted survival curves. ResultsThe study population included 9 793 503 delivery hospitalizations (weighted estimate, 18 207 346), with a weighted estimate of 10 428 (0.06%) pregnant patients with cancer. Individuals with cancer were older, with higher rates of comorbid conditions, than those without cancer. VTE incidence in individuals with cancer at 42 and 330 days was 1.11% and 2.19%, respectively, vs 0.11% and 0.14%, respectively, in those without cancer. At 330 days, this finding was significant in both unadjusted (relative risk, 15.52; 95% CI, 11.54-19.51) and adjusted (relative risk, 9.68; 95% CI, 7.18-12.18) models. Stratification by cancer type and delivery route demonstrated elevated VTE risk across cancer types, with cesarean delivery conferring a greater risk. ConclusionCancer in pregnancy confers excess thromboembolic risk extending beyond the immediate postpartum period. Further study is needed to identify optimal VTE prophylactic strategies for this population.

Incidence of thromboembolic events in glioblastoma multiforme: The first Middle Eastern study risk stratifying patients from this region.

e14044 Background: Prophylactic anticoagulation for Glioblastoma Multiforme patients remains an area of high controversy with no definite guidelines and with clinical practice recommendations depending mainly on individual center based strategies. Considering that the middle eastern population is known to be associated with increased incidence of thrombophilia due to the high prevalence of factor V R506Q Mutation-Leiden and with no studies reporting incidence of VTE with GBM patients in this region, we aimed to conduct the first middle east based study to see if the incidence of VTE in GBM patient will be higher than the other overall reported incidence worldwide and we looked whether using the Khorana score will be a good predictor for assessing the need for VTE prophylaxis in these patients. Methods: we conducted a retrospective chart review to determine the incidence of initial VTE in GBM patients who received treatment at a tertiary care center in Beirut. Results: The total patient population was 132 with males constituting 71.2% of our population compared to 28.8 % females. Preexisting risk factors included: 34.8 % for hypertension, 65.2% for diabetes, and 25% were smokers, 0.8% had history of thrombophilia, and 7.6% had preexisting episode of VTE while 94% of the population had craniotomy. The incidence of deep vein thrombosis (DVT) was 15.4%, while 7.2 % developed a pulmonary embolism (PE). Recurrent VTEs affected 34.8% of those who had a previous VTE, and 7.4% of patients had the recurrent VTE while they were on anticoagulation. Regarding complications, 7.3% developed bleeding, 66% of those had intracranial bleeding while 33 % had a gastrointestinal bleed. Out of all of those who developed bleeding, only 3.4% were on anticoagulation so anticoagulation was not a major risk factor for bleeding. 57.6% of the patients had a Khorana score of 0, 28.8% had a score of 1,7.6% had a score of 2,1.6% had a score of 3, while 8% had a Khorana score of 4. In our cohort, all patients with a Khorana score of 3 and 4 developed VTE which indicated that this could be used as a risk assessment tool for our GBM patients. Conclusions: In conclusion in our study, with its retrospective limitation, we could not prove that our middle eastern populations, though known to have higher incidence of congenital thrombophilia, is associated with much higher incidence of VTE when compared to many studies involving different populations in the world however our cohort of patients with GBM undergoing craniotomy are still at increased risk of thrombotic events with low risk of bleeding despite anticoagulation and the Khorana score could be a risk stratifying method to help us establish the patients who have the highest risk of developing VTE. Prospective studies involving higher number of patients with thrombophilia testing should be explored to risk stratify our patients.

COVID-19 and prevalence of venous thromboembolism among cancer patients: A nationwide inpatient sample analysis.

e18839 Background: Cancer, as well as immunosuppression from chemotherapy, aggravates thromboembolism risk. The risk is likely amplified in an additive fashion with COVID-19 infection, which confers a higher risk of VTE risk with viral sepsis, endothelial inflammation, and microthrombi formation. Numerous studies have shown the heightened risk of pulmonary embolism among severe COVID-19 patients. We sought to evaluate further the extent of COVID-19-associated coagulopathy and associated outcomes. Methods: National Inpatient Sample 2020 was used to identify non-elective hospitalizations of patients with a secondary diagnosis of any cancer. These were stratified into two cohorts based on the presence of the primary diagnosis of COVID-19. Primary outcomes include venous thromboembolism, PE, and VTE without PE in cancer patients with and without Covid-19 infection. The secondary outcomes examined were in-patient mortality, the average length of stay (LOS), and total hospital charge (THC). Multivariate analysis was performed to obtain the odds ratio. All weighted analysis was conducted through STATA 17. Results: Out of 1,734,735 non-elective admissions of patients with cancer, 36,295 (2%) were admitted for COVID-19. Our analysis showed statistically non-significant increased odds of venous thromboembolism(aOR:1.09 CI 0.99-1.20) in cancer patients with COVID. There was, however, a significant increase in the odds of pulmonary embolism(aOR 1.7, CI: 1.51- 1.91) among cancer patients with Covid-19. There were decreased odds of VTE without PE(aOR: 0.67 CI: 0.57-0.78). There was a statistically significant increase in odds of mortality (aOR: 2.8 CI: 2.63-3.0), length of stay(aOR:1.85 CI: 1.65- 2.05), total hospital charges($83,201 vs. $78,869 p: < 0.01) in cancer patients with COVID-19 compared to cancer patients without COVID-19. Conclusions: This study shows that COVID-19 in cancer patients has deleterious effects, including an increased risk of pulmonary embolism and poor in-hospital outcomes. The finding of a lower incidence of non-PE VTE in patients with cancer is likely related to limitations with coding in NIS, in which lower complexity codes might be omitted in patients with multiple diagnoses. With significantly increased mortality and economic burden, these findings emphasize the significance of thrombotic prophylaxis and vaccination in cancer patients. [Table: see text]

Aspirin as a thromboprophylaxis agent after revision knee arthroplasty: A retrospective analysis

IntroductionTotal knee arthroplasty is a common and effective procedure. Although complication rates are low, certain complications such as venous thromboembolism are potentially serious. The optimal prophylactic agent and dosage after revision knee arthroplasty remains unclear. The main objective of this work was to study the efficacy and safety of aspirin as a thromboprophylaxis agent following revision knee arthroplasties. Patients and methodsA retrospective review of patients undergoing revision knee arthroplasty between 2013 and 2020at a University Teaching Hospital was undertaken. The primary outcome was the development of a symptomatic thromboembolic event requiring treatment within 90 days post-surgery. The secondary outcomes were adverse events associated with aspirin therapy: surgical site infection rate; incidence of major bleeding; readmission rate and mortality within 90 days post-surgery. Results490 patients were included. 374 (76.3%) received prophylactic aspirin (150 mg once daily for 28 days) and 75 (15.3%) patients received dalteparin for 28 days due to contraindication to aspirin use. Those already receiving other thromboprophylaxis agents for pre-existing comorbidities continued these after relevant medical consultation. The overall rates of venous thromboembolism and symptomatic DVT after aspirin prophylaxis were 0.6% (3/490) and 0.8% (3/374), respectively. VTE incidence did not significantly differ between those administered aspirin and other agents. No patient experienced major bleeding within 90 postoperative days. Only 2 of 490 (0.4%) patients had wound infection requiring readmission; neither received prophylactic aspirin. ConclusionExtended out-of-hospital thromboembolic prophylaxis with aspirin may be at least as effective as other agents in patients undergoing revision knee arthroplasty. Aspirin is safe, effective, and cheap compared with other agents.

Long-term ambient air pollution and venous thromboembolism in a population-based Swedish cohort

Air pollution is a major contributor to the global burden of disease and has been linked to several diseases and conditions, including cardiovascular disease. The biological mechanisms are related to inflammation and increased coagulability, factors that play an important role in the pathogenesis of venous thromboembolism (VTE, i.e., deep vein thrombosis or pulmonary embolism). This study investigates if long-term exposure to air pollution is associated with increased VTE incidence. The study followed 29 408 participants from the Malmö Diet and Cancer (MDC) cohort, which consists of adults aged 44–74 recruited in Malmö, Sweden between 1991 and 1996. For each participant, annual mean residential exposures to particulate matter <2.5 μg (PM2.5) and <10 μg (PM10), nitrogen oxides (NOx) and black carbon (BC) from 1990 up to 2016 were calculated. Associations with VTE were analysed using Cox proportional hazard models for air pollution in the year of the VTE event (lag0) and the mean of the prior 1–10 years (lag1-10). Annual air pollution exposures for the full follow-up period had the following means: 10.8 μg/m3 for PM2.5, 15.8 μg/m3 for PM10, 27.7 μg/m3 for NOx, and 0.96 μg/m3 for BC. The mean follow-up period was 19.5 years, with 1418 incident VTE events recorded during this period. Exposure to lag1-10 PM2.5 was associated with an increased risk of VTE (HR 1.17 (95%CI 1.01–1.37)) per interquartile range (IQR) of 1.2 μg/m3 increase in PM2.5 exposure. No significant associations were found between other pollutants or lag0 PM2.5 and incident VTE. When VTE was divided into specific diagnoses, associations with lag1-10 PM2.5 exposure were similarly positive for deep vein thrombosis but not for pulmonary embolism. Results persisted in sensitivity analyses and in multi-pollutant models. Long-term exposure to moderate concentrations of ambient PM2.5 was associated with increased risks of VTE in the general population in Sweden.

Remdesivir use in severe and critical COVID-19 patients might be associated with lower incidence of arterial thrombotic events

IntroductionVenous thromboembolism (VTE) and arterial thrombotic (AT) events are a striking feature of severe COVID-19, however, relationship of remdesivir use and the risk of thrombotic events is unknown and has not been investigated before. MethodsWe retrospectively analyzed a cohort of 876 consecutive hospitalized severe and critical COVID-19 patients who were treated with remdesivir and compared them to 876 case-matched control patients. All patients were treated in our tertiary-level institution in period from 10/2020 to 6/2021. VTE and AT were diagnosed by objective imaging and laboratory methods. ResultsAfter exclusion of 71 VTE and 37 AT events present at the time of hospital admission, there were a total of 70 VTE (35 in the remdesivir and 35 in the control group) and 38 AT events occurring during hospitalization (13 in the remdesivir and 25 in the control group). There was a similar cumulative post-admission VTE incidence among both remdesivir and matched control patients (P = 0.287). Significantly lower cumulative post-admission AT incidence was observed among patients treated with remdesivir than among matched control patients (1.7% vs 3.3%, HR = 0.51, P = 0.035). Tendency for lower AT rates was evident in subgroups of patients stratified according to the type of AT, as well as according to the intensity of required oxygen supplementation at the time of remdesivir use. ConclusionRemdesivir use in severe and critical COVID-19 patients might be associated with lower occurrence of AT during hospitalization, whereas similar rates of VTE events were observed among both patients treated with remdesivir and control patients.

Venous Thromboembolism Rates Have Not Decreased in Elective Lumbar Fusion Surgery from 2011 to 2020.

Retrospective cohort study. This study aimed to (1) evaluate for any temporal trends in the rates of VTE, deep venous thrombosis (DVT), pulmonary embolism (PE), and mortality from 2011 to 2020 and (2) identify the predictors of VTE following lumbar fusion surgery. Annual incidences of 30-day VTE, DVT, PE, and mortality were calculated for each of the operation year groups from 2011 to 2020. Multivariable Poisson regression was utilized to test the association between operation year and primary outcomes, as well as to identify significant predictors of VTE. A total of 121,205 patients were included. There were no statistically significant differences in VTE, DVT, PE, or mortality rates among the operation year groups. Multivariable regression analysis revealed that compared to 2011, operation year 2019 was associated with significantly lower rates of DVT. Age, BMI, prolonged operation time, prolonged length of stay, non-home discharge, anterior fusion, smoking status, functional dependence, and chronic steroid use were identified as independent predictors of VTE following lumbar fusion. Female sex, Hispanic ethnicity, and outpatient surgery setting were identified as protective factors from VTE in this cohort. Rates of VTE after lumbar fusion have remained mostly unchanged between 2011 and 2020. Older age, higher BMI, longer operation time, prolonged length of stay, non-home discharge, anterior fusion, smoking, functional dependence, and steroid use were independent predictors of VTE after lumbar fusion, while female sex, Hispanic ethnicity, and outpatient surgery were the protective factors.

14. Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery

PURPOSE: Conflicting data exist regarding increased perioperative VTE risk while on feminizing hormone therapy. The effect has been poorly studied within the transgender population. Acute perioperative cessation of feminizing hormone therapy often leads to unpleasant side effects and exacerbates gender dysphoria in the perioperative period. We seek to identify the VTE incidence in patients undergoing facial feminization while continuing HRT throughout the time of surgery. METHODS: A 40-year retrospective cohort study within a two surgeon practice was designed to adequately power a comparative study. The primary outcome variable was identified as sustaining a VTE postoperatively. RESULTS: 1,496 patients underwent facial feminization surgery within our 40-year search window. 1,109 met inclusion criteria for this study. 1 (0.1%) patient was diagnosed with a VTE postoperatively, comparable to reported literature rates for similar cosmetic and orthognathic procedures. The average Caprini score of all patients was 2.9±0.9 and the average case length was 516.5±102.4 minutes. Subgroup analysis of patients before and after internal practice changes identified 913 (82.3%) patients continuing on full dose hormonal therapy perioperatively, 149 (13.4%) patients undergoing hormonal dose reduction to 25-50% perioperatively, and 47 (4.3%) patients who were either not taking hormonal therapy or stopped in the perioperative period. There was no significant difference in VTE incidence between the 3 subgroups (p > 0.99). CONCLUSION: Perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in patients undergoing facial feminization surgery. Therefore, it is safe to continue these medications through the time of surgery.

Predictive factors on postoperative venous thromboembolism after minimally invasive colorectal cancer surgery: a retrospective observational study

BackgroundVenous thromboembolism (VTE) is a serious and preventable postoperative complication. However, the predictive significance of perioperative biochemical parameters for VTE after minimally invasive colorectal cancer surgery remains unclear.MethodsA total of 149 patients undergoing minimally invasive colorectal cancer surgery were collected between October 2021 and October 2022. Biochemical parameters related to preoperative and postoperative day 1, day 3, and day 5 were collected, including D-Dimer, mean platelet volume (MPV), and maximum amplitude (MA) of thromboelastography (TEG). Receiver operating characteristic (ROC) curves were used to explore the predictive powers of meaningful biochemical parameters for postoperative VTE, and calibration curves were used to assess predictive accuracy.ResultsThe overall cumulative incidence of VTE was 8.1% (12/149). The preoperative and postoperative day 3 D-Dimer, postoperative day 3, and day 5 MPV, and postoperative day 1, day 3, and day 5 TEG-MA was significantly higher in the VTE group than in the non-VTE group (P < 0.05). The results of both the ROC curve and the calibration curve indicated that these meaningful D-Dimer, MPV, and TEG-MA had moderate discrimination and consistency for postoperative VTE.ConclusionsD-Dimer, MPV, and TEG-MA may predict postoperative VTE in patients undergoing minimally invasive surgery for colorectal cancer at specific times in the perioperative period.

Risk and factors associated with venous thromboembolism following abdominal transplantation

BackgroundVenous thromboembolism (VTE) remains under-studied among patients undergoing kidney, liver and pancreas (abdominal) transplantation. We characterized the risk and predictors of VTE using a nationally-representative cohort. MethodsThe 2014–2019 Nationwide Readmissions Database was queried to identify all adults undergoing abdominal transplantation. Patients who developed pulmonary embolism or deep venous thrombosis were considered the VTE cohort (others: nonVTE). Multivariable models were developed to identify factors linked with VTE and assess the independent associations between VTE and key outcomes. ResultsOf ~141,977 transplant recipients, 1.9 % (2722) developed VTE. The VTE cohort was similarly female (39.2 vs 38.0, p = 0.51), but more often demonstrated a higher Elixhauser comorbidity index (4.19 ± 1.40 vs 3.93 ± 1.39, p < 0.001).After adjustment, congestive heart failure (AOR 1.54, 95%CI 1.25–1.91), cardiac arrhythmias (AOR 1.54, 95%CI 1.34–1.78), peripheral vascular disease (AOR 1.29, 95%CI 1.02–1.63), coagulopathies (AOR 1.63, 95%CI 1.38–1.92), previous history of VTE (AOR 1.14, 95%CI 1.06–1.22), and heparin-induced thrombocytopenia (AOR 2.61, 95%CI 2.07–3.28) were associated with VTE. The development of VTE was linked with significantly greater in-hospital mortality (AOR 4.56, 95%CI 2.07–10.10), as well as infectious (AOR 2.59, 95%CI 1.55–4.21), cardiac (AOR 2.59, 95%CI 1.39–4.82), and respiratory (AOR 1.78, 95%CI 1.21–2.63) complications. VTE was further associated with increased length of stay (+8.18 days, 95%CI +1.32–15.41), expenditures (+$42,000, 95%CI $24,800-59,210), and odds of VTE upon readmission (AOR 4.51, 95%CI 1.32–15.41). ConclusionsVTE after abdominal transplantation is linked with significantly greater in-hospital mortality, complications, resource utilization, and risk of VTE at readmission. Novel risk assessments and prophylaxis protocols are needed to reduce VTE incidence and sequelae.