Incidence Rates Of Pulmonary Embolism Research Articles

Increased Risk for Pulmonary Embolism among Patients with Ankylosing Spondylitis-Results from a Large Database Analysis.

Background: Axial spondyloarthropathy(AS) is a chronic inflammatory disease primarily affecting the axial skeleton, often characterized by sacroiliitis. While pulmonary embolism (PE), a potentially lethal condition, has been linked to several autoimmune diseases, limited data exist regarding PE risk among patients with AS. Methods: This retrospective cohort study utilized the Clalit Healthcare Services (CHS) database, including 5825 patients with AS and 28,356 matched controls. Follow-up began at the date of first AS diagnosis for patients and at the matched patient's diagnosis date for controls and continued until PE diagnosis, death, or study end date. Results: Prevalence of PE before AS diagnosis in patients compared to controls was 0.4% vs. 0.2% (p < 0.01). The incidence rate of PE was 11.6 per 10,000 person-years for patients with AS and 6.8 per 10,000 person-years for controls. The adjusted hazard ratio (HR) for PE in patients with AS was 1.70 (p < 0.001). Subgroup analysis demonstrated excess risk for PE in patients with AS regardless of gender and age, with variations among AS treatment categories. Discussion: Our findings highlight a significant association between AS and PE, indicating an increased risk in patients with AS independent of age and sex and suggests a subclinical level of inflammation. Preliminary results suggest a protective role of immunosuppressing drugs. Further research into the impact of treatment strategies should be conducted and could inform clinical management and reduce the life-threatening risk of PE in Patients with AS.

534 - Incidence of venous thromboembolic events and atherosclerotic cardiovascular disease risk factors in adolescents and adults with atopic dermatitis in Denmark: a population-based cohort study

Abstract Background Atopic dermatitis (AD) is associated with substantial impairment in quality of life, including sleep disturbances, anxiety, and depression, which may increase the risk of cardiovascular disease (CVD). However, the association between CVD and AD is not well established. Objectives To evaluate incidence rates (IRs) of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) in patients with and without AD in a population-based cohort study in Denmark, and to assess IRs of malignancies, major adverse cardiovascular events (MACE), VTE, and the distribution of Atherosclerotic Cardiovascular Disease (ASCVD) risk factors in patients with AD and rheumatoid arthritis (RA) in a nested cohort analysis. Methods Data from all individuals aged ≥12 years (≥18 years in the nested cohort analysis) between January 1, 2000, and December 31, 2018, were extracted from the Danish National Patient Registry. Patients with ≥1 AD diagnosis during the study period were matched on sex and age with 10 individuals from the general population. The nested cohort analysis included patients diagnosed with RA as an additional comparison population. In the overall cohort, IRs of VTE, DVT, and PE were assessed; the nested cohort analysis evaluated the distribution of ASCVD risk factors and incidence of malignancies, MACE, and VTE in patients with and without ASCVD risk factors (age ≥65 years, and history of smoking, coronary artery disease, stroke, DVT, PE, and malignancy). The follow-up period was from the first diagnosis during the study period until the occurrence of death or an endpoint, the first instance of migration, or December 31, 2018. IRs are shown per 100 patient-years (PY) of exposure with 95% confidence intervals. Results The population-based cohort comprised 190,751 patients, including 17,341 patients with AD and 173,410 age- and sex-matched controls. The IR/100 PY of VTE was similar between the AD cohort (0.14 [95% CI, 0.12-0.16]) and the general population (0.11 [0.11-0.12]). The IR/100 PY for VTE was higher in patients with AD aged ≥65 years (0.71 [0.56-0.90]) than the age-matched general population (0.50 [0.46-0.54]) and lower in the younger AD cohorts (12 to &amp;lt;18 years, 0.02 [0.00-0.08]; 18 to &amp;lt;65 years, 0.12 [0.09-0.13]). The IRs/100 PY of DVT and PE were comparable between the AD cohort (DVT, 0.08 [0.06-0.09]; PE, 0.06 [0.05-0.08]) and the general population (DVT, 0.06 [0.06-0.07]; PE, 0.05 [0.05-0.05]).. The nested cohort analysis comprised 195,807 patients, including 13,432 with AD, 48,055 with RA, and 134,320 age- and sex-matched controls. Distribution of risk factors for malignancies (excluding nonmelanoma skin cancer [NMSC]), MACE, and VTE was comparable in the AD cohort and general population, but higher in patients with RA. The IR/100 PY for malignancies (excluding NMSC) was higher in patients with AD with a history of malignancy (11.41 [9.83-13.25]) than those without (0.44 [0.40-0.48]), and in those aged ≥65 years (3.09 [2.75-3.48]) versus &amp;lt;65 years (0.36 [0.33-0.40]). Similarly, the IR/100 PY for MACE was higher in patients with AD aged ≥65 years (2.30 [2.01-2.63]) versus &amp;lt;65 years (0.15 [0.13-0.17]), and patients with a history of ASCVD (5.02 [4.37-5.76]) versus without (0.15 [0.13-0.18]). Patients with AD with a history of VTE (including DVT/PE) and inherited thrombophilia had a greater risk of VTE than patients without these risk factors. Conclusions In these 2 large cohort studies of adults and adolescents with AD, IRs of VTE, DVT, and PE were comparable with the general Danish population. The risk of VTE, malignancy, and MACE was higher in patients with AD with a history of risk factors for ASCVD. This underscores the need for appropriate monitoring and reporting of cardiovascular events in patients with AD, and active management of risk factors with early and effective therapeutic intervention.

Long COVID and Wavering Incidence of Pulmonary Embolism: A Systematic Review.

Pulmonary embolism (PE) is a serious medical condition that can occur as a result of venous thromboembolism (VTE). COVID-19, also known as Post-Acute Sequelae of SARS-CoV-2 infection (PASC), can potentially lead to PE due to the formation of blood clots in the lungs. This study aims to collate and report trends of PE in patients with long COVID (4-12 weeks since infection) and post-COVID-19 syndrome (>12 weeks since infection). The study adhered to PRISMA Statement 2020 guidelines, and a systematic search was conducted in four databases. In total, nine observational studies were included with a total patient count of 45,825,187. The incidence of PE with long COVID/post-COVID-19 syndrome was seen among 31,885 individuals out of 44,967,887 participants. The incidence rate of PE was observed as 0.07%, given that the studies included matched controls. While we cannot state with certainty that COVID-19 infection in itself leads to higher risks of PE at a later time, this study emphasizes the need for optimized care and longitudinal studies during the COVID-19 era to account for deviations from the norm.

Noninvasive optical monitoring of pulmonary embolism: a Monte Carlo study on visible Chinese human thoracic tissues.

In recent years, the incidence rate of pulmonary embolism (PE) has increased dramatically. Currently, the correct diagnosis rate of PE in China is relatively low, and the diagnosis error rate and missed diagnosis rate were as high as about 80%. The most standard method of PE detection is pulmonary artery digital subtraction angiography (DSA), but pulmonary artery DSA is an invasive examination, and patients can have certain risks and discomfort. Noninvasive monitoring of PE remains challenging in cardiovascular medicine. We attempt to study the light propagation in human thoracic tissues and explore the possibility of near-infrared spectroscopy (NIRS) in noninvasive detection of PE. In this study, by utilizing the Monte Carlo simulation method for voxelized media and the Visible Chinese Human dataset, we quantified and visualized the photon migration in human thoracic region. The influence of the development (three levels) of PE on the light migration was observed. Results showed that around 4.6% light fluence was absorbed by the pulmonary tissue. The maximum signal sensitivity distribution reached 0.073% at the 2.8- to 3.1-cm light source-detector separation. The normalized light intensity was significantly different among different PE levels and formed a linear relationship ( , ). The study found that photons could reach the pulmonary artery tissue, the light intensity was linearly related to the degrees of embolism, PE could be quantitatively diagnosed by NIRS. Meanwhile, the optimized distance in between the light source and detector, 2.8 to 3.1cm, was recommended to be used in future potential noninvasive optical diagnosis of PE.

Analysis of lethal outcomes in COVID-19 convalescents in multidisciplinary hospital

Health status of COVID-19 convalescents poses a serious burden on the healthcare system due to frequent decompensation of existing diseases and high mortality after episode of infection. This requires an analysis of not only the causes of death, but also the time of occurrence of complications in order to implement preventive measures and potentially reduce mortality Aim. The aim of the study was to carry out a clinical and pathoanatomical analysis of fatal outcomes in convalescents of COVID-19 in a multidisciplinary hospital.Material and Methods. The medical documentation of 67 deceased patients with a documented history of COVID-19 was analyzed. Patients were divided into five groups based on the nosological principle.Results. The study showed that the absolute majority of fatal outcomes occurred within one to two months (chi2 = 15.53; p = 0.001; df = 1); after that, the mortality rate gradually decreased over time. The rate of patients who died from acute and chronic decompensated cardiac diseases was 63%, which may be attributed to the specifics of the hospital. The number of neglected oncological diseases was 21% in our sample, which also should be considered a negative impact of the pandemic. In our study, the neglected oncological diseases were observed in 45% of patients, which was probably due to the profile of the hospital. The incidence rate of pulmonary embolism and other thrombotic complications was significantly higher in women (chi2 = 30.73; p &lt; 0.001; df = 1). While comparing the time between recovery from COVID-19 and onset of death, we found that thrombotic complications occurred more often either immediately or within one to two months after recovery from COVID-19; sometimes patients already had a formed lung infarction, but in these cases the interval was longer (four to six months), which suggested the beginning of thrombosis during the acute stage of disease.Conclusion. At the early stage, it is necessary to analyze basic information about the epidemiology of post-COVID-19 syndrome taking into account patient age and comorbidities. Given the high frequency of deaths, most often associated with thrombotic events or disorders of the cardiovascular system, it is necessary to plan clinical and laboratory tests, appropriate registries and clinical trials in order to properly assess thee risks and prepare for the long-term consequences of COVID-19.

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study

Background: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. Methods: An ambispective, observational cohort study. A total of 305 patients ≥ 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden’s index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. Results: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. Conclusions: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels.

Abstract PS10-17: Palbociclib (P) in combination with fulvestrant (F) or letrozole (L) in endocrine-sensitive patients (pts) with hormone receptor (HR)[+]/HER2[-] metastatic breast cancer (MBC): detailed safety analysis from a multicenter, randomized, open-label, phase II trial (PARSIFAL)

Abstract Background: P led to a meaningful improvement in clinical outcomes when used in combination with endocrine therapy for first- or later-line regimen in HR[+]/HER2[-] MBC. Grade 3-4 neutropenia was the most common adverse event (AE) in the P-containing regimens. Although venous thromboembolic events (VTE) have been rarely reported in registrational trials, a systematic review and meta-analysis of randomized controlled trials demonstrated a higher rate of these AEs. Moreover, rare but severe cases of interstitial lung disease (ILD)/pneumonitis have been observed during post-approval use of P. Here, we present a comprehensive toxicity profile of pts included in the PARSIFAL study, with particular emphasis given to AEs of special interest of the overall safety population. Methods: A total of 486 pts with HR[+]/HER2[-] MBC with no prior therapy in the advanced setting and endocrine sensitive criteria (relapse &amp;gt;12 months [mo] after the end of adjuvant endocrine therapy or diagnosed with de novo metastatic disease) were randomly assigned 1:1 to receive P (oral 125 mg/day [d]; 3 weeks on/1 week off) plus either F (intramuscular injection 500 mg/d; d 0, 14, 28, and then every 28 ds) or L (oral 2.5 mg/d). Pts were stratified by visceral involvement and type of disease presentation (de novo/recurrent). Safety assessments included blood analysis and collection of vital signs at screening, d1 of each cycle, and end of treatment/withdrawal. Severity was graded as per the NCI Common Terminology Criteria for Adverse Events v.4.03. Results: The incidence rate of any grade, grade 3-4, and serious AEs was 99.6%, 80.9%, and 29.9%, respectively, in the FP arm, and 99.2%, 78.5%, and 21.1% in the LP arm. Discontinuations due to AEs were 5.4% in the FP arm and 2.1% in the LP arm. Neutropenia, leukopenia, anemia, asthenia, arthralgia, fatigue, and diarrhea were the most frequent AEs in both arms. Febrile neutropenia was reported in 1.2% (3 pts) and 0.4% (1 patient) in the FP and LP arms, respectively. The rate of VTE of any grade was 5.8% (14 pts) in the FP arm and 4.5% (11 pts) in the LP arm (p = 0.531). Among 18 pts who had grade ≥ 3 pulmonary embolism (PE), the incidence reported in the FP and LP arms was 5% (12 pts) vs 2.5% (6 pts), respectively, and many of them (n=16, 88.9%) were unrelated PE. Asymptomatic grade 3 PE was reported in 10 pts of the entire study population on every 3-mo CT scan. Further, in 5 pts PE was detected in the context of progressive disease. Median time from the first dose of study drugs to occurrence of PE was 4.1 mo (range 1.4-32.0 mo) in the FP arm and 7 mo (range 1.8-19.3 mo) in the LP arm. Analysis of baseline characteristics in the whole population revealed that older pts had a significantly increased risk for developing PE (69.5 years [range 47-84 years]; p &amp;lt; 0.01). ECOG performance status, menopausal status, metastatic disease, visceral involvement, number of disease sites, and prior therapies including antithrombotic agents did not significantly increase the risk for developing PE. Grade 3 ILD/pneumonitis was rarely observed in the FP and LP arms (0.8% vs 1.2%, respectively) with no grade 4 AE. Conclusions: First-line treatment with FP and LP for HR[+]/HER2[-] MBC in the PARSIFAL study confirmed the favorable safety profile, with neutropenia representing the most common AE. Although rare, ILD/pneumonitis can be a side effect of P-based regimens. VTE and PE incidence rates were low and consistent with age-specific analyses from PALOMA trials and breast cancer population. Early detection of these AEs may assist in optimizing their management. Citation Format: José Manuel Pérez-García, Antonio Llombart-Cussac, Meritxell Bellet, Florence Dalenc, Miguel J. Gil Gil, Manuel Ruiz Borrego, Joaquín Gavilá, Miguel Sampayo-Cordero, Elena Aguirre, Peter Schmid, Frederik Marmé, Serena Di Cosimo, Joseph Gligorov, Andreas Schneeweiss, Joan Albanell, Pilar Zamora, Duncan Wheatley, Eduardo Martínez-De Dueñas, Vicente Carañana, Kepa Amillano, Andrea Malfettone, Javier Cortés. Palbociclib (P) in combination with fulvestrant (F) or letrozole (L) in endocrine-sensitive patients (pts) with hormone receptor (HR)[+]/HER2[-] metastatic breast cancer (MBC): detailed safety analysis from a multicenter, randomized, open-label, phase II trial (PARSIFAL) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-17.

Mid- and Short-Term Efficacy of Percutaneous Mechanical Thrombectomy in the Treatment of Acute Iliofemoral Deep Vein Thrombosis

We aimed to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in treating acute iliofemoral deep vein thrombosis (DVT). We retrospectively analyzed the clinical data of 82 acute iliofemoral DVT patients between November 2017 and December 2018. The therapeutic effects were evaluated based on the thrombus removal rate and circumference changes 10cm above the affected knee. Incidence rates of pulmonary embolism were evaluated to determine the safety of the procedure. During follow-up, the incidence of postthrombotic syndrome (PTS) was evaluated using the Villalta score, whereas the patency rate of the iliac vein was evaluated via duplex ultrasonography and venography. The surgical success rate was 100%. We identified 48 patients with iliac vein compression syndrome (IVCS) intraoperatively: three of these underwent stent implantation and the others underwent percutaneous transluminal angioplasty (PTA). Grade II and III thrombus removal was achieved in 32.9% (27/82) and 67.1% (55/82) patients, respectively. Postoperative venography revealed that four patients had many floating thrombi under their inferior vena cava filters, which were not removed. The circumference 10cm above the affected knee decreased from 50.3±3.5cm preoperatively to 46.3±3.3cm postoperatively (P<0.05). During follow-up, a PTS incidence rate of 9.8% was observed. The patency rate of the iliac vein was 66.6% after stent implantation and 93.3% after PTA. PMT is feasible, safe, and effective for acute iliofemoral DVT. With regard to IVCS, we suggest PTA alone as a one-stage surgery, and the need of secondary stent implantation should be determined based on follow-up results.

The Risk of Venous Thromboembolism in Patients with Gallstones.

The objective of this study is to assess the relationship between gallstones and venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and the risk of VTE after cholecystectomy for gallstones. This nationwide population-based cohort study retrieved the hospitalization database from the Longitudinal Health Insurance Research Database (LHID2000), a database belonging to the National Health Insurance (NHI) program of Taiwan. A total of 345,793 patients aged ≥ 18 years with gallstones diagnosed between 2000 and 2010 were identified as the study cohort. The beneficiaries without gallstones were randomly selected as the control cohort by propensity score matching with the study cohort at a 1:1 ratio based on age, sex, urbanization, occupation, comorbidities, and year of the index date. We compared the risk of VTE between both cohorts and measured the risk differences of VTE between the gallstones patients with (n = 194,187) and without cholecystectomy (n = 151,606). Each patient was examined from the index date until the occurrence of DVT or PE, death or withdrawal from the NHI program, or the end of 2011. The incidence rate of DVT was 7.94/10,000 person-years for the non-gallstones cohort and 9.64/10,000 person-years for the gallstones cohort (hazard ratio (HR) = 1.35, 95% confidence interval (CI) = 1.25–1.47), respectively (p < 0.001). The incidence rate of PE was 3.92/10,000 person-years for the non-gallstones cohort and 4.65/10,000 person-years for the gallstones cohort (HR = 1.35, 95% CI = 1.20–1.53), respectively (p < 0.001). The cumulative incidence of DVT (6.54/10,000 person-years vs 14.6/10,000 person-years, adjusted hazard ratio (aHR) = 0.60, 95% CI = 0.54–0.67) and PE (3.29/10,000 person-years vs 6.84/10,000 person-years, aHR = 0.67, 95% CI = 0.58–0.77) for gallstones patients was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort after adjustment for age, sex, urbanization level, occupation, frequency of medical visits, history of pregnancy, and comorbidities (log-rank test, p < 0.001). Our findings indicate that the risk of DVT or PE in patients with gallstones was greater than those without gallstones. However, the risk of DVT and PE in the patients with gallstones would decrease after cholecystectomy. This area of research needs more studies to ascertain the pathogenesis for the contribution of gallstones to the development of VTE and the protective mechanisms of cholecystectomy against the development of VTE.

Risk of venous thromboembolism in ankylosing spondylitis: a general population-based study

BackgroundVenous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), can be life threatening. An increased frequency of VTE has been found in inflammatory conditions. To date, evidence...

A changing landscape: Temporal trends in incidence and characteristics of patients hospitalized with venous thromboembolism 2006–2015

BackgroundVenous thromboembolism (VTE) has major clinical and public health impact. However, only sparse data on calendar time trends in incidence from unselected populations reflecting current clinical practice are available. ObjectivesTo examine temporal trends in the incidence and characteristics of patients hospitalized with first-time VTE in Denmark between 2006 and 2015. Patients/MethodsUsing nationwide health care registries, we calculated yearly hospitalization rates for first-time VTE from 2006 to 2015. The rates were standardized to the age and sex distribution in 2006. Based on the hospitalization and prescription history of each patient, we assessed the risk profile and evaluated changes over time. ResultsWe identified 67,426 patients with a first-time VTE hospitalization. The age- and sex-standardized incidence rate increased from 12.6 (95% CI: 12.3–12.9) per 10,000 person years at risk in 2006 to 15.1 (95% CI: 14.7–15.4) in 2015, corresponding to an increase of 19.8%. The increase was due to a 73.9% increase in the standardized incidence rate of pulmonary embolism (PE), whereas no increase was observed for deep vein thrombosis. The risk profile changed with an increasing proportion of elderly patients and patients with comorbidity (proportion of patients with a Charlson's Comorbidity Index score of ≥1). ConclusionsThe hospitalization rate of first-time VTE, and particularly PE, has increased substantially within the last decade in Denmark. In addition, the risk profile of the VTE population has changed with more elderly and more patients with comorbidity being diagnosed. Further efforts are warranted to explore the changes in VTE epidemiology and the clinical implications.

Plu]na tromboembolija i uloga faktora V Leiden u njenom nastanku - pregled literature

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are associated with considerable morbidity and mortality, and for as much as twenty-five percent of PE patients the primary clinical appearance is unexpected death. Diagnosis of PE is based on clinical suspicious at first, but sometimes its diagnostics can be extremely difficult. Newly increased interest in an inherited thrombophilic states has been provoked by the discovery of several common inherited abnormalities, i.e. the prothrombin (PT) gene G20210A, Factor V Leiden (FVL) mutation (Arg506Gln), hyperhomocystenemia and homocysteiuria, Wein-Penzing defect, Sticky Platelet Syndrome (SPS), Quebec platelet disorder (QPD) and Sickle Cell Disease (SCD). PE incidence rates increase in recent years. The only explanation at this moment is increased awareness of PE, especially after any kind of surgery, immobile state or unexplained shorthness of breath.

PCN296 - BIG DATA ANALYSIS OF CANCER TREATMENT IN GERMANY - MAPPING OF TREATMENT LANDSCAPE BASED ON A GERMAN STATUTORY HEALTH INSURANCE (SHI) CLAIMS DATA ANALYSIS

This study analyzed the potential of big data sets for health care research. Treatment patterns and medical care of oncological patients with thrombosis and the associated prescription of anticoagulation according to German guidelines were analyzed. A nationally representative sample of 4.1 million (5.5 %) statutory health insured (SHI) persons was drawn from a database of 70 German SHI providers. The database contains information on demographics, both inpatient and outpatient care, on medication, and costs. Thereof, the retrospective analysis (2011-2016) defined demographical key figures, comorbidities and resource use to depict actual patterns of cancer treatment. Oncological patients were identified using coded diagnoses (ICD-10-GM) and outpatient prescriptions of anticoagulation (ATC Codes). The observation period of the study population was one year. 322,600 patients with tumor (80.7 per 1,000) and 91,622 patients with thrombosis (independent of cancer diagnosis) were identified. An incidence rate of pulmonary embolism of 0.8% (7.7 per 1,000) was determined in 30,978 patients. The overlap of patients with thrombosis and pulmonary embolism was 10,703 with an incidence rate of 0.3% (2.7 per 1,000). 7,313 tumor patients suffered from thrombosis and received prescriptions for anticoagulant treatment, representing an incidence rate of 0.2% (1.8 per 1,000). The use of big data sources is increasingly important in health care research; they provide many possibilities to create reliable information on care reality. The SHI claims data analysis generates high validity to describe the current status of oncology care in Germany. In addition to epidemiological findings for the German health care research, a lack of adherence to guidelines was revealed. These results may have an impact on further guideline development and will be examined in further publications.

MP52-16 ANDROGEN DEPRIVATION THERAPY INCREASED THE RISK OF PULMOMARY EMBOLISM IN PATIENT WITH PROSTATE CANCER - FROM 24,464 PATIENTS, TAIWAN NATIONAL HEALTH INSURANCE RESEARCH DATABASE

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III1 Apr 2018MP52-16 ANDROGEN DEPRIVATION THERAPY INCREASED THE RISK OF PULMOMARY EMBOLISM IN PATIENT WITH PROSTATE CANCER - FROM 24,464 PATIENTS, TAIWAN NATIONAL HEALTH INSURANCE RESEARCH DATABASE Jian-Hua Hong, Yu-Chuan Lu, Chao-Yuan Huang, and Yeong-Shiau Pu Jian-Hua HongJian-Hua Hong More articles by this author , Yu-Chuan LuYu-Chuan Lu More articles by this author , Chao-Yuan HuangChao-Yuan Huang More articles by this author , and Yeong-Shiau PuYeong-Shiau Pu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Androgen deprivation therapy (ADT) has been one kind of treatments for prostate cancer (PCa) but subsequent risks of some complications should be considered. Therefore, we aim to investigate the risks of peripheral arterial occlusive disease (PAOD) and pulmonary embolism (PE) in PCa patients with ADT treatment. METHODS We constructed a retrospective cohort study of total 24,464 men with newly diagnosed PCa from a longitudinal health insurance database of catastrophic illness patients in Taiwan. All patients were further divided into one treatment group and two matched control groups: 1) patients undergoing ADT treatment (ADT group), 2) PCa patients without ADT and are individual-matched with age (comparison 1 group), and 3) PCa patients without ADT and are propensity score-matched with continuous age and comorbidity etc. (comparison 2 group). Individual comorbidity history as well as outcome ascertainments of PAOD and PE were obtained from clinical diagnosis and medical records. Multivariate Cox proportional hazard regression and Kaplan–Meier analysis were performed in the present analyze. RESULTS During the 11 year follow-up, the incidence rates of PE were 1.41, 0.93, and 0.63 as well as those of PAOD were 3.60, 4.04 and 3.21per 1000 person-years in the ADT, comparison 1, and comparison 2 groups, respectively. PCa patients with ADT treatment significantly increased nearly twofold risk of PE, especially for those receiving combined androgen blockade or surgical castration. However, no association between ADT therapy and PAOD risk were observed. ADT patients with specific comorbidities, such as other cancers, heart failure or stroke had a much higher risk of subsequent PE. In addition, ADT patients with stroke had a twofold increase in the risk of PAOD. CONCLUSIONS CAB or surgical castration increased subsequent risk of PE, neither for PAOD risk. This treatment should be considered for patients with certain clinical comorbidities. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e701-e702 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jian-Hua Hong More articles by this author Yu-Chuan Lu More articles by this author Chao-Yuan Huang More articles by this author Yeong-Shiau Pu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of alcohol intoxication on the risk of venous thromboembolism

This study investigated whether alcohol intoxication (AI) increases the risk of venous thromboembolism (VTE) by using the Taiwan National Health Insurance Research Database (NHIRD).Using data from the NHIRD, we assembled 61,229 patients with acute AI and randomly selected 244,916 controls. Each patient was monitored from 2000 to 2011 to identify those who were subsequently diagnosed with deep vein thrombosis (DVT) and pulmonary embolism (PE). Cox proportional hazard regression analysis was conducted to determine the risk of VTE in the patients with AI compared with the controls.The incidence rate of DVT during the 10 years follow-up period was 9.36 per 10,000 person-years and 2.07 per 10,000 person-years in the AI and non-AI cohorts, respectively. Moreover, the incidence rate of PE was 4 per 10,000 person-years in the AI cohort and 0.93 in the non-AI cohort. After adjustment for age, sex, and comorbidities, the risks of DVT and PE were 3.40 [95% confidence interval (CI) = 2.83–4.08] and 3.53 (95% CI = 2.69–4.65)-fold higher in the AI cohort than in the non-AI cohort.An increased incidence of VTE was observed among patients with AI. Therefore, physicians should carefully estimate the risk of VTE in patients with AI.

Incidence of Pulmonary Embolism in CCU at King Faisal Hospital, Taif, Saudi Arabia

Background: Pulmonary embolism (PE) is a frequent cause of death and serious disability with a risk extending far beyond the acute phase of the disease. Despite advances in diagnosis and treatment, high mortality rates are still a common problem. Aim of the work: was to assess the incidence rate of pulmonary embolism among patients attending CCU of King Faisal hospital in Taif, Saudi Arabia and the most common risk factors of pulmonary embolism in these patients. Patients and methods: across sectional study for 6 month duration, in the period from June 2016 to December 2016. Patients were chosen from CCU of King Faisal hospital, Taif, Saudi Arabia. The study includes 20 patients diagnosed as pulmonary embolism from both sexes (male/female =10/10) with mean age 58.9±19.9 years old and 20 healthy control volunteers (male/female =14/6) with mean age 52.1±19.5 years old were chosen for comparison;incidence rate of pulmonary embolism was calculated and the related risk factors in these patients were evaluated via a questionnaire done to each patient and control. Results: 80% and 70% of patients and control lived in Taif, respectively. Incidence rate of pulmonary embolism was 5.5%. 25% of patients were smoker and 15% of control group were smoker. Conclusion: the presented study assessed the incidence of pulmonary embolism and its risk factors in King Faial hospital in Taif, Saudi Arabia. All risk factors of pulmonary embolism mentioned in international researches were emphasized in this research particularly travelling history, oral contraceptive therapy and cancer with respect to other risk factors.

The Risk of Deep Venous Thrombosis and Pulmonary Embolism in Primary Sjögren Syndrome: A General Population-based Study.

To estimate the future risk and time trends of venous thromboembolism (VTE) in individuals with newly diagnosed primary Sjögren syndrome (pSS) in the general population. Using a population database that includes all residents of British Columbia, Canada, we created a study cohort of all patients with incident SS and up to 10 controls from the general population matched for age, sex, and entry time. We compared incidence rates (IR) of pulmonary embolism (PE), deep vein thrombosis (DVT), and VTE between the 2 groups according to SS disease duration. We calculated HR, adjusting for confounders. Among 1175 incident pSS cases (mean age 56.7 yrs, 87.6% women), the IR of PE, DVT, and VTE were 3.9, 2.8, and 5.2 per 1000 person-years (PY), respectively; the corresponding rates in the comparison cohort were 0.9, 0.8, and 1.4 per 1000 PY. Compared with non-SS individuals, the multivariable HR for PE, DVT, and VTE among SS cases were 4.07 (95% CI 2.04-8.09), 2.80 (95% CI 1.27-6.17), and 2.92 (95% CI 1.66-5.16), respectively. The HR matched for age, sex, and entry time for VTE, PE, and DVT were highest during the first year after SS diagnosis (8.29, 95% CI 2.57-26.77; 4.72, 95% CI 1.13-19.73; and 7.34, 95% CI 2.80-19.25, respectively). These findings provide population-based evidence that patients with pSS have a substantially increased risk of VTE, especially within the first year after SS diagnosis. Further research into the involvement of monitoring and prevention of VTE in SS may be warranted.

Incidence of pulmonary embolism after the first 3 months of spinal cord injury.

Pulmonary embolism (PE) is a significant cause of morbidity and mortality in patients with spinal cord injury (SCI). Prophylactic anticoagulation is associated with a reduction in mortality rates, but there is limited evidence regarding the incidence rate of PE following cessation of anticoagulation after the first 3 months of injury. Single-centre retrospective study. To estimate the incidence rate of PE after 90 days of SCI. The National Spinal Injuries Centre at Stoke Mandeville Hospital, Aylesbury, UK. The study includes 640 new-onset SCI patients. All computer tomography pulmonary angiograms (CTPAs) or ventilation-perfusion lung scans between 2008 and 2013 were identified. Medical notes and scans were reviewed and clinical outcomes and radiological findings were recorded. A total of 91 patients with a new-onset SCI had a CTPA or a perfusion lung scan. PE was detected in a total of 8 patients. The incidence of PE was 1.25%; 95% confidence interval (0.39-2.11) over a 6-year period. The duration of injury at the time of PE was 7 months. The incidence rate of PE post 3 months of SCI remains significant, though much lower than immediately post injury.

The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study

ObjectiveTo estimate the future risk and time trends of newly diagnosed venous thromboembolism (VTE) in individuals with incident systemic lupus erythematosus (SLE) in the general population. MethodsUsing a population-based database that includes all residents of British Columbia, Canada we conducted a study cohort of all patients with incident SLE and up to 10 age-, sex-, and entry-time-matched individuals from the general population. We compared incidence rates of pulmonary embolism (PE), deep venous thrombosis (DVT), and VTE between the two groups according to SLE disease duration. We calculated hazards ratios (HR), adjusting for confounders. ResultsAmong 4863 individuals with SLE (86% female; mean age, 48.9 years), the incidence rates (IRs) of PE, DVT, and VTE were 2.58, 3.33, and 5.32 per 1000 person-years, respectively, whereas the corresponding rates in the comparison cohort were 0.67, 0.57, and 1.11 per 1000 person-years. Compared with non-SLE individuals, the multivariable HRs among SLE patients were 3.04 (95% CI: 2.08–4.45), 4.46 (95% CI: 3.11–6.41), and 3.55 (95% CI: 2.69–4.69), respectively. The age-, sex-, and entry-time-matched HRs for PE, DVT, and VTE were highest during the first year after SLE diagnosis [13.57 (95% CI: 7.66–24.02), 11.13 (95% CI: 6.55–18.90), and 12.89 (95% CI: 8.56–19.41), respectively]. ConclusionThese findings provide population-based evidence that patients with SLE have a substantially increased risk of VTE, especially in the first year after SLE diagnosis. Awareness and increased vigilance of this potentially fatal, but preventable, complication is recommended.

Fatal pulmonary embolism after arthroscopic rotator cuff repair: a case series

pulmonary embolism (PE) is a rare and serious complication of arthroscopic orthopaedic surgery. Currently there is great paucity in the literature regarding PE events following arthroscopic rotator cuff (ARCR) surgery. The purpose of this case series was to (1) report our known incidence rate of symptomatic PE following ARCR for a single surgeon and (2) describe five cases of pulmonary embolism following ARCR, detailing patient medical history and potential perioperative risk factors. the number of PE events were queried retrospectively from the institutional database with the ICD-9 code 415.1 within a 10 year time frame (2003-2013). Cases of PE identified by ICD-9 query were reviewed for type of procedure, postoperative day of event, and surgeon. Only patients with a confirmed diagnosis by computed tomography (CT) scan or post-mortem exam, were included in this study. Patient medical records belonging to affected patients were ordered and reviewed by a single investigator. Pre, intra, and postoperative information was obtained and summarized. 5 cases of PE were identified, two of which were fatal. All events occurred in the perioperative period following ARCR. The 10 year incidence rate for PE following ARCR was 0.89%. Medical record review revealed significant risk factors for these patients when compared to current VTE prophylactic guidelines. our ten year incidence rate of PE following arthroscopic shoulder surgery and ARCR was 0.25 and 0.89% respectively. These rates were found to be considerably higher than reported rates of PE in the general population and following arthroscopic shoulder surgery. In addition, our methods failed to detect subclinical PE events, resulting in the likelihood of this value to be an underestimate of the true incidence. Medical record review revealed risk factors which would qualify patients for chemoprophylaxis under certain guidelines, however, the validity of available risk stratification methods continue to be a topic of debate. Level IV; case series.