Incidence Rate Of Venous Thrombosis Research Articles

Incidence rate of venous thrombosis in women switching combined oral contraceptives: a cohort study

BackgroundThe incidence rate of venous thrombosis (VT) in women switching combined oral contraceptives (COCs) is unknown. ObjectivesWe hypothesize that women switching COCs may have a similar increased incidence rate of VT as women who start COCs. Switching means starting with a new COC, which may biologically approximate starting. MethodsWe conducted a cohort study with data from the Netherlands and Denmark. First, we identified starters who were defined as women who did not use COCs in the 2 years prior to the start of their first COC prescription within the study period. Switchers were a subset of COC starters who redeemed a COC formulation different from their initial COC during follow-up but not longer than 12 months after starting. We estimated incidence rate ratios (adjusted incidence rate ratio [aIRR]) of VT with 95% CIs among COC switchers as compared with COC starters using Poisson regression adjusted for age, COC progestogen generation, and preexisting obesity. ResultsIn both countries, we found an increased risk of VT among switchers as compared with starters during the first 3 months of the follow-up (aIRR = 1.77; 95% CI, 1.22-2.56 in the Netherlands and aIRR = 1.50; 95% CI, 1.04-2.16 in Denmark). ConclusionSwitchers, particularly in the first 3 months after switching, may experience a renewed starter effect thereby increasing the risk of VT.

Incidence and Risk Factors of Deep Vein Thrombosis in Hospitalized COVID-19 Patients

Deep vein thrombosis (DVT) is prevalent in patients with coronavirus disease 2019 (COVID-19). However, the risk factors and incidence rate of DVT remains elusive. Here, we aimed to assess the incidence rate and risk factors of DVT. All patients diagnosed with COVID-19 and performed venous ultrasound by ultrasound deparment between December 2019 and April 2020 in Wuhan Jin Yin-tan hospital were enrolled. Demographic information and clinical features were retrospectively collected. Notably, a comparison between the DVT and the non-DVT groups was explored. The incidence rate of venous thrombosis was 35.2% (50 patients out of 142). Moreover, the location of thrombus at the proximal extremity veins was 5.6% (n = 8), while at distal extremity veins was 35.2% (n = 50) of the patients. We also noted that patients with DVT exhibited a high level of D-dimer (OR 10.9 (95% CI, 3.3-36.0), P < 0.001), were admitted to the intensive care unit (OR 6.5 (95% CI, 2.1-20.3), P = 0.001), a lower usage of the anticoagulant drugs (OR 3.0 (95% CI, 1.1-7.8), P < 0.001). Finally, this study revealed that a high number of patients with COVID-19 developed DVT. This was observed particularly in critically ill patients with high D-dimer levels who required no anticoagulant medication.

Klinefelter syndrome and testosterone treatment: a national cohort study on thrombosis risk.

ObjectivesKlinefelter syndrome (KS), 47,XXY, can be viewed as a disease model for investigating the risk of thrombosis in male hypogonadism and the subsequent risk related to testosterone treatment. We describe rates of thrombotic risk factors, thrombosis and thrombosis mortality in KS and the association with testosterone treatment.MethodsNational registry-based matched cohort study with follow-up from 1995 to 2016 set in Denmark. For the study, 1155 men with KS were each matched by year and month of birth to 100 men from the background population. First thrombotic events and thrombosis mortality was evaluated by event rates and hazard ratios (HRs) and by applying testosterone treatment as a time-dependent covariate.ResultsThe KS cohort had higher incidence of venous thromboembolism relative to the comparison cohort (HR, 3.95; 95% CI, 2.83–5.52). Total thrombotic deaths were increased in KS (HR, 1.76; 95% CI, 1.18–2.62), and all-cause mortality was increased in KS following arterial thrombosis (HR 1.73; 95% CI 1.22–2.47). Only 48.7% of men with KS redeemed prescriptions for testosterone. Untreated men with KS were on average born 12 years before those treated, and the majority of untreated men with KS with available biochemistry were hypogonadal. Testosterone treatment in KS was associated with a non-significant decrease in venous thromboembolism and thrombotic deaths.ConclusionThrombosis and thrombotic deaths are increased in KS. Only half of the men with KS ever received testosterone treatment, despite overt hypogonadism in the non-treated. Testosterone treatment in Klinefelter syndrome was insignificantly associated with lower incidence rates of venous thrombosis and thrombotic deaths.

Application of limbs and fingers movement combined with moxibustion in patients with PICC catheterization

Objective To explore the application of limbs and fingers movement combined with moxibustion in patients with PICC catheterization. Methods A total of 346 PICC catheterized patients treated from August 2014 to July 2017 were randomly divided into control group (173 cases) and observation group (173 cases) according to random number table method. The control group was given local hot-wet compression at 3-4 cm of puncture point after 24 h of catheterization, and the observation group was given preventive moxibustion with the direction of the punctured vein at the same site in the control group, and then was given limbs and fingers movement. The levels of serum monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8), hemorheological parameters [rate of high and low shear whole blood viscosity (RBV), rate of plasma specific viscosity (RPV), hematocrit (HCT)] and the incidence rates of mechanical phlebitis and venous thrombosis were compared between the two groups after intervention. Results The levels of MCP-1, TNF-α and IL-8 were (53.03±7.86), (85.93±10.72), (54.65±9.23) ng/L in the observation group, (60.27±8.45), (94.74±11.36), (63.08±10.07) ng/L in the control group, and there were significant differences (t =8.252, 7.419, 8.117, all P<0.05). The levels of high shear RBV, low shear RBV, RPV and HCT were (3.94±0.85) mPa·s, (6.55±1.22) mPa·s, (1.70±0.54) mPa·s and (43.71±4.82)% respectively in the observation group, (4.18±0.74) mPa·s, (6.97±1.25) mPa·s, (1.92±0.59) mPa·s and (45.13±4.65)% in the control group, and there were significant differences (t=2.789-3.618, P<0.05). The incidence rates of venous thrombosis and phlebitis were 1.16% (2/173) and 5.78% (10/173) respectively in the observation group, 5.78% (10/173) and 13.29% (23/173) in the control group, there were significant differences (χ2=4.230, 5.661, P<0.05). Conclusions Limbs and fingers movement combined with moxibustion can effectively improve the blood flow status, and reduce the occurrence of mechanical phlebitis and venous thrombosis in patients with PICC catheterization. Key words: PICC catheterization; Moxibustion; Mechanical phlebitis; Venous thrombosis; Limbs and fingers movement

Clinical Study of Aspirin in the Prevention of Thrombosis in Breast Cancer Patients with Postoperative Chemotherapy after PICC Insertion

Objective: To study the clinical effect of aspirin in the prevention of venous thrombosis in breast cancer patients with postoperative chemotherapy after peripherally inserted central catheter (PICC) insertion. Methods: 240 cases of female breast cancer patients with postoperative chemotherapy after PICC insertion in The First People’s Hospital of Jingzhou from June 2014 to December 2017 were selected and divided into experimental group (n = 120) and control group (n = 120) according to the length of stay. The modified Seldinger technique was used in both groups. The experimental group had oral Aspirin enteric-coated tablet on the day of PICC insertion, 100 mg/day until the PICC catheter was removed, while the control group did not take anticoagulant drugs. The therapeutic effects were evaluated by color Doppler ultrasound, Coagulation analysis, and complete blood count. Results: There were three cases with venous thrombosis in the experimental group, and the incidence rate was 2.5%, while ten cases in the control group developed venous thrombosis, and the incidence rate was 10%. There was a statistically significant difference in the incidence of thrombosis between the two groups (P < 0.05). Conclusion: This study showed that oral Aspirin can effectively reduce the incidence rate of venous thrombosis in breast cancer patients with postoperative chemotherapy after PICC insertion. Therefore, it is worthy of clinical application.

Updates of Pulmonary Embolism

Pulmonary embolism (PE) is the third most common cause of cardiovascular death worldwide, behind myocardial infarction and stroke. Due to pulmonary bed obstruction, PE can result in acute right ventricular (RV) failure which is a life-threatening condition. Because most patients ultimately die within the first hours of presentation, early diagnosis is very important (1). Mortality due to pulmonary embolism varies greatly, depending on various factors including age, comorbid conditions, and stability on presentation. Patients with low-risk PE have a 1-year survival rate over 95%. In contrast, patients presenting with high risk PE and hemodynamic instability have an approximately 40% mortality rate within 90-days. In this review, we will discuss the basic pathophysiology of PE, risk factors for developing PE, and standard diagnostic testing modalities. We will also cover risk stratification of patients presenting with PE and the implications for treatment and disposition. While no exact epidemiological data are available, the incidence of PE is estimated to be approximately 60 to 70 per 100,000, and that of venous thrombosis approximately 124 per 100,000 of the general population (2). The European guidelines for the diagnosis and management of PE report annual incidence rates of venous thrombosis and PE of approximately 0.5 to 1.0 per 1000 inhabitants (3). However, the actual figures are likely to be substantially higher because silent PE can develop in up to 40% to 50% of patients with deep vein thrombosis (DVT) (3)

Impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly

Objective To study the impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly. Methods 86 elderly patients with hip fracture surgery were divided into the control group(43 cases) and observation group(43 cases) according to random number table method.The control group was given low molecular heparin calcium, and the observation group was given rehabilitation training combined with low molecular heparin calcium.After four weeks, the hip functional recovery and venous thrombosis occurrence were observed in the two groups.The levels of blood rheology indicators such as blood high shear viscosity, shear viscosity, low shear viscosity, erythrocyte aggregation index and coagulant function index of thrombin time and D-dimer were detected. Results The scores of hip joint pain, joint function, joint mobility, deformity and Harris score in the observation group were higher than those in the control group, the differences were statistically significant(t=3.713, 3.224, 3.345, 1.861 and 8.087, all P<0.05). The incidence rate of venous thrombosis in the observation group was 6.89%, which was lower than 23.26% in the control group, the difference was statistically significant (χ2=4.440, P=0.035). After 4 weeks treatment, the levels of the whole blood high shear viscosity, shear viscosity, low shear viscosity and erythrocyte aggregation index in the observation group were lower than those in the control group, the differences were statistically significant (t=2.092, 2.590, 1.716 and 2.590, all P<0.05). After treatment, the level of D-dimer in the observation group was lower than that in the control group, and the prothrombin time in the observation group was higher than that in the control group, the differences were statistical significance(t=7.510 and 2.151, all P<0.05). Conclusion The rehabilitation training combined with low molecular heparin calcium can promote hip joint function recovery of postoperative period of hip fracture in the elderly, reduce the incidence of venous thrombosis, improve blood rheology and blood coagulation function indicators. Key words: Rehabilitation training; Low molecular heparin calcium; Hip fracture; Venous thrombosis; Blood rheology; Blood coagulation function

Abstract 339: Association of the American Heart Association’s Life’s Simple 7 Metric for Cardiovascular Health with Risk of Venous Thrombosis: the Reasons for Geographic and Racial Differences in Stroke Cohort

Background The AHA released a metric, Life’s Simple 7 (LS7), in 2010 to track cardiovascular health. The AHA 2020 Goals include improving population levels of LS7 by 20%. LS7 classifies 7 health components into poor, intermediate or ideal levels. The 7 components are physical activity, diet, smoking, body-mass index, glucose, blood pressure and cholesterol. Associations of these individual components with risk of venous thrombosis (VT) vary in the literature, but we hypothesized a decreased risk of VT with favorable LS7 summary scores. Methods We recruited 30,239 black and white participants age ≥45 across the US in 2003-7. With 4.6 years of follow up we validated 278 cases of first-time VT, including deep vein thrombosis and pulmonary embolus. We considered a 14 point summary score for LS7 and divided it into inadequate (0-4 points), average (5-9 points) and optimum (10-14) cardiovascular health. Cox proportional hazards models were used to relate baseline LS7 score to risk of subsequent VT, adjusting for age, sex, race, income, education and region of residence. Results Cases of VT were older and more likely to be male than noncases. Across categories of optimum, average and inadequate baseline health based on the summary LS7 score, the incidence rates of VT were 1.8, 2.1 and 3.1 per 1000 person years, respectively. Compared to those with inadequate health, persons with average health had an adjusted HR of VT of 0.60 (95% CI 0.42-0.84) while those with optimum health had a HR 0.52 (95% CI 0.36-0.77). The HR for a 1 point improvement in overall score (analogous to improvement of one of the 7 factors from poor–&gt;intermediate or intermediate–&gt;ideal) was 0.87 (95% CI 0.81-0.94). The individual factors of LS7 most strongly related to VT risk were ideal physical activity level (HR 0.61, 95% CI 0.46-0.83) and ideal body-mass index (HR 0.42, 95% CI 0.30-0.60); these associations were independent of each other. All associations were similar in blacks and whites. Conclusions A summary measure of cardiovascular health was strongly associated with reduced risk of VT in this US population sample. Results suggest that lifestyle interventions might be effective in reducing incidence of VT, and that achieving AHA’s 2020 Goals will also reduce VT incidence.

Venous Thrombosis in Users of Non-Oral Hormonal Contraception: Follow-Up Study, Denmark 2001-10

Conclusion: Women who use transdermal patches or vaginal rings for contraception have approximately a six to seven times increased risk of venous thromboembolism (VTE) compared to women who do not use hormonal contraception. Summary: It is well known oral contraceptive agents increase the risk of VTE. There are, however, little to no data regarding the effects of methods other than pills to deliver hormonal contraceptive agents. Such methods include transdermal patches, subcutaneous implants, and vaginal rings. The authors used a historic national registry in a cohort study design to assess absolute and relative risk of VTE in Danish women using nonoral hormonal contraception. This national registry-based cohort study used four national registries from Denmark. All Danish nonpregnant women aged 15 to 49 years (n = 1,626,158), who were free of previous VTE or cancer, were followed up from 2001 to 2010. The main outcome measures were incidence rates of VTE in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception. Relative risk of venous thrombosis was compared with nonusers of hormonal contraception, and rate ratios of venous thrombosis in current users of nonoral products were compared with the standard reference of an oral contraceptive with levonorgestrel and estrogen (30-40 μg). A diagnosis of VTE was considered confirmed if there was at least 4 weeks of anticoagulation therapy after the initial VTE diagnosis. There were 5,287 first ever VTE events recorded within 9,429,128 women-years of observation. Of these VTE events, 3,434 were confirmed. The rate of confirmed VTE events was 2.1/10,000 years in nonusers of hormonal contraception. After adjustment for age, calendar year, and education, the relative risks and 95% confidence interval (95% CI) of confirmed VTE in users of transdermal combined contraceptive patches and vaginal ring compared with nonusers of hormonal contraception were 7.9 (3.5-17.7) and 6.5 (7.4-8.9), respectively. Corresponding incidence events per 10,000 exposure-years were 9.7 and 7.8 events. The relative risk (95% CI) was increased in women who used subcutaneous implants (1.4 [0.6-3.4]) but not in those who use the levonorgestrel intrauterine system (0.6 [0.4-0.8]). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk (95% CI) of VTE was 2.3 (1.0-5.2) in users of transdermal patches and 1.9 (1.3-2.7) in users of the vaginal ring. Comment: In the last paragraph of the discussion portion of this article the authors succinctly point out the implications of their study, “if the incidence rate of venous thrombosis in women using combined oral contraceptives containing levonorgestrel is 6 per 10,000 exposure years, that of the vaginal ring is 11 per 10,000 exposure years, and that of the transdermal patch is 14 per 10,000 exposure years, then 2000 women using the vaginal ring, and 1250 using the transdermal patch should shift to combined oral contraceptives with levonorgestrel to prevent 1 event of VTE in one year. A risk of 10 per 10,000 years implies a risk of VTE more than 1% over a 10 year user period. Therefore, women are generally advised to use combined oral contraceptives with levonorgestrel or norgestimate, rather than to use transdermal patches or vaginal rings.”

Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10

Objective To assess the risk of venous thrombosis in current users of non-oral hormonal contraception.Design Historical national registry based cohort study.Setting Four national registries in Denmark.Participants All Danish non-pregnant women...

High risk of venous thrombosis in patients with pancreatic cancer: A cohort study of 202 patients

To estimate the risk of venous thrombosis associated with pancreatic malignancies we followed a cohort of patients with pancreatic cancer (n = 202). We calculated incidence rates of venous thrombosis and compared this with population rates using a Standardised Morbidity Ratio (SMR). The effects of location, histology and treatment were assessed by Cox-modelling. The incidence of venous thrombosis was 108.3/1000 patient-years (95% confidence interval (CI) 64.4-163.8), 58.6-fold increased (SMR 58.6, 95% CI 36.9-92.9). Patients with a tumour of the corpus/cauda had a 2-fold increased risk compared with those with a tumour of the caput. Patients treated with chemotherapy had a 4.8-fold increased risk (HR(adj) 4.8, 95% CI 1.1-20.8), whereas radiotherapy did not increase the risk. In a postoperative period of 30 d, patients had a 4.5-fold increased risk of venous thrombosis (HR(adj) 4.5, 95% CI 0.5-40.9). The risk was 1.9-fold increased in the presence of distant metastases (HR(adj) 1.9, 95% CI 0.7-5.1). Anti-thrombotic prophylaxis seems warranted in the first month after surgery, during and after treatment with chemotherapy, and when distant metastases have been diagnosed.

Osteoporosis and other complications of inflammatory bowel disease

Osteoporosis has received increasing attention as a potential complication of inflammatory bowel disease (IBD). The first population-based data on incidence of fractures in an IBD population were published this past year. The incidence of fractures was one per 100 patient years. Compared with the general population, the fracture rate was increased; however, the relative risk was 1.4 and, therefore, not as high as might be expected from the myriad of studies reporting high rates of osteopenia measured by dual energy x-ray absorptiometry (DXA). Another area receiving increasing attention is that of the enhanced risk of venous thrombosis in patients with IBD. The first population-based incidence rates of venous thrombosis in IBD were also published this past year and showed that IBD patients are affected by venous thrombosis at a rate of approximately one per 200 patient years. The relative risk for venous thrombosis compared with the general population was 3.5. Several studies have reported on associated risk markers or genetic clotting abnormalities, but no clear paradigm has emerged to account for those patients who will suffer a clot. Finally, the first North American population-based study was published, quantifying the prevalence rates of extraintestinal manifestations in patients with IBD for at least 10 years. Some gender- and disease-specific findings emerged. This study found that iritis and uveitis were more common in female patients with ulcerative colitis (3.2%), primary sclerosing cholangitis (PSC) was most common in male patients with ulcerative colitis (3%), ankylosing spondylitis was most common in male patients with Crohn disease (2.7%), and erythema nodosum was most likely to occur in female patients with Crohn disease (1.9%).