Occurrence Of Venous Thromboembolism In Patients Research Articles

Nomogram model combined thrombelastography for venous thromboembolism risk in patients undergoing lung cancer surgery.

Background: The aim of this study was to develop a nomogram model in combination with thromboelastography (TEG) to predict the development of venous thromboembolism (VTE) after lung cancer surgery. Methods: The data of 502 patients who underwent surgical treatment for lung cancer from December 2020 to December 2022 were retrospectively analyzed. Patients were then randomized into training and validation groups. Univariate and multivariate logistic regression analyses were carried out in the training group and independent risk factors were included in the nomogram to construct risk prediction models. The predictive capability of the model was assessed by the consistency index (C-index), receiver operating characteristic curves (ROC), the calibration plot and decision curve analysis (DCA). Results: The nomogram risk prediction model comprised of the following five independent risk factors: age, operation time, forced expiratory volume in one second and postoperative TEG parameters k value(K) and reaction time(R). The nomogram model demonstrated better predictive power than the modified Caprini model, with the C-index being greater. The calibration curve verified the consistency of nomogram between the two groups. Furthermore, DCA demonstrated the clinical value and potential for practical application of the nomogram. Conclusion: This study is the first to combine TEG and clinical risk factors to construct a nomogram to predict the occurrence of VTE in patients after lung cancer surgery. This model provides a simple and user-friendly method to assess the probability of VTE in postoperative lung cancer patients, enabling clinicians to develop individualized preventive anticoagulation strategies to reduce the incidence of such complications.

Development and external validation of a prediction model for venous thromboembolism in systemic lupus erythematosus

ObjectivePatients with systemic lupus erythematosus (SLE) have an increased risk of venous thromboembolism (VTE). We conducted this study to develop a risk score algorithm for VTE in patients with SLE...

Risk factor analysis and a new prediction model of venous thromboembolism after pancreaticoduodenectomy

AimThe present study aimed to identify risk factors for venous thromboembolism (VTE) after pancreaticoduodenectomy (PD) and to develop and internally validate a predictive model for the risk of venous thrombosis.MethodsWe retrospectively collected data from 352 patients who visited our hospital to undergo PD from January 2018 to March 2022. The number of patients recruited was divided in an 8:2 ratio by using the random split method, with 80% of the patients serving as the training set and 20% as the validation set. The least absolute shrinkage and selection operator (Lasso) regression model was used to optimize feature selection for the VTE risk model. Multivariate logistic regression analysis was used to construct a prediction model by incorporating the features selected in the Lasso model. C-index, receiver operating characteristic curve, calibration plot, and decision curve were used to assess the accuracy of the model, to calibrate the model, and to determine the clinical usefulness of the model. Finally, we evaluated the prediction model for internal validation.ResultsThe predictors included in the prediction nomogram were sex, age, gastrointestinal symptoms, hypertension, diabetes, operative method, intraoperative bleeding, blood transfusion, neutrophil count, prothrombin time (PT), activated partial thromboplastin time (APTT), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT), and total bilirubin (TBIL). The model showed good discrimination with a C-index of 0.827, had good consistency based on the calibration curve, and had an area under the ROC curve value of 0.822 (P < 0.001, 95%confidence interval:0.761–0.882). A high C-index value of 0.894 was reached in internal validation. Decision curve analysis showed that the VTE nomogram was clinically useful when intervention was decided at the VTE possibility threshold of 10%.ConclusionThe novel model developed in this study is highly targeted and enables personalized assessment of VTE occurrence in patients who undergo PD. The predictors are easily accessible and facilitate the assessment of patients by clinical practitioners.

The early and long-term occurrence of symptomatic venous thromboembolism after lung cancer surgery without extended thromboprophylaxis-a single center experience with 435 patients.

The incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), after lung cancer resections varies in the literature, and there is limited evidence regarding the optimal duration of thromboprophylaxis. This study aimed at determining the early and long-term occurrence of thromboembolic complications in patients who received in-hospital thromboprophylaxis and underwent resective surgery for lung cancer. The study included all patients who underwent lung cancer surgery at Tampere University Hospital between 2004 and 2016. Postoperative thromboprophylaxis was administered for the duration of the hospitalization. Data on subsequent episodes of VTE and survival were obtained from national registries. The results were compared to a demographically matched reference population. The study comprised 435 patients and 4,338 individuals in the reference population. The overall occurrence of VTE in patients and the reference group was 0.3% vs. 0.2% at 90 days (P=0.56), 3.5% vs. 0.7% at 1 year (P<0.001), 9.2% vs. 2.2% at 3 years (P<0.001), and 18.7% and 3.9% at 5 years (P<0.001), respectively. The majority of cases represented PE. The overall mortality at 5 years was 44.4% vs. 11.6% (P<0.001). No associations between patient characteristics and the occurrence of VTE during follow-up were detected. Patients undergoing lung cancer surgery and who receive in-hospital medical thromboprophylaxis do not seem to be in high risk for symptomatic VTE during the early postoperative period. However, during long-term follow-up the occurrence of symptomatic VTE was significant.

Correlation of Platelet Function with Postpartum Hemorrhage and Venous Thromboembolism in Patients with Gestational Hypertension Complicated with Diabetes.

Objective This study was aimed at investigating the correlation of platelet function with postpartum hemorrhage and venous thromboembolism (VTE) in gestational hypertension patients with diabetes mellitus. Methods A total of 93 patients with gestational hypertension complicated with diabetes treated from March 2020 to June 2021 were selected as the research group, and 56 healthy pregnant women during the same period were selected as the control group. Platelet function-related indicators (platelet count (PLT), platelet volume distribution width (PDW), and mean platelet volume (MPV)) were compared between the two groups. The patients were divided into a severe group (n = 13), mild group (n = 28), and nonbleeding group (n = 52) according to the severity of postpartum hemorrhage, and the value of combined detection of platelet function-related indicators on the severity of postpartum hemorrhage was evaluated and analyzed. According to the occurrence of VTE, the patients were divided into a VTE group and non-VTE group to analyze the predictive value of combined detection of platelet function-related indicators for VTE occurrence in patients. Results The PLT value of the study group was lower than that of the control group, while the PDW and MPV values were higher than those of the control group (all P < 0.05). The PLT value increased with the aggravation of postpartum hemorrhage, while the PDW and MPV values decreased with the aggravation of postpartum hemorrhage among the three groups with different severities of postpartum hemorrhage (all P < 0.05). The area under the curve (AUC) of PLT, PDW, and MPV combination to evaluate the severity of postpartum hemorrhage in patients with gestational hypertension combined with diabetes was greater than that of PLT alone and PDW alone (both P < 0.05). The PLT value was negatively correlated with the severity of postpartum hemorrhage, while PDW and MPV values were positively correlated with the severity of postpartum hemorrhage (both P < 0.05). According to the occurrence of VTE, patients were divided into the VTE group (n = 10) and non-VTE group (n = 83). The PLT value of the VTE group was higher than that of the non-VTE group, while the PDW and MPV values were lower than those of the non-VTE group (all P < 0.05). The AUC of PLT, PDW, and MPV combination to predict the occurrence of VTE in patients with gestational hypertension combined with diabetes was greater than that of each index alone (all P < 0.05). Conclusion Patients with gestational hypertension complicated with diabetes had abnormal platelet function, and the platelet function was related to postpartum hemorrhage and VTE.

Immune activation and inflammatory biomarkers as predictors of venous thromboembolism in lymphoma patients

BackgroundLymphomas are characterized by elevated synthesis of inflammatory soluble mediators that could trigger the development of venous thromboembolism (VTE). However, data on the relationship between specific immune dysregulation and VTE occurrence in patients with lymphoma are scarce. Therefore, this study aimed to assess the association between inflammatory markers and the risk of VTE development in patients with lymphoma.MethodsThe erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase (LDH), total protein (TP), and albumin were assessed in 706 patients with newly diagnosed or relapsed lymphoma. Data were collected for all VTE events, while the diagnosis of VTE was established objectively based on radiographic studies. ROC (receiver operating characteristic) curve analysis was performed to define the optimal cutoff values for predicting VTE.ResultsThe majority of patients was diagnosed with aggressive non-Hodgkin lymphoma (58.8%) and had advanced stage disease (59.9%). Sixty-nine patients (9.8%) developed VTE. The NLR, PLR, ESR, CRP, and LDH were significantly higher in the patients with lymphoma with VTE, whereas the TP and albumin were significantly lower in those patients. Using the univariate regression analysis, the NLR, PLR, TP, albumin, LDH, and CRP were prognostic factors for VTE development. In the multivariate regression model, the NLR and CRP were independent prognostic factors for VTE development. ROC curve analysis demonstrated acceptable specificity and sensitivity of the parameters: NLR, PLR, and CRP for predicting VTE.ConclusionInflammatory dysregulation plays an important role in VTE development in patients with lymphoma. Widely accessible, simple inflammatory parameters can classify patients with lymphoma at risk of VTE development.

Inter-observer reliability of a risk assessment model for venous thromboembolism in acutely-ill medical hospitalized patients: Results from a prospective cohort study.

To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for "immobilization", to almost perfect (0.98; 95% CI 0.97-0.99) for "thrombophilia"; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.

Statins can benefit patients with primary membranous nephropathy on venous thromboembolism

Objective The aim of this study was to investigate the role of prophylactic use of statin in venous thromboembolism (VTE) in patients with primary membranous nephropathy (PMN). Methods A total of 734 patients with PMN were consecutively enrolled in this retrospective study. 564 patients had received statins prescription, while 170 patients did not. Kaplan–Meier methods were used for cumulative incidence plots of thromboembolic events and Cox proportional hazards regression models were used to assess risk factors. Finally, the effects of different potency of statins were evaluated. Results In the cohort, 37 patients (5.0%) experienced VTE. In a univariate Cox proportional hazard model, the hazard ratio (HR) for VTE in statin users versus statin non-users was 0.5 (95% CI 0.3–0.8, p = .03). Multivariable model proportional-hazards analysis corrected for co-medications and risk factors revealed that adjusted HR was 0.4 (95% CI 0.1–0.7, p = .03). According to the type and dose, statin users were assigned into 3 groups: high-intensity group (n = 278), moderate-intensity group (n = 186), and low-intensity group (n = 49). In comparison, incidences of VTEs in the three groups were similar (2.9% vs 4.8% vs 2.0%, p = .45). Conclusions The prophylactic use of statins could effectively decrease the occurrence of VTE in patients with PMN, and the benefits have no difference in different potency of statins.

Development and Validation of a Cancer-Associated Venous Thromboembolism Clinical Risk Prediction (CAT-CR) Model in Newly Diagnosed Cancer Patients Treated with Cheomotherapy

Introduction Cancer and its treatments are well-recognized risk factors for the development of venous thromboembolism (VTE). However, the risk of developing VTE varies greatly among individuals, depends on several factors. Yet, the commonly used prediction models for cancer-associated thrombosis (CAT) mostly focus only on patients with solid cancers treated in an ambulatory setting. Their applicability in patients with hematologic malignancies or inpatient cancer cares is limited. Here we aimed to develop and validate a simple clinical prediction model for CAT in newly diagnosed hematologic malignancies and solid cancers patients treated with chemotherapy, to be used both in an ambulatory and inpatient setting to enhance its generalizability. Methods Data of consecutive patients, 18 years of age or older, with a newly diagnosis of both hematologic malignancies or solid cancers who were diagnosed and treated with chemotherapy at our institution between 2008 to 2015 were included in this analysis. Patients without a histologically confirmed cancer diagnosis or those who were treated with anticoagulantion were excluded. Patients were followed up from date of cancer diagnosis until VTE occurrence, death, or censoring at 36 months. The primary outcome was cumulative incidence (CI) of objectively confirmed VTE at 6 months after cancer diagnosis. To develop the CAT-CR model, a Fine and Gray competing risk regression with stepwise selection was used to select prognostic variables included in the model, treating death not related to VTE as a competing event. Variables with P value &lt; 0.05 were included in the final model. A risk score was then calculated from the sum of adjusted β regression coefficient weighted points from all significant risk factors for each patient. The internal validation was done using bootstrap resampling method to generate new 1,000 datasets by random sampling of the original data with replacement. Multivariable competing risk regression with the same condition as in the original data set was then calculated for the new data sets in order to obtain the bootstrap parameter estimates. Harrell's C-concordance index and area under time-dependent receiver operating characteristic curves (AUC) associated with risk of VTE within 6 months were used to assess the discrimination ability of the model. Results A total 1598 patients were included in the analysis with a median age of 59 years (range 18-94). Primary sites of cancer were breast (N=344, 21.5%), colon (N=262, 16.4%), gynecologic (N=174, 10.9%), hematologic malignancies (N=335, 21%) and others (N=483, 30.2%) while 1070 patients (67%) were in advance stage disease. Khorana risk score were low, intermediate and high in 597 (37.4%), 882 (55.2%) and 119 (7.5%) patients, respectively. VTE was developed in 86 patients (5.4%) with cumulative incidence at 6 months of 2.33%. Factors associated with a significantly increased risk of VTE included in the final model were age &gt; 60 years, advance stage, high risk cancer (gynecologic, lung, stomach, pancreas, esophagus, liver), ECOG performance status 3-4, inpatient chemotherapy, and hemoglobin &lt; 10 g/dl. with score weighted assignment of 1, 1, 2, 2, 2 and 2, respectively. Patients were then divided into 3 CAT-CR risk groups: low (score 0-3, N=714), intermediate (score 4-5, N=803) and high (score &gt; 5, N=81) with the CI of VTE at 6 months of 1.01%, 2.98% and 7.66%, respectively (P&lt;0.001) (Figure 1A). Compared with low risk group patients in intermediate and high risk group had a significantly increased risk of VTE with the subdistribution hazard ratio (SHR) of 1.68 (1.24-2.71, P0.032) and 5.15 (2.59-7.22, P&lt;0.001) in the developing cohort and 1.74 (1.28-2.93, P0.022) and 2.96 (2.37-6.53, P&lt;0.001) in bootstrap validation datasets. The CAT-CR model had good discrimination ability with C-index of 0.681 and AUC of 0.773. The decision-curve analysis showed that the model had greater clinical utility for thromboprophylaxis indication than did the strategies of treat all or treat none and better than the commonly used Khorana risk model. (Figure 1B) Conclusions The CAT-CR model can be successfully used to predict the occurrence of VTE in patients with hematologic malignancies and solid cancers who are treated in both ambulatory and inpatient setting. The improved generalizability of the CAT-CR model could aid physicians in selection of high risk cancer patients who will most benefit from thromboprophylaxis. Disclosures No relevant conflicts of interest to declare.

Is VTE Prophylaxis Necessary on Discharge for Patients Undergoing Adrenalectomy for Cushing Syndrome?

BackgroundPatients with Cushing syndrome (CS) have an increased risk for venous thromboembolism (VTE). However, it is unclear whether patients undergoing adrenalectomy for CS are at increased risk for postoperative VTE. The aim of this study was to determine the rate of postoperative VTE in patients undergoing adrenalectomy for CS.MethodsA retrospective analysis of patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent adrenalectomy from 2005 to 2016 was performed. We compared the clinical characteristics and 30-day postoperative VTE occurrence in patients with and without CS.ResultsA total of 4217 patients were analyzed; 2607 (61.8%) were female and 310 (7.4%) had CS. The overall prevalence of postoperative VTE was 1.0% (n = 45). The rates of VTE were higher in patients with CS (2.6% vs 0.9%; P = 0.007). In the two groups, CS was associated with younger age, increased body mass index, and diabetes mellitus (P < 0.001). CS was also associated with longer length of operation and longer hospital length of stay (P < 0.001). In the subgroup of patients who had diagnosed VTE, CS was associated with longer length of operation (P < 0.001). Rates of laparoscopic vs open surgery were equivalent between patients with and without CS, and VTE events did not differ. The median time to VTE event was 14.5 days (range, 1 to 23 days) in the CS group and 4 days (range, 2 to 25 days) in the group without CS.ConclusionsThe prevalence of postoperative VTE was increased in patients undergoing adrenalectomy for CS. In patients with CS undergoing adrenalectomy, VTE prophylaxis for 28 days should be considered upon discharge.

Risk Factors and Associated Complications of Symptomatic Venous Thromboembolism in Patients with Craniotomy for Meningioma

Patients undergoing surgical resection of meningioma are at increased risk for developing venous thromboembolism (VTE). The aim of this study was to assess occurrence of VTE in patients who underwent surgical resection of meningioma to determine risk factors and associated complications of VTE. The American College of Surgeons National Surgical Quality Improvement Project database from 2012 to 2015 was reviewed for patients who had undergone meningioma resection according to primary Current Procedural Terminology codes and International Classification of Diseases, Ninth Revision. The study included 5036 patients with meningioma. Rate of VTE was 3.38%, with pulmonary embolism rate of 1.47% and deep venous thrombosis rate of 2.42%. During the first 30 days after surgery, patients with VTE had a mortality rate of 5.88% compared with 1.15% for patients without VTE. Multivariate binary logistic regression analysis determined 5 risk factors for VTE,: age ≥60 years, American Society of Anesthesiologists classification III, operative time ≥310 minutes, ventilator dependence, and preoperative transfusions. Univariate analysis revealed a number of complications significantly associated with VTE occurrence, including unplanned intubation, ventilator use for >48 hours, stroke, sepsis, septic shock, pneumonia, urinary tract infection, and transfusions. Risk factors of VTE and associated complications were identified. Understanding these risk factors provides physicians with further insight in managing this subgroup of patients in a personalized fashion in the perioperative period to minimize the incidence and morbidity of VTE.

Longer procoagulant phospholipid-dependent clotting time, lower endogenous thrombin potential and higher tissue factor pathway inhibitor concentrations are associated with increased VTE occurrence in patients with newly diagnosed multiple myeloma: results of the prospective ROADMAP-MM-CAT study

Venous thromboembolism (VTE) is a common complication in newly diagnosed symptomatic multiple myeloma (NDMM) patients. We explored cellular and plasma hypercoagulability in NDMM patients to identify relevant biomarkers that can be used in combination with clinical factors in the development of a risk assessment model (RAM) for VTE. Untreated patients (n = 144) with NDMM were prospectively enrolled, baseline biomarkers prior to anti-myeloma treatment and thromboprophylaxis initiation were obtained. These were compared against values in a group of healthy individuals with similar age and sex distribution. The primary study end point was symptomatic VTE occurrence. At 12-month follow-up cumulative VTE rate was 10.4%. NDMM patients showed biological signs of cellular and plasma hypercoagulability and endothelial cell activation. Procoagulant phospholipid clotting time (Procoagulant-PPL) was shorter, P-selectin levels lower and thrombin generation attenuated overall compared to healthy subjects. Longer Procoag-PPL®, lower endogenous thrombin potential (ETP), and higher levels of tissue factor pathway inhibitor (TFPI) were associated with VTE occurrence. Multivariate analysis showed that Procoag-PPL® and ETP were independent risk factors for VTE. We conclude that Procoag-PPL® and ETP can be prospectively incorporated into a RAM for VTE in MM in combination with clinical and disease risk factors.

Abstract 351: National Rates of Venous Thromboembolism in Patient with STEMI: Results from the National Inpatient Sample 2003-2013

Background: There is a growing body of evidence against the use of triple therapy (anticoagulation and dual antiplatelet) among patients with acute coronary syndrome. Venous thromboembolism (VTE) is another potential indication for triple therapy, but the magnitude of such problem is unknown. Therefore, we aimed to determine the trends of annual rate of immediate VTE occurrence in patients with ST-segment elevation myocardial infarction (STEMI) and measure its impact. Methods: We queried the 2003-2013 Nationwide Inpatient Sample to identify adults with primary diagnosis of STEMI using ICD-9-CM codes. VTE, including limb vein thrombosis and pulmonary embolism, was allocated when present among the secondary discharge diagnosis. Demographics and inpatient outcomes were compared in the VTE and non-VTE group. Results: From 2,495,757 hospitalizations for STEMI, 15,471 (0.6%) also experienced VTE. The group who experienced VTE was older (mean age: 68.44 vs 64.81, p&lt;0.01) and had higher proportions of black patients (10.6% vs 7.7%, p&lt;0.001) and females (42.1% vs 35%, p&lt;0.001) compared to the non-VTE group. There was an increasing trend in the annual rate of VTE during the study period (2003: 0.3% vs 2013: 0.9%, p &lt; 0.01). Patients with VTE had a prolonged hospitalization (12.8 vs 4.63 days, p &lt;0.01), higher risk of gastrointestinal bleeding (OR:1.65; 95% CI 1.54-1.76, p&lt;0.01) and intracranial hemorrhage(OR:1.52, 95% CI:1.23-1.87, P&lt;0.01), needed more blood transfusions (OR:1.74; 95% CI:1.66-1.82, p&lt;0.01) and had increased mortality (OR:1.53, 95%CI:1.46-1.6, p&lt;0.01). Conclusion: There is an increasing annual rate in immediate VTE occurrence in patients with STEMI. VTE is associated with more bleeding complications, longer hospital stay, and higher mortality. It is plausible that individualized or more aggressive protocols of VTE prophylaxis are needed in this population.

Mean platelet volume as a predictive marker for venous thromboembolism in patients treated for Hodgkin lymphoma.

Mean platelet volume (MPV) is reported to be associated with the risk of venous thromboembolism (VTE) and mortality in patients with cancer.We sought to determine the association of MPV with symptomatic VTE occurrence in patients treated for newly diagnosed Hodgkin lymphoma (HL) and their outcomes. We retrospectively studied 167 consecutive adult patients treated with HL. During first-line treatment 12 (7.2%) patients developed VTE and 14 (8%) died within the observation period. The pre-chemotherapy values of MPV were significantly lower in VTE patients than those without (p=0.0343). Patients with MPV≤25th percentile (6.8 fl) had an increased risk of VTE occurrence (p=0.0244). In multivariate analysis, MPV≤25th percentile (OR 2.21; 95%CI 1.07-4.57, p=0.033), advanced stage (OR 2.08; 95%CI 1.06-4.07, p=0.033) and bulky disease (OR 2.23; 95%CI 1.16-4.31, p=0.016) were significant factors for developing VTE. Only the impact of MPV≤25th percentile on VTE-free survival rates was found. VTE occurred in 43% (n=3) of the high-risk patients of the Thrombosis Lymphoma (ThroLy) score and in 17% (n=2) of the high-risk of the Khorana Risk Score (KRS). Neither the KRS nor the ThroLy score could identify patients at a high risk of VTE with a high degree of accuracy. We expanded the ThroLy score with the addition of the MPV≤25th percentile to more accurately identify HL patients with a higher risk of VTE.Our study indicates that the pre-chemotherapy MPV value, while of no use as an overall prognosis predictor, may still represent a useful prognostic marker for a significant VTE risk especially when incorporated into VTE-risk assessment models.

Risk of post-operative venous thromboembolism in patients with meningioma.

The surgical resection of meningiomas can be complicated by venous thromboembolism (VTE) in the post-operative period, but the exact incidence of this event is not known. Aim of this study was to assess the occurrence of VTE in patients operated for meningioma who underwent a post-operative clinical and objective screening for VTE. Patients undergoing meningioma resection between 2000 and 2010 who accepted to be investigated for VTE in the post-operative period were included in the study. The screening included daily clinical assessment, pulmonary perfusion scintigraphy (Q-SCAN) on day 2 and venous compression ultrasonography (CUS) of the lower limbs within day 7. The univariate and multivariate statistical analysis of risk factors for VTE included sex, age, presence of comorbidities, pre- and post-operative Karnofsky Performance scale (KPS), post-operative neurological worsening and post-operative walking ability. Two-hundred and seventy-five patients were included in the study. VTE was diagnosed in 82 patients (29.8%). Univariate analysis revealed that age ≥ 65 years, cardiovascular comorbidities, pre- and post-operative KPS < 80/100, post-operative neurological worsening and impaired post-operative walking ability were significantly associated with VTE. Multivariate analysis confirmed only age ≥ 65years (p = 0.011) and post-operative KPS < 80/100 (p = 0.002) as independent risk factors for VTE. Patients operated for meningioma have a 30% risk of VTE. Age ≥ 65years and post-operative KPS < 80 were independent risk factors for VTE.

Elevated Blood Urea Nitrogen/Creatinine Ratio Is Associated with Venous Thromboembolism in Patients with Acute Ischemic Stroke.

ObjectiveAlthough venous thromboembolism (VTE) is frequently related to dehydration, the impact of dehydration on VTE in acute ischemic stroke (AIS) is not clear. This study investigated whether dehydration, as measured by blood urea nitrogen (BUN)/creatinine (Cr) ratio, influences the occurrence of VTE in patients with AIS.MethodsThis is a retrospective study of patients with AIS between January 2012 and December 2013. Patients with newly diagnosed AIS who experienced prolonged hospitalization for at least 4 weeks were included in this study.ResultsOf 182 patients included in this study, 17 (9.3%) suffered VTE during the follow-up period; in two cases, VTE was accompanied by deep vein thrombosis and pulmonary embolism. Patients with VTE were more frequently female and had higher National Institutes of Health Stroke Scale (NIHSS) score, more lower limb weakness, and elevated blood urea nitrogen BUN/Cr ratio on admission. In a multivariate analysis, BUN/Cr ratio >15 (odds ratio [OR] 8.75) and severe lower limb weakness (OR 4.38) were independent risk factors for VTE.ConclusionDehydration on admission in cases of AIS might be a significant independent risk factor for VTE.

Hypercoagulability in patients with Cushing disease detected by thrombin generation assay is associated with increased levels of neutrophil extracellular trap-related factors.

Patients with Cushing disease (CD) are at increased risk of venous thromboembolism (VTE). It was surmised, but not conclusively shown that the risk is related to plasma hypercoagulability secondary to the glucocorticoids effect. This study is aimed at detecting hypercoagulability in patients with CD. Case-control study of 48 CD patients and controls enrolled at two Italian clinics for whom we assessed the thrombin-forming-potential in the presence of optimal activation of protein C obtained by adding into the assay system its main endothelial activator, thrombomodulin. These experimental conditions mimic more closely than any other test the in vivo situation. We observed enhanced thrombin-generation in CD patients, as shown by the modification of thrombin-generation parameters [i.e., shortened lag-time and time-to-peak, increased thrombin peak and endogenous thrombin potential (ETP)]. Moreover, the ETP ratio (with/without thrombomodulin), recognized as an index of hypercoagulability, was increased in patients as compared to controls. We attempted to explain such hypercoagulability by measuring both procoagulant and anticoagulant factors, and some other non-coagulation parameters (i.e., neutrophil extracellular traps (NET), recently associated with the VTE risk and/or increased hypercoagulability. We showed that the hypercoagulability in patients with CD is associated with increased levels of factor VIII and NET-related variables. We detected plasma hypercoagulability in patients with CD and found experimental explanation for its occurrence. Whether this hypercoagulability can entirely explain the occurrence of VTE in patients with CD should be investigated by ad-hoc clinical trials. However, until these studies will be available the evidence supports the concept that patients with CD are candidates for antithrombotic prophylaxis.

ADAMTS‐13 and von Willebrand factor predict venous thromboembolism in patients with cancer

ESSENTIALS: Cancer patients are at high risk of venous thromboembolism (VTE). In this study, cases and controls were cancer patients who did or did not develop VTE. von Willebrand factor (VWF) levels were higher if compared with controls and correlated with cancer stage. VWF and ADAMTS-13 are associated with the occurrence of VTE in cancer. Patients with cancer are at high risk of venous thromboembolism (VTE). ADAMTS-13 regulates von Willebrand factor (VWF) activity, which plays a role in the development of cancer and in VTE. The aim of this study was to search for an association between the levels of VWF and ADAMTS-13 and VTE in patients with cancer and to compare current scoring systems for prediction of VTE before and after addition of these parameters. In a case-control study, in which patients with recently diagnosed cancer were followed-up for 6 months, we compared 20 patients who developed VTE (cases) and 140 patients with cancer without VTE (controls), matched for sex, age, and type and stage of cancer. We measured VWF, ADAMTS-13 (activity and antigen), P-selectin, D-dimer and F1 + 2 levels at baseline, and calculated both the Khorana score and the Khorana score expanded after addition of P-selectin and D-dimer levels. VWF levels were significantly higher in cases when compared with controls (326 ± 185% vs. 242 ± 158%) and correlated with advanced stage of cancer: localized, 185 [142; 222]; locally advanced, 240 [146; 257]; metastatic, 267 [153; 324] (mean [interquartile range]). The addition of two biomarkers, ADAMTS-13 activity and F1 + 2 levels, to the Khorana score improved receiver operating curves. von Willebrand factor and ADAMTS-13 are associated with the occurrence of VTE in patients with cancer. Moreover, addition of ADAMTS-13 and F1 + 2 levels to the Khorana score considerably increases the predictive value for VTE.

Post-operative Venous Thromboembolism in Patients Operated on for Aorto-iliac Obstruction and Abdominal Aortic Aneurysm, and the Application of Pharmacological Thromboprophylaxis

In light of the methods generally used to assess the risk of venous thromboembolism (VTE), major vascular operations should be regarded as high risk procedures. Nevertheless, no principles for implementing and maintaining thromboprophylaxis have so far been developed. The aim of this study was to determine the frequency and nature of VTE occurrence in patients routinely applying pharmacological thromboprophylaxis following implantation of an aorto-bifemoral prosthesis. The prospective non-randomized study included 105 patients with aortoiliac obstruction and 119 patients with abdominal aortic aneurysm (AAA) treated surgically. During hospitalization pharmacological thromboprophylactic procedures were observed. A duplex test was performed on the day before surgery, on the day of discharge, and 30 days after the patients had left the hospital. VTE was detected in 18.1% of the patients with aortoiliac obstruction (9.5% of patients during hospitalization and 8.6% of patients after discharge). VTE was diagnosed in 21.0% of patients with AAA (15.1% of patients during hospitalization and 5.9% of patients after discharge). The incidence of VTE was comparable in both groups, both during hospitalization (P = .51) and in the 30 day period following the end of hospitalization (P = .48). It is advisable that before hospital discharge routine duplex ultrasonography tests should be conducted on the venous systems of all patients who have undergone major vascular operations. It is likewise advisable to consider whether thromboprophylaxis for vascular patients should be extended beyond their discharge from hospital.

Post-operative Venous Thromboembolism in Patients Operated on for Aorto-iliac Obstruction and Abdominal Aortic Aneurysm, and the Application of Pharmacological Thromboprophylaxis

In light of the methods generally used to assess the risk of venous thromboembolism (VTE), major vascular operations should be regarded as high risk procedures. Nevertheless, no principles for implementing and maintaining thromboprophylaxis have so far been developed. The aim of this study was to determine the frequency and nature of VTE occurrence in patients routinely applying pharmacological thromboprophylaxis following implantation of an aorto-bifemoral prosthesis. The prospective non-randomized study included 105 patients with aortoiliac obstruction and 119 patients with abdominal aortic aneurysm (AAA) treated surgically. During hospitalization pharmacological thromboprophylactic procedures were observed. A duplex test was performed on the day before surgery, on the day of discharge, and 30 days after the patients had left the hospital. VTE was detected in 18.1% of the patients with aortoiliac obstruction (9.5% of patients during hospitalization and 8.6% of patients after discharge). VTE was diagnosed in 21.0% of patients with AAA (15.1% of patients during hospitalization and 5.9% of patients after discharge). The incidence of VTE was comparable in both groups, both during hospitalization (p = .51) and in the 30 day period following the end of hospitalization (p = .48). It is advisable that before hospital discharge routine duplex ultrasonography tests should be conducted on the venous systems of all patients who have undergone major vascular operations. It is likewise advisable to consider whether thromboprophylaxis for vascular patients should be extended beyond their discharge from hospital.