Odds Of Venous Thromboembolism Research Articles

Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry

Increasing evidence supports the role of red blood cells (RBCs) in physiological hemostasis and pathologic thrombosis. Red blood cells are commonly transfused in the perioperative period; however, their association with postoperative thrombotic events remains unclear. To examine the association between perioperative RBC transfusions and postoperative venous thromboembolism (VTE) within 30 days of surgery. This analysis used prospectively collected registry data from the American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) database, a validated registry of 525 teaching and nonteaching hospitals in North America. Participants included patients in the ACS-NSQIP registry who underwent a surgical procedure from January 1 through December 31, 2014. Data were analyzed from July 1, 2016, through March 15, 2018. Risk-adjusted odds ratios (aORs) were estimated using multivariable logistic regression. The primary outcome was the development of postoperative VTE (deep venous thrombosis [DVT] and pulmonary embolism [PE]) within 30 days of surgery that warranted therapeutic intervention; DVT and PE were also examined separately as secondary outcomes. Subgroup analyses were performed by surgical subtypes. Propensity score matching was performed for sensitivity analyses. Of 750 937 patients (56.8% women; median age, 58 years; interquartile range, 44-69 years), 47 410 (6.3%) received at least 1 perioperative RBC transfusion. Postoperative VTE occurred in 6309 patients (0.8%) (DVT in 4336 [0.6%]; PE in 2514 [0.3%]; both DVT and PE in 541 [0.1%]). Perioperative RBC transfusion was associated with higher odds of VTE (aOR, 2.1; 95% CI, 2.0-2.3), DVT (aOR, 2.2; 95% CI, 2.1-2.4), and PE (aOR, 1.9; 95% CI, 1.7-2.1), independent of various putative risk factors. A significant dose-response effect was observed with increased odds of VTE as the number of intraoperative and/or postoperative RBC transfusion events increased (aOR, 2.1 [95% CI, 2.0-2.3] for 1 event; 3.1 [95% CI, 1.7-5.7] for 2 events; and 4.5 [95% CI, 1.0-19.4] for ≥3 events vs no intraoperative or postoperative RBC transfusion; P < .001 for trend). In subgroup analyses, the association between any perioperative RBC transfusion and postoperative VTE remained statistically significant across all surgical subspecialties analyzed. The association between any perioperative RBC transfusion and the development of postoperative VTE also remained robust after 1:1 propensity score matching (47 142 matched pairs; matched OR, 1.9; 95% CI, 1.8-2.1). The results of this study suggest that perioperative RBC transfusions may be significantly associated with the development of new or progressive postoperative VTE, independent of several putative confounders. These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices.

Temporal trends in venous thromboembolism after radical cystectomy

PurposeTo determine whether the rate of venous thromboembolism (VTE) following radical cystectomy (RC) is changing overtime. Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent RC for bladder cancer from 2011 to 2016. VTE was defined as pulmonary embolism or deep vein thrombosis within 30 days of RC. VTE rate by year was assessed using the Cochran-Armitage test for trend. Associations between patient features and VTE were evaluated with multivariable logistic regression. ResultsA total of 8,241 patients undergoing RC were identified, of whom 348 (4.2%) were diagnosed with VTE. VTE was diagnosed at a median of 13 days (IQR: 7–19) after RC, with 171 (49%) occurring after hospital discharge. Notably, the rate of VTE after RC was found to significantly decrease over time, from 5.1% in 2011 to 2.8% in 2016 (P = 0.001). On multivariable analysis, clinical factors significantly associated with increased odds of VTE included congestive heart failure (odds ratio [OR] = 2.83, P = 0.01), prolonged operative time (OR: 1.48–1.56, P = 0.02–0.01), and receipt of a perioperative blood transfusion (OR = 1.27; P = 0.04). When postoperative complications were adjusted for, sepsis/septic shock (OR = 2.37, P<0.001) and perioperative infection (OR = 1.74, P<0.001) were likewise found to be associated with VTE. ConclusionsThe rate of VTE after RC significantly decreased in recent years, potentially reflecting improvements in perioperative care. The specific casual factors underlying this trend, in addition to efforts to address identified risk factors for VTE, warrant continued study.

Morbidity, mortality and cost associated with venous thromboembolism among hospitalized breast cancer patients: Results from national inpatient sample.

e13573 Background: Venous thromboembolism (VTE) is an important cause of morbidity and mortality among hospitalized cancer patients. We aimed to study prevalence of VTE and its impact among hospitalizations in patients with breast cancer (BC). Methods: We used the National Inpatient Sample (NIS) database from 2001 to 2013 to identify adults ( > = 18 yrs) with BC as well as presence of VTE using ICD-9 codes and compared demographic characteristics and in-hospital outcomes between BC with and without VTE. Regression analysis was used to calculate odds of association. Results: 267,714 (3.01%) of a total of 8,880,681 hospitalized breast cancer patients had associated VTE. Demographic characteristics including age, race, comorbidity index and gender are shown in the table. BC patients with VTE had a longer mean length of stay (LOS) (7.16 days vs 4.54 days, OR 2.6 (CI 2.5 – 2.7), p < 0.001), higher average cost of hospitalization ($14518 vs $10513, OR 1.4 (CI 1.3 – 1.5), p < 0.001) and higher inpatient mortality (5.67% vs 2.92%, OR 2.0 (CI 1.9 – 2.1), p < 0.001). Factors associated with higher odds of VTE were male sex, African-American race, higher comorbidity index and use of chemotherapy based on multivariate analysis. Interestingly, smoking and female sex were associated with lower odds of occurrence of VTE. Conclusions: VTE in BC is associated with increased mortality, longer hospitalization and higher cost. Effective measures to reduce the VTE among the BC patients could help improve in-hospital outcomes. VTE No VTE DVT PE Age (yrs) 69.26 69.18 69.56 68.25 Female (%) 98.79 98.79 98.73 98.95 Race: Caucasian 75.79 79.37 74.34 76.92 African American 15.24 10.75 16.00 14.96 Others 8.96 9.88 9.66 8.12 Charlson comorbidity Index (%) < = 2 52.15 63.66 3 8.62 9.40 > = 4 39.22 26.93 Mean LOS (days) 7.16 4.54 7.48 6.48 Mortality 5.67% 2.92% 4.35% 8.15% Cost of hospital stay ($) 14517.77 10512.85 14906.57 13566.18 Factors associated with VTE: Multivariate regression, OR (CI) Smoking Chemotherapy Age Female Race Charlson Comorbidity Index AA Others 3 4 0.90 (0.87 – 0.92) 1.49 (1.42- 1.1.56) 1.00 (1.003 – 1.004) 0.76 (0.70- 0.83) 1.40(1.36– 1.44) 0.92(0.87 – 0.96) 1.10(1.05 – 1.14) 1.72(1.67 – 1.78)

Description of Venous Thromboembolism in Hospitalized Patients With Metastatic Cancer: A National Sample.

Background: This study aimed to determine patient-, tumor-, and hospital-level characteristics associated with venous thromboembolism (VTE), and to assess the impact of VTE on in-hospital mortality and length of hospital stay in hospitalized patients with metastatic cancer. Methods: Using the Nationwide Inpatient Sample database, a cross-sectional analysis was performed of patients aged ≥18 years with at least 1 diagnosis of primary solid tumor and subsequent secondary or metastatic tumor between 2008 and 2013. Results: Among 850,570 patients with metastatic cancer, 6.6% were diagnosed with VTE. A significant trend for increasing VTE rates were observed from 2008 to 2013 (5.7%-7.2%; P<.0001). Using an adjusted multilevel hierarchical regression model, higher odds of VTE were seen among women (odds ratio [OR], 1.04; 95% CI, 1.02-1.06), black versus white patients (OR, 1.14; 95% CI, 1.11-1.18), and those with an Elixhauser comorbidity index score of ≥3 (OR, 2.50; 95% CI, 2.38-2.63). Hospital-level correlates of VTE included treatment in a teaching hospital (OR, 1.05; 95% CI, 1.01-1.11) and an urban location (OR, 1.18; 95% CI, 1.09-1.27), and admission to hospitals in the Northeast (OR, 1.16; 95% CI, 1.08-1.24) and West (OR, 1.09; 95% CI, 1.03-1.16) versus the South. Patients with metastasis to the liver, brain, or respiratory organs and those with multiple (≥2) metastatic sites had higher odds of VTE, whereas those with metastasis to lymph nodes and genital organs had lower odds. Patients diagnosed with versus without VTE had higher odds of in-hospital mortality (OR, 1.50; 95% CI, 1.38-1.63) and prolonged hospital stay (OR, 1.65; 95% CI, 1.57-1.73). Conclusions: The frequency of VTE in patients with metastatic cancer is increasing. Patient characteristics, hospital factors, and site of metastasis independently predict the occurrence of VTE and allow for better stratification of patients with cancer according to their VTE risk.

The Role of Intraoperative Intermittent Pneumatic Compression Devices in Venous Thromboembolism Prophylaxis in Total Hip and Total Knee Arthroplasty.

Venous thromboembolism (VTE) is a common complication after total hip arthroplasty (THA) and total knee arthroplasty (TKA), occurring in up to 85% of patients who are not treated with prophylaxis. The initiation of VTE development may occur intraoperatively. This study investigated whether this gap in VTE prophylaxis can be addressed by the use of intraoperative intermittent pneumatic compression devices (IPCDs) and if intraoperative IPCDs have a meaningful benefit in preventing symptomatic VTE. The authors defined symptomatic VTE as deep venous thrombosis in either lower extremity or a pulmonary embolism. The authors evaluated the medical records of 3379 patients who underwent THA or TKA at their institution in 2014 and 2015. Effects of various factors, including age, sex, body mass index, and smoking status, were compared between these 2 cohorts. Patients who experienced a symptomatic VTE were also matched by age, sex, and procedure type with randomly selected controls. In the patient sample, 47 patients (1.4%) developed VTE. Forty (1.2%) of these patients underwent TKA, whereas 7 (0.2%) underwent THA. Venous thromboembolism occurred less frequently in patients who received intraoperative IPCDs (0.8%) than in patients who did not receive them (1.5%); however, this difference did not reach statistical significance. Total knee arthroplasty was associated with increased odds of VTE compared with THA, as was female sex. These results did not show a statistically significant benefit to the intraoperative use of IPCDs. Pneumatic compression remains a fast, easy, low-cost, low-risk, intuitive intervention that can supplement the postoperative multimodal approach and is worthy of further study. Intraoperative IPCD use should be considered for patients with a higher risk of VTE. [Orthopedics. 2018; 41(1):e98-e103.].

Efficacy of standard dose unfractionated heparin for venous thromboembolism prophylaxis in morbidly obese and non-morbidly obese critically Ill patients.

To determine the efficacy of standard dose unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in critically ill morbidly obese patients. Retrospective single-center observational cohort study in a single tertiary teaching hospital intensive care units (ICUs) in Multiparameter Intelligent Monitoring in Intensive Care II Clinical Database. Patients 18years or older, admitted to the ICU, and received either UFH 5000 units subcutaneously twice daily or UFH 5000 units three times daily for VTE prophylaxis between 2001 and 2008 were included. Total 243 patients in the BMI ≥ 40kg/m2 group and 2813 patients in the BMI < 40kg/m2 group were identified. There was no difference in VTE incidence between the two groups. However, a strong linear association was found showing as BMI increased so did the rate of VTE incidence. Morbidly obese patients had longer hospital (17 vs. 14 days, P = 0.016) and ICU length of stay (10 vs. 8 days, P = 0.007). After controlling Padua score, logistic regression analysis revealed the odds of VTE increased by a factor of 1.026 for each one-unit increase in BMI. Additionally, having a BMI ≥ 40kg/m2 was associated with a greater likelihood of VTE incidence in males (OR 3.92) but not in females. In patients treated with standard dose UFH, morbid obesity does not increase VTE risk overall. However, BMI has a strong linear relationship with VTE incidence and morbid obesity is more likely associated with greater hospital and ICU length of stay.

Association of chemotherapy regimen with venous thromboembolic risk in patients with urothelial tract cancer.

314 Background: Cisplatin chemotherapy (CTX) is associated with increased risk of venous thromboembolism (VTE); however, other agents have also been hypothesized to increase risk. We assessed the association of VTE with different CTX regimens in urothelial tract cancer patients. Methods: We identified &gt; 66 year-old patients diagnosed with urothelial tract cancers (excluding renal pelvis) from the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database from 1998 to 2011. CTX regimens included gemcitabine/cisplatin (GC), methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), or gemcitabine/carboplatin (GCarbo). We calculated VTE rates within 120 days of CTX initiation and compared VTE by CTX regimen with multivariable logistic regression models adjusted for patient and cancer characteristics. Results: Of 5050 identified patients, VTE occurred in 13.1% (660/5050). VTE rates were 15.3% (265/1737) and highest for GC; 8.8% (23/262) and 12.2% (372/3051) of MVAC and GCarbo patients experienced VTE, respectively. Adjusted for patient demographic and cancer-specific variables, MVAC and GCarbo were associated with lower odds of VTE compared with GC (see Table). Conclusions: Compared with GC, MVAC and GCarbo are associated with a decreased rate of VTE. This finding suggests that gemcitabine may add to the increased thrombosis risk from cisplatin. Patients treated with GC should be counseled about this association. Sensitivity analyses to assess VTE risk of different CTX regimens in the perioperative setting will be presented. [Table: see text]

Venous Thromboembolism in Pediatric Heart Disease Is Associated with Significant Health Care Burden and Expenditures

BackgroundMost pediatric venous thromboembolism (VTE) occur in children with at least one complex chronic condition (CCC) admitted to a tertiary care pediatric hospital (Setty et al, Pediatr Blood Cancer2012). Reports estimate 14.6%-29% of all inpatient childhood VTE occur in patients with chronic pediatric heart disease (CPHD) (Andrew et al, Blood 1994; Rafinni et al, Pediatrics 2009). The influence of acute VTE risk factors and the impact of non-cardiac CCCs on VTE in CPHD remain unknown. A large cohort of privately-insured children was used to evaluate the odds of VTE, estimate the healthcare burden, and delineate the risk factors associated with VTE diagnoses in CPHD.MethodsChildren <18 years of age between April 1, 2003 and June 30, 2013 at the time of their initial CPHD diagnostic code were identified from the MarketScan Commercial Databases®. CPHD was defined using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes for cardiomyopathies, single ventricle physiology congenital heart defects, double ventricle physiology congenital heart defects, conduction disorders and dysrhythmias, and acquired chronic cardiac conditions. Children with CPHD were categorized into the VTE group if an ICD-9-CM for VTE or Current Procedural Terminology (CPT) code for a VTE-associated procedure was found concomitantly with their first CPHD diagnosis or during a 6 month follow-up period. The demographics, mortality, healthcare resource utilization, expenditures, and co-morbid conditions of children with CPHD with and without a VTE diagnosis were compared.ResultsThere were 120,884 children 0-17 years of age with a CPHD diagnosis. VTE events occurred in 957 (0.79%) of these children, 802 (83.8%) of which were isolated DVT and 155 (16.2%) were PE with or without concomitant DVT. Male gender was significantly associated with VTE (P<0.001). In-hospital mortality was considerably higher in children with VTE (10.8%) than in those without VTE (1.3%; P<0.001).All CPHD were associated with a significant VTE risk except those with conduction disorders or dysrhythmias (Table 1). VTE occurred in 2.3% of children with single ventricle physiology, 1.9% of those with acquired CPHD, 1.6% with cardiomyopathy, and 0.5% with double ventricle physiology. Children who experienced VTE were significantly (P<0.001) more likely to have a non-cardiac CCC, acute acquired VTE risk factors (recent trauma, recent non-cardiac surgery, recent cardiac surgery, or an acute acquired cardiovascular condition), recent extracorporeal membranous oxygenation, and heart transplantation (Table 1). Acute acquired VTE risk factors did not appear to affect the VTE risk when controlled for non-cardiac CCC. Stratifying for recent cardiac surgery, (a) all of the non-cardiac CCCs were significantly associated with VTE without a recent cardiac surgery (P<0.001) and (b) all non-cardiac CCCs except for gastrointestinal CCCs and malignancy CCCs were significantly (P≤0.02) associated with VTE in the setting of recent cardiac surgery.All measures of healthcare utilization (mean number of inpatient admissions (2.19 vs 0.62), mean inpatient length of stays (55.14 vs 8.7 days), mean number of outpatient visits (28.6 vs 11.22), and mean number of pharmaceutical claims (13.27vs 4.74)) were significantly higher (P<0.001) for CPHD patients with VTE compared to those without VTE. VTE diagnosis was associated with significantly higher medical expenditures: a 9-fold increase in total expenditures compared to the non-VTE group ($344,807 vs $37,102; P<0.001); a 10-fold increase in inpatient expenditures ($316,379 vs $29,678; P<0.001); over 3-fold increase in outpatient expenditures ($25,866 vs $6,838; P<0.001); over a 4-fold increase in pharmaceutical claims ($2,561 vs $585; P<0.001).ConclusionsAlthough VTE in CPHD patients is rare, it does carry a significantly increased healthcare resource utilization and in-hospital mortality. All of the co-morbid conditions examined were significantly associated with VTE, but when controlling for non-cardiac CCC the odds of VTE was not affected. All of the non-cardiac CCC were significantly associated with VTE except malignancy and GI CCC when accounting for recent cardiac surgery. This suggests that non-cardiac CCCs may be an important determinant of VTE risk for children with CPHD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A Single Institution Retrospective Analysis of the Effect of Erythropoiesis Stimulating Agents in Patients with Multiple Myleoma

Background: Erythropoiesis Stimulating Agents (ESAs) are FDA approved for chemotherapy induced anemia and anemia of chronic kidney disease. These indications are more frequent in patients with multiple myeloma. Use of ESAs has been associated with an increased risk of heart attack, stroke, venous thromboembolism (VTE), and all-cause mortality. In patients with cancer, ESA's have been associated with worse progression free survival (PFS) and overall survival (OS) Previous research regarding ESA use in patients with multiple myeloma has been limited and conflicting. In this study, we evaluate the effects of ESA use in patients with multiple myeloma. Additionally, we examined the frequency of ESA usage after the 2007 FDA safety update revising product labeling for ESAs.Methods: A retrospective chart review was conducted on patients diagnosed with active multiple myeloma between January 1st, 2000 and December 31st, 2015 at Gundersen Health System in La Crosse Wisconsin. Collected data include patient demographics, medications, lab tests, comorbidities, and the dates of any VTE, stroke, or myocardial infarction. Both a logistic regression and a matched case-control analysis were used to compare rates of complications in patients using ESAs to those that did not. ESA effect on median survival time was also calculated for each International Staging System (ISS) stage of disease.Results:There were 278 patients included for demographic analysis (Table 1), of which 268 were included in the logistic regression analysis and 124 (62 pairs) in the matched case-control analysis.A logistic regression model constructed via stepwise selection found that bone lesions at diagnosis (Odds Ratio (OR): 2.5 [1.2-5.1]), antiplatelet drug use (OR: 3.7 [1.2-11.3]) and ESA use (OR: 4.7 [2.2-9.9]) were associated with increased risk of VTE in our patient population. Use of an Angiotensin Converting Enzyme (ACE) inhibitor (OR: 0.4 [0.2-0.9]) was associated with a decreased risk of VTE. Increased odds of VTE with ESA usage (OR: 5.9 [1.9 - 18.8]) were also noted in the matched case-control analysis. There was no association found between rate of stroke and ESA usage in either logistic or matched case-control analysis. No significant association between ESA use and overall survival was noted in either logistic or matched case-control analysis.When comparing outcomes based upon pre and post FDA revised product labeling, we found a 50% reduction in ESA usage within our institution. In this same time period, the percentage of patients with multiple myeloma developing VTEs has been significantly reduced (18.6% vs 12.8% [p<0.007]).Conclusions: In our population, the use of ESAs in multiple myeloma patients was associated with increased risk of VTE. No significant association between ESA use and overall survival was noted. The observed decrease in both ESA use and rate of VTE in patients with myeloma after the 2007 revised safety labelling by the FDA may reflect practice changes in response to this revision at our institution. Further study in a prospective large multicenter dataset with further control of confounding variables is warranted. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

BackgroundTrends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay.MethodsThis was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD), hospital administrative (Hospital Episodes Statistics, HES), population statistics (Office of National Statistics, ONS) and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records.ResultsThere were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years). Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710) when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118.3/1000 patient-years in esophagogastric resection. Predictors of VTE included emergency surgery (OR = 1.91 95%CI 1.60–2.28, p<0.001), age (OR = 1.02 95%CI 1.02–1.03, p<0.001), body mass index (OR = 1.03 95%CI 1.01–1.04, p<0.001), previous VTE (OR = 8.07 95%CI 6.61–9.83, p<0.001), length of stay (OR = 1.00 95%CI 1.00–1.00, p = 0.007) and cancer stages II (OR = 1.38 95%CI 1.03–1.87, p = 0.033), III (OR = 1.50 95%CI 1.11–2.01, p = 0.008) and IV (OR = 1.63 95%CI 1.03–2.59, p = 0.038). Major organ resections had the greatest odds of VTE when adjusted for other risk factors including length of hospital stay. Post-discharge VTE accounted for 64.8% (636/981) of all recorded VTE. In-hospital VTE (165.4/1000 patient-years) was recorded more frequently than post-discharge VTE (16.2/1000 patient-years). Both in-hospital (OR = 2.07 95%CI 1.51–2.85, p<0.001) and post-discharge (OR = 4.03 95%CI 2.95–5.51, p<0.001) VTE independently predicted 90-day mortality. In patients who died and VTE was recorded on HES or CPRD (n = 56), VTE was one of the causes of death in 37.5% (21/56) of cases.ConclusionsA large proportion of postoperative VTE was detected in primary care. Evaluation of linked databases was a useful way of measuring postoperative VTE at population level. These resources identified a significant association between post-discharge VTE and mortality in general surgery.

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease.

COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear. Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE-, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE. The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE- group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history. BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.

National Epidemiology of Inpatient Venous Thromboembolism in Patients with Hematologic Malignancies in United States from 1993 to 2012

▪Background: Venous thromboembolism (VTE) is an important cause of morbidity and mortality in patients with hematologic malignancies (HMs). The national burden of inpatient VTE in patients with HMs is not known.Methods: We used the National Inpatient Sample (NIS), one of the largest publicly-available inpatient dataset in United States (U.S.), which represents a 20% stratified random sample of discharges from all hospitals, excluding rehabilitation and long-term acute care hospitals. The NIS is drawn from all States participating in Healthcare Cost and Utilization Project, representing more than 95 percent of the U.S. population. Discharge weights are used to generate national estimates. Patients with HMs were identified using ICD9 codes published by NIS and VTE was defined by ICD9 codes 451 - 453 and 415.1. Annual rates of inpatient VTE were calculated from 1993 to 2012 by HM type. Multivariate odds of inpatient VTE was determined by logistic regression controlling for confounders (age, sex, Charlson co-morbidity index, metastasis, chemotherapy, transfusion of blood products, major operating room procedure, primary hypercoagulable state, disseminated intravascular coagulation, heparin induced thrombocytopenia and thrombosis, antiphospholipid syndrome, obesity and calendar year). The malignancies with non-specific designation (e.g. unspecified leukemia) or with less than 1000 patients (weighted number) were excluded from results.Results: 8.42million hospitalized patients (weighted number) with HMs were identified, and 335,240had VTE (3.98%). In patients with HMs, rates of inpatient VTE increased from 2.59% to 5.22% between 1993 and 2012 (p<0.01). A detailed analysis of VTE rates for various HMs is presented in Table 1. The HMs with highest odds of inpatient VTE are peripheral T-cell lymphoma (PTCL), anaplastic large cell lymphoma (ALCL) and primary central nervous system (CNS) lymphoma (OR 1.56, 1.53, and 1.39, p<0.05) as compared to all other HM. Among leukemias, hairy cell leukemia had higher odds of VTE (OR 1.19, p<0.05). The HMs with the least odds of VTE were acute lymphoid leukemia, chronic monocytic leukemia and plasma cell leukemia (OR 0.65, 0.66 and 0.71, p<0.05). The HMs with the highest rates of VTE were PTCL, large cell lymphoma and ALCL (6.96%, 6.35% and 6.27%). The HMs with lowest rate of VTE were megakaryocytic leukemia, acute lymphoid leukemia and acute monocytic leukemia (1.42%, 2.04%, and 2.73%).Conclusions: Our study provides national estimates of inpatient VTE in HM, which are increasing over the last 20 years. Certain HMs have higher rates and odds of VTE as compared to others. Identification of these differences provides valuable information for the use of prophylaxis in HM with high risk of VTE.Table 1Multivariate Odds and Rates of Inpatient Venous Thromboembolism in Patients with Hematologic Malignancies (Total weighted N = 8.42 million)Hematologic malignancyInpatient VTE rate (%)Adjusted OR (95% CI) of inpatient VTE compared to all other HMHodgkin's diseaseHodgkin's disease - lymphocyte rich3.861.15 (0.82 - 1.61)Hodgkin's disease - nodular sclerosing4.041.3 (1.18 - 1.43)Hodgkin's disease - mixed cellularity4.021.22 (0.89 - 1.68)Hodgkin's disease - lymphocyte depleted3.881.14 (0.73 - 1.77)Non-hodgkin's lymphomaNodular lymphoma4.891.2 (1.13 - 1.28)Mycosis fungoides4.831.25 (1.16 - 1.35)Sezary's disease3.991.08 (0.72 - 1.62)Peripheral t-cell lymphoma6.961.56 (1.32 - 1.85)Burkitt's lymphoma3.441.05 (0.97 - 1.15)Marginal zone lymphoma5.571.07 (0.91 - 1.26)Mantle cell lymphoma4.911.03 (0.92 - 1.15)Primary CNS lymphoma6.181.39 (1.18 - 1.64)Anaplastic large cell lymphoma6.271.53 (1.21 - 1.94)Large cell lymphoma6.351.36 (1.22 - 1.51)SarcomaMyeloid sarcoma4.241.14 (0.9 - 1.44)Myeloma and leukemiaMultiple myeloma4.571.14 (1.1 - 1.18)Plasma cell leukemia2.850.71 (0.5 - 1)Lymphoid leukemia - acute2.040.65 (0.61 - 0.69)Lymphoid leukemia - chronic3.430.76 (0.73 - 0.78)Myeloid leukemia - acute3.710.97 (0.93 - 1)Myeloid leukemia - chronic2.930.72 (0.68 - 0.76)Monocytic leukemia - acute2.730.75 (0.59 - 0.96)Monocytic leukemia - chronic2.740.66 (0.44 - 0.98)Erythrocytic leukemia - acute2.950.81 (0.5 - 1.32)Megakaryocytic leukemia1.420.48 (0.23 - 1.02)Hairy cell leukemia4.721.19 (1.07 - 1.32) DisclosuresNo relevant conflicts of interest to declare.

National Epidemiology of Venous Thromboembolism in Patients with Malignancy in United States from 1993 to 2012

▪Background: Venous thromboembolism (VTE) is an important cause of morbidity and mortality in cancer patients. National burden of inpatient VTE in patients with cancer is not known.Methods: We used the National Inpatient Sample (NIS), one of the largest publicly-available inpatient dataset in United States (U.S.), which represents a 20% stratified random sample of discharges from all hospitals, excluding rehabilitation and long-term acute care hospitals. The NIS is drawn from all States participating in Healthcare Cost and Utilization Project, representing more than 95 percent of the U.S. population. Discharge weights are used to generate national estimates. Patients with cancer were identified using ICD9 codes published by NIS. VTE was defined by ICD9 codes 451 - 453 and 415.1. Annual rates of inpatient VTE were calculated from 1993 to 2012 by cancer type. Multivariate odds of inpatient VTE was determined by logistic regression controlling for confounders (Age, sex, Charlson co-morbidity index, metastatic disease, chemotherapy, blood transfusion, major therapeutic operating room procedure, primary hypercoaguable state, disseminated intravascular coagulation, heparin induced thrombocytopenia, anti-phospholipid antibody syndrome, obesity and calendar year). Incidence of VTE in population was calculated by using prevalence published by CDC as our denominator from 2001 to 2011.Results: 69.1 million hospitalized patients (weighted number) with cancer were identified, and 2.6 million had VTE (3.8%). Rates of inpatient VTE increased for all cancers from 1993 and 2012 (Table 1). The cancers with sharpest rise in inpatient VTE rate were liver and bile duct (LBD), pancreas and esophagus (Slope: 0.33, 0.31 and 0.22 percent per year). The cancers with highest odds of inpatient VTE were pancreas, brain and LBD (OR: 2.49, 2.41, and 2.23). The cancers with highest incidence of VTE in population were pancreas, LBD and esophagus (182, 116, and 67 per 1000 person-year). The cancers with lowest odds of inpatient VTE were thyroid, head and neck and prostate (OR: 0.5, 0.67, and 0.87). The cancers with lowest incidence of VTE in population were thyroid, melanoma and testis (2, 2.5, and 4.8 per 1000 person-year).Conclusions: Our study provides national estimates of VTE, which are increasing across all cancer types. Certain cancers have higher incidence and odds of VTE as compared to others. Identification of these trends provides valuable information for the use of prophylaxis in cancers with high risk of VTE.Table 1Incidence, Multivariate Odds and Rates of In-patient VTE in Cancer Patients in US.Cancer TypeIncidence of VTE in Population (per 1000 person-year)Multivariate OR (95% CI) for Inpatient VTE Compared to All Other CancersInpatient VTE Rate (%) 1993 vs. 2012 (p<0.01)Slope of Change in VTE Rates from 1993 to 2012Pancreas182.42.49 (2.39 - 2.6)5.712.0+ 0.31Brain and nervous system34.62.41 (2.29 - 2.54)4.36.3+ 0.08Liver and intrahepatic bile duct115.82.23 (2.13 - 2.34)3.59.9+ 0.33Multiple myeloma55.01.72 (1.62 - 1.81)2.75.3+ 0.16Non-Hodgkin`s lymphoma19.71.69 (1.61 - 1.76)3.25.7+ 0.10Hodgkin`s disease8.11.6 (1.51 - 1.7)3.05.2+ 0.08Ovary30.81.59 (1.52 - 1.67)2.66.6+ 0.20Testis4.81.5 (1.41 - 1.6)2.45.6+ 0.16Bronchus, lung59.41.43 (1.37 - 1.49)2.66.6+ 0.21Stomach40.11.39 (1.33 - 1.47)3.06.8+ 0.20Esophagus66.61.38 (1.31 - 1.45)2.26.1+ 0.22Cervix14.71.34 (1.27 - 1.42)3.04.5+ 0.07Uterus and Other female genital organs8.61.32 (1.26 - 1.38)2.95.3+ 0.09Kidney and renal pelvis16.01.2 (1.14 - 1.26)2.95.0+ 0.10Leukemias24.41.15 (1.1 - 1.2)1.84.3+ 0.11Urinary bladder7.71.09 (1.04 - 1.14)2.14.4+ 0.12Colon, Rectum and Anus15.31.08 (1.04 - 1.13)2.74.6+ 0.09Breast7.21 (0.96 - 1.04)2.53.9+ 0.05Bone and connective tissuen/a1 (0.95 - 1.07)1.44.1+ 0.15Melanomas of skin2.50.91 (0.87 - 0.96)1.93.7+ 0.08Prostate5.40.87 (0.83 - 0.9)2.33.5+ 0.06Head and neck7.00.67 (0.64 - 0.7)0.93.3+ 0.12Thyroid2.00.5 (0.47 - 0.53)0.72.4+ 0.07 DisclosuresNo relevant conflicts of interest to declare.

Darbepoetin Hits a Double As Epoetin Hits a Home Run in Response to the 2007 FDA Black Box Warning

Background: Darbepoetin and epoetin are erythropoiesis stimulating agents (ESAs) that have been used to treat chemotherapy related anemia in cancer patients since 2002 and 1993. ESAs reduce rates of blood transfusions in both CKD and cancer patients. In the cancer setting, toxicities for ESAs include venous thromboembolism (VTE), tumor progression, and death. In March 2007, these toxicities were described by FDA in a revised "black box" warning. The warning advised clinicians to use the lowest dose possible of ESAs among persons with chemotherapy associated anemia and to administer ESAs to cancer patients who are receiving chemotherapy for palliation versus the curative setting. While several studies report decreased ESA utilization among cancer patients with chemotherapy-induced anemia following the Black Box warning, these studies have not reported on changes in ESA use for darbepoetin versus epoetin nor have they reported on changes in VTE rates. We report on darbepoetin versus epoetin utilization trends in cancer patients with chemotherapy-associated anemia in addition to VTE and transfusion rates during the years 2002 to 2010.Methods: We merged South Carolina Medicaid data with South Carolina Cancer Registry dataset for the years 2002- 2010. Breast, non-small cell lung and colorectal patients 18 years of age and older evaluated. From the chemotherapy population in this cohort based on tumor registry data, ESA users were identified from medical and pharmacy claims. The final sample contained persons with a first ESA claim after chemotherapy administration among Medicaid persons who are not dually enrolled in Medicare and Medicaid.Results: Of 1,315 chemotherapy patients who received an ESA, 940 (71%) were darbepoetin users and 375 (29%) were epoetin users. In 2002, epoetin and darbepoetien users accounted for 37.5% and 13% of the chemotherapy population respectively. Epoetin users decreased to 13% for 2004-2006 and declined further to 3.4% by 2010. Darbepoetin administration increased to 43.5% in 2005 among cancer patients receiving chemotherapy and decreased to 7.1% among chemotherapy patients by 2010. Among chemotherapy patients who received epoetin, VTE rates were 8% in 2002 and 3% in 2010 (p<0.05). In contrast, among darbepoetin-treated cancer patients, VTE rates were 5.5% in 2002 and 5.1% in 2010. For transfusions among epoetin-treated cancer patients, transfusion rates were between 5% and 7% in the years 2002- 2008, and then increased to 13% in 2009 and 2010. In contrast, among cancer patients who received darbepoetin, transfusion rates were 7% in the years 2002- 2009 and 9% in 2009. For VTEs, logistic regression indicated that epoetin users had a 60% reduction in VTE odds after the black box warning was disseminated in 2007 and darbepoetin users' had a 35% reduction (p<.05). For transfusions, epoetin users had a 158% increase in odds of receiving a transfusion after the black box warning was added in 2007 and darbepoetin users had a 74% increase after the Black Box warning (p<.05). There is also a marked change in per-cycle dose administration for darbepoetin, but not for epoetin users. While darbepoetin treated cancer patients received a significantly higher monthly, epoetin patients received a lower monthly dose after the black box was disseminated, dose (table).Conclusion: Among cancer patients with chemotherapy-associated anemia who received ESAs between 2002 and 2010, darbepeotin users exhibited a decrease in utilization, little to no response in VTEs or transfusion risks, and marked increases in per cycle and per month dosing. In contrast, epoetin users showed decreased utilization, decreased per-cycle and per-month dosing, decreased VTE rates, and increased transfusion rates. The Black Box warning appears to have had differential effects on epoetin- versus darbepoetin-treated cancer patients with chemotherapy associated anemia.Table 1EpoetinDarbepoetin200220072010200320072010Utilization38%9%3%33%35%7%Transfusions2%6%12%4%7%6%VTEs8%4%3%6%7%5%Mean Total Monthly Dose110,026 IU95,507 IU99,625 IU328mcg403mcg452mcgDifferences between epoetin and darbeoetin patients from 2002-2010 DisclosuresNo relevant conflicts of interest to declare.

Efficacy and Bleeding Risk of Newer Anticoagulants Compared to Conventional Treatment in Patients with Chronic Kidney Disease- a Meta-Analysis of Randomized Controlled Trials

▪BackgroundMultiple newer oral anticoagulants (NOAC) are currently approved for the prevention, treatment of venous thromboembolism (VTE) and prevention of stoke in atrial fibrillation (AF). Most of the clinical trials with NOAC have excluded patients with severe renal insufficiency. There is a paucity of safety and efficacy data of NOAC in comparison with conventional treatment (CT) in patients with mild or moderate renal impairment. We performed a meta-analysis of the randomized control trials (RCTs) comparing NOAC to CT in patients with renal insufficiency to understand the safety and efficacy of NACs.MethodsMedline, PubMed, EMBASE, EBSCO, CINAHL and Cochrane databases were queried with the keywords - "newer anticoagulants", "renal insufficiency", "dabigatran", "rivaroxaban", "apixaban", and "edoxaban". RCTs comparing NOAC to CT (warfarin, low molecular weight heparin, heparin, aspirin or placebo) were included. Non-randomized single arm trials were excluded. Authors of RCTs with missing pertinent data were contacted through electronic mail. The safety end point analyzed was clinically significant or major bleeding risk. The efficacy end points analyzed were incidence of arterial embolism in AF studies and venous thromboembolism in VTE studies. European Medical Agency classification of renal insufficiency was used, with mild renal insufficiency defined as estimated glomerular filtration rate (eGFR) from 50 to 79 and moderate renal insufficiency defined as eGFR of 30 to 49 and severe renal insufficiency defined as eGFR< 30.ResultsSixteen RCTs with 115,147 patients fulfilled our inclusion criteria. Rivoroxaban, apixaban, edoxaban and dabigatran were the newer anticoagulants used in these 16 RCTs. Among these, 48,403 patients had either mild or moderate renal insufficiency. Patients with mild renal insufficiency treated with NAOC had lower bleeding risk [Odds ratio 0.81(CI 0.72-0.90) p<0.0001], lower incidence of arterial thromboembolism [Odds ratio 0.74(CI 0.64-0.85) p<0.0001] compared to conventional treatment. Patients with moderate renal insufficiency treated with NAOC had lower incidence of arterial thromboembolism [Odds ratio 0.74(CI 0.62-0.89) p=0.001] and a trend towards lower bleeding risk [Odds ratio 0.89(CI 0.66-1.18) p=0.41], compared to conventional treatment. Also, a trend of lowered VTE incidence was observed with NOAC compared to conventional treatment in patients with mild [Odds ratio 0.70(CI 0.46 to 1.070) p=0.1] as well moderate [Odds ratio 0.69(CI 0.34 to 1.41) p=0.31] renal insufficiency.Conclusion:Newer anticoagulants have decreased odds for VTE, arterial embolism and bleeding in patients with mild to moderate renal insufficiency compared to conventional treatment. DisclosuresNo relevant conflicts of interest to declare.

The Prevalence of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism After Anterior Cruciate Ligament Reconstruction

Background: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. The incidence and risk factors of venous thromboembolism (VTE) after ACL reconstruction remain unclear. Purpose: To define the incidence of VTE after ACL reconstruction and identify associated risk factors in a large cohort of patients. Study Design: Descriptive epidemiological study. Methods: All patients aged ≥18 years who underwent ACL reconstruction between 2005 and 2011 were identified from the Department of Defense Medical Data Repository. The prevalence of VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), within 3 months of ACL reconstruction was queried. Univariate analyses were performed to define odds ratios (ORs) for demographic, medication use, and procedural-related risk factors. Results: A total of 87 VTE events (0.53% [95% CI, 0.42%-0.65%]) occurred after 16,558 ACL reconstructions performed on 15,767 patients. DVT was documented after 55 procedures and PE after 35 procedures. Three patients were documented to have both DVT and PE within the study period. The odds of VTE increased in patients aged ≥35 years (OR, 1.96 [95% CI, 1.27-3.04]; P = .003). Nicotine history increased the odds of DVT (OR, 1.99 [95% CI, 1.15-3.43]; P = .014). Concomitant high tibial osteotomy (HTO) increased the odds of PE (OR, 18.31 [95% CI, 2.4-139.6]; P = .005), whereas concomitant posterior cruciate ligament (PCL) reconstruction increased the odds of both VTE (OR, 3.43 [95% CI, 1.07-11.2]; P = .38) and DVT (OR, 5.57 [95% CI, 1.71-18.14]; P = .004). Nonsteroidal drug use was associated with decreased odds for VTE and DVT (OR, 0.44 [95% CI, 0.28-0.70]; P < .001 and OR, 0.38 [95% CI, 0.22-0.69]; P < .001, respectively). Anticoagulants were associated with increased odds for VTE, DVT, and PE (OR, 98.32 [95% CI, 61.63-156.86]; P < .001; OR, 111.93 [95% CI, 63.95-195.92]; P < .001; and OR, 47.84 [95% CI, 22.55-101.52]; P < .001, respectively). No detectible difference in odds was found for sex, body mass index, or aspirin or cyclooxygenase-2 inhibitor use. Conclusion: The incidence of VTE after ACL reconstruction in this large population was low. Increased odds of VTE was identified in patients aged ≥35 years with a history of nicotine use, anticoagulant use, concomitant HTO, or concomitant PCL reconstruction. Controlled studies are necessary to determine the efficacy of chemoprophylaxis and to develop evidence-based clinical practice guidelines to minimize VTE after ACL reconstruction.

Incidence, determinants and the transient impact of cancer treatments on venous thromboembolism risk among lymphoma patients in Denmark

BackgroundValid estimation of the incidence and risk factors for venous thromboembolism (VTE) among lymphoma patients has been limited by small studies focused on selected lymphoma subtypes and failure to account for death as a competing risk. Using a nationwide cohort of Danish lymphoma patients diagnosed from 2000 to 2010, we examined the incidence and risk factors for VTE and evaluated the transient impact of cancer treatments on VTE risk. MethodsMedical databases contained cancer, comorbidity, treatment, and VTE information. We computed VTE incidence rates (IRs) per 1000person-years and 1- and 2-year incidence accounting for competing risks. Using Cox proportional hazards models, we identified factors associated with VTE risk. In a nested self-controlled design, we evaluated the transient effect of chemotherapy, radiation, central venous catheter use and rituximab on VTE risk using logistic regression models and adjusted odds ratios (aORs). ResultsVTE IRs were >40/1000person-years within 180days post-diagnosis, decreasing to 8/1000person-years in year two. VTE risk was 2.9% and 3.5% at 1 and 2years, respectively. Lymphoma subtype, central nervous system involvement, and elevated lactate dehydrogenase were associated with VTE risk. Central venous catheter use increased the transient odds of VTE (aOR=6.7 (1.2, 28.1)). ConclusionsWe report a lower VTE incidence among lymphoma patients compared with prior studies. Lymphoma aggressiveness was the main driver of baseline VTE risk, whereas central venous catheter use increased transient risks. These accurate estimates may improve the identification of lymphoma subgroups at highest VTE risk, for whom future targeted prevention interventions may be beneficial.

OC-089 Linked hospital and primary care database study of venous thromboembolism and associated mortality following general surgical procedures in england

Introduction Trends towards shortening hospital stay through day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly occur following hospital discharge. However, population rates of postoperative VTE cannot be measured from hospital databases alone, as they do not capture information outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of linked hospital and primary care data to gain a better understanding of rates of hospital care-related VTE, 1 however, data for surgical patients is lacking. Method Ninety-day in-hospital and post-discharge VTE and mortality were evaluated in twelve general surgical procedures performed from 1997 to 2012 using linked Clinical Practice Research Datalink (CPRD), Hospital Episodes Statistics (HES), Office of National Statistics (ONS) and National Cancer Intelligence Network (NCIN) databases. The proportion of VTE captured in each database and risk factors for VTE and mortality were evaluated. Results 168005 operations over fifteen years were evaluated. There were 981 (0.58%) VTE events recorded after 90 days postoperatively. Different datasets recorded variable rates of VTE. CPRD recorded 56.0% (549/981), HES recorded 66.3% (650/981) and ONS recorded 8.3% (81/981) of all recorded VTE. For VTE recorded in two databases, 28.3% (278/981) were in HES and CPRD and 2.1% (21/981) in HES and ONS. Overall VTE rate ranged between 0.08% (14/17554, 3.2/1000 patient years) following haemorrhoidectomy to 2.92% (61/2091, 118.3/1000 patient years) following oesophagogastrectomy. Predictors of VTE included emergency surgery (OR = 1.91), age (OR = 1.02), body mass index (OR = 1.03), previous VTE (OR = 8.07), length of stay (OR = 1.00) and cancer stages II (OR = 1.38), III (OR = 1.50) and IV (OR = 1.63). Major organ resections had the greatest odds of VTE. The frequency of in-hospital VTE ranged from 76.4 to 288.9/1000 person years, while post-discharge VTE ranged from 2.6 to 82.1/1000 patient years. Both in-hospital (OR = 2.07) and post-discharge (OR = 4.03) VTE independently predicted 90-day mortality (p Conclusion A large proportion of postoperative VTE were detected in the primary care setting. Evaluation of linked databases is a useful way of measuring postoperative VTE at population level. These resources identified substantial harm from post-discharge VTE following general surgical procedures. Disclosure of interest None Declared. Reference National Institute for Health and Care Excellence. Venous thromboembolism in patients admitted to hospital. Guideline No. 92, 2010

Is lipid lowering therapy an independent risk factor for venous thromboembolism? A population-based case–control study

IntroductionThe independent effect of lipid lowering therapy (LLT) on venous thromboembolism (VTE) risk is uncertain. ObjectiveTo test statin and non-statin LLT as potential VTE risk factors. MethodsUsing Rochester Epidemiology Project resources, we identified all Olmsted County, MN residents with objectively diagnosed incident VTE (cases) over the 13-year period, 1988–2000 (n=1340), and one to two matched controls (n=1538). We reviewed their complete medical records for baseline characteristics previously identified as independent VTE risk factors, and for statin and non-statin LLT. Using conditional logistic regression, we tested the overall effect of LLT on VTE risk and also separately explored the role of statin versus that of non-statin LLT, adjusting for other baseline characteristics. ResultsAmong cases and controls, 74 and 111 received statin LLT, and 32 and 50 received non-statin LLT, respectively. Univariately, and after individually controlling for other potential VTE risk factors (i.e., BMI, trauma/fracture, leg paresis, hospitalization for surgery or medical illness, nursing home residence, active cancer, central venous catheter, varicose veins, prior superficial vein thrombosis, diabetes, congestive heart failure, angina/myocardial infarction, stroke, peripheral vascular disease, smoking, anticoagulation), LLT was associated with decreased odds of VTE (unadjusted OR=0.73; p=0.03). When considered separately, statin and non-statin LLT were each associated with moderate, non-significant lower odds of VTE. After adjusting for angina/myocardial infarction, each was significantly associated with decreased odds of VTE (OR=0.63, p<0.01 and OR=0.61, p=0.04, respectively). ConclusionsLLT is associated with decreased VTE risk after adjusting for known risk factors.

Venous Thromboembolism in Body Contouring

PURPOSE: To examine the incidence and predictors of venous thromboembolism (VTE) following body contouring procedures. METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2012 for all identifiable body contouring cases. A bootstrap analysis and multivariable logistic regression analyses (MVR) were used to determine independent predictors of VTE. Odds ratios from the MVR were then used to define risk magnitudes for each significant predictor, and each patient’s risk score was totaled. RESULTS: Seventeen thousand seven hundred and seventy four patients underwent body contouring during the study period. Average BMI of patients undergoing body contouring was 31.4 kg/m2, while 2,137 individuals were morbidly obese (BMI ≥ 40 kg/m2). The most common areas of intervention were the breast and abdominal regions (N=11,881, 66.8%; N=5,501, 30.9% respectively). 16,306 (91.7%) patients underwent an isolated contouring procedure, while 1,293 (7.3%) underwent 2 procedures, and 175 (1.0%) underwent 3. VTE occurred in 99 (0.56%) individuals. Multivariate logistic regression revealed that age greater than 45 years (45-60 years: OR 1.54, P=0.1; >60 years: OR 3.1, P<0.001), undergoing abdominal contouring (OR 3.33, P<0.001), obesity (30≤BMI<35: OR 3.30, P<0.001; 35≤BMI<40: OR 4.26, P<0.001; BMI≥40: OR 3.09, P=0.001;), and being admitted as an inpatient (OR 3.01, P<0.001) were associated with an increased odds of VTE. Each of the aforementioned variables were assigned rounded risk scores (Table 1), with patients’ total scores being categorized as low (0-4), medium (5-7), or high risk (8-9). The low risk cohort exhibited a VTE incidence of 0.15%, while the medium risk cohort experienced an incidence of 1.12%, and the high risk group a VTE incidence of 3.03% (Figure 1).Table 1: Risk factor weights.Figure 1: Risk Scoring Model.CONCLUSION: This study identifies predictors of VTE and defines a simple risk scoring model using a large, prospective dataset. These findings show that in the presence of certain risk factors incidence of VTE increases dramatically; in these cases VTE prophylaxis my be warranted.