Potential Risk Factors For Venous Thromboembolism Research Articles

Risk factors for venous thromboembolism in patients with pneumonia in the pre-COVID-19 era: a meta-analysis and systematic review.

Elevated risk of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19) pneumonia has been recognized, while the risk factors associated with VTE in patients with non-COVID-19 pneumonia remain to be defined. This study aimed to conduct a meta-analysis and systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify potential risk factors for VTE in patients with pneumonia from the pre-COVID-19 era. PubMed, EMBASE, and Cochrane Library were searched. Two reviewers performed screening, full-text review, and extraction. Risk factors and odds ratio (OR) were estimated. Of 595 articles identified, six studies were included. Pooled analysis suggested that age ≥60 years [OR =2.75, 95% confidence interval (CI): 2.55-2.97, P<0.001], mechanical ventilation (MV) (OR =9.48, 95% CI: 8.24-10.91, P<0.001), hypertension (OR =1.41, 95% CI: 1.09-1.83, P=0.010), diabetes (OR =1.49, 95% CI: 1.36-1.64, P<0.001), heart failure (OR =3.15, 95% CI: 1.05-9.41, P=0.040) and cancer (OR =2.86, 95% CI: 2.07-3.95, P<0.001) were associated with higher risk for deep vein thrombosis in patients with pneumonia. While age ≥60 years (OR =2.46, 95% CI: 2.21-2.73, P<0.001), bacterial pneumonia (OR =3.80, 95% CI: 1.65-8.73, P=0.002), hyperlipidemia (OR =1.55, 95% CI: 1.00-2.41, P=0.049), heart failure (OR =2.70, 95% CI: 2.05-3.56, P<0.001), chronic obstructive pulmonary disease (OR =4.73, 95% CI: 3.11-7.17, P<0.001) and cancer (OR =2.90, 95% CI: 2.39-3.53, P<0.001) were risk factors for pulmonary embolism in patients with pneumonia. Patients with non-COVID-19 pneumonia, particularly those with advanced age, MV, cardiovascular comorbidities or cancer, warrant individualized management during hospitalization. Our findings could contribute to refining risk prediction models and further risk stratification for VTE in patients with pneumonia in clinical practice.

Using Machine Learning (ML) Models to Predict Risk of Venous Thromboembolism (VTE) Following Spine Surgery.

A retrospective cohort study. Venous thromboembolism (VTE) is a potentially high-risk complication for patients undergoing spine surgery. Although guidelines for assessing VTE risk in this population have been established, development of new techniques that target different aspects of the medical history may prove to be of further utility. The goal of this study was to develop a predictive machine learning (ML) model to identify nontraditional risk factors for predicting VTE in spine surgery patients. A cohort of 63 patients was identified who had undergone spine surgery at a single center from 2015 to 2021. Thirty-one patients had a confirmed VTE, while 32 had no VTE. A total of 113 attributes were defined and collected via chart review. Attribute categories included demographics, medications, labs, past medical history, operative history, and VTE diagnosis. The Waikato Environment for Knowledge Analysis (WEKA) software was used in creating and evaluating the ML models. Six classifier models were tested with 10-fold cross-validation and statistically evaluated using t tests. Comparing the predictive ML models to the control model (ZeroR), all predictive models were significantly better than the control model at predicting VTE risk, based on the 113 attributes ( P <0.001). The Random Forest model had the highest accuracy of 88.89% with a positive predictive value of 93.75%. The Simple Logistic algorithm had an accuracy of 84.13% and defined risk attributes to include calcium and phosphate laboratory values, history of cardiac comorbidity, history of previous VTE, anesthesia time, selective serotonin reuptake inhibitor use, antibiotic use, and antihistamine use. The J48 model had an accuracy of 80.95% and it defined hemoglobin laboratory values, anesthesia time, beta-blocker use, dopamine agonist use, history of cancer, and Medicare use as potential VTE risk factors. Further development of these tools may provide high diagnostic value and may guide chemoprophylaxis treatment in this setting of high-risk patients.

Venous thromboembolism: Exploring incidence and utility of screening in spinal cord injury

Objective To assess the incidence and possible risk factors for venous thromboembolism (VTE) in patients admitted to a SCI rehabilitation center. Design Retrospective review. Setting Acute neurorehabilitation hospital specializing in SCI. Methods Records of 228 consecutive admissions were reviewed. All patients received screening four limb ultrasounds on admission. Charts were reviewed to determine whether VTE was diagnosed at the acute care hospital or in the rehabilitation center; either on admission screening or later in the rehabilitation stay. Charts were reviewed to identify potential risk factors for VTE as well as the incidence of bleeding complications in patients on full anticoagulation. Results In this cohort, 115 deep venous thromboses (DVTs) were identified in the following settings: 27% in acute care [n = 31], 70% on admission to rehabilitation [n = 80], and 24% during the rehabilitation stay [n = 28]. Of those on therapeutic anticoagulation due to admission diagnosis of VTE [n = 63], 12.7% developed recurrent DVT and 9.5% had bleeding complications. Of those who were initiated and continued on therapeutic anticoagulation, there was zero incidence of PE. Risk factors for the development of VTE included age, body mass index (BMI), rehabilitation length of stay, injury etiology, spinal cord-related surgery, and history of inferior vena cava filter. Conclusions DVT was identified in 70% of this cohort with screening ultrasound on admission to rehabilitation and of those initiated and continued on therapeutic anticoagulation, none developed PE, while 9.5% had bleeding complications. Given the findings of this study, prospective research in noninvasive vascular ultrasound screening for VTE should be considered.

Prediction of Venous Thromboembolism after Ankle Fractures using Machine Learning: To Give Prophylaxis or Not to Give, That is the Question

Category: Ankle; Other Introduction/Purpose: The risk of venous thromboembolism (VTE) after foot and ankle surgery is significantly lower than rates after hip/knee arthroplasty, but it isn't zero. Specific subgroups of patients may be at higher risk, forcing patients and clinicians to navigate the risks and benefits of chemoprophylaxis with insufficient data. Efforts have been made to add clarity to such decision making using conventional data-analysis and risk-scoring methods, but none of these methods were patient-specific or built on robust models of a given patient's individual characteristics. In this study we used machine-learning to determine the potential risk factors for VTE after ankle fracture. We aimed to develop a patient-specific predictive model to assist clinicians and patients in deciding upon the use of postoperative chemoprophylaxis after foot and ankle surgery. Methods: In this preliminary machine-learning-based case-control study, 16,421 patients with ankle fractures were recruited retrospectively. We used an automated-string search method to find patients who were clinically suspected to have developed VTE. Among 1176 such patients, 239 had confirmed VTE within 180 days of sustaining an ankle fracture (cases) and 937 did not (controls). Groups were further sub-divided in patients who had been receiving chemoprophylaxis and those who hadn't. Over 110 factors and variables including patient demographics, past-medical and surgical history, fracture characteristics, treatment, medications, and laboratory values were included in our machine-learning dataset. Three analytical algorithms were used in our machine-learning methods including backward-logistic-regression, decision-tree-classifier (depth=5), and neural networks (two dense layers (n=16 and 4), two drop-out layers, and a sigmoid classifier). Conventional statistics were also used to compare the case and control groups (chi-squared, t-test, p&lt;0.05 considered significant), and the odds-ratio (OR) was calculated for significant parameters. Results: Based on overall performance scores including specificity, sensitivity, area under the ROC curve, accuracy, PPV, NPV, F- 1 score, among the 3 machine-learning methods, the Backward-Logistic-Regression model was superior in predicting VTE post ankle fracture and in determining whether administering prophylaxis can be beneficial for the patient or not (Tables 1 and 2). Other than the previously suggested risk factors, our algorithms showed a positive correlation between the incidence of VTE and smoking (OR=2.09, p&lt;0.001), age &lt;55 y/o (p=0.001), open fracture (OR=2.49, p&lt;0.001), male sex (OR=1.98, p&lt;0.001), surgical versus nonoperative treatment (OR=1.88, p=0.001), and multiple fractures at the time of trauma (OR=1.9, p=0.001). Factors that showed negative correlation with VTE include statins use (OR=0.36, p&lt;0.001), hypertension (OR=0.53, p=0.001), vitamin D (OR=0.43, 0.002), calcium supplementation (OR= 0.43, p= 0.01), hyperlipidemia (OR=0.55, p=0.006), cataract (OR=0.19, p=0.01), osteoporosis (OR=0.36, p=0.02), cardiovascular diseases (OR=0.54, p=0.02), hypokalemia (OR=0.26, p=0.03), and proton pump inhibitor use (OR=0.5, p=0.03). Conclusion: Our machine learning algorithms showed that factors such as tobacco use, younger age, open fracture, multi-trauma, operative treatment, as well as male sex heightened the risk of VTE. In contrast, certain factors such as vitamin D supplementation had negative correlation with VTE. Machine learning algorithms acted in a more complex manner and incorporated more factors in decision-making compared to conventional methods. External validation using larger and more granular datasets as well as using the algorithms in trial modes (shadow modes) are needed to build trust in this algorithm to assist clinicians in predicting/preventing VTE after foot and ankle surgeries.

229. Using machine learning (ML) models to predict risk of venous thromboembolism (VTE) following spine surgery

229. Using machine learning (ML) models to predict risk of venous thromboembolism (VTE) following spine surgery

Real-World Insurance Claims Analysis of Venous Thromboembolism in Japanese Patients with Inflammatory Bowel Disease

BackgroundInflammatory bowel disease (IBD), which encompasses both ulcerative colitis (UC) and Crohn’s disease (CD), is a risk factor for venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).AimTo investigate the incidence of, and risk factors for, VTE in patients with IBD in Japan.MethodsThis was a retrospective, non-interventional study in patients with IBD from the Japan Medical Data Center claims database. Incidence rates (IRs; unique patients with events per 100 patient‐years) were calculated for VTE, DVT, and PE among the IBD, UC, and CD cohorts. Odds ratios of potential risk factors were calculated by univariate and multivariate analyses in a nested case–control design.ResultsOverall, 16 273 patients with IBD were included: 13 585 with UC and 3443 with CD. VTE events occurred in 1.3%, 1.2%, and 1.9% of patients with IBD, UC, and CD, respectively. In patients with IBD, UC, and CD, IRs of VTE were 0.45, 0.40, and 0.64, respectively, IRs of DVT were 0.42, 0.38, and 0.61, respectively, and IRs of PE were 0.07, 0.07, and 0.11, respectively. In patients with IBD, treatment history (immunomodulators), cardiovascular risk (hypertension, high-density lipoprotein or diabetes mellitus, and history of coronary artery disease or heart failure), malignancy, and undergoing major surgery were identified as potential risk factors for VTE in the multivariate analysis, with similar risk factors reported for patients with UC and CD.ConclusionsThis large study provides insight into the incidence and risk factors for VTE in patients with IBD from Japan.

Predictors of Venous Thromboembolism in Patients with Acute Myeloid Leukemia or Acute Lymphoblastic Leukemia

Introduction: The association of malignancy, largely solid tumors, with venous thromboembolism (VTE) is well-known and a widely validated score, Khorana score, guides prophylactic anticoagulation in high-risk patients. However, increasing albeit scarce evidence suggests a high incidence of VTE in patients with hematologic malignancies, which are comparable to high-risk solid tumors. In this study, we sought to explore the incidence and predictors of VTE (including the variables in the Khorana score) in patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) from a large database.Methods: We performed a retrospective cohort study of patients diagnosed with AML or ALL using an aggregated de-identified data from electronic medical record of >300 major hospitals in US (IBM Watson Explorys). Patients aged 20 to 79 years, diagnosed with AML or ALL within the past 5 years were included. The primary endpoint was the incidence of cancer associated VTE defined as deep vein thrombosis, pulmonary embolism or superficial vein thrombosis within 1 year of AML/ ALL diagnosis. Baseline characteristics including age, sex, race, body mass index (BMI), prothrombotic mutations (Factor V Leiden, prothrombin gene 20210A mutation), smoking status, prior history of VTE, presence of central venous catheter (CVC), antineoplastic agent use, erythropoietin (EPO) and pegylated asparaginase (PegA) use as well as baseline laboratory values (as included in Khorana score) were compared between acute leukemia patients with cancer associated VTE within 1 year to those without. Fibrinogen and D-dimer were not available to be explored. A univariate analysis was performed using two-sided chi-square test to study these baseline variables. A p-value <0.05 was considered statistically significant. All statistical analyses were performed using GraphPad Prism version 9.0 (GraphPad Software, San Diego, CA, USA).Results: A total of 19,050 adult patients with a diagnosis of AML or ALL in the last 5 years were included. Of these, 1,550 patients had VTE within 1 year of acute leukemia diagnosis, with an overall incidence of 8.14%. Baseline characteristics of patients with acute leukemia with and without cancer associated VTE within 1 year were compared (Table 1). On univariate analysis, age>60, Caucasian or African American race, obesity, remote or current smoking status, Factor V Leiden, prior history of VTE, presence of CVC, anemia, leukocytosis, antineoplastic agent/EPO or PegA use were all associated with an increased risk of cancer associated VTE. Interestingly, both low platelet counts (<50 x 10 9/L) and high platelet counts (>350 x 10 9/L) were associated with increased cancer associated VTE. Among these, prior history of VTE had the strongest association (OR 7.46). Younger age (20-39) and Asian race were in fact inversely associated with VTE. A multivariable analysis is currently underway to assess the significance of these risk factors independently towards cancer associated VTE in this AML/ALL population.Conclusions: Our study highlights and reiterates a high risk of VTE within one year of diagnosis of AML/ALL in what we believe is the largest cohort studied to date. Older age, Caucasian or African American race, smoking, prior VTE, presence of CVC, Factor V Leiden, antineoplastic agent or PegA use were associated with increased risk. Among the Khorana score variables, obesity, anemia, EPO use and leukocytosis stood out as potential risk factors for VTE in this population. Risk of VTE was however increased regardless of platelet counts, which emphasizes the need to consider surveillance or thromboprophylaxis strategies in AML/ALL patients with thrombocytopenia with presumed high bleeding risk. Lastly, young age and Asian ethnicity seem to confer some protection against thrombosis in this population. Our ongoing efforts include a multivariable analysis and examining the effect of the Khorana score risk stratification in our large cohort of AML/ALL patients. Finally, further studies will be fundamental to meet the unmet need for a specific risk stratification system(s) for patients with AML/ALL. [Display omitted] DisclosuresNayak: BioChip Labs: Current Employment.

Venous thromboembolism is not a risk factor for the development of bloodstream infections in critically ill COVID-19 patients

Venous thromboembolism is not a risk factor for the development of bloodstream infections in critically ill COVID-19 patients

Aspirin May be Inadequate Thromboprophylaxis in Multiple Myeloma

BackgroundMultiple myeloma (MM) is associated with a 9-fold increased risk of venous thromboembolism (VTE). Current guidelines support routine thromboprophylaxis in select patients (ASCO, IMWG). The 2015 ASCO guidelines recommend low-molecular-weight heparin or low-dose aspirin in patients receiving immunomodulatory drugs (IMIDs) in combination with chemotherapy and/or dexamethasone. The IMWG guidelines recommend low-dose aspirin for MM patients with one or no VTE risk factors including those on lenalidomide in combination with low-dose dexamethasone, melphalan, or doxorubicin. Two randomized trials support thromboprophylaxis in patients receiving lenalidomide and thalidomide; however, patients with a prior history of VTE were excluded from participation (Palumbo 2011, Larocca 2012). We assessed the association between aspirin use and VTE in a large cohort of patients with MM.MethodsPatients diagnosed with MM within the Veterans Health Administration between September 1, 1999 and December 31, 2013 were identified in the Veterans Administration Central Cancer Registry (VACCR) using International Classification of Diseases (ICD)-O3 codes 9732/3. We retrospectively followed the cohort through December 2014. We excluded patients who did not receive MM-directed therapy within 6-months of diagnosis. We collected baseline information on demographics, comorbidities, laboratory data, MM-directed therapy, and use of aspirin, warfarin, and statins. All drug therapy was analyzed as time-varying. Using a previously validated algorithm, (Sanfilippo, 2015), we identified patients diagnosed with VTE after MM diagnosis by a combination of ICD-9 code for VTE plus pharmacologic treatment for VTE or IVC filter placement. We used competing risk analysis to assess the association between aspirin use and incident VTE while adjusting for known VTE risk factors and for death as a competing event.ResultsWe identified a cohort of 4,892 patients of whom 586 developed VTE. A total of 1,888 patients received aspirin therapy after MM diagnosis while 862 received warfarin therapy. After adjusting for known potential VTE risk factors, including history of VTE and use of IMIDs, aspirin was not associated with a decreased risk of VTE (adjusted Hazard Ratio (aHR) 1.18; 95% Confidence Interval (CI) 0.92-1.52). Warfarin use was associated with a trend towards reduction in risk of VTE (aHR 0.77; 95% CI 0.53-1.12). Risk factors for VTE after MM diagnosis included: history of prior VTE (aHR 3.83; 95% CI: 2.68-5.48), lenalidomide (aHR 2.36; 95% CI 1.82-3.05), and thalidomide (aHR 2.60; 95% CI: 2.09-3.24). The figure shows the high probability of developing VTE after MM diagnosis, especially among patients with a history of VTE.ConclusionsLenalidomide, thalidomide, and a prior VTE increased the risk of VTE after MM diagnosis. Patients with such history should be considered high risk for VTE. In this high-risk population, aspirin may not provide adequate thromboprophylaxis. [Display omitted] DisclosuresSanfilippo:Bristol Myers Squibb: Speakers Bureau. Carson:Seattle Genetics: Honoraria.

Incidence, risk factors and clinical outcome of venous thromboembolism in non-small cell lung cancer patients receiving immune checkpoint inhibition

BackgroundBesides the cancer itself, venous thromboembolism (VTE) is the leading cause of death in cancer patients receiving outpatient chemotherapy (CT). Data on VTE development and impact on treatment course and outcome in real-life NSCLC patients receiving immune check-point inhibitors (ICI) is currently sparse. More knowledge within this area is warranted due to the emerging use of ICI in clinical practice. ObjectivesTo quantify risk of VTE and recurrent VTE in NSCLC patients receiving ICI. Explore the clinical impact of VTE on ICI course and survival and explore potential risk factors for VTE. Patients/methodsPatients with advanced/metastatic NSCLC treated with an immune checkpoint inhibitor (ICI) at the University Hospital of Odense, Denmark during 2015–2018 were identified and data gathered retrospectively from electronic medical records (n = 118). All patients had finished ICI at the time of data-cut off. Baseline Khorana Score (KRS) was calculated within one week prior to ICI initiation. Based on follow-up data cumulative incidence of VTE and its impact on outcome and survival was performed using Kaplan Meier and cox-regression hazard estimation. ResultsRisk of VTE was 8% during ICI and 15% at any time point after ICI initiation. Cumulative incidence rates of VTE at 1, 3, 6 and 18 months after first ICI was 1.7%, 5.2%, 6.9% and 13.8% respectively. Median time to VTE during ICI was 2.3 months [IQR 0.6–5.4]. Having VTE during ICI lead to discontinuation of ICI in 78% of cases, most due to fatal PE. History of VTE before onset of ICI was a significant risk factor for recurrent VTE during ICI (24% within this subgroup) despite use of anticoagulant therapy. ConclusionsThe incidence and impact of VTE during ICI for real-life NSCLC patients is not negligible with almost 10% developing VTE leading to termination of further ICI in the majority of cases - many due to fatal PE. The risk of recurrent anticoagulant resistant VTE in patients with known VTE during ICI is also considerable, which calls for better management and prevention of VTE including development of treatment specific VTE risk assessment models.

A184 INCIDENCE OF VENOUS THROMBOTIC EVENTS AND RISK FACTORS IN CHILDREN HOSPITALIZED WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE, CASE-CONTROL STUDY

Abstract Background Limited research has been published to describe the incidence of venous thromboembolism (VTE) and relevant risk factors in Canadian children with inflammatory bowel disease (IBD). Aims The present study aimed to investigate the incidence of VTE amongst hospitalized pediatric IBD patients over a 10-year period and identify risk factors for the development of VTE. Methods A retrospective, matched case-control study was performed at McMaster Children’s Hospital. Hospitalized pediatric patients with IBD (&amp;lt;18 years old) from September 2009 to August 2020 were selected. Inpatient data was extracted from the medical record database, including baseline demographic data, thromboembolic events and potential risk factors for VTE. Results There were 890 hospitalizations of IBD patients during the study period. 15 (1.69%) were diagnosed with a VTE, including 4 males and 11 females (mean age 13.4±2.9 years old). 12 ulcerative colitis (UC) (80%) and 3 Crohn’s disease (CD) (20%) hospitalizations were comprised in the VTE group. There was a significant difference in VTE rate between females (2.7%) and males (0.8%) (P = 0.03). The VTE rate in the UC group (4.2%) was significantly higher than in the CD group (0.6%) (P = 0.001). The incidence of VTE amongst hospitalized IBD patients did not vary over the 10-year period (P = 0.496). Length of stay in hospital, albumin level and central venous catheter were shown to be significantly different, although they were not identified as independent risk factors (P &amp;gt;0 .05). Of the 15 hospitalizations with VTE, 6/15 (40%) were superficial VTEs in the extremities and 9/15 (60%) had a deep vein thrombosis (DVT) including 6 in the extremities and 3 in the abdomen. VTEs were associated with a peripheral line in 7 patients and with a PICC line in 4 hospitalizations. 2 of 9 (22%) with extremity DVT developed symptomatic pulmonary embolism. An inherited thrombotic condition was identified in 2 of 15 with VTEs. 12/15 (80%) with VTEs were symptomatic and all VTE related symptoms happened in patients with extremity thrombosis and pulmonary embolism. 7 of 15 (47%) VTEs were treated with anticoagulation therapy for 1–6 months. VTE related symptoms and repeat imaging tests significantly improved, and no patient developed a bleeding complication as a result of treatment. Conclusions The VTE rate in pediatric IBD patients was relatively low at McMaster Children’s hospital. Children with VTE were disproportionately females with ulcerative colitis compared with children with no VTE. Central venous line insertion may be correlated with the risk for VTE in children with IBD. Most VTEs and related symptoms happened in patients with extremity thrombosis and secondary pulmonary embolus. Anticoagulation therapy in children with IBD with active disease appears to be safe. Funding Agencies Kids Dig Health Funding from McMaster Children’s Hospital, McMaster University

Combined Oral Contraceptive Use Increases the Risk of Venous Thromboembolism After Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction: An Analysis of 64,165 Patients in the Truven Database

To use the Truven MarketScan database to (1) report the incidence of venous thromboembolism (VTE), including deep vein thromboses (DVTs) and pulmonary embolism (PE), in patients undergoing simple knee arthroscopy and anterior cruciate ligament (ACL) reconstruction, and (2) evaluate combined oral contraceptive (COCP) use as a potential risk factor for VTE in patients undergoing knee arthroscopy. All female patients between the ages of 16 and 40 years undergoing knee arthroscopy and ACL reconstruction between 2010 and 2015 were identified in the MarketScan database. Patients were stratified by whether they had a documented pharmaceutical claim for COCP therapy, and the primary outcome was the risk of DVT and or PE within 90 postoperative days. In total, 64,165 patients were identified for inclusion. While the overall incidence of VTE was low, patients taking COCPs had an increased risk of a DVT or PE compared with those not on COCPs (odds ratio [OR] 2.1, P < .001). When patients were analyzed by procedural subgroup (ACL reconstruction and simple knee arthroscopy), similar results held true. Furthermore, smoking and obesity had a synergistic effect when combined with COCPs use on the risk of VTE. Specifically, 3.1% of patients with obesity on COCPs (OR 3.1, P < .001) and 4.0% of smokers on COCPs (OR 4.3, P < .001) developed a postoperative VTE. This study demonstrates that COCP use is associated with an increased risk for a symptomatic DVT or PE (1.70% and 0.27%, respectively) after knee arthroscopy and an increased risk for DVT, but not PE (1.80% and 0.23%, respectively), after ACL reconstruction. In addition, patients with multiple risk factors present such as tobacco use, obesity, and COCP use had odds ratios greater than the sum of the individual risk factors alone. level III prognostic cohort study.

Hypereosinophilia with Concurrent Venous Thromboembolism: Clinical Features, Potential Risk Factors, and Short-term Outcomes in a Chinese Cohort

Idiopathic hypereosinophilia (IHE) and hypereosinophilic syndrome (HES) are benign haematological disorders. Studies have suggested that venous thromboembolism (VTE) is a rare but sometimes fatal complication of hypereosinophilia; however, data are limited. We retrospectively analysed clinical features and short-term outcomes of 63 consecutive patients (82.5% men; mean age, 40.92 ± 10.89 years) with IHE or HES with concurrent VTE from January 1998 through December 2018. Risk factors for pulmonary embolism (PE) were explored by multivariate logistic analysis. DVT and/or PE was detected by imaging in all patients. Independent risk factors for PE were a body mass index of >24.1 kg/m2 (odds ratio [OR]: 5.62, 95% confidence interval [CI]: 1.21–26.13, P = 0.028), peak absolute eosinophil count of >6.3 × 109/L (OR: 5.55, 95% CI: 1.292–23.875, P = 0.021), and >13.9-month duration of hypereosinophilia (OR: 4.51, 95% CI: 1.123–18.09, P = 0.034). All patients were treated with corticosteroids and anticoagulants. The short-term hypereosinophilia remission rate was 100%; no recurrent VTE or major bleeding was observed. Hypereosinophilia is a potential risk factor for VTE. PE in patients with IHE/HES and DVT is associated with a higher body mass index, higher peak absolute eosinophil count, and longer duration of hypereosinophilia. Corticosteroids and anticoagulants provided effective short-term control of hypereosinophilia and VTE.

Potential Venous Thromboembolism Risk in Female Astronauts.

BACKGROUND: Whether the unique environment of space affects astronaut risk of venous thromboembolism (VTE) is not known. On Earth, it is known that use of combined oral contraceptives (COCs) doubles the risk of VTE. Since some female astronauts choose to use COCs, this retrospective study examined known risk factors associated with VTE risk to determine whether the available data suggested elevated VTE risk in female astronauts.METHODS: Longitudinal health data were requested for female astronauts who flew short and long duration missions between 2000 and 2014. Pre- and postflight hematological and biochemical blood markers were available and evaluated. Astronauts' postflight measurements were compared to clinically relevant terrestrial high risk levels to determine any trend toward increased risk for VTE following spaceflight. Secondarily, a comparison of pre- and postflight changes was made, as well as an assessment of COC impact.RESULTS: A total of 38 astronaut-flights were included in this study and no VTE events were found. Analysis of potential VTE risk factors showed no evidence suggesting elevated VTE risk in female astronauts associated with spaceflight, regardless of contraceptive use.DISCUSSION: Arguably, all astronauts encounter many physiological stressors during spaceflight missions, but women using the combined contraceptive pill add a known risk factor for VTE. The risk factors analyzed within this study showed no trend toward an increased risk of VTE for female astronauts. This study provides an evidence base supporting the safety of COC use by female astronauts and also reinforces the importance of healthy lifestyle on VTE risk reduction.Jain V, Ploutz-Snyder R, Young M, Charvat JM, Wotring VE. Potential venous thromboembolism risk in female astronauts. Aerosp Med Hum Perform. 2020; 91(5):432-439.

Venous thromboembolism following 672,495 primary total shoulder and elbow replacements: Meta-analyses of incidence, temporal trends and potential risk factors

BackgroundThere is wide variability in reported venous thromboembolism (VTE) incidence following total shoulder replacement (TSR) or total elbow replacement (TER). It is uncertain which risk factors influence the risk of VTE following TSR or TER. We conducted a PRISMA compliant meta-analysis to evaluate the incidence, temporal trends and potential risk factors for VTE following primary TSR and TER. MethodsMEDLINE, Embase, Web of Science, and Cochrane Library were searched to September 2019 for longitudinal studies reporting VTE outcomes after TSR or TER. Incidence and relative risks (RR) (95% confidence intervals) were estimated. ResultsWe identified 43 articles with data on 672,495 TSRs and TERs (668,699 TSRs and 3796 TERs). The overall pooled 3-month VTE incidence following TSR was 0.85% (0.39–1.46). For TER, the 3-month incidence of VTE was 0.23% (0.08–0.44). Older age, body mass index (BMI) ≥25 kg/m2, and alcohol abuse were each associated with increased VTE risk following TSR. Comorbidities associated with increased VTE risk following TSR were chronic pulmonary disease, previous VTE, heart failure, anaemia, coagulopathy, arrhythmia, epilepsy, urinary tract infection, sleep apnoea, and fluid & electrolyte imbalance. Anatomic and outpatient TSR were each associated with decreased VTE risk. ConclusionsThe average 3-month incidence of VTE following TSR or TER is <1%. High risk groups such as older patients, those with a previous VTE history and those undergoing reverse or inpatient TSR may need close monitoring. Modifiable factors such as high BMI, alcohol abuse, and comorbidities could be identified and addressed prior to surgery. Systematic review registrationPROSPERO 2019: CRD42019134096.

To What Extent Does Posthospital Discharge Chemoprophylaxis Prevent Venous Thromboembolism After Bariatric Surgery?: Results From a Nationwide Cohort of More Than 110,000 Patients.

The aim of the present study was to assess the incidence, risk factors, and the impact of posthospital discharge (PHD) chemoprophylaxis on venous thromboembolism (VTE) in patients undergoing bariatric surgery (BS). VTE is a major concern after BS, especially during the PHD period. No large-scale study has previously focused on the clinical value of PHD chemoprophylaxis. In this nationwide observational population-based cohort study, all data from patients undergoing BS were extracted from the French National Health Insurance database (SNIIRAM) from 1st January 2012 to 31st September 2014. Logistic regression models were used to compute odds ratios for potential risk factors for VTE occurring within 90 postoperative days (PODs). The association between use of PHD chemoprophylaxis (heparin) and VTE was also assessed. The majority (56%) of the 110,824 patients had sleeve gastrectomy. VTE rates during the first 30 and 90 PODs were 0.34% and 0.51%, respectively. On multivariate analyses, the major risk factors for VTE during the first 90 PODs were history of VTE [odds ratio = 6.33 95% confidence interval (4.44-9.00)], postoperative complications [9.23 (7.30-11.70)], heart failure [2.45 (1.48-4.06)], and open surgery [2.38 (1.59-3.45)]. PHD chemoprophylaxis was delivered to 75% of patients. No use of PHD chemoprophylaxis [1.27 (1.01-1.61)] was an independent predictive factor of VTE during the first 90 PODs [in the gastric bypass group: 1.51 (1.01-2.29)). In the modern era of BS, this nationwide study shows a non-negligible rate of VTE especially after sleeve gastrectomy, depending on the individual risk level. Use of PHD chemoprophylaxis may decrease the risk of PHD VTE.

HOMOCYSTEINE IS ASSOCIATED WITH FUTURE VENOUS THROMBOEMBOLISM IN TWO PROSPECTIVE COHORTS OF WOMEN

Numerous cross-sectional studies of venous thromboembolism (VTE) have identified plasma homocysteine as a potential risk factor for VTE. In contrast, prospective data are sparse with limited studies conducted among women. Given current interest in expanded indications for anticoagulation therapy, we

Venous thromboembolism during treatment with antipsychotics: Results of a drug surveillance programme

Objectives: Venous thromboembolism (VTE) can be a life-threatening medical condition that may lead to leg swelling, respiratory distress and death.Methods: The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a continuous multicentre drug surveillance programme that assesses severe adverse drug reactions during treatment of psychiatric inpatients. We report on a total of 264,422 inpatients who were treated with antipsychotics (APs) and monitored from 1993 to 2011 in 99 psychiatric hospitals.Results: During this period VTE events were reported for 89 inpatients, corresponding to an occurrence rate of 34 cases per 100,000 inpatient admissions treated with APs or 43 cases per 10,000 person-years. The occurrence of VTE was greatest in patients over the age of 65 years of age with mood disorders. The chemical class of butyrophenones (48/100,000) followed by atypical APs (36/100,000) showed the highest occurrence rate for VTE compared to thioxanthenes (23/100,000), which were less associated with VTE. If imputed alone, pipamperone (61/100,000) and risperidone (55/100,000) were most frequently associated with VTE. In general, there was no difference in occurrence rate of VTE between high- and low-potency APs.Conclusions: These results suggest that clinicians should consider AP drug exposure as a potential risk factor for VTE for patients older than 65 years. Additionally, the diagnosis of an affective disorder seems to increase the risk for VTE.

Khorana score and histotype predicts incidence of early venous thromboembolism in non-Hodgkin lymphomas. A pooled-data analysis of 12 clinical trials of Fondazione Italiana Linfomi (FIL).

Current data suggests that the risk of venous thromboembolism (VTE) in patients with non-Hodgkin lymphoma (NHL) is comparable to that observed in patients with solid tumours, although more robust confirmatory analyses are required. With that in mind, we investigated the occurrence of VTE in a pooled analysis of 12 "Fondazione Italiana Linfomi" (FIL) prospective clinical studies. Specifically, we wished to assess the cumulative incidence of VTE in NHL patients, evaluate the predictive value of the Khorana Score (KS), and identify other potential risk factors for VTEs. Data for VTE occurrence were retrieved from study databases and pharmacovigilance reports. Our analysis includes 1717 patients from 12 prospective phase II and III trials, including newly diagnosed NHL. We observed 53 VTEs (any grade) in 46 patients, with 20 severe VTEs in 17 patients. The cumulative incidences for "all-grade" or grade ≥3 VTEs were 2.9 % (95 % CI: 2.1-3.8) and 1.1 % (95 % CI: 0.6-1.6), respectively. KS categories were positively associated with the risk of VTE of any grade, and with severe events (i. e. grade ≥3; Gray's test p-values = 0.048 and 0.012, respectively). Among NHL patients, those with diffuse large B-cell lymphoma (DLBCL) showed a greater risk of (any grade) VTE (HR: 3.42, 95 % CI: 1.32-8.84, p-value = 0.011). Our study indicates that 1) VTE is a relevant complication for NHL patients, 2) KS is predictive of VTE events and 3) DLBCL histotype is an independent risk factor for VTE incidence, for which preventative interventions could be considered.

Creation of a Venous Thromboembolism Risk Prediction Tool for Critically Ill Children - the Cleveland Score

IntroductionThe incidence of Venous Thromboembolism (VTE) in critically ill children with central venous catheters (CVCs) is increasing. VTE in Pediatric Intensive Care Unit patients with CVCs (VTE-PICU) have been associated with fewer ventilation free days, prolonged length of stay (LOS) and higher risk of mortality. Screening and prophylaxis practices vary amongst clinicians due to the lack of a simple and reliable risk stratification tool. A validated bedside prediction tool could help clinicians improve outcomes by identifying patients who may benefit from screening and prophylaxis.MethodWith IRB approval, the Virtual Pediatric Systems, LLC database was interrogated for children < 18yo admitted between 01/2009-09/2014 to any of 130 participating PICUs who had a CVC present and developed VTE at some point during PICU care. This cohort was chosen due to an expected high prevalance of risk factors and a high incidence of VTE. From this cohort a prediction model was created using logistic regression. The logistic regression model was constructed using potential VTE risk factors and reduced to find the best fitting parsimonious model. The model reduction process was performed using Frank Harrell’s "step down" model approximation method, where all the risk factors are ranked by their impact on the full model’s R2 from the least impact to the most impact and removed from the model. The Model’s performance was measured by discrimination, using c-statistic, which is the area under the receiver operator curve (ROC) describing the model’s ability to distinguish between a patient at higher risk of the event from a patient who is at lower risk. The c-statistic ranges from 0 to 1, where 1 indicates that model has perfect discrimination and 0.5 indicates that the model does no better than chance. All reported measurements of accuracy were internally validated using a 200 bootstrap resampling process to correct for the bias of over fitting. The nomogram was then generated from the logistic regression model by rescaling the model’s coefficients to a point scale to allow users of the model to make predictions of probability. Subjects whose risk score was in the lower third percentile were considered to have "normal risk," middle third percent tile "moderate risk" and those in the highest third percent tile were considered to have "high risk." Decision curve analysis was used to look at which strategy leads to the largest net benefit. VPS data was provided by Virtual Pediatric Systems (VPS, LLC).ResultsThere were 1623 VTE-PICU amongst 158,299 PICU patients who had a CVC during their admission (10.3 per 1000 patients). A logistic regression model was generated and internally validated; Bootstrapped C-index was 0.832. Figure 1 shows the area under the receiver operator curve [82.55% (95% CI: 80.71%-84.38%)]. The decision curve analysis showed that across the range of reasonable threshold probabilities, the predicted model has a higher net benefit than "treat all" and "treat none" approach. Figure 2 shows the nomogram (the "Cleveland Score") generated from the logistic regression model by rescaling the model's coefficients to a point scale to allow users of the model to make predictions of probability. The major categories in the Cleveland Score are age, sex, race, primary diagnosis, post-op status and type of surgery, past medical history, type of central venous line, airway/ventilation status, and presence of cardiac catheterization. Using the Cleveland Score, a hypothetical 1-month-old white male, with a past medical history of sepsis, who remains intubated after a cardiac catheterization and congenital heart disease repair and has a percutaneous central venous catheter, has a high risk probability of 4.526% of developing a VTE.ConclusionUsing a large multicenter database we were able to build and validate a nomogram to predict the risk of developing a VTE in critically ill hospitalized children. Furthermore, we created an easy to use bedside application for the prediction model - The Cleveland Score. We plan to prospectively validate the Cleveland score using the same database. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.