Prevalence Of Thromboembolism Research Articles

Hyperhomocysteinemia is associated with the risk of venous thromboembolism in patients with mental illness: a case-control study.

The risk of venous thromboembolism in patients with mental illness has been insufficiently addressed. This study aimed to assess the correlation between hyperhomocysteinemia and venous thromboembolism prevalence among this population. Patients with a diagnosis of mental illness and concurrent venous thromboembolism, admitted to Sir Run Run Shaw Hospital at Zhejiang University School of Medicine between January 2014 and December 2021, were included in the venous thromboembolism group. The control group, approximately twice the size, comprised individuals with mental illness but without venous thromboembolism. Basic clinical data were gathered for both cohorts. In psychiatric patients, elevated D-dimer levels(OR=5.60,95% CI 3.28-10.00), hyperhomocysteinemia (OR=2.37,95% CI 1.10-5.14), and hyperprolactinemia(OR= 2.68,95% CI 1.12-6.42)were significant risk factors for venous thromboembolism. According to further subgroup analyses, hyperhomocysteinemia is a significant risk factor associated with pulmonary embolism, with an OR of 5.08 (95% CI 1.20-21.48). An interaction effect between gender and homocysteine level was found, with a p-interaction of 0.022.A subsequent analysis confirmed the association between hyperhomocysteinemia and venous thromboembolism in female psychiatric patients, with an OR of 3.34 (95% CI 1.68-6.65), indicating that hyperhomocysteinemia is a significant risk factor for venous thromboembolism in women. Patients with psychiatric disorders were found to have an elevated risk of venous thromboembolism, which was associated with increased levels of D-dimer, hyperprolactinemia, and hyperhomocysteinemia. A strong correlation between hyperhomocysteinemia and pulmonary embolism was identified in patients with mental illnesses. Furthermore, the study revealed that female psychiatric patients with hyperhomocysteinemia constituted a high-risk group for venous thromboembolism. This finding holds significant clinical implications, suggesting that early preventative measures could be implemented for this high-risk population to reduce the incidence of thromboembolic events during hospitalization for psychiatric patients.

Abstract 18593: High Prevalence of Venous Thrombosis in Cardiac Amyloidosis and the Proposed Clinical and Echocardiographic Integrated Risk Stratification Tool

Introduction: The prevalence of thromboembolism (VTE) in cardiac amyloidosis (CA) is not well defined. Additionally, there is no risk stratification tool to identify CA subjects at risk for VTE to guide prophylactic treatment. We sought to identify the prevalence of VTE in CA and to develop a model to predict VTE in this population. Methods: A total of 150 subjects from two academic centers with confirmed CA (69±11years, 56% male, 58% AL-CA), and no history of VTE, atrial arrhythmia or anticoagulation use were included. The primary endpoint was DVT, pulmonary embolism or right atrial thrombi (RA). The LASSO technique was used to evaluate nearly 50 potential clinical and echocardiographic covariates in order to develop a multivariable model for predicting VTE. The subjects were randomly divided in a proportion of 70:30 into training and testing dataset. The diagnostic performance of the model was assessed by calculating the AUC of a ROC curve. Results: Thirty-two subjects (21%) developed VTE after CA diagnosis (18 DVT, 3 RA thrombus, 11 in multiple concurrent locations). The majority occurred within one year of the echocardiogram (78%). Multivariable analysis revealed four variables independently predictive of VTE (p<0.05), based on the regularization parameter (lambda=0.08). VTE was more likely in the presence of liver disease or alcohol abuse, end-stage renal disease, increased LA volume and lower TAPSE. The model had excellent discrimination (AUC=0.823) (Panels A-B) and when applied to the test set an accuracy of 84.4%. The nomogram that can be used to predict the probability of VTE in CA using the covariates identified is illustrated on Panel C. Conclusions: High prevalence of VTE was identified in CA. The developed clinical and echocardiographic risk scheme is user-friendly and has the potential to identify patients with CA at high risk for VTE. It remains to be determined if pre-emptive anticoagulation in this higher risk group might be beneficial.

Prevalence and factors related with venous thromboembolism in patients admitted to the critical care units: A systematic review and meta-analysis

ObjectiveVenous thromboembolism is one of the most common cardiovascular disorders in the any intensive care units (ICUs), which annually leads to death and imposes great costs on patients and society worldwide. The present study was conducted with the aim of determining the prevalence and factors related to venous thromboembolism in the ICUs as a systematic review and meta-analysis. MethodsThe current study was conducted in international databases, on all descriptive and analytical studies and clinical and semi-experimental trial studies, without time limit until November 2, 2021. The present study was designed and implemented based on PRISMA guideline. The quality of the studies was checked using STROBE checklist and meta-analysis was performed using CMA software. ResultsAmong the 3204 articles found, after the evaluations, 189 articles entered the full text review phase, and as a result, 38 articles were included in the study. The reported prevalence of thromboembolism was 1-45%. The prevalence of venous thromboembolism was 12% in overall. The chance of venous thromboembolism was higher in ICUs patients >57 years old and ICUs patients with a history of venous thromboembolism. ConclusionThe results of this study showed that venous thromboembolism has a higher prevalence in ICUs patients in comparison to non-ICUs patients. It is recommended to nurses and healthcare staffs to provide accurate decision and care for prevention of venous thromboembolism and paying attention to the patient's warning signs, timely administration of anticoagulants, and monitor coagulation factors.

Incidence of thromboembolism in children with primary nephrotic syndrome: a systematic review and metaanalysis

ObjectiveTo estimate the incidence of thromboembolism in children with primary nephrotic syndrome with Meta-analysis.MethodsRelevant studies published from January 1, 1980 to December 31, 2021 were retrieved from Pubmed, Web of science, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database(VIP) and Wangfang Database. Quality evaluation of the literatures included was conducted according to Agency for Healthcare Research and Quality(AHRQ) assessment tool, followed by data extraction and Meta-analysis with software RevMan 5.3.ResultsA total of seven studies involving 3675 subjects were included. The overall prevalence was 4.9% with 95% CI of 2.83 to 7.05.However, a significant heterogeneity (P < 0.001) was observed with I2 = 89%. The prevalence of venous thromboembolism was 3.3% with 95% CI of 1.7 to 4.9. The prevalence of arterial thromboembolism was 0.5% with 95% CI of 0.2 to 1.4.ConclusionChildren with nephrotic syndrome are prone to thromboembolism, and it may lead to disability or death, therefore prevention measures is critical to decreasing the prevalence of thromboembolism.

Thromboembolism is associated with poor prognosis and high mortality in patients with inflammatory bowel disease: Acase-control study.

The information on the risk of thromboembolism (TE) in inflammatory bowel disease (IBD) and its predictors are lacking, especially from developing countries. The present study evaluated the prevalence, predictors, and prognosis of TE in IBD. This case-control study included 35 patients with IBD (ulcerative colitis [UC, n = 25]; Crohn's disease [CD], n = 10) and history of TE, from a cohort of 3597 patients (UC n = 2752, CD n = 845) under follow-up from 2005 to 2018. Details on demographics, extraintestinalmanifestations (EIMs), patient status, type and outcomes of TE, treatment details, and disease course were compared with IBD patients without TE (age, gender, and duration of follow-up matched) in the ratio of 1:4. Prevalence of TE in IBD was 0.9% (UC-0.89%, CD-1.2%). Among TE patients (mean age: 34.9 ± 13.1years, 48.6% males), median duration from diagnosis to TE was 12 (inter-quartile range [IQR]: 3-36) months, 37% had other EIMs, 94.1% had moderate/severe disease at time of TE, 62.8% had steroid-dependent/refractory disease, and 5 patients (14.2%) died because of disease-related complications. Lower limb was the commonest site (57.1%), 14.3% had pulmonary TE, and 31.4% had involvement of multiple sites. Phenotypically, more patients with TE (among UC) had steroid-dependent disease (60% vs. 25%, p = 0.001), pancolitis (76% vs. 36%, p = 0.002), chronic continuous disease course (44% vs. 19%, p = 0.009), and acute severe colitis (48% vs. 18%, p = 0.002), of which the latter three were also independent predictors of TE. Approximately 1% of patients with IBD develop thromboembolism relatively early during their disease course, and TE is associated with severe disease and higher disease-related complications including mortality.

Occurrence of Thromboembolism in Paediatric Patients With Inflammatory Bowel Disease: Data From the CEDATA-GPGE Registry.

ObjectiveAmong patients with inflammatory bowel disease (IBD), the risk of thromboembolism (TE) is increased, representing a relevant cause of morbidity and mortality. In contrast to other extraintestinal IBD manifestations, TE receives much less attention because of its low incidence, estimated at merely 0.4–0.9% in hospitalised children with IBD.MethodsCases with TE, as documented in the German-Austrian Paediatric IBD registry gesellschaft für pädiatrische gastroenterologie und ernährung – large paediatric patient registry (CEDATA-GPGE), were analyzed retrospectively. For all patients with signs of TE, a questionnaire was filled in by the treating paediatric gastroenterologist.ResultsOver 10 years, 4,153 paediatric patients with IBD (0–18 years) were registered in the registry, and 12 of them identified with TE. Eight patients were diagnosed with ulcerative colitis (UC), three with Crohn’s disease (CD), and one with IBD-unclassified. The median age at IBD diagnosis was 10 years and at the manifestation of TE 13 years, respectively, with a median latency to TE of 2 years. Prevalence of TE was 0.3%, with a significantly higher risk for patients with UC than CD (OR 5.9, CI 1.56–22.33, p = 0.008). More girls than boys were affected (f:m = 7:5) without reaching significance. Approximately 90% of patients experienced TE during active disease, with relevant cerebral and limb involvement in 6/12 patients. Various risk factors, e.g., hospitalisation, coagulopathy, or anaemia were identified. TE management included intensive care and surgery. Among the 12 patients, 11 recovered fully, in which one patient has focal epilepsy as a sequela.ConclusionPaediatric patients with IBD have a substantially increased risk for TE. Risk factors, such as those identified should be considered when managing paediatric IBD and preventive measures for those hospitalised taken routinely. Initiating pharmacological thromboprophylaxis is challenging for the lack of published trials on efficacy and safety in paediatric IBD but should be considered carefully in each case.

The Thromboembolism and Bleeding Event in Patients Receiving Warfarin, Dabigatran, or Rivaroxaban in Nonvalvular Atrial Fibrillation

Increasing in trend of Dabigatran and Rivaroxaban usage every year in Hospital Sultanah Nur Zahirah (HSNZ) has raised concerns regarding their effectiveness and safety compared to Warfarin. Therefore, we investigated the prevalence of thromboembolism (stroke or systemic embolism) and bleeding events in patients receiving Warfarin, Dabigatran or Rivaroxaban in our setting. This retrospective cohort study involved patients with nonvalvular atrial fibrillation who were started on Warfarin, Dabigatran or Rivaroxaban from January 1, 2014 to December 31, 2018. To fulfil inclusion criteria, patients must be on treatment for at least one year and for Warfarin group, at least 65% of Time in Therapeutic Range (TTR) should be achieved. Data were collected from Warfarin registration book, drug usage record card and Hospital Information System. 142 patients (Warfarin, n=98; Dabigatran, n=30; Rivaroxaban, n=14) with mean age of 68±8.7 years old were included in the study. Majority of them were male, Malay and non-smoker with 57.0%, 97.2% and 95.8% respectively. Upon study enrolment, all patients were at moderate risk of stroke (median CHA2DS2-VASc score=3) and low risk of bleeding (median HAS-BLED score=2). One Ischemic stroke was identified in each group of Rivaroxaban 15 mg and Dabigatran 150 mg. Four bleeding events occurred in all groups except for Dabigatran group that were hematuria, gum bleeding and upper gastrointestinal bleeding. Thromboembolism and bleeding events still occur in all groups. However, the prevalence is small in our setting with the percentage of 1.4% and 2.8% respectively. The events mostly attributed by the predisposed risk factors.

A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy.

Noncompaction cardiomyopathy (NCCM) is a rare condition characterized by prominent trabeculae, deep intertrabecular recesses, and a left ventricular myocardium with a two‐layered structure, characterized by a spongy endocardial layer and a thinner and compacted epicardial one. NCCM can be isolated or associated with other congenital heart diseases and complex syndromes involving neuromuscular disorders and facial dysmorphisms. To date, more than 40 genes coding for sarcomeric, cytoskeletal, ion channels, and desmosomal proteins have been identified. Clinical presentation is also highly variable, ranging from no symptoms to end‐stage heart failure (HF), lethal arrhythmias, sudden cardiac death, or thromboembolic events. In particular, the prevalence of thromboembolism in NCCM patients appears to be higher than that of a similar, age‐matched population without NCCM. Thromboembolism has a multifactorial aetiology, which is linked to genetic, as well as traditional cardiovascular risk factors. In previous studies, atrial fibrillation (AF) was observed in approximately 25–30% of adult NCCM patients and embolism had a cardiac source in ~63–69% of cases; therefore, AF represents a strong predictor of adverse events, especially if associated to HF and neuromuscular disorders. Left ventricular dysfunction is another risk factor for thromboembolism, as a result of blood stagnation and local myocardial injury. Moreover, it is not completely clarified if the presence of deep intertrabecular recesses causing stagnant blood flow can constitute per se a thrombogenic substrate even in absence of ventricular dysfunction. For the clinical management of NCCM patients, an appropriate stratification of the thromboembolic risk is of utmost importance for a timely initiation of anticoagulant therapy. The aim of the present study is to review the available literature on NCCM with particular attention on thromboembolic risk stratification and prevention and the current evidence for oral anticoagulation therapy. The use of direct oral anticoagulants vs. vitamin K antagonists is also discussed with important implications for patient treatment and prognosis.

Prevalence of Thromboembolism and Predictors for Bleeding Complications in Patients who Underwent Valvular Heart Surgery with Warfarin Interruption: An Analysis in High-Risk Group

Objective: Warfarin therapy is crucial to prevent thromboembolism in patients with valvular heart disease and prosthesis. For valvular heart surgery, it is still controversial to either bridging with heparin or no bridging of warfarin prior to the procedure. In clinical practice at the Queen Sirikit Heart Center, Khon Kaen University, no bridging therapy is the main treatment. The present study aimed to evaluate the prevalence of thromboembolism and predictors for bleeding complications in the high risk patients who underwent valvular heart surgery with warfarin interruption. Materials and Methods: The present study was a retrospective cohort study and conducted at The Queen Sirikit Heart Center, Thailand. The present study period was between January 1st, 2015 and December 31st, 2015. The inclusion criteria were adults with high risk for thromboembolism who underwent valvular heart surgery and stop taking warfarin before surgery for three to five days. The main outcome was evidence of any thromboembolism or bleeding events at 90 days after surgery. Prevalence of thromboembolism and predictors for post-operative bleeding were analyzed. Results: During the study period, there were 416 patients met the study criteria. Of those, 24 patients (5.76%) were in high-risk group. There were two patients (8.33%) had thromboembolism events: ischemic stroke. Among 24 patients who had warfarin interruption, 11 patients (45.83%) had bleeding events. Baseline characters and laboratory results of those with and without bleeding were comparable. There was no one significant factor between both groups: Bleed MAP score. The bleeding group had significantly higher score of 1 and 2 than the non-bleeding group (63.64% vs. 0% for score of 1 and 27.27% vs. 0% for score of 2; p&lt;0.001). Conclusion: Thromboembolism and bleeding in high risk patients who underwent valvular heart surgery with the non-bridging regimen were 8.33% and 45.83%. Bleed MAP score is suggestive for postoperative bleeding in this setting. Keywords: Prevalence; Predictors; Valvular heart disease; Warfarin; Thromboembolism; Bleeding

Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with risk for thromboembolic complications and mortality in patients with COVID-19

Abstract Background/Introduction The high prevalence of thromboembolism in patients with COVID-19 causes significant morbidity and mortality. The soluble urokinase-type plasminogen activator receptor (suPAR), a known inflammatory and immune mediator in several renal and cardiovascular conditions, has recently been shown to correlate with acute kidney injury and severe respiratory failure in COVID-19. To date, no study has investigated the association between suPAR and thromboembolism in COVID-19. Purpose To evaluate associations between suPAR, thromboembolic complications, and mortality in COVID-19. Methods We conducted a retrospective cohort study of a random sample of 109 patients among those hospitalised at a tertiary medical centre comprising three hospitals between March and June 2020 for COVID-19 who had blood samples collected and stored on admission. Serum suPAR was measured using a commercially available enzyme immunoassay. Baseline (hospital admission) variables extracted from electronic medical records included age, sex, race/ethnicity, body mass index (BMI), history of cardiovascular disease (including deep venous thrombosis [DVT] and pulmonary embolism [PE]), serum creatinine, serum D-dimer, incident DVT/PE, and death during hospitalization. Patients were subsequently grouped by suPAR quartiles. Associations between suPAR, thromboembolic complications (PE and/or DVT), and overall mortality were evaluated using multivariable logistic regression. Results Among the 109 patients, mean age was 56 (standard deviation [SD], 16) years, 34 (39%) were women, mean BMI was 35 (SD, 8) kg/m2, 78 (71%) had coexisting cardiovascular disease, median creatinine level was 1.2 (interquartile range [IQR]: 0.8–2.3) mg/dl, median D-dimer level was 1.5 (IQR, 0.8–6.4) μg/ml, and median suPAR level was 10.1 (IQR: 4.1–14.4) pg/mL. Seven (6%) patients were found to have PE, 18 (17%) developed PE/DVT, and 22 (20%) died during the admission (Table). Per quartile higher suPAR level, there was higher risk for PE or DVT (OR=2.02, 95% CI 1.07–3.83, p=0.03). Compared to those in the lowest suPAR quartile, patients in the highest quartile had 11.1 times higher risk for PE/DVT (OR=11.1, 95% CI 1.51–81.8, p=0.02, Figure). SuPAR is also associated with overall mortality, with 2.25 times higher risk of death seen per quartile increase in suPAR level (OR= 2.25, 95% CI 1.24–4.06, p=0.007). Conclusion Higher suPAR levels at the time of hospital admission is associated with higher risk for thromboembolic complications i.e., PE and DVT, as well as mortality in patients with COVID-19. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Rush University Medical Center

COVID-19: Autopsy findings in six patients between 26 and 46 years of age

ObjectivesStudies on coronavirus disease 2019 (COVID-19) usually focus on middle-aged and older adults. However, younger patients may present with severe COVID-19 with potentially fatal outcomes. For optimized, more specialized therapeutic regimens in this particular patient group, a better understanding of the underlying pathomechanisms is of utmost importance. MethodsOur study investigated relevant, pre-existing medical conditions, clinical histories, and autopsy findings, together with SARS-CoV-2-RNA, determined by qPCR, and laboratory data in six COVID-19 decedents aged 50 years or younger, who were autopsied at the Charité University Hospital. ResultsFrom a total of 76 COVID-19 patients who underwent an autopsy at our institution, six (7.9%) were 50 years old or younger. Most of these younger COVID-19 decedents presented with pre-existing medical conditions prior to SARS-CoV-2 infection. These included overweight and obesity, arterial hypertension, asthma, and obstructive sleep apnea, as well as graft-versus-host disease following cancer and bone marrow transplantation. Furthermore, clinical histories and autopsy results revealed a disproportionally high prevalence of thromboembolism and ischemic organ damage in this patient cohort. Histopathology and laboratory results indicated coagulopathies, signs of immune dysregulation, and liver damage. ConclusionsIn conclusion, pre-existing health conditions may increase the risk of severe and fatal COVID-19 in younger patients, who may be especially prone to developing thromboembolic complications, immune dysregulation, and liver damage.

Venous thromboembolism prophylaxis practices and outcomes at an Australian level-one trauma service

Background Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of potentially preventable morbidity and mortality amongst trauma patients. Venous thromboembolism prevalence varies from 1 to 58%, and traditionally, compliance with prophylaxis protocols is low in major trauma cohorts. This study aimed to describe VTE prevalence, prophylaxis practices and outcomes amongst VTE cases at an Australian level-one trauma centre. Methods A retrospective review of all VTE cases occurring in acute, major trauma admissions between 1 January 2010 and 30 June 2019 was conducted using prospectively collected registry data. Data regarding demographics, time to diagnosis, VTE prophylaxis, VTE risk assessment tool (RAT) usage and all-cause mortality were collected. Chemoprophylaxis was considered adequate if administered for 48 h prior to diagnosis. VTE cases diagnosed within 48 h of admission were excluded from prophylaxis compliance analysis. A subgroup analysis of patients with intracranial haemorrhage (ICH) was also completed. Results During the study period, 238 VTE events occurred in 237 patients from 7482 major trauma admissions, giving a VTE prevalence of 3.18%. The all-cause mortality rate was 8.0%. VTE chemoprophylaxis was administered for 109 of 211 eligible patients (51.7%). Of the remaining 102 VTE cases, 75 (73.5%) did not receive prophylaxis due to a documented contraindication, while 27 (26.5%) did not receive prophylaxis with no contraindication recorded. The VTE RAT was completed in 49.0% of cases. Conclusion Venous thromboembolism prevalence at our institution was consistent with published figures for comparable institutions. A review of compliance with prophylaxis protocols showed several potential areas for improvement.

Pulmonary Embolism and Acute Psychosis, a Case Report of an Outpatient with a Mild Course of COVID-19.

The increased risk for thromboembolism in hospitalized COVID-19 patients has been communicated extensively. The fact that home quarantined patients can develop pulmonary embolism, however, has so far not been reported. Furthermore, attention should be brought to psychotic developments in COVID-19 patients. We report a 46-year-old previously healthy patient with a mild course of COVID-19, who developed a massive pulmonary embolism with right heart strain while being home quarantined. He was hospitalized and anticoagulant therapy was started. Nine days after admission, the patient appeared increasingly psychotic and suffered from hallucinations as well as paranoid thoughts. After treatment with risperidone and valproate, the patient’s condition improved. At a follow-up 1 month after discharge, he was completely recovered regarding the respiratory, cardiac, and psychic situation. SARS-CoV-2 infection can not only increase the prevalence of thromboembolism in hospitalized patients but also in outpatients. COVID-19 also increases the risk of developing psychiatric reactions.

Prevalence of Deep Vein Thrombosis in Patients Supported With Extracorporeal Membrane Oxygenation.

Prevalence of Deep Vein Thrombosis in Patients Supported With Extracorporeal Membrane Oxygenation.

Venous Thromboembolism in Japanese Patients With Pancreatic Cancer.

ObjectivePancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths in Japan. Previous studies from other countries have reported venous thromboembolism prevalence rates of 12 to 36% in patients with pancreatic cancer. In this study, we aimed to determine the incidence of VTE in patients with PDAC in Japan and compare the characteristics of patients with and without VTE.MethodsIn this retrospective cohort study, clinicopathological characteristics of patients with and without concomitant VTE were compared.PatientsPatients with PDAC treated at Fukui Prefectural Hospital, Japan from 2010 to 2019.ResultsThe 1-year survival rate of all patients with pancreatic cancer was 40.7%. Among 432 patients with PDAC, 31 developed VTE. Seventeen (55%) patients received anticoagulant therapy. Compared with the non-VTE group, the VTE group had significantly more patients whose body mass index was >25 kg/m² (p = .035) and had a significantly higher rate of chemotherapy (p = .024). There was no significant difference in median survival time from PDAC diagnosis between the VTE and non-VTE groups. The 6-month mortality rate after VTE diagnosis was 54.8%. PDAC-related death was the most frequent cause of death, and thrombus-related death was not observed.ConclusionSeveral baseline characteristics differed between patients with and without VTE. The incidence of VTE in patients with PDAC is high. However, because the prognosis of PDAC itself remains quite poor, VTE may not have a significant effect on prognosis.

Reply by Authors.

You have accessJournal of UrologyLetters to the Editor/Errata1 Oct 2020Reply by Authorsis a reply to letterRe: COVID-19 Coagulopathy: Considerations for Urologists J. S. Jue and M. Alameddine J. S. JueJ. S. Jue More articles by this author and M. AlameddineM. Alameddine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail The COVID-19 pandemic has drawn attention toward respiratory symptoms and treatment of multiple organ dysfunction syndrome, while urological complaints and pathologies are sometimes overlooked. Cai et al describe a series of 18 patients with SARS-CoV-2 infection and superimposed urosepsis during the pandemic. In their series 5 of 18 patients (28%) were diagnosed with PE immediately after the onset of urosepsis. The authors note that 40% of the patients with PE died, while 60% were successfully treated. These initial results highlight the increased prevalence of thromboembolism in patients with COVID-19 with active urological problems. Cai et al do not mention if the PEs in their series were detected incidentally or as a result of a sudden change in clinical status. They also do not mention the specific venous thromboembolism (VTE) prophylaxis used prior to PE diagnosis. It is essential that patients with COVID-19 be treated with pharmacological VTE prophylaxis while inpatients, and escalated to therapeutic anticoagulation if a new VTE is confirmed.1 Initiation of therapeutic anticoagulation for suspected PE has been commonly practiced during the COVID-19 pandemic due to difficulty transporting mechanically ventilated patients for cross-sectional imaging and initiatives to limit staff exposure to COVID-19.1 Currently reasons to suspect PE include sudden respiratory decompensation, evidence of right heart strain and confirmation of deep vein thrombosis. There is likely low value in performing computerized tomographic pulmonary angiography purely in the setting of urosepsis without clinical suspicion of PE. It is important to remember that many patients with urosepsis or SARS-CoV-2 infection have a concomitant acute kidney injury (AKI). Patients with both infections are likely to have an AKI that is multifactorial in nature. AKI in COVID-19 has been attributed to cardiovascular comorbidities, endothelial damage, immune response dysregulation and microthromboemboli.2 AKI in the setting of COVID-19 progresses to the point of requiring renal replacement therapy in 2% to 9% of patients.3,4 This rate increases to 6% to 23% when severe infection is present.5,6 Therefore, we only recommend diagnostic testing for PE if clinically suspected, in order to avoid the unnecessary risks associated with therapeutic anticoagulation and intravenous contrast material. Reference 1. : COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135: 2033. Google Scholar 2. : Management of acute kidney injury in patients with COVID-19. Lancet Respir Med 2020; doi: 10.1016/S2213-2600(20)30229-0. Crossref, Google Scholar 3. : Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507. Google Scholar 4. : Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061. Google Scholar 5. : Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475. Google Scholar 6. : Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708. Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology1 Jul 2020Re: COVID-19 Coagulopathy: Considerations for Urologists Volume 204Issue 4October 2020Page: 849-850 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. S. Jue More articles by this author M. Alameddine More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry.

BackgroundThe Cancer-VTE Registry evaluates the occurrence and management of venous thromboembolism in Japanese participants with major solid tumors. Using Registry data, we evaluated the frequency of concurrent venous thromboembolism in cancer patients prior to treatment initiation by cancer type.MethodsThe Cancer-VTE Registry is an ongoing (March 2017–September 2020) prospective cohort study using a nationwide, multicentre clinical registry. Participants aged ≥20 years with colorectal, lung, stomach, pancreatic, breast or gynecologic cancer, confirmed staging, ≥6 months life expectancy post-registration and who had undergone venous thromboembolism screening were managed with routine clinical care. Venous thromboembolism frequency at registration was evaluated.ResultsOf 9735 participants, 571 (5.9%) had venous thromboembolism at baseline, including asymptomatic [5.5% (n = 540)] and symptomatic venous thromboembolism [0.3% (n = 31)]. Most participants with venous thromboembolism (n = 506, 5.2%) had deep vein thrombosis only; 65 (0.7%) had pulmonary embolism with/without deep vein thrombosis. The prevalence of distal and proximal deep vein thrombosis was 4.8% (n = 466) and 0.9% (n = 83), respectively. The highest prevalence of venous thromboembolism was for pancreatic cancer (8.5%) and the lowest for breast cancer (2.0%). Venous thromboembolism prevalence increased as cancer stage advanced.ConclusionsAlthough there was a marked difference in venous thromboembolism by cancer type, the data suggest that cancer stage is an important risk factor for venous thromboembolism. Thus, metastasis seems a critical risk factor for venous thromboembolism. This is the first demonstration of venous thromboembolism prevalence and risk factors in Japanese cancer patients prior to treatment.Trial registrationUMIN000024942.

Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis.

Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

Comorbidity in gout at the time of first diagnosis: sex differences that may have implications for dosing of urate lowering therapy

BackgroundThe aim of this study is to examine the occurrence of comorbidities at the time of first diagnosis of gout compared with matched population controls, overall and by sex, as well as to examine the crude and age-standardized prevalence of these comorbidities in men and women with gout at first diagnosis.MethodsA population-based study used data from Swedish national and regional registers, including 14,113 gout patients aged ≥ 20 years, with a first recorded diagnosis of gout between 1 January 2006 and 31 December 2012, and 65,782 population controls, matched by age, sex and county. Prevalence ratios (95% confidence intervals) comparing gout cases and controls were calculated, overall and by sex. Crude and age-standardized prevalence (95% confidence interval) of all comorbidities in gout patients were calculated, to show differences between sexes, taking also the higher age at diagnosis in women into account.ResultsAll examined comorbidities were 1.2–2.5-fold more common in gout patients at diagnosis than in population controls in both sexes. Women with gout were on average 6 years older than men at first gout diagnosis and most comorbidities, including obesity and diuretic use, were or tended to be more frequent in women than in men. When standardizing for age, women had a higher prevalence of thromboembolism (6.6% vs 5.2%) and chronic obstructive pulmonary disease (3.1% vs 2.4%). Men, on the other hand, had a higher prevalence of coronary heart disease (9.4% vs 6.4%), atrial fibrillation (9.0% vs 6.0%), congestive heart failure (7.7% vs 6.6%) and stroke (4.1% vs 3.3%).ConclusionsThe occurrence of most comorbidities was significantly increased at first diagnosis of gout in both sexes. Women were older at diagnosis and had higher occurrence of most comorbidities, including obesity and diuretic use, factors that increase serum urate, and this needs to be taken into account when starting and optimizing urate lowering therapy. These sex differences were attenuated when standardizing for age and the occurrence of cardiovascular diseases was actually higher in men.

P218 Venous thromboembolism in a Finnish IBD cohort

Background: Venous thromboembolism (VTE) presents a common and life-threatening extra-intestinal complication of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study is to investigate the prevalence of thromboembolism in patients in a Finnish IBD cohort, and to analyze VTE risk factors. Methods: A register of IBD patients was established in 1986 at Tampere University Hospital, Tampere, Finland, and it was maintained until the end of 2007. A total of 1915 patients (47% female) were included, of which 65.4% were diagnosed with UC and 28.8% with CD. The register included all IBD patients in the area regardless of the level of difficulty of the disease. Index patients were identified from the IBD register on the diagnosis of either thrombophlebitis, deep venous thromboembolism, and/or pulmonary embolism. VTEs that occurred 1986–2014 were collected retrospectively. A control group of non-VTE IBD patients was collected from the IBD register as well. Two controls for each case were matched regarding gender, year of birth, IBD diagnosis, and location of the disease Results: Between 1986 and 2014, 85 IBD patients out of 1915 developed one or several venous thromboembolisms (range 1–5 VTE events). VTE index patients (49.4% female) included 57 UC (67%), 27 (32%) CD, and 1 (1%) IBD unclassified. The incidence was 2.20/1000 patient years. 39% of the first VTE events were deep venous thromboembolism (DVT) in lower extremity and 31% were pulmonary embolism (PE). VTE group and non-VTE group are compared in Table 1. Table 1. Comparison of VTE and non-VTE groups *Smoking, oral contraceptives/hormone replacement treatment/pregnancy, obesity, VTE tendency in family, presence of one more VTE risk increasing conditions. **Non-exhaustive list: cancer; asthma, COPD; diabetes; atrial fibrillation or other arrhythmia; kidney failure; cardiac failure, rheumatoid arthritis. 43.8% of gut-operated and 18.2% of non-gut-operated VTE patients had more than one VTE event (p=0.086). In a sub-group of 1986–2007 data, the extent of the UC disease correlated with the number of VTE events (rS=0.471, p=0.005). Conclusions: According to our study and in agreement of previous work, IBD patients have roughly a twofold risk of VTE to that of general population. In a sub-group, the extent of CU correlated with the number of VTE events.