Prevalence Of Venous Thromboembolism Risk Factors Research Articles

Psoriasis and its impact on the clinical outcome of patients with pulmonary embolism

BackgroundAn increased risk for venous thromboembolism (VTE), comprising pulmonary embolism (PE) and deep venous thrombosis, has been reported in psoriasis patients. The impact of psoriasis on prognosis of VTE patients is widely unknown. MethodsHospitalized PE patients were stratified for psoriasis and the impact of psoriasis on outcome was investigated in the German nationwide inpatient sample of the years 2005–2017. ResultsOverall, 1,076,384 hospitalizations of PE patients (53.7% females, median age 72.0 [60.0–80.0] years) were recorded in Germany 2005–2017. Among these, 3145 patients had psoriasis (0.3%). Psoriatic PE patients were younger (68.0 [57.0–76.0] vs. 72.0 [60.0–80.0] years,P < 0.001) and more often male (64.1% vs. 46.3%,P < 0.001). The prevalence of VTE risk factors, traditional cardiovascular risk factors and cardiovascular comorbidities was higher in psoriatic than in non-psoriatic individuals.Psoriatic PE patients showed a lower in-hospital case-fatality rate (11.1% vs. 16.0%,P < 0.001), confirmed by logistic regressions showing an independent association of psoriasis with reduced case-fatality rate (OR 0.73 [95%CI 0.65–0.82],P < 0.001), despite higher prevalence of pneumonia (24.8% vs. 23.2%,P = 0.029). Psoriasis was an independent predictor for gastro-intestinal bleeding (OR 1.35 [95%CI 1.04–1.75],P = 0.023) and transfusion of blood constituents (OR 1.23 [95%CI 1.11–1.36],P < 0.001). ConclusionsPE patients with psoriasis were hospitalized in median four years earlier than those without. Although psoriasis was associated with an unfavorable cardiovascular-risk and VTE-risk profile in PE patients, our data demonstrate a lower in-hospital mortality in psoriatic PE, which might be mainly driven by younger age. Our findings may improve the clinical management of these patients and contribute evidence for relevant systemic manifestation of psoriasis. Translational perspectiveAn increased risk for venous thromboembolism (VTE), comprising pulmonary embolism (PE) and deep venous thrombosis, has been reported in psoriasis patients, but the impact of psoriasis on prognosis of VTE patients is widely unknown. PE patients with psoriasis were younger and psoriasis was associated with an unfavorable cardiovascular-risk and VTE-risk profile. In-hospital mortality was lower in psoriatic PE patients, which might be mainly driven by younger age. Our findings improve the clinical management of PE patients and contribute evidence for relevant systemic manifestation of psoriasis. One sentence summaryPsoriasis with chronic inflammation promotes PE development, is associated with an unfavorable cardiovascular and VTE-risk profile, but lower in-hospital mortality.

Risk of venous thromboembolism in immune-mediated inflammatory diseases: a UK matched cohort study

ObjectivesTo describe the risk of venous thromboembolism (VTE), and risk factors for VTE, in people with immune-mediated inflammatory diseases (IMID) (ulcerative colitis, Crohn’s disease (CD), rheumatoid arthritis (RA) and psoriatic...

Prevalence of venous thromboembolism risk factors in pregnant women

Introduction: Venous thromboembolism (VTE) is the leading cause of maternal mortality in the Western population. Studies have shown that the incidence of VTE may not be different in the Indian population. The aim of this study is to understand the prevalence of VTE risk factors in Indian pregnant women. Materials and Methods: Two hundred antenatal and postnatal women attending the Gynecology outpatient clinics between April 1, 2019 and July 31, 2019, were sampled using pragmatic approach. Green-top guidelines (Royal College of Obstetricians and Gynecologists) were used to identify the risk factors. Descriptive statistics were used to analyze and present the data. Results: The mean age of the women was 26.18 (range 20–41). In the sampled population, 39 (19.5%), 41 (20.5%), and 110 (55%) women were in the first, second, and third trimester, respectively. Ten women (5.3%) were in the postpartum period. Out of 200 pregnant women, 2 (1%) had the previous history of VTE putting them in the high-risk group and 40 (20%) had one or more intermediate risk factors (immobility, OHSS, medical comorbidities, and surgical procedures). Eleven women (5.5%) had three or more risk factors and 40 women (20%) had two or more of the low-risk factors. Overall, 80 of 200 pregnant women (40%) had VTE risk factors that would require DVT prophylaxis during and/or postpartum period. Conclusion: The study highlights that a significant proportion of pregnant women in India have VTE risk factors. Routine VTE risk assessment and thromboprophylaxis could identify the women at risk and reduce the incidence of VTE in pregnant women.

Prevalence of postpartum venous thromboembolism risk factors in an Irish urban obstetric population

BackgroundObstetric venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality. A clear understanding of the burden of VTE risk at a population level is a prerequisite to effective prevention; however, existing data are limited. ObjectivesDescribe the prevalence and patterns of VTE risk factors among postpartum women and consider the implications for VTE prevention practices. MethodWe undertook a cross‐sectional study of prospectively collected data from sequential postpartum VTE risk assessments completed between January 2015 and December 2017 in the Rotunda Hospital, Dublin. ResultsWe analyzed postpartum VTE risk factors in a large unselected Irish urban obstetric cohort of 21 019 consecutively sampled women. This represents more than 90% of all women giving birth in a single institution over a 3‐year period. The most common VTE risk factors related to maternal characteristics and delivery characteristics, including overweight and obesity (36%), age ≥35 (35%) and cesarean delivery (32%). More than three‐quarters of women had at least 1 VTE risk factor (78%) and more than 40% had multiple (2 or more) VTE risk factors. One‐fifth of women had no VTE risk factors before delivery, yet went on to develop VTE risk factors during delivery or in the postpartum period. Reflecting the differences in thromboprophylaxis thresholds internationally, the proportion of women who would have received a recommendation for postpartum thromboprophylaxis ranged from 7% to 37% under various clinical guidelines. ConclusionThis study demonstrates the high prevalence of VTE risk factors among postpartum women. Postpartum VTE risk is highly individualized and complex.

The risk of venous thromboembolism in patients with multiple sclerosis: the Clinical Practice Research Datalink

In patients with multiple sclerosis (MS), disability and autoinflammatory processes may result in an increased risk of venous thromboembolism (VTE) OBJECTIVE: To evaluate the risk of VTE associated with MS. We conducted an observational-cohort study within the Clinical Practice Research Datalink (1987-2009) linked to the National Registry of Hospitalizations (1997-2008). At the time of MS diagnosis, a comparison cohort (N=33370) without a recorded MS diagnosis during the study period was matched (6:1) to the MS cohort (n=5566) by birth year, sex, and practice. Subjects were followed from the index date until the occurrence of VTE, end of data collection, migration, or death, whichever came first. Cox proportional-hazards models were used to derive adjusted hazard ratios and 95% confidence intervals for VTE associated with MS and VTE risk factors within the MS cohort. Time-dependent adjustments were made for age, comorbidity, and medication use. Compared with the comparison cohort, a 2.6-fold increased risk of VTE was observed for MS patients (adjusted hazard ratio 2.56, 95% confidence interval 2.06-3.20). A prior VTE event, varicose veins, obesity, and major trauma were found to be associated with an increased risk of VTE within the MS population. Moreover, the risk of VTE was increased in MS patients with recent records indicating immobility, spasticity, glucocorticoid use, or disability. Patients with MS had an increased risk of VTE. Furthermore, our results provide evidence that this association is, at least in part, mediated through an increased prevalence of VTE risk factors in MS patients.

Risk factors for thrombosis in an african population.

SUMMARYLittle is known about the biological, epidemiological, and clinical risk factors for thrombosis and venous thromboembolism (VTE) among Black Africans. We undertook a study of the prevalence of VTE risk factors for thrombosis in a Senegalese population.A three-year cross-sectional and case–control study involving 105 cases and 200 controls was conducted in various hospitals in Dakar (Senegal). Our results demonstrate that oral contraception, immobilization by casts, surgery, and blood group were significantly associated with VTE occurrence. Additionally, 16 cases and 2 controls had protein S (PS) values of less than 48.4% (M-2SD), exhibiting a highly significant difference (P < 1 × 10−4). The number of cases with a low protein C (PC) level was significantly higher than the respective number of controls. Using logistic regression methods, we established a correlation between significantly associated variables and deep venous thrombosis (DVT) occurrence. Age, obesity, sickle cell disease, and PC deficiency were not significantly associated with thrombosis. In contrast, gender, PS deficiency, varicose veins, surgery, non-O blood type, and the presence of antiphospholipid antibodies were significantly and independently associated with DVT.These findings are extremely useful for clinical management of patients suffering from DVT and can help to reduce the high recurrence rate observed in our study.

Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism

AbstractThe clinical significance of subsegmental pulmonary embolism (SSPE) remains to be determined. This study aimed to investigate whether SSPE forms a distinct subset of thromboembolic disease compared with more proximally located pulmonary embolism (PE). We analyzed 3728 consecutive patients with clinically suspected PE. SSPE patients were contrasted to patients with more proximal PE and to patients in whom suspected PE was ruled out, in regards of the prevalence of thromboembolic risk factors and the 3-month risks of recurrent venous thromboembolism (VTE) and mortality. PE was confirmed in 748 patients, of whom 116 (16%) had SSPE; PE was ruled out in 2980 patients. No differences were seen in the prevalence of VTE risk factors, the 3-month risk of recurrent VTE (3.6% vs 2.5%; P = .42), and mortality (10.7% vs 6.5%; P = .17) between patients with SSPE and those with more proximal PE. When compared with patients without PE, aged >60 years, recent surgery, estrogen use, and male gender were found to be independent predictors for SSPE, and patients with SSPE were at an increased risk of VTE during follow-up (hazard ratio: 3.8; 95% CI: 1.3-11.1). This study indicates that patients with SSPE mimic those with more proximally located PE in regards to their risk profile and clinical outcome.

Venous thromboembolism prophylaxis usage in critical care units in National Hospital Sri Lanka

Background: Venous thromboembolism (VTE) is an important cause of mortality and morbidity in critical care patients. This is as a result of high prevalence of VTE risk factors in this group of patients including physical inactivity, immobilization, vascular injury and / or hypercoagulable state. The effect of these risk factors are cumulative1,2,3. VTE may progress into thrombophebitis or pulmonary embolism (PE) with increased mortality and morbidity and have enormous economic issues. But the risk of VTE and its prevention have been poorly characterized in this population. Evidence based thromboembolic prophylaxis guidelines are also not widely available for these critically ill patients 3,4. The main objectives of this audit were to determine the presence and the type of the risk factors and the prophylaxis given in patients admitted to five adult intensive care units (ICU) in National Hospital Sri Lanka (NHSL). Method: This audit was carried out from 1st to 31st of March 2011 in five critical care units in NHSL. Confidentiality was maintained. Data was obtained with the use of pre formed data collection forms, filled by post graduate trainees in anaesthesiology. Results: There were a total of 90 patients, 53% male and 47% female, and 40% were in the 30-40 year age group. Majority (49%) of the patients were admitted to ICU following surgery. 35 patients (38.9%) had at least 2 risk factors for VTE. 39 patients (43.3%) had received VTE prophylaxis. 51 patients (56.6%) did not get any prophylaxis against VTE. 43.3% were given only pharmacological prophylaxis and 33.3% were offered both pharmacological and mechanical prophylaxis. Enoxaparin 40mg daily was used as the drug of choice in majority of the patients irrespective of their body weight. Pharmacological VTE prophylaxis for the postoperative patients was started 8-12 hours after admission in the majority. Conclusion: We found an under usage of VTE prophylaxis on at risk patients in intensive care units at NHSL. We would like to highlight the importance of having institutional guidelines on VTE prophylaxis and improving the awareness on VTE among the ICU staff. DOI: http://dx.doi.org/10.4038/slja.v20i1.4273 Sri Lankan Journal of Anaesthesiology 20(1): 33-38 (2012)

Venous thromboembolism risk assessment and thromboprophylaxis among hospitalized acute medical patients in China – the RAMP study

Background In developed countries, hospitalized patients with acute medical conditions are at significant risk for venous thromboembolism (VTE). Little is known about VTE risk and prophylaxis practices in China. Objective To determine the VTE risk and the frequency of recommended VTE prophylaxis in hospitalized Chinese patients with acute medical conditions. Methods Multi-center, cross-sectional, observational study. Eligibility criteria: ≥ 30 years, admitted to an intensive care unit (ICU)/coronary care unit (CCU) for acute medical illness, had ≥ 1 VTE risk factor/1 disease that predisposes to VTE, and provided informed consent. We used 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines to assess VTE risk and the frequency of recommended VTE prophylaxis. Results 1247 patients from 19 hospitals in 11 cities across 11 provinces of China were enrolled from July 2007 to June 2008. 57.3% patients had > 2 VTE risk factors. Only 20.2% received ACCP-recommended VTE prophylaxis (CCU patients: 22.7%, ICU patients: 16.9%, p = 0.0117). Limitations Excluding some patients with VTE risk factors did not allow assessment of the prevalence of VTE risk in the acute hospital-care setting. We could not determine whether the duration of prophylaxis complied with the ACCP recommendations. Our results may not be representative of hospitals in small cities/rural areas in China. Conclusions The prevalence of VTE risk factors in Chinese patients was similar to that in developed countries; however, only a small proportion of eligible patients received the recommended VTE prophylaxis. Our findings highlight the need for dissemination and implementation of appropriate VTE prophylaxis guidelines in China.

Thromboembolierisiko und -prophylaxe internistischer und chirurgischer Patienten im Krankenhaus

Venous thromboembolism (VTE) leads to an increased morbidity in hospitalized patients. This multinational cross-sectional survey was designed to assess the prevalence of VTE risk factors and to determine the proportion of at-risk patients who receive effective VTE-prophylaxis. The results of the 16 participating German hospitals of the study are presented and compared with the international results. All hospital inpatients aged >or= 40 years admitted to a medical ward and all surgical inpatients aged >or= 18 years were enrolled. The American College of Chest Physicians (ACCP) guidelines (2004) were applied to assess VTE risk and to determine whether patients were receiving recommended VTE prophylaxis. Overall, 2,370 patients were enrolled: 1,210 (51 %) were categorised as surgical and 1,160 (49 %) as acute medically ill. 838 (69 %) of surgical and 479 (41 %) of medical patients were judged to be at risk for VTE. Of the surgical patients at risk, 772 (92 %) received ACCP-recommended VTE prophylaxis, compared with 337 (70 %) medical patients at risk of VTE. Low-molecular weight heparins were most frequently used. In total, in comparison to other countries, Germany has a leading position in the implementation of international guidelines with regard to VTE prophylaxis. Whereas in a surgical ward effective VTE prophylaxis is consistently standard care, in the medical indications there is still room for improvement in terms of stratification of VTE risk and corresponding VTE-prophylaxis.