Prevalence Of Venous Thromboembolism Research Articles

Risk factors for venous thromboembolism in a single pediatric intensive care unit in China

BackgroundAnalyses of extensive, nationally representative databases indicate a rising prevalence of venous thromboembolism (VTE) among critically ill children. However, the majority of studies on childhood VTE have primarily concentrated on Caucasian populations in the United States and European countries. There is a lack of epidemiological studies on VTE in Chinese children.MethodsWe conducted a retrospective cohort study of data from the Pediatric Intensive Care (PIC) database. Data were obtained and extracted by using Structured Query Language (SQL) and the administrative platform pgAdmin4 for PostgreSQL. Bivariate analyses were conducted in which categorical variables were analyzed by a chi-square test and continuous variables were analyzed by a Student’s t-test. Separate multivariable logistic regressions were employed to investigate the associations between VTE and sociodemographic factors as well as clinical factors.ResultsOur study included 12,881 pediatric patients from the PIC database, spanning the years 2010 to 2018. The incidence rate of pediatric VTE was 0.19% (24/12,881). The venous thrombotic locations were deep venous thrombosis extremities (n = 18), superior vena cava (n = 1), cerebral sinovenous (n = 1), and other deep venous thrombosis (n = 4). Univariate analysis showed that age, weight, shock, sepsis, cancer and vasopressor receipt were statistically significant risk factors for pediatric VTE (all p ≤ 0.05). After multivariable logistic regression analysis, only shock (aOR: 6.77, 95%CI: 1.33–34.73, p = 0.019) and admission for sepsis (aOR: 6.09, 95%CI: 1.76–21.09, p = 0.004) were statistically significant associated with pediatric VTE.ConclusionsIn conclusion, data obtained from the Pediatric Intensive Care (PIC) database revealed a prevalence of VTE in pediatric patients of 0.19%. The most common location for venous thrombi was deep venous thrombosis (DVT) in the extremities. We identified that shock and sepsis were statistically significant factors associated with pediatric VTE.

Prevalence of Venous Thromboembolism after Immediate Screening in Hip Fracture Patients.

Venous thromboembolism (VTE) is a major complication for hip fracture patients, and may exist preoperatively. This study aimed to examine the prevalence of VTE after immediate screening in hip fracture patients. Hip fracture patients with an elevated level of D-dimer underwent screening for VTE using computed tomography (CT) angiography. Anticoagulation treatments were administered preoperatively to patients diagnosed with VTE, followed by administration of additional anticoagulation postoperatively. Medical records were reviewed to identify risk factors for preoperative VTE and determine the prognosis of the patients. Among 524 hip fracture patients, 66 patients (12.6%) were diagnosed with VTE, including 42 patients with deep vein thrombosis (DVT), 17 patients with pulmonary thromboembolism (PTE), and 7 patients with both DVT and PTE. Of the patients with VTE, 68.2% were diagnosed within 24 hours of injury, and 33.3% of these patients had PTE. VTE patients showed a tendency toward being overweight (P<0.01) and not on anticoagulant medication (P=0.02) compared to patients without VTE. The risk of VTE was higher for femur shaft fractures (odds ratio [OR] 4.83, 95% confidence interval [CI] 2.18-10.69) and overweight patients (OR 2.12, 95% CI 1.17-3.85), and lower for patients who were previously on anticoagulants (OR 0.36, 95% CI 0.18-0.74). Patients with preoperatively diagnosed VTE were asymptomatic before and after surgery. Clinicians should be aware that VTE may be present within 24 hours of injury, and screening for VTE or prophylactic measures should be considered for high-risk patients.

An Effective Protocol for Perioperative Venous Thromboembolism Prophylaxis in DIEP Flap Breast Reconstruction: A Single Institution Retrospective Review.

Deep inferior epigastric artery perforator (DIEP) free flap breast reconstruction is one of the most highly used procedures for autologous breast reconstruction. Many venous thromboembolism (VTE) risk assessment models have been proposed in breast reconstructive surgery, including the widely used Caprini score. However, a paucity of data suggests an effective standardized VTE protocol. The purpose of this study was to determine the rate of VTE in our DIEP flap patients who were treated with this protocol. A retrospective single-center review of DIEP flap breast reconstruction from 2016 to 2021 was performed. Data were collected on 554 patients and 893 flaps including demographics, intraoperative and perioperative details, and postoperative course. Patients who were not treated with our standard protocol were excluded. Data were analyzed with alpha = 0.05. The average age was 50.4 ± 9.9 years, and the total follow-up time was 16.9 ± 12.6 months. The average body mass index for the cohort was 30.1 ± 5.2. During the 90 postoperative days, the mean length of hospital stay was 4.3 days. There were six cases of postoperative VTE: five patients presented with pulmonary embolism (0.9%) and one patient (0.2%) had deep venous thrombosis with an overall VTE prevalence of 1.1%. No specific single factor could be attributed to VTE occurrence. Using our standardized VTE prophylaxis protocol, our institution was effective at keeping VTE rates low. Additional studies would be beneficial to determine optimal VTE prophylaxis protocols in higher-risk patients, such as those with known clotting disorders.

Venous thromboembolism prophylaxis in Asian patients with severe COVID-19: A prospective cohort study

The severe coronavirus disease 2019 (COVID-19) triggers various coagulation cascades, culminating in the manifestation of venous thromboembolism (VTE). The efficacy of anticoagulant prophylaxis in averting VTE occurrence in severe COVID-19 cases in Thailand remains uncertain. We aimed to determine the prevalence of symptomatic VTE in patients with severe COVID-19 who received a standard dose of anticoagulants and to evaluate the risk factors. Our prospective cohort study included patients with severe COVID-19 who received anticoagulant prophylaxis. VTE, bleeding events and mortality were monitored until 60 days after VTE prophylaxis initiation. Of the 250 study patients, pulmonary embolism was observed in 7.2% of patients. In a multivariate Cox regression model, endotracheal intubation [hazard ratio (HR) = 13.75; 95% confidence interval (CI) = 2.87–65.82; p = 0.001] and high D-dimer levels [HR = 1.052; 95% CI = 1.023–1.081; p < 0.001) were significantly associated with higher VTE risk within 60 days of VTE prophylaxis. Bleeding and major hemorrhage occurred in 35 (14%) and eight (3.2%) patients, respectively. These findings indicated that a standard dose of anticoagulant may not be sufficient for preventing thrombosis in patients who require intensive care. Further research on the appropriate dose is necessary.

Prevalence of venous thromboembolism in patients with chronic liver disease: A Turgut Özal Medical Center based study

Venous thromboembolism (VTE) is an important complication observed in patients with chronic liver diseases. This study aims to present demographics and some clinical characteristics of patients with chronic liver disease (CLD) with an emphasis on the development of venous thromboembolism. The study was conducted with the data of patients having chronic liver disease who were admitted to Inonu University Turgut Özal Medical Center Liver Transplant Institute. 63 patients diagnosed with chronic liver diseases were included in the study. Chronic liver disease patients were confirmed according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Positive Doppler ultrasonography, computed tomography, or angiographic study documentation were used to confirm the presence of thrombosis. In conclusion, although patients with CLD are traditionally prone to bleeding disorders, VTE is also a serious complication in these patients. Therefore, it should be considered that anticoagulation treatment should be provided to all CLD patients with verified VTE.

A Predictive Model for Cancer-Associated Thrombosis in Japanese Cancer Patients: Findings from the J-Khorana Registry.

Background  Although the close relationship between cancer and venous thromboembolism (VTE) has been identified, risk stratification for VTE in Japanese patients with cancer remains unclear. Objectives  This study aimed to validate the Khorana VTE risk assessment score (KRS) for VTE diagnosis and establish an optimal predictive model for VTE in Japanese patients with cancer. Methods  A total of 7,955 Japanese patients with cancer were subdivided into low- (0), intermediate- (1-2), and high-score (3) groups according to the KRS. Using 37 explanatory variables, a total of 2,833 patients with cancer were divided into derivation and validation cohorts (5:5). A risk model for Japanese participants was developed using the derivation cohort data. Results  The prevalence of VTE in low-, intermediate-, and high-score patients was 1.2, 2.5, and 4.3%, respectively. Logistic regression analysis demonstrated that cancer stage (III-IV) and KRS ≥ 2 were independent and significant predictors of VTE onset. The risk model for VTE assigned 1 point to body mass index ≥25 kg/m 2 and 2 points each to the prevalence of osteochondral cancer and D-dimer level ≥1.47 µg/mL. The areas under the curve of the risk model were 0.763 and 0.656 in the derivation and validation cohorts, respectively. Conclusion  The KRS was useful in Japanese patients, and our new predictive model may be helpful for the diagnosis of VTE in Japanese patients with cancer.

Management strategies in persons with inherited haemophilia requiring antithrombotic therapy: A scoping review

AbstractBackgroundThromboembolic events are increasingly reported in the aging haemophilia population. The purpose of this study was to understand current practices and identify knowledge and research gaps in the management of persons with haemophilia requiring antithrombotic therapy for cardiovascular disorders (CVD) or venous thromboembolism (VTE).MethodsWe searched MEDLINE, EMBASE and Scopus for studies reporting on more than two patients with inherited haemophilia A or B, without inhibitors, requiring antithrombotic therapy for CVD or VTE. Data were extracted by two independent reviewers and analysed using descriptive statistics and narrative synthesis.ResultsWe included 32 studies reporting on 432 persons with haemophilia. Three themes described the observed practice variation: (1) Difficulty weighing competing bleeding and thrombotic risks; (2) Tensions in providing standards of care and minimizing bleeding risk; (3) Advocacy for individualized strategies and multidisciplinary care. Different management strategies were used to treat persons with haemophilia in the setting of thromboembolic events, such as avoiding or choosing lower intensity antithrombotic therapy, or procedural alternatives to antithrombotic therapy. Initiation or alteration in haemostatic therapies along with antithrombotic therapy were common strategies and reported in 30 studies. However, data on target factor levels and bleeding and thrombotic events were largely missing.DiscussionOur scoping review highlights unmet needs in the management of an aging population of persons with haemophilia with increasing prevalence of CVD and VTE. Management is inconsistent and divergent from those of non‐haemophilic patients. Prospective data are needed to inform optimal and evidence‐based management strategies of CVD and VTE in persons with haemophilia.

An Unusual Case of Isolated Right Ventricular Thrombus and Bilateral Extensive Pulmonary Thromboembolism in an Adult with Nephrotic Syndrome Occurring Five Years after the Diagnosis: A Case Report

It is an established fact that nephrotic syndrome is associated with a heightened risk of thromboembolic complications including deep vein thrombosis (DVT), renal vein thrombosis (RVT) and pulmonary thromboembolism (PTE). Intra-cardiac thrombi are not uncommon but predominantly involve left atrium (LA), right atrium (RA) and left ventricle (LV). However, Isolated right ventricular (RV) thrombus in an adult with nephrotic syndrome was very rarely reported. Common causes of intra-cardiac thrombi include LV dysfunction, atrial fibrillation (AF), mitral stenosis (MS), nephrotic syndrome, cardiac prosthetic valves, indwelling central venous catheters, pacing leads, anti-phospholipid antibody syndrome, hyperhomocysteinemia, infection with COVID-19 virus, Behcet’s disease and congenital thrombophilia. Above conditions can cause intra-arterial, intravenous, as well as, intra-cardiac thrombi. Patients with nephrotic syndrome especially due to membranous glomerulonephritis can develop a hypercoagulable state in greater than 25% of adult patients. The risk of thrombosis was noted to be highest in the first three to six months after diagnosis. The exact incidence and prevalence of venous thromboembolism (VTE) are unknown in nephrotic syndrome. We are reporting a rare case of isolated RV thrombus presenting as acute PTE five years after initial diagnosis of nephrotic syndrome due to membranous glomerulonephritis which responded to thrombolytic therapy. There were only three case reports of isolated RV thrombus in an adult with nephrotic syndrome published so far.

Prevalence and Time Trends of Oral Anticoagulant Utilization in Adults with Sickle Cell Disease

Background: Sickle cell disease (SCD) is an inherited red blood cell disorder, caused by a genetic mutation in the β-hemoglobin chain. SCD is associated with chronic activation of coagulation and an increased risk of venous thromboembolism (VTE). Although the American Society of Hematology guidelines recommend indefinite anticoagulation for unprovoked or recurrent provoked VTE, no guidance is given regarding choice of anticoagulant due to a paucity of data. Existing evidence on the use of anticoagulants in patients with SCD has been mostly focused on oral anticoagulants, was limited by small sample sizes, and did not clearly demonstrate the temporal utilization patterns. Real-world evidence on oral anticoagulant use in SCD from large population-based studies is largely lacking. This study examined the prevalence and time trends of oral anticoagulant utilization in patients with SCD in the United States (US). Methods: This retrospective, repeated cross-sectional study analyzed the Cerner Health Facts® database from January 1, 2011, to December 31, 2016, which captures longitudinal electronic medical records (EMR) of patient data from participating facilities in the US. To be included, patients were required to (1) have ≥ 1 inpatient or emergency department encounters with SCD, or 2 outpatient encounters that were 30 days apart in a calendar year from 2012 to 2016, (2) have ≥ 1 prescription records on the encounters with SCD, (3) aged ≥ 18 years at index, and (4) have ≥ 1 encounter with SCD in a year prior to the index. For patients with multiple encounters with SCD in the calendar year, we randomly selected one encounter with SCD and defined it as the index. In this design, a patient contributed only one observation per year but may contribute to multiple years of observations if meeting the selection criterion. The outcome was the use of anticoagulants, defined as any prescription drug encounter for an oral anticoagulant (Vitamin K antagonist [VKA]: warfarin; direct oral anticoagulants [DOACs]: apixaban, rivaroxaban, dabigatran, edoxaban) within a grace period of 7 days discharged from the index. The independent variable was each calendar year measured as dummy variables. Covariates were measured during the 12-month baseline period prior to the index, which included patient demographics, comorbidities and complications of SCD, and facility characteristics. Time trends on the proportions of eligible patients with anticoagulant use against the calendar years of the SCD diagnosis were plotted, and the significance on the crude trend was examined using Cochran-Armitage trend test. In the main analysis, a modified Poisson regression by using generalized estimating equations (GEEs) estimated the adjusted prevalence ratios (APRs) for the trends and covariates associated with any anticoagulant utilization. In subgroup analysis, we estimated the APRs of covariates for the use of DOACs versus VKA. Results: The cohort included 8,824 adult patients with SCD in 182 facilities using automated Cerner EMR system for the years 2012 to 2016. Prescription rates of all oral anticoagulants gradually increased from 2012 to 2014; the rates of VKA prescriptions substantially dropped from 11.1/1000 to 4.1/1000 persons between 2014 and 2016, whereas prescription rates of DOACs increased significantly from 12.0/1000 to 29.1/1000. Prevalence of VTE was stable at approximately 6.2/1000 to 7.5/1000 between 2012 and 2016. Prescription rates of DOACs were lower in patients with (versus without) VTE (6.1/1000 vs 7.3/1000), while a reversed prescription pattern was observed for VKA (VTE [yes vs no]: 4.4/1000 vs 1.8/1000). Controlling for covariates, our main analysis demonstrated that patients with a diagnosis of acute chest syndrome, pulmonary hypertension, and depression were 1.51, 2.30, and 1.57 times more likely to have oral anticoagulant prescription, respectively (all p &amp;lt;0.05). Subgroup analysis showed that having a diagnosis of VTE was associated with a decreased likelihood of DOACs prescription relative to VKA (APR= 0.75, 95%CI: 0.62-0.91). Conclusion: Prescription of oral anticoagulants in adults with SCD has significantly increased from 2012 to 2016 and the increase was dominated by DOACs. The treatment paradox of a lower relative rate of DOACs utilization versus VKA in adults with SCD requires more study to understand the reasons and additional clinical outcomes associated with the utilization patterns.

Risk Factors of Venous Thromboembolism in Lymphoma Patients: A Meta-Analysis

Background: The prevalence and risk factors of venous thromboembolism (VTE) in lymphoma patients have been extensively studied, but with varying degrees of research quality and inconsistent findings. The primary objective of our study was to investigate the prevalence and identify risk factors associated with VTE in lymphoma patients. Methods: We conducted a systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library databases up to February 2023 to identify relevant studies investigating VTE in lymphoma patients. We calculated the pooled odds ratio using a fixed- or random-effect model and evaluated the quality of each study using the Newcastle-Ottawa Scale. To evaluate the robustness of our findings, we conducted sensitivity analysis. We also identified any potential publication bias using funnel plots and Egger's test. Two researchers independently assessed eligibility and extracted data to ensure accuracy. Results: Our analysis included a total of 17 studies with a combined sample size of 4,983 lymphoma patients (Figure 1). The pooled prevalence of VTE among these patients was 12% (with a confidence interval of 0.09-0.15). Sensitivity analyses were performed, and the results were consistent with the overall pooled estimate. Our meta-analysis revealed that several factors were significant risk factors for VTE in lymphoma patients, including female sex, older age, history of VTE, DLBCL lymphoma type, Ann Arbor stage III~IV, higher ECOG-PS, bulky disease, central nervous system involvement, WBC count &amp;gt;11×10 9/L, D-dimer level &amp;gt;0.5mg/L, central venous catheterization, and treatments with doxorubicin ( P&amp;lt;0.05) (Table 1). However, the funnel plot suggested that there may be some potential publication bias, which was further confirmed by statistical tests. Nevertheless, the results of the trim-and-fill method demonstrated that the pooled estimate remained stable after the addition of nine “missing” studies. Conclusions: Our study revealed that the pooled prevalence of VTE in OC was approximately 12% across lymphoma patients. Risk factors for VTE were identified which may aid in preventative measures for VTE in lymphoma patients.

Bleeding Associated with Prophylactic Anticoagulation for Hospital Related Venous Thromboembolism Prevention: A Case Series

The use of heparin products for prophylaxis of venous thromboembolism (VTE) have decreased the prevalence of VTE in all hospitalized patients, however the possibility of bleeding from prophylactic heparin cannot be disregarded. While life-threatening bleeding is less common with prophylactic doses, it can occur in the presence of other risk factors for bleeding. We aim to describe characteristics that may increase bleeding risk from prophylactic use of heparin. We present a single-center, retrospective case series of patients who received protamine for bleeding complications from prophylactic heparin administration at our facility between 2016-2020. We assessed patient demographics, medical history, types of heparin formulations administered, and patient outcomes. We observed that all patients were female. Patients who developed bleeding events from VTE prophylaxis had at least two of these attributes; BMI &amp;lt;18.5 kg/m2, weight &amp;lt;50kg, trauma within 1-month, surgery within 1-month or were taking anti-platelet agents. We suggest that the collective presence of two or more of these characteristics should lend consideration to dose adjustment and/or closer monitoring. In the absence of rigorous research comparing alternative doses to standard doses for prophylaxis in these patients, these decisions fall largely to the discretion of individual physicians. Designing larger studies following patients over long periods of time can help conclusively identify risk factors that predispose patients to bleeding.

Pharmacotherapy for Reducing RBC Transfusion for Patients in the ICU: A Systematic Review and Network Meta-Analysis.

To determine optional therapeutic strategies by comparing monotherapies and combination therapies to reduce RBC transfusion requirement for patients in the ICU. MEDLINE, CENTRAL, and Embase were searched for studies published from database inception until July 2023. We included randomized controlled trials comparing erythropoiesis-stimulating agents (Epo), iron, combination therapy with iron and Epo, hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), vitamin D 3 (VD3), and placebo/no treatment. A frequentist network meta-analysis (NMA) was performed using a random effects model, and the confidence in NMA was rated. Of 117 eligible studies, 75 studies (15,091 patients) were included in the quantitative analysis. Compared with placebo/no treatment, the combination therapy reduces the requirement for RBC transfusion (risk ratio [RR]: 0.60; 95% CI, 0.49-0.74; confidence rating: moderate). The Epo or iron monotherapy may reduce the requirement for RBC transfusion (RR: 0.81; 95% CI, 0.63-1.04; confidence rating: low; RR: 0.83; 95% CI, 0.70-0.98; confidence rating: low, respectively). Combination therapy may not increase the prevalence of both venous thromboembolism (VTE) (RR: 0.73; 95% CI, 0.25-2.08; confidence rating: low) and infection. Epo monotherapy may not increase the prevalence of VTE but may increase that of infections (RR: 1.27; 95% CI, 0.94-1.73; confidence rating: low). Iron monotherapy may not increase the prevalence of both VTE and infection. Evidence for VD3 and HIF-PHI remains uncertain. Combination therapy with iron and Epo likely reduces the requirement for RBC transfusion and may be less harmful than other therapies.

SAT513 Venous Thromboembolism and Thyroid Cancer. Analysis of National Inpatient Sample

Abstract Disclosure: M. Botros: None. N. Mazzaferro: None. P. Greenberg: None. D.A. Cohen: None. Introduction: Current literature describes the strong association between thrombosis risk and cancer. Multiple studies have shown a relationship between cancer and venous thromboembolism (VTE), a condition that occurs when a blood clot forms in a vein and includes deep vein thrombosis (DVT) and pulmonary embolism (PE) (1). Few European studies have shown an association between VTE and thyroid cancer (2). However, research studying the association of thyroid cancer with VTE in the United States or on a large scale is lacking. The discovery of thyroid cancer as a risk factor in the development of VTE may improve the detection of thyroid cancer and prevent future morbidity and mortality from thyroid cancer and VTE. Objectives: Using the National (Nationwide) Inpatient Sample (NIS) database, this study reports VTE incidence in various cancer types to determine if the association between VTE prevalence is higher in thyroid cancer than in other cancer types. The study also compared the coexistence of VTE and thyroid cancer in hospitalized patients to the prevalence in the general population. Methods: NIS uses ICD 9 and 10 diagnosis codes for extracting data. For this study, we obtained data for the years 2015-2017. In this analysis, we reviewed the number of patients over 18 admitted with ICD 10 codes with any of sixteen different cancer types and the diagnosis of VTE. We reviewed the literature comprehensively and selected sixteen types of cancer most commonly associated with VTE. Patients with coagulation disorders and pregnant patients with ICD-10-related codes were excluded. Other variables included smoking status, obesity, and gender. Results: Data from 3,471,240 hospitalized patients were collected. 1,662,710 (48%) were females. The cancers most commonly associated with VTE were lymphoid leukemia (22.3%), non-Hodgkin’s lymphoma (14.6 %), Hodgkin’s lymphoma (13%), pancreatic cancer (11.3%), and lung cancer (10%). The cancers with the lowest cancers VTE co-diagnosis were gall bladder (9.8%), urinary bladder (9%), stomach (9%), ovarian (8.7%), melanoma (7.7%), breast (7.2%), prostate (6.8%), uterine (6%), kidney (5.7%), colon (5.4%), and thyroid (3.3%). Conclusion: In this analysis, 3.3% of all patients with thyroid cancer carried a diagnosis of VTE. Although this suggests a relatively low risk, it is still higher than VTE incidence in the general population (0.001%) (3). The increased frequency of thyroid cancer in patients with VTE may warrant further screening for underlying thyroid cancer in patients with unprovoked PE. 1.Gervaso L, et al. Venous and Arterial Thromboembolism in Patients with Cancer. J Am Coll CardiolCardioOnc. 2021. 2.Walker AJ, et al. Incidence of venous thromboembolism in patients with cancer - A cohort study using linked United Kingdom databases. European Journal of Cancer. 3.Kearon C. Epidemiology of venous thromboembolism. Semin Vasc Med. 2001. Presentation Date: Saturday, June 17, 2023

THU033 High Prevalence Of Venous Thrombotic Events In Cushing’s Syndrome: Data From ERCUSYN

Abstract Disclosure: K. Isand: None. R.A. Feelders: None. T.C. Brue: None. M. Toth: None. T. Deutschbein: None. M. Reincke: None. M. Krsek: None. A. Santos: None. F. Demtroder: None. O. Chabre: None. C.J. Strasburger: None. J.A. Wass: None. S.M. Webb: None. A. Aulinas Maso: None. V. Volke: None. E. Valassi: None. For all ERCUSYN investigators Background: Patients with Cushing’s syndrome (CS) have increased risk of developing venous thromboembolic complications. The UK audit and meta-analysis of literature on Cushing’s disease (CD) over 50-years in Stoke-on-Trent by Clayton et al concluded that overall mortality in CD is double that of the general population. The risk of a thrombotic event (TE) (both arterial and venous) in patients with CS has been reported to be up to 10 times higher than that of the general population. When it comes to the cause of death, atherosclerotic diseases and venous thromboembolism (VTE) account for 43.4% of the deaths in patients with endogenous CS. Aim: To evaluate the prevalence of VTE in patients included in The European Registry on Cushing’s syndrome (ERCUSYN) and to study the details of each event to determine if there is any common line in patients who have been diagnosed with VTE. Methods: A retrospective observational cohort study; data extraction from the registry was taken on the 07.02.2022. Results: There were 95 VTE events among 2173 CS patients (prevalence of 4.4 %). Among the 57 centres included in the database (from 26 European countries), events were reported in 28 (from 16 countries). Patients were aged between 14-75 years, median age 47 years; 63(66%) were female. The 95 VTE events were observed in 70 (74%) pituitary-dependent, 12 (13%) adrenal-dependent, 10 (11%) ectopic and 3(3%) CS due to other causes. Comparing aetiologies, ectopic origin accounted for 10.5% of VTE patients and only 5% of those without VTE. Mean ± SD body mass index (BMI) reported in 68/95 patients was 28.8 ± 10.7 kg/m2, and more than three quarters (52; 76%) had a BMI above 25 kg/m2, being either overweight or obese; 21 (22%) patients were smoking. The most frequent comorbidity was hypertension (65 cases, 68%), followed by diabetes mellitus (40 cases, 42%) and osteoporosis (23, 24%); 7 (7%) had a cancer; 7 (7%) had active hypercortisolism (defined by elevated levels of midnight serum cortisol, urinary cortisol or cortisol day curve), 15 (16%) were in partial remission, 46 (48%) were cured and for 7 (7%) the status was unknown. Sixty-two (65%) had had 1 surgery, 22 (23%) had had two surgeries and 1 in the VTE group had 5 operations. Comparing groups, the VTE group had more surgeries than the no-VTE group. Mean operation rate per patient was 1.42 for the VTE group and 1.2 for no-VTE event group (p=0.0068). Seven (7%) patients died during the follow-up time (for different reasons). Conclusion: We report a high VTE rate in CS patients within ERCUSYN. Of note, to our knowledge this is the largest registry-based study to date looking at VTE in CS patients. Importantly, more than half of the VTE events were diagnosed in patients with normocortisolaemia. Presentation: Thursday, June 15, 2023

Developing a Word Lexicon from Electronic Health Records for Natural Language Processing Analysis of Free-Text Reports for Patients with Venous Thromboembolism.

Patients with gliomas, particularly glioblastomas (GBM) have a higher risk of developing venous thromboembolism (VTE), including both pulmonary embolism (PE) or deep vein thrombosis (DVT), both correlating with overall survival (OS) and potential biological signaling relevance for analysis of the tumor state in conjunction with evolving biomarkers. Artificial intelligence (AI) approaches thar employ VTE as a clinical feature in brain tumor patients is understudied due to the difficulty in analyzing unstructured clinical data in electronic health records (EHR). Data expansion by creating a word lexicon for natural language processing (NLP) of free-text clinical reports will allow exposure of VTE for classification of large-scale data sets, NLP and AI. Patients with a pathologic diagnosis of GBM (2005-2021) were extracted from EHR and screened for the development of VTE based on radiology free-text reports - ultrasound (US) of extremities and Computed Topography-pulmonary angiogram (CT). Language data were collected manually and verified computationally using radiology report text filtration. Common phrases and words employed were collected to generate a lexicon for future computational analysis. Kaplan-Meier survival analyses were generated for VTE in relation OS and progression-free survival (PFS). A total of 163 patients (mean age = 56.1 ± 12.1, 65% male) were included, 48 (29.4%) were screened for VTE following clinical suspicion on history or physical exam, and 15 (9.2%) were found to have a VTE. Screening methods were US 83.3% (40) or CT 13.9% (6), or both 4.6% (2). 28.6% (12) of US and 37.5% (3) of CT resulted in a positive VTE diagnosis. Terms that were only detected in patients with VTE were for US: "complete" 44%, "thrombosis detected" (8.3%), "occlusive" (16%), "partial" (16%), "critical" (25%), "residual" (8.3%) and for CT: "critical" (67%) and "pulmonary emboli" (33%). Words used in free-text reports showed a high degree of inter-reporter variability. The words "partial", "residual", "complete", "critical" or "clotted" when used as an "or" Boolean statement applied to US and CT radiology reports identified ∼93% of the patients with VTE. Patients with VTE had worse OS (median 14 vs. 19 months, p = .0189) and PFS (median 6 vs. 9 months, p = .0239) compared to patients without VTE indicating underlying pathology associated with both prevalence of VTE and tumor burden and the need to incorporate VTE as a clinical feature in large scale data analyses. US and CT yield a similar percentage of positive VTE findings while employing different terms to characterize VTE. We confirm that patients with VTE have poorer outcomes and present a word combination that identifies patients with VTE in large-scale radiology report data. Further research will focus on validation in other datasets, NLP approaches to optimize and data aggregation with laboratory data and large-scale omics panels to expose thrombosis as a clinical feature for biomarker analysis.

Retracted: Study on the Correlation between the Prevalence of Venous Thromboembolism in Kazak Pregnant and Lying-In Women in Xinjiang.

[This retracts the article DOI: 10.1155/2022/7001743.].

Prior COVID-19 and Venous Thromboembolism Risk in Total Joint Arthroplasty in Patients Over 65 Years of Age

BackgroundThe COVID-19 pandemic has been associated with increased risks of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). However, there is limited literature investigating prothrombotic states and complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We investigated (1) trends in VTE, PE, and DVT rates post-THA and TKA from 2016 to 2019 compared to 2020 to 2021 and (2) associations between prior COVID-19 diagnosis and VTE, PE, and DVT. MethodsA national dataset was queried for elective THA and TKA cases from 2016 to 2021. We first assessed trends in 90-day VTE prevalence between 2016 to 2019 and 2020 to 2021. Second, we investigated associations between previous COVID-19 and 90-day VTE with regression models. ResultsFrom 2016 to 2021, a total of 2,422,051 cases had an annual decreasing VTE prevalence from 2.2 to 1.9% (THA) and 2.5 to 2.2% (TKA). This was evident for both PE and DVT (all trend tests P < .001). After adjusting for covariates (including vaccination status), prior COVID-19 was associated with significantly increased odds of developing VTE in TKA patients (odds ratio 1.2, 95% confidence interval 1.1 to 1.4, P = .007), but not DVT or PE (P > .05). There were no significant associations between prior COVID-19 and VTE, DVT, or PE after THA (P > .05). ConclusionsOur study suggests that a previous diagnosis of COVID-19 is associated with increased odds of VTE, but not DVT or PE, in TKA patients. Ongoing data monitoring is needed given our effect estimates, emerging COVID-19 variants, and evolving vaccination rates.

Incidence and risk factors for venous thromboembolism in the Cancer-VTE Registry pancreatic cancer subcohort

BackgroundThis substudy of the Cancer-VTE Registry estimated venous thromboembolism (VTE) incidence and risk factors in pancreatic cancer patients.MethodsThe Cancer-VTE Registry was an observational study that collected VTE data from patients with solid tumors across Japan. We measured baseline VTE prevalence, and at 1-year follow-up, the cumulative incidence of symptomatic and composite VTE (symptomatic VTE and incidental VTE requiring treatment), bleeding, cerebral infarction/transient ischemic attack (TIA)/systemic embolic event (SEE), and all-cause death.ResultsOf 1006 pancreatic cancer patients, 86 (8.5%) had VTE at baseline, and seven (0.7%) had symptomatic VTE. Significant risk factors of baseline VTE were Eastern Cooperative Oncology Group performance status (ECOG PS) of 1, body mass index (BMI) ≥ 25 kg/m2, history of VTE, D-dimer > 1.2 µg/mL, and hemoglobin < 10 g/dL. At 1-year follow-up, the cumulative incidence of events was higher for pancreatic cancer vs other cancers. Pancreatic cancer patients with VTE vs those without VTE had significantly higher incidences of bleeding, cerebral infarction/TIA/SEE, and all-cause death. No significant risk factors for composite VTE were identified.ConclusionsThe cumulative incidence of composite VTE during cancer treatment was higher in pancreatic cancer than in other cancer types. Some risk factors for VTE prevalence at cancer diagnosis were identified. Although VTE prevalence at cancer diagnosis did not predict the subsequent 1-year incidence of composite VTE, it was a significant predictor of other events such as all-cause death in pancreatic cancer patients.Trial registrationUMIN Clinical Trials Registry; UMIN000024942

HIDDEN2: Study protocol for the hospital deep vein thrombosis detection study in patients with cancer receiving palliative care

IntroductionMedical patients, admitted acutely to hospital, are at risk of venous thromboembolism (VTE). Clinical guidelines advise thromboprophylaxis prophylaxis for those at high risk of VTE. VTE is a common sequela...

Factor V Leiden, estrogen, and multimorbidity association with venous thromboembolism in a British-South Asian cohort

Multimorbidity, estrogen use, and Factor V Leiden (FVL) are known independent risk factors for venous thromboembolism (VTE). This cross-sectional analysis of women in the Genes& Health British-South Asian cohort (N 20,048) linked the F5 SNP rs6025 with estrogen prescribing data and VTE events. Multivariable logistic regression was used to test the association between estrogen use, FVL, common medical co-morbidities, and VTE. Estrogens were prescribed to 30% of women. 3% of participants were FVL carriers. 439 participants had a VTE event (2.2%), and VTE prevalence increased with obesity, hypertension, dyslipidemia, chronic kidney disease, estrogen use, and in the presence of FVL. One medical condition above wasindependently associated with VTE with an OR 1.6 (CI 1.2-2.0, p 0.001); two medical conditions OR 2.7 (CI 2.0-3.7, p<0.001); three OR 5.3 (CI 3.8-7.4, p<0.001); four OR 8.1 (CI 4.9-13.0, p<0.001). Multimorbidity and FVL compound risk of VTE with estrogen use.