Risk Factors For Thromboembolic Events Research Articles

Prethrombotic status and long-time thromboembolic events in primary hypertensive patients with or without elevated homocysteine level

To evaluate the association between homocysteine level and prethrombotic status and long-term thromboembolic events in patients with primary hypertension. Results between 110 hypertensive patients with elevated homocysteine (HCY) level were compared with 110 hypertensive patients with normal HCY level which were enrolled from October 2003 to November 2009. Fibrinogen (FIB), viscosity, thrombomodulin (TM), granule membrane protein (GMP-140), prethrombin F1+2 fragment (F1+2), D-dimer fragment (D-Dimer) and antithrombin III (AT-III) were measured and correlated to HCY and prethrombotic state. The endpoints of the study were arterial and venous thromboembolic events. The variables linked with arterial and venous thromboembolic events were included in Cox proportional hazard models. The event-free survival was illustrated with Kaplan-Meier survival curves and compared by the Log-rank test. The patients were followed up for 8-122 months (median follow-up time was 85 months). Compared with hypertensive patients with normal HCY, the plasma level of TM ((4.8±1.2) µg/L vs. (4.5±1.0) µg/L, P = 0.045), GMP-140 ((18.8±3.2) µg/L vs. (17.1±4.3) µg/L, P = 0.001), F1+2 ((1.2±0.4) nmol/L vs. (1.0±0.6) nmol/L, P = 0.004) were significantly higher while the plasma level of AT-III ((95.3±10.4) % vs. (98.6±10.6)%, P = 0.021) was significantly lower in hypertensive patients with elevated HCY level. FIB, viscosity of plasma and D-dimer were similar between the two groups. Multiple regression analyses indicated that HCY level was negatively correlated with AT-III (β = -0.199, P = 0.011) and positively correlated with age (β = 0.217, P = 0.04), female gender (β = 5.667, P = 0.001) and TM (β = 2.341, P = 0.003). Cox multivariate analysis revealed that age and HCY level were independent prognostic risk factors of thromboembolic events (OR 1.046, 95% CI 1.013-1.082, OR 1.052, 95% CI 1.027-1.078, respectively) (all P < 0.05). Kaplan-Meier curves showed that there was a significant difference in the event-free survival between the two groups (Log-rank test, P = 0.027). Compared with normal HCY hypertensive patients, the levels of plasma prothrombin activators such as TM, GMP-140 and F1+2 were significant increased and anti-thrombin factor such as AT-III was significant decreased in hypertensive patients with elevated HCY. Old age and high HCY level were independent prognostic risk factors of thromboembolic events. The event-free survival in hypertensive patients with elevated HCY is lower than in hypertensive patients with normal HCY level.

Abstract T P187: How High Is Too High? An Analysis of the Upper Threshold for Serum FVIII in Ischemic Stroke

Background: Elevated factor VIII (FVIII) is an independent risk factor for thromboembolic events and acute ischemic stroke (AIS). Laboratory reference ranges categorize levels &gt;150% and &gt;200% activity as elevated and severely elevated, respectively. We sought to identify the upper limit of FVIII activity with the most clinical relevance for outcomes after AIS. Methods: From our stroke registry, patients admitted with AIS between 07/2008 to 10/2013 were included if FVIII levels were measured during admission. Logistic regression, was used to assess differences in baseline, in-hospital, and outcome variables in patients with FVIII elevation as compared to those with normal levels. The primary outcome was poor modified Rankin Scale (mRS) score on discharge, defined as mRS&gt;2. Serial dichotomized FVIII levels using a 5-point incremental analysis of levels were analyzed with respect to poor outcome. The threshold yielding the largest area under the curve (AUC) was determined. Results: Among 1,453 cases in our registry, inclusion criteria were met for 267 patients. In our sample, in a comparison of normal FVIII levels vs. elevation &gt;150%, and elevation &gt;200%, patients differed significantly according to race (p=0.0017), history of diabetes (p=0.0001), and history of congestive heart failure (p=0.0401). FVIII elevation threshold of 150% was the best predictor of poor mRS on discharge (OR 3.7, 95% CI 1.77-8.05, p=0.0006) with an AUC of 0.618. Conclusions: FVIII elevation greater than 150% is the most clinically useful threshold for the prediction of poor clinical outcomes in the setting of AIS based on data from our center.

Abstract W P154: Von Willebrand Factor Elevation Threshold for Poor Clinical Outcomes in Patients with Ischemic Stroke

Background: Elevation in von Willebrand factor (vWF) is an independent risk factor for thromboembolic events and acute ischemic stroke (AIS). Laboratory reference ranges categorize levels &gt;150% activity as abnormal. Our prior research demonstrated worse outcomes with severe (&gt;200%) elevation in vWF. We sought to determine the most clinically relevant threshold value for vWF with respect to patient outcome in AIS. Methods: From our stroke registry, patients admitted with AIS between 07/2008-10/2013 were included if vWF levels were measured during admission. Logistic regression was used to assess differences in baseline, in-hospital, and outcome variables in patients with vWF elevation as compared to those with normal levels. Optimal threshold levels were determined by assessing dichotomized vWF levels using a 5-point incremental analysis of levels with respect to outcome, and subsequent determination of the threshold yielding the largest area under the curve (AUC). The outcome was poor modified Rankin Scale (mRS) score on discharge, defined as mRS&gt;2. Results: Among 1,453 cases in our registry, inclusion criteria were met for 99 patients. Compared to patients with normal vWF, elevated vWF was associated with age, female gender, and diabetes. vWF elevation threshold of 200% was the best predictor of poor mRS on discharge (OR 2.88, 95% CI 1.32-6.29, p=0.0079) with an AUC of 0.629. Conclusions: Despite a laboratory cut-off of 150% as a normal value, elevation of vWF &gt;200% is the most clinically useful threshold for the prediction of poor clinical outcome in the setting of AIS based on data from our center.

Cisplatin-Based Chemotherapy Is a Strong Risk Factor for Thromboembolic Events in Small-Cell Lung Cancer.

PurposeCisplatin-associated arterial and venous thromboembolic events (TEEs) are becoming an increasing concern. In patients with small-cell lung cancer (SCLC) who are treated using cisplatin-based chemotherapy, we assume that the overall risk of TEEs is high. However, cisplatin-associated vascular toxicity in patients with SCLC has been overlooked to date. The aim of this study was to determine the incidence of TEEs in patients with SCLC and to analyze the predictors for TEE occurrence.Materials and MethodsWe retrospectively analyzed 277 patients who received chemotherapy for SCLC between 2006 and 2012. As the influence of chemotherapy on TEE occurrence developed after its initiation, a time-dependent Cox regression analysis was used to estimate the significant predictors for TEE.ResultsAmong the 277 patients, 30 patients (11%) developed a TEE. The 3-month, 6-month, and 1-year cumulative incidences of TEEs were 5.0%, 9.1%, and 10.2%, respectively. Of 30 total TEEs, 22 (73%) occurred between the time of initiation and 4 weeks after the last dose of platinum-based chemotherapy. Approximately 218 patients (79%) received cisplatin-based chemotherapy. In multivariate analysis, cisplatin-based chemotherapy was an independent risk factor for TEE occurrence (hazard ratio [HR], 4.36; p=0.05). Variables including smoking status (common HR, 2.14; p=0.01) and comorbidity index (common HR, 1.60; p=0.05) also showed significant association with TEE occurrence.ConclusionThe 1-year cumulative incidence of TEE is 10.2% in Asian patients with SCLC. Cisplatin-based chemotherapy in SCLC might be a strong predictor for the risk of TEE.

Intravenous immunoglobulin-related thromboembolic events - an accusation that proves the opposite

Intravenous immunoglobulin-related thromboembolic events - an accusation that proves the opposite

Safety of C1-Esterase Inhibitor in Acute and Prophylactic Therapy of Hereditary Angioedema: Findings from the Ongoing International Berinert Patient Registry

The plasma-derived, pasteurized C1-inhibitor (C1-INH) concentrate, Berinert has a 4-decade history of use in hereditary angioedema (HAE), with a substantial literature base that demonstrates safety and efficacy. Thromboembolic events have rarely been reported with C1-INH products, typically with off-label use or at supratherapeutic doses. Active surveillance of safety and clinical usage patterns of pasteurized C1-inhibitor concentrate and the more recent pasteurized, nanofiltered C1-INH, with a particular interest in thromboembolic events. A registry was initiated in April 2010 at 27 US and 4 EU sites to obtain both prospective and retrospective safety and usage data on subjects who were administered C1-INH (Berinert). As of May 10, 2013, data were available for 135 subjects and 3196 infusions. By subject, 67.4% were using C1-INH as on-demand therapy and 23.0% as both on-demand therapy and prophylactic administration. Approximately half of the infusions (49.5%) were administered for prophylaxis and >90% were given by the patient or a caregiver in the home setting. A total of 299 adverse events were reported, for an overall rate of 0.09 events per infusion with only 6 considered related to C1-INH. Two thromboembolic events were reported, both in patients with prothrombotic risk factors. This large pool of real-world clinical usage data in HAE further supports the extensive safety profile of 2 Berinert formulations when used on demand and/or for prophylaxis in both home and health care settings. No evidence was found to suggest that Berinert is an independent, causative risk factor for thromboembolic events.

Incidence of a first thromboembolic event in carriers of isolated lupus anticoagulant

Among the so called antiphospholipid (aPL) antibodies Lupus Anticoagulant (LAC) is considered the strongest risk factor for thromboembolic events. In individuals without a previous thromboembolic event (carriers), LAC is a risk factor when associated with the presence of anticardiolipin (aCL) and aβ2-Glycoprotein I (aβ2GPI) antibodies. On the other hand, data on carriers of isolated LAC positivity are sparse and inconclusive. The aim of this study was to prospectively determine the incidence of thrombosis in a cohort of carriers of isolated LAC positivity. One-hundred seventy-nine carriers of LAC confirmed twelve weeks apart and in a reference laboratory were studied. During a total follow up of 552 person-years, there were seven thromboembolic events (1.3% person-y). All the seven patients had at least one adjunctive major risk factor for thrombosis. The cumulative incidence of thromboembolic events was 3.1% (95% CI 0.6-5.6) after 2years, and 5.9% (95% CI 1.2-10.6) after 5 and 10years. On a multivariate regression analysis considering age, sex, autoimmune disease, risk factors for arterial and venous thrombosis, use of aspirin, only age was found to be an independent predictor of thromboembolic events (HR=1.1, 95% CI 1.0-1.2, p=0.02). These data might be relevant in clinical practice and underline the importance of differentiating LAC carriers in terms of isolated positivity or positivity associated with the presence of antibodies to aCL and β2-glycoprotein I.

Http://esciencecentral.org/journals/left-atrial-slow-flow-and-its-potential-complication-2329-9517.1000147.php?aid=24959

It has been estimated that 2.2 million people in United States have paroxysmal or persistent atrial fibrillation. The incidence has increased 13% over the past 20 years and it seems to be on the rise. The most feared complication of atrial fibrillation is systemic thromboembolic events. Mitral stenosis and atrial fibrillation is risk factors for cardiac thrombus formation. We report an interesting case in which a 69-year-old male with rheumatic mitral stenosis, atrial fibrillation and congestive heart failure developed rapidly worsening dyspnea on anticoagulation. Subsequent investigation demonstrated impaired left ventricular systolic function, severe mitral valve stenosis and a large left atrial thrombus. Since the patient’s symptoms had worsened rapidly during a relatively short period of time, we hypothesize that the thrombus was obstructing blood flow through the left atrium and was causing the patient’s symptoms. Mitral valve stenosis, itself, is a risk factor for thromboembolic events. Combined with atrial fibrillation and left ventricular systolic dysfunction, slow flow in the left atrium may contribute to thrombus formation. Even though, our patient was anticoagulated, the stability of oral anticoagulation therapy is essential. We want to highlight one particular group of patients, classified as high risk, in which close clinical follow-up and more intense anticoagulation might be of benefit. Also, the possibility of thrombus formation in the left atrium should be considered when there is a sudden change in symptoms

Single institutional experience of prevalence and risk factors of thromboembolic events in children with solid tumors

Children with cancer are long-term survivors and sequelae from thromboembolic events (TEEs) that include postthrombotic syndrome can cause significant morbidity. Prevalence and risk factors in children with solid tumors are not well described despite some recent studies. If risk factors were better defined, it may be possible to institute appropriate strategies to prevent TEEs and sequelae. A single institution study was performed to investigate the prevalence and risk factors of TEEs in pediatric solid tumors; this included a retrospective analysis of children with central nervous system (CNS) and non-CNS solid tumors with and without TEEs. TEEs were observed in 7.16% of analyzed tumors, higher in the non-CNS (10.6%) than in the CNS tumor category (1.9% P <0.0066). Factors associated with significant risk of TEEs are as follows: presence of a mediastinal mass (P = 0.0005), metastatic disease (P = 0.0086), infection (0.0120), central venous access device (CVAD) (P = 0.0167), and steroids as chemotherapy (P = 0.01). In patients with CVADs, a mediastinal mass (P = 0.0024) and the type of CVAD (peripherally inserted central catheters were more significant risk factors compared with Mediport; P < 0.0001) were significant risk factors. There was a 3.5-fold increased risk of TEEs in patients with CVADs with an underlying diagnosis of lymphoma vs. CNS tumors. Patients with non-CNS solid tumors had increased prevalence of TEEs in our study. Risk factors included metastatic disease, presence of a mediastinal mass, CVAD use, infection, and the use of steroids. Our study underscores the need to conduct a prospective study to formulate the use of prophylactic anticoagulation in patients with identified risk factors to prevent TEEs.

Thromboembolic complications with Pipeline Embolization Device placement: impact of procedure time, number of stents and pre-procedure P2Y12 reaction unit (PRU) value

BackgroundThromboembolic events after Pipeline Embolization Device (PED) placement remain a feared complication among neuroendovascular surgeons. This study aimed to investigate potential risk factors for thromboembolic events in patients undergoing PED...

Systemic Chemotherapy Interferes in Homocysteine Metabolism in Breast Cancer Patients

Hyperhomocysteinemia in breast cancer (BC) patients can be a risk factor for thromboembolic events. This study aimed to evaluate homocysteine and its cofators (folic acid and vitamin B12) concentrations and platelet count at diagnosis of BC, 3 and 6 months after the beginning of chemotherapy treatment and to correlate them with clinical data. Thirty-five BC patients were included; blood samples were obtained by venipuncture. Plasmatic Hcy and cofactors concentrations were measured by competitive chemiluminescent enzyme immunoassay method. Platelet count was done using an automated analyzer. Statistical analysis was performed using the software SPSS. During chemotherapy, homocysteine (P = 0.032) and vitamin B12 (P < 0.001) concentrations increased, while folate and platelets decreased (P < 0.001). Among the clinical data, the menopausal status showed significant positive correlation (P = 0.022) with homocysteine concentration increase. Evaluation of homocysteine concentrations during chemotherapy is extremely important because their levels increase during chemotherapy treatment, thus increasing the risk of thromboembolism development.

Impact of Gender on the Prognosis of Patients With Nonvalvular Atrial Fibrillation

Treatment guidelines for atrial fibrillation (AF) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF (NVAF). The present study aimed to determine the impact of gender on prognosis of Japanese patients with NVAF. A subanalysis of 7,406 patients with NVAF (mean age 70 years) who were followed-up prospectively for 2 years was performed using data from the J-RHYTHM registry. The primary end points were thromboembolic events, major hemorrhaging, total mortality, and cardiovascular mortality. Compared with male subjects (n = 5,241), female subjects (n = 2,165) were older and displayed greater prevalences of paroxysmal AF, heart failure, and hypertension but less prevalences of diabetes, previous cerebral infarction, and coronary artery disease. Male and female patients had mean CHADS2 (Congestive heart failure, Hypertension, Age of 75 years or more, Diabetes mellitus and prior Stroke or transient ischemic attack) scores of 1.6 and 1.8, respectively (p <0.001). Warfarin was given to 87% of male patients and 86% of female patients (p = 0.760), and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline (1.91 vs 1.90, respectively, p = 0.756). Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging (odds ratio 1.59, 95% confidence interval 1.05 to 2.40, p = 0.027) and all-cause mortality (odds ratio 1.78, 95% confidence interval 1.25 to 2.55, p <0.002) but not for thromboembolic events (odds ratio 1.24, 95% confidence interval 0.83 to 1.86, p = 0.297) or cardiovascular mortality (odds ratio 0.96, 95% confidence interval 0.56 to 1.66, p = 0.893). In conclusion, female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin. However, male gender is a risk factor for major hemorrhaging and all-cause mortality.

Bilateral renal infarction: an uncommon presentation of fibromuscular dysplasia.

While fibromuscular dysplasia (FMD) is an established cause of secondary hypertension, its association with renal infarction is less well recognized. We report a middle-aged man who presented with complaints of loin pain and severe hypertension. Computed tomography angiography of the abdomen revealed bilateral renal infarction with multiple short-segment arterial dissection compatible with FMD in the absence of systemic vasculitis and other risk factors for thromboembolic events. Bilateral renal infarction complicating FMD is extremely rare and has so far been reported only in a handful of cases. Physicians encountering cases of otherwise unexplained renal infarction/ischemia need to be aware of this complication.

Mean platelet volume levels in patients with cardiac myxoma

Thromboembolic events such as cerebrovascular stroke are common and serious complications in patients with cardiac myxomas (CMs). Previous studies have reported that a high mean platelet volume (MPV) level reflects an activated platelet function and has been proven to be an independent risk factor for thromboembolic events. The aim of this study was to evaluate the relation between MPV level and CM. We compared the MPV levels between patients with CM and control subjects, and also evaluated the differences in the MPV levels in patients with CM before and after a successful surgical treatment. Furthermore, we compared the MPV levels in patients with and without cerebrovascular embolic symptoms. Fifty-one consecutive patients (13 men, 38 women, mean age 51.1 ± 16.9 years) who underwent excision of CM in our hospital in the last 13 years and 50 normal subjects as the control group were included in this study. The patients with CM were divided into two groups according to the presence or absence of cerebrovascular embolic symptoms. The preoperative and postoperative MPV levels of each CM patient was evaluated. MPV levels were found to be significantly higher in patients with CM than in control subjects (9.86 ± 1.30 fL vs. 7.63 ± 0.78 fL, p < 0.001). Moreover, the MPV levels significantly decreased after the surgical removal of CM (9.86 ± 1.30 fL vs. 8.68 ± 1.20 fL, p < 0.001). We also found that the MPV values were significantly higher in patients with neurological embolic events (10.55 ± 1.29 fL vs. 9.59 ± 0.78 fL, p = 0.016). We conclude that increased MPV levels might be considered as a marker of increased thromboembolic risk in patients with CM.

Stroke Stratification Scores in the Leipzig Heart Center AF Ablation Registry

All three stroke stratification scores are associated with risk of thromboembolic (TE) events in anticoagulated patients after radiofrequency catheter ablation of atrial fibrillation (AF). This article presents the information from the Incidence and Risk Factors for Thromboembolic Events After Catheter Ablation of Atrial Fibrillation: The Leipzig Heart Center AF Ablation Registry.

Patients with and without Left Ventricular Dysfunction Suffering from Acute Ischemic Stroke Benefit Similarly from Thrombolytic Therapy

Heart failure is an important risk factor for thromboembolic events and it is associated with a greater incidence of ischemic stroke and worse outcomes. However, little is known regarding results of thrombolytic therapy in patients with left ventricle systolic dysfunction suffering from ischemic stroke. In this scenario, where cerebral perfusion may be impaired by lower cardiac output, thrombolysis may not be as effective as expected.

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

Tranexamic acid (TXA) reduces blood loss and transfusion after total joint arthroplasty (TJA) but concerns remain that patients with severe medical comorbidities might be at increased risk for thromboembolic complications. Among patients undergoing primary TJA with severe systemic medical disease, (1) was TXA associated with increased symptomatic thromboembolic events; (2) was TXA associated with decreased blood transfusion rates; and (3) were there differences in symptomatic thromboembolism or transfusions in the subset of patients with a history of, or risk factors for; thromboembolic disease? We performed a retrospective review of 1131 primary TJAs in 1002 patients with American Society of Anesthesiologists score III or IV. Of these, 402 had at least one of seven risk factors for thromboembolic events and were designated as high risk; 240 of those patients received TXA. Outcome measures included 30-day postoperative symptomatic thromboembolic events and postoperative transfusion. There were no differences in symptomatic thromboembolic events within 30 days of surgery between patients who received TXA and those who did not (2.5% versus 2.6%, p = 0.97). Fewer patients treated with TXA received transfusions (11% with versus 41% without; p < 0.0001). In high-risk patients, TXA was not associated with an increase in symptomatic thromboembolic events (6.7% with versus 4.3% without; p = 0.27) and was associated with a decrease in transfusion rates (17% with versus 48% without; p = 0.001). Although TXA seemed safe and effective in this database review of patients with severe medical comorbidities, a larger prospective trial is warranted to confirm these results.

Evaluation of the safety and efficacy of warfarin in Taiwanese patients

The safety and efficacy of warfarin therapeutic range in Asians remain to be ascertained. Physicians in Taiwan consider Asians are more likely to have bleeding complications rather than thromboembolic events from warfarin. The aim of this study was to determine if the proper INR range for patients in Taiwan is different. A retrospective study was conducted with 161 patients on warfarin therapy for more than 24 consecutive months during March 1, 2006 to Sepember 30, 2008. Total follow-up time was 3,504 patient-months. The incidence rates of thromboembolic and bleeding events for INR categories were calculated. The overall incidence rates of INR ranges of < 1.5, 1.5 - 1.9, 2.0 - 2.4, 2.5 - 2.9, 3.0 - 3.4, and ≥ 3.5 were 8.1, 5.6, 2.0, 7.6, 33.3, and 121.2 per 1,000 patientmonths, respectively. The overall incidence rate at INR of > 3 is higher than that at INR of < 2 or 2 - 3 (p < 0.001), with the lowest incidence rate at INR between 2.0 and 2.4. When INR was maintained at a level < 2, patients taking warfarin for secondary prevention had a significantly higher event rate compared to the primary prevention group (p < 0.05). Age greater than 73 years was a risk factor for thromboembolic events before and after covariate adjustment. An INR range of 2 - 2.4 appeared to be associated with lower complications and better clinical outcomes in Taiwanese patients treated with warfarin. Lowering the intensity of anticoagulant therapy further does not decrease the number of events.

Proteinuria and hypoalbuminemia are risk factors for thromboembolic events in patients with idiopathic membranous nephropathy: an observational study

BackgroundPatients with nephrotic syndrome are at an increased risk of thromboembolic events (TEs). However, this association has not been thoroughly investigated in adult patients with idiopathic membranous nephropathy (IMN).MethodsA retrospective analysis of all 101 consecutive adult patients with MN diagnosed at our centre during 1995 to 2008 was performed. Pertinent data including thromboembolic events and the risk factors for TEs were recorded.ResultsThe cohort was followed for 7.2 ± 3 years. Out of 78 patients with IMN, 15 (19.2%) had at least one TE. No TEs occurred six months after diagnosis. The incidence of TEs in the first 6 months of diagnosis was 7.69% (95%CI, 2.5-17.0) and all patients except one had venous TEs. At the time of diagnosis of MN, the patients with TEs had lower serum albumin (1.9 ± 0.5 vs. 2.4 ± 0.4 g/dl, TE vs. no TE; p < 0.01) and greater serum cholesterol (414 ± 124 vs. 317 ± 108 mg/dl, TE vs. no TE; p = 0.01) and 24-h proteinuria (10.7 ± 3 vs. 7.1 ± 4 g, TE vs. no TE; p < 0.01). Multivariate logistic regression adjusted for age, sex, cholesterol and creatinine revealed, an odds ratio of 0.8 (95% CI 0.7 – 0.96; p = 0.01) for every one g/dl increase in baseline serum albumin and, an odds ratio of 1.3 (95% CI 1.05-1.58; p = 0.01) for one gram increase in 24-h proteinuria, for TEs.ConclusionsOur study finding confirms IMN as a prothrombotic state particularly in the first six months of diagnosis. Proteinuria, in addition to hypoalbuminemia, is a risk factor for TEs. These results have important implications for clinical care of patients with IMN, particularly with regards to initiation and duration of prophylactic anticoagulation.

1599P - Ambulatory Patients with Metastatic or Locally Advanced Cancer: is Body Mass Index ≥ 35 A Risk Factor for Thromboembolism also in European Countries?

ABSTRACT Introduction Five variables (site of cancer, platelet count, haemoglobin level, leukocyte count and body mass index [BMI]) define the Khorana risk score, predicting the high (≥ 3), the moderate (1-2) and the low (0) risk of thromboembolic events (TE) in cancer outpatients. This score has validated BMI ≥ 35 as a risk factors for TE in the USA. Methods The aim of our retrospectively study was to evaluate the incidence of a BMI ≥ 35 (obesity of second and third class), a BMI ≥ 30 (obesity of all classes) and a BMI ≥ 25 (all forms of overweight) among 1150 ambulatory cancer patients receiving chemotherapy enrolled in the PROTECHT study: a randomized, double-blind, placebo-controlled study, evaluating the efficacy (incidence of symptomatic TE) of subcutaneous injections of nadroparin (3800 IU anti-Xaonce a day). We evaluated also the distribution of TE among the three BMI categories. Results are reported in the table below as percentage and (Number of patients) for BMI distribution and number of detected TE for each BMI class: BMI ≥ 35 BMI ≥30 BMI ≥25 Treatment arm Pts TE Pts TE Pts TE PLACEBO 381 pts 1.3 (5) 1 13.4 (51) 2 51.2 (195) 5 NADROPARIN 769 pts 2.6 (20) 0 14.0 (108) 1 49.0 (377) 9 Conclusion In our study nearly 50% of patients with metastatic or locally advanced diagnosis of cancer are overweight and more than 25% of them are obese. The incidence of BMI ≥ 35 in a European cancer population seems to be negligible, otherwise all classes of overweight seems to be related to a higher risk of TE. A formal study is needed to evaluate the risk of all BMI classes as independent risk factors of TE among cancer patients. Disclosure T. Perrone: TP is employee of Italfarmaco S.p.A. All other authors have declared no conflicts of interest.