Risk Factors For VTE Research Articles

VTE rates and risk factors in major trauma patients

BackgroundVenous thromboembolism (VTE) is a common and in some instances life-threatening complication following severe traumatic injury. Owing to a lack of high-quality evidence in VTE risk prediction and prevention in this cohort, major trauma patients receive variable VTE preventative care. The aim of this systematic review was to determine the reported rates of VTE in major trauma patients, and associated risk factors. MethodsA comprehensive database search was conducted using EBSCO/MEDLINE, EMBASE, CINAHL, Cochrane and Scopus to identify studies published between 1990 and 2023. Original Studies quantifying the occurrence of and/or evaluating risk factors for VTE, PE and DVT in a defined population were eligible for inclusion. Five reviewers screened, appraised, and extracted data from the selected studies. ResultsA total of 22 studies fulfilled the inclusion criteria. Most studies were conducted in Northern America (72%), followed by Asia (18%), and Europe (9%). Of the 22 studies, 17 were retrospective, 4 were prospective and 1 was the control arm of an RCT. The reported rates in included studies ranged from 0.39% to 32% (VTE), 0.59% to 57.60% (DVT) and 0.35% to 24.0% (PE). Operative procedure was the most consistently reported associated variable for DVT followed by delays to prophylaxis and pelvic injury. Lower extremity injury was the most frequently reported associated variable for PE followed by male sex and increased age. Age was the most frequently reported variable for both DVT and PE. ConclusionThere exists significant variation in the reported rates of VTE in major trauma patients globally. Operative procedure, delays to prophylaxis and pelvic injury were the most consistently reported associated variables for DVT. Lower extremity injury followed by male sex and increased age were the most frequently reported associated variables for PE. Although studies indicate possible differences in risk factors for DVT and PE, heterogeneity in study characteristics and outcome reporting impedes any meaningful conclusions. Reconciliation of VTE rates in major trauma patients is necessary when comparing populations.

FP2.6 - Opportunities for Improvement in Venous Thromboprophylaxis (VTE) of High-Risk Patients Hospitalized for Inflammatory Bowel Disease (IBD) Related Bowel Resection

Abstract Background IBD had a relative risk of 2.2 for VTE compared to the normal population. In May 2020, an international consensus created a statement on VTE prevention in IBD patients. 28days of extended thromboprophylaxis was recommended after discharge only in high risk patients. We aimed to identify high-risk patients for VTE post-IBD-related bowel resection. Methods Retrospective review of 131 patients over 5 years of surgical admissions for IBD-related resection at DGH. Examined factors included patients’ demographics, risk factors for VTE, disease history, and compliance with extended thromboprophylaxis. SPSS22 and Chi-square test were used for analysis. Results The median age was37years.76(58%) were female,74(56.5%) were white-British, Chron’s disease (CD) was98(74.8%), median disease duration was65 months, 101(77.1%) were done laparoscopically, 87(66.4%) were elective, and the median LOS was7days. 5 patients (3.7%) had VTE events. No postoperative stroke happened. DVT and PE were associated with failure of extended thromboprophylaxis prescription (P=0.004,0.000). All VTE events were seen in the 1st 10 days post-discharge. Occurrence of DVT was associated with white-British ethnicity(P=0.000), CD> ulcerative colitis (P=0.001), emergency > elective surgery (P=0.026), bowel anastomosis >stoma formation (P=0.029), ITU admission (P=0.000), Post-operative leak (0.0001), postoperative wound complications(P=0.000). Surgical approach, previous VTE event, and site of diseases weren’t associated with VTE occurrence (P=0.8,0.97,0.94). Conclusion IBD patients are vulnerable to VTE events more than the normal population. Bowel resection in this group of people needs attention for extended VTE prophylaxis, particularly in patients with CD, ITU admission, postoperative leak, and wound complications. These data outline opportunities for improvement, particularly in regard to the extended VTE prophylaxis for 28 days in the before-mentioned high-risk patients.

Risk factors and mortality associated with venous thromboembolism in the elderly US population with chronic lymphocytic leukemia

BackgroundVenous thromboembolism (VTE) causes morbidity and mortality in cancer patients. The association of VTE with known risk factors in chronic lymphocytic leukemia (CLL) is not known. ObjectiveTo examine risk factors and mortality associated with VTE in White, Black, and Asian CLL patients. MethodsThe United States SEER-Medicare database (2000–2015) was used for CLL patients ≥ 65 years. Logistic regression was used to examine VTE risk factors and Cox proportional regression was used to evaluate the effect of VTE on mortality in White, Black, and Asian CLL patients. ResultsAmong 34,075 CLL patients, VTE was diagnosed in 11.6 % of 31,395 White, 14.6 % of 2062 Black and 6.3 % of 618 Asian patients. Risk of having VTE was, ORa = 1.2 (95 % CI, 1.0–1.4) for Black patients and ORa = 0.5 (95 % CI, 0.4–0.7) for Asian patients compared to White patients. Anemia and heart failure were associated with VTE in all three racial cohorts and were the only risk factors in Asian patients. Other risk factors in White patients were the same as in the overall population, including hypertension, obesity, COPD, kidney disease, diabetes, hyperlipidemia, myocardial infarction, and chemotherapy. In Black patients, other risk factors were hypertension, and chemotherapy. Mortality was slightly higher with VTE in the overall population and in White patients. ConclusionThere was difference in VTE risk factors in White, Black, and Asian patients. VTE was marginally associated with mortality in CLL patients. Our findings may help to identify patients at higher risk of VTE in racially diverse CLL populations.

PREVALENCE OF VENOUS THROMBOEMBOLISM IN PATIENTS WITH TOTAL CONTACT CAST

BackgroundVenous Thrombo-Embolism is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers, frequently for long time periods. To our knowledge there is no literature stating the prevalence of VTE in patients undergoing TCC. We perceive that neuropathic patients with active charcot have other risk factors for VTE which would predispose them to this condition and would mandate the use of prophylaxis. We report a retrospective case series assessing the prevalence of VTE in the patients being treated with TCCs.MethodsPatients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events.ResultsThere were 143 TCC episodes in 104 patients. Average age at cast application was 55 years. Time in cast averaged 45 days (range 5 days – 8 months, median 35 days). 3 out of 4 patients had neuropathy as a consequence of diabetes. One TCC related VTE (0.7% of casting episodes) was documented. This was a proximal DVT confirmed on USS 9 days following cast removal. No patient received VTE prophylaxis while in TCC.ConclusionDespite these complex patients having a multitude of co-morbidities the prevalence of VTE in the TCC setting remains similar to that of the general population. This may be due to the fact that TCCs permit weight bearing. This case series suggests that, while all patients should be individually VTE risk assessed as for any lower limb immobilization, chemical thromboprophylaxis is not routinely indicated in the context of TCCs.

763 Is Central Venous Catheter the Main Culprit for Clinically Significant Venous Thromboembolism in Burn Patients

Abstract Introduction Venous thromboembolism (VTE) is a significant clinical problem for burn patients. The incidence of VTE has been reported as 0.25% to 47.1%. Known risk factors include large burn size, increasing age, male gender, active smoker or alcohol use, blood transfusion and surgeries. Central venous line (CVL) use is also a known risk factor for VTE. With all the known factors, we retrospectively analyzed our patients with VTE. Methods Retrospective chart review was performed on a single institution burn center in the calendar year of 2022. Pediatric patients were excluded. Following data were collected: age, burn size, mechanism, length of hospital stays, VTE diagnosis, VTE chemoprophylaxis, and central venous line days. VTE diagnosis was made using CT venogram or ultrasound. This project was a quality improvement initiative. Results There were 420 patients in the study period. Of all the admitted patients, there were 6 patients diagnosed with 7 VTE. One patient had 2 separate diagnoses of VTE at 2 distinct period and anatomical site. The incidence of VTE is 1.7%. Upon further chart review, all the VTE were at the site of central venous catheters. All the patients were on VTE chemoprophylaxis. The correlation between burn size, age, length of hospital stay and VTE was not significant. Conclusions Risk of VTE is high in burn patients due to the correlation with the Virchow’s Triad. All the patients admitted to the burn unit are placed on chemoprophylaxis unless contraindicated. The 7 patients diagnosed with VTE were on chemoprophylaxis. All the VTE were at the site of central venous catheter insertion sites, which is a known complication of catheters. The incident of 1.7% is on par with VTE incidents of burn patients, but much less than VTE caused by central venous catheters in non-burn patients. Large multicenter data collection is needed to validate this finding. Applicability of Research to Practice Directly appliable

120 Venous Thromboembolism Prophylaxis in Burn Patients

Abstract Introduction Venous thromboembolism (VTE) is extensively studied in trauma patients, but burn patients require special consideration due to their unique pathophysiology and management strategies. Currently, there are no specific prophylaxis recommendations to help mitigate VTE in burn patients. Methods The US National Trauma Data Bank (NTDB) was analyzed to identify patients with burn encounters from 2017-2021 using ICD-10 event codes. Our primary outcome measure was incidence of VTE, which included deep venous thrombosis and pulmonary embolism. Secondary outcome measures included need for blood transfusion and need to return to the operating room due to hemorrhage from skin/soft tissues/extremities. Multivariable regressions were conducted to evaluate the relationship between various VTE prophylaxis types and timing of VTE prophylaxis and VTE incidence while controlling for age, sex, %TBSA and inhalation injury. Results A total of 326,614 patients with burn injuries were identified in the NTDB during the study period, of whom 5,604 (1.7%) had a VTE event during their hospital admission. The majority of patients did not receive VTE prophylaxis (54.1%). Of those that did, the most commonly used VTE prophylaxis was LMWH (37.9%), followed by unfractionated heparin (4.1%). When controlling for age, sex, inhalation injury, and %TBSA, unfractionated heparin and LMWH were significantly associated with an increased risk of VTE (heparin: OR=1.8 95% CI 1.3-2.5, p < .001; LMWH: OR=1.5 95% CI 1.2-1.8, p < .001). Longer time to VTE prophylaxis was significantly associated with increased odds of VTE when controlling for the same covariates (OR=1.04 95% CI 1.03=1.07, p < .001). Neither VTE prophylaxis type nor timing of VTE prophylaxis administration was significantly associated with an increased need for blood transfusion. Heparin was the only VTE prophylaxis type significantly associated with increased odds of returning to the OR for a bleeding-related complication (p < .001). Conclusions A majority of burn patients in the NTDB did not receive VTE chemoprophylaxis, and counterintuitively, patients who received VTE chemoprophylaxis had higher rates of VTE than patients who did not, despite controlling for known VTE risk factors. In patients who did get chemoprophylaxis, unfractionated heparin is associated with a higher rate of VTE and surgical bleeding complications when compared with LMWH. Delayed initiation of VTE prophylaxis correlates with a higher likelihood of VTE occurrence. These findings underscore the importance of better studying and developing specialized VTE prevention guidelines for burn patients to enhance their care and outcomes. Applicability of Research to Practice Prompt initiation of VTE prophylaxis is essential to reduce the risk of VTE among burn patients, highlighting the importance of timely interventions. Developing specialized VTE prevention guidelines for this population can enhance their care and outcomes.

Incidence and characteristic of deep venous thrombosis in hospitalized chronic heart failure patients.

This study was conducted to investigate the incidence of deep venous thrombosis (DVT), outcomes and its characteristics in patients with chronic heart failure (CHF) in a retrospective setting. Patients died of cardiac shock or acute exacerbation of heart failure (HF), admitted to intensive care unit (ICU) due to acute exacerbation of HF, patients decided to withdraw treatment and return home due to acute exacerbation of HF. From January 2015 to June 2022, we admitted 359 patients diagnosed with CHF, and lower limb ultrasonography was performed for the examination of DVT after admission. The incidence of DVT was recorded and patients with known risk factors of VTE were identifiedand excluded after incidence of DVT was calculated. Patients' clinical data were thencollected. The occurrence of DVT was 10.0% (36/359), as calf intramuscular vein thrombosis was the main constitution (n = 28, 75%). DVT patients with other factors (carcinoma, surgery, stroke, previous history of DVT) constituted a considerable part (33.3%, 12/36). Age, history of Diabetes Mellitus (DM), levels of DDi (D-Dimer), levels of alanine transferase (ALT) and left ventricular end-diastolic diameter (LVEDd) were independent predictors or risk factors of DVT in CHF patients, while chronic kidney disease (CKD) stage 1-4, white blood cell (WBC) and direct oral anticoagulant (DOAC) were protective factors. Incidence of DVT was correlated with a poor outcome of CHF patients (Pearson Chi-Square test, Value 19.612, P < 0.001). In this retrospective study, incidence of DVT was found to be relatively high among hospitalized CHF patients, while patients with DVT was associated with a poor prognosis.

Comparison of enoxaparin 40 mg versus 60 mg dosage for venous thromboprophylaxis in patients undergoing bariatric surgery: A randomized controlled trial

BackgroundVenous thromboembolism (VTE) is a common cause of morbidity and mortality after bariatric surgery. Morbid obesity is an independent risk factor for VTE, with goals of prophylactic anti-factor Xa levels within 0.2–0.5 IU/mL. The recommended dosing regimen of enoxaparin for VTE prophylaxis in patients with morbid obesity is lacking in available guidelines. ObjectivesTo evaluate the achieving prophylactic anti-factor Xa levels with different dosages of enoxaparin for morbid obesity patients. SettingWe conducted a study at Chulalongkorn Bariatric and Metabolic Institute, King Chulalongkorn Memorial Hospital. MethodsWe conducted a randomized controlled trial comparing anti-factor Xa levels 4 h after the administration of enoxaparin. All recruited patients randomly received 40 mg or 60 mg of enoxaparin 12 h before the operation. Blood specimens were collected 4 h after the administration of enoxaparin. ResultsIn total, 56 patients who presented between April 2019 and March 2020 at King Chulalongkorn Memorial Hospital were recruited. Of these patients, 28 received 40 mg and 28 received 60 mg of enoxaparin. In both groups, the rates of achieving target levels were 53.57% and 78.57%, respectively (p-value = 0.048). The mean anti-factor Xa levels were 0.19 IU/mL ± 0.06 IU/mL and 0.28 and 0.28 ± 0.10 IU/mL, respectively (p < 0.001). No significant difference was found in the estimated blood loss between the groups. No patient obtained anti-factor Xa levels exceeding 0.5 IU/mL. In both groups, no symptomatic VTE occurred. ConclusionsA 60 mg of enoxaparin regimen achieved more prophylactic anti-factor Xa levels than 40 mg in obese patients undergoing bariatric surgery without any adverse events.

A pharmacoepidemiological nested case-control study of risk factors for venous thromboembolism with the focus on diabetes, cancer, socioeconomic group, medications, and comorbidities.

A pharmacoepidemiological study to assess VTE risk factors in a diabetes-rich population. The study comprised 299,590 individuals. We observed 3450 VTEs and matched them with 15,875 controls using a nested case-control approach and collected data on comorbidities and prescriptions. By multivariable conditional logistic regression, we calculated ORs with 95%CIs for comorbidities and medications to evaluate their associations with VTE. Diabetes (aOR 2.16; 95%CI 1.99-2.34), inflammatory bowel disease (1.84; 1.27-2.66), and severe psychiatric disorders (1.72; 1.43-2.05) had the strongest associations among the non-cancer comorbidities. Pancreatic (12.32; 7.11-21.36), stomach (8.57; 4.07-18.03), lung and bronchus (6.26; 4.16-9.43), and ovarian (6.72; 2.95-15.10) cancers were ranked as high-risk for VTE. Corticosteroids, gabapentinoids, psychotropic drugs, risedronic acid, and pramipexole were most strongly associated (aOR exceeding 1.5) with VTE. Insulin (3.86; 3.33-4.47) and sulphonylureas (2.62; 2.18-3.16) had stronger associations than metformin (1.65; 1.49-1.83). Statins and lercanidipine (0.78; 0.62-0.98) were associated with a lowered risk of VTE. In this cohort, with 50% diabetes prevalence, pancreatic, stomach, lung and bronchus, and ovarian cancers were strongly associated with VTE. Corticosteroids, gabapentinoids, and psychotropic medications had the strongest associations with VTE among medications. This may be valuable for generating hypotheses for the further research. Lercanidipine may be a novel protective medication against VTE.

Considering Colorectal Cancers as a Major Risk Factor for VTE

Considering Colorectal Cancers as a Major Risk Factor for VTE

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy.

Venous thromboembolism (VTE) is a potentially fatal complication of hepatectomy. The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding. Therefore, we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy. To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy. The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether or not they developed VTE after hepatectomy, as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities. Clinicopathological factors, including demographic data and perioperative D-dimer values, were compared between the two groups. Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value. Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors. In total, 234 patients who underwent hepatectomy were, of whom (5.6%) were diagnosed with VTE following hepatectomy. A comparison between the two groups showed significant differences in operative time (529 vs 403 min, P = 0.0274) and blood loss (530 vs 138 mL, P = 0.0067). The D-dimer levels on postoperative days (POD) 1, 3, 5, 7 were significantly higher in the VTE group than in the non-VTE group. In the multivariate analysis, intraoperative blood loss of > 275 mL [odds ratio (OR) = 5.32, 95% confidence interval (CI): 1.05-27.0, P = 0.044] and plasma D-dimer levels on POD 5 ≥ 21 μg/mL (OR = 10.1, 95%CI: 2.04-50.1, P = 0.0046) were independent risk factors for VTE after hepatectomy. Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

Late venous thromboembolism in survivors of adolescent and young adult cancer: A population-based study in California

IntroductionVenous thromboembolism (VTE), a common complication in cancer patients, occurs more often during the initial phase of treatment. However, information on VTE beyond the first two years after diagnosis (‘late VTE’) is scarce, particularly in young survivors. MethodsWe examined the risk of, and factors associated with, late VTE among adolescents and young adults (AYA, 15–39 years) diagnosed with cancer (2006–2018) who survived ≥2 years. Data were obtained from the California Cancer Registry linked to hospitalization, emergency department and ambulatory surgery data. We used non-parametric models and Cox proportional hazard regression for analyses. ResultsAmong 59,343 survivors, the 10-year cumulative incidence of VTE was 1.93 % (CI 1.80–2.07). The hazard of VTE was higher among those who had active cancer, including progression from lower stages to metastatic disease (Hazard Ratio (HR) = 10.41, 95 % confidence interval (CI): 8.86–12.22), second primary cancer (HR = 2.58, CI:2.01–3.31), or metastatic disease at diagnosis (HR = 2.38, CI:1.84–3.09). The hazard of late VTE was increased among survivors who underwent hematopoietic cell transplantation, those who received radiotherapy, had a VTE history, public insurance (vs private) or non-Hispanic Black/African American race/ethnicity (vs non-Hispanic White). Patients with leukemias, lymphomas, sarcoma, melanoma, colorectal, breast, and cervical cancers had a higher VTE risk than those with thyroid cancer. ConclusionsVTE risk remained elevated ≥2 years following cancer diagnosis in AYA survivors. Active cancer is a significant risk factor for VTE. Future studies might determine if late VTE should prompt evaluation for recurrence or second malignancy, if not already known.

Development of a Risk Assessment Tool for Venous Thromboembolism among Hospitalized Patients in the ICU.

ICU patients have a high incidence of VTE. The American College of Chest Physicians antithrombotic practice guidelines recommend assessing the risk of VTE in all ICU patients. Although several VTE risk assessment tools exist to evaluate the risk factors among hospitalized patients, there is no validated tool specifically for assessing the risk of VTE in ICU patients. A retrospective corhort study was conducted between June 2018 and October 2022. We obtained data from the electronic medical records of patients with a variety of diagnoses admitted to a mixed ICU. Multivariable logistic regression analysis was used to evaluate the independent risk factors of VTE. Receiver operating characteristic (ROC) curves were used to analyse the predictive accuracy of different tools. A total of 566 patients were included, and VTE occurred in 89 patients (15.7%), 62.9% was asymptomatic VTE. A prediction model (the ICU-VTE prediction model) was derived from the independent risk factors identified using multivariate analysis. The ICU-VTE prediction model included eight independent risk factors: history of VTE (3 points), immobilization ≥4 days (3 points), multiple trauma (3 points), age ≥70 years (2 points), platelet count >250 × 103/μL (2 points), central venous catheterization (1 point), invasive mechanical ventilation (1 point), and respiratory failure or heart failure (1 point). Patients with a score of 0-4 points had a low (1.81%) risk of VTE. Patients were at intermediate risk, scoring 5-6 points, and the overall incidence of VTE in the intermediate-risk category was 17.1% (odds ratio [OR], 11.1; 95% confidence interval [CI], 4.2-29.4). Those with a score ≥7 points had a high (44.1%) risk of VTE (OR, 42.6; 95% CI, 16.4-110.3). The area under the curve (AUC) of the ICU-VTE prediction model was 0.838, and the differences in the AUCs were statistically significant between the ICU-VTE prediction model and the other three tools (ICU-VTE score, Z = 3.723, P < 0.001; Caprini risk assessment model, Z = 6.212, P < 0.001; Padua prediction score, Z = 7.120, P < 0.001). We identified eight independent risk factors for acquired VTE among hospitalized patients in the ICU, deriving a new ICU-VTE risk assessment model. The model aims to predict asymptomatic VTE in ICU patients. The new model has higher predictive accuracy than the current tools. A prospective study is required for external validation of the tool and risk stratification in ICU patients.

Scrutinizing VTE risk factors in complex renal tumor patients: a comprehensive look at the VTE-RT-IVCTT study.

Scrutinizing VTE risk factors in complex renal tumor patients: a comprehensive look at the VTE-RT-IVCTT study.

Trends in deep vein thrombosis prophylaxis after total hip arthroplasty: 2016 to 2021

IntroductionVenous thromboembolism (VTE) has long been acknowledged as a potential complication of total hip arthroplasty (THA) contributing to heightened patient morbidity, mortality, and substantial healthcare costs. We aimed to: 1) assess trends in VTE prophylaxis utilization between 2016 and 2021; 2) determine the incidence of postoperative VTE and transfusions; and 3) identify independent risk factors for 90-day VTE and transfusion risks following THA in relation to the use of aspirin, dabigatran, enoxaparin, rivaroxaban, and warfarin. MethodsA national, all-payer database was queried from January 1, 2016 and December 31, 2022. Use trends for aspirin, enoxaparin, rivaroxaban, dabigatran, and warfarin as thromboprophylaxis following THA was assessed. Incidence of ninety-day postoperative outcomes assessed included rates of 90-day postoperative VTE and transfusion. ResultsFrom 2016 to 2021, aspirin (n = 36,346) was the most used agent for VTE prophylaxis after THA, followed by dabigatran (n = 13,065), rivaroxaban (n = 11,790), enoxaparin (n = 11,380), and warfarin (n = 6326). Independent risk factors for 90-day VTE included CKD, COPD, CHF, obesity, dabigatran, enoxaparin, rivaroxaban, and warfarin (all p < 0.05). ConclusionAspirin was used with increasing frequency and demonstrated lower rates of VTE and transfusion following THA, compared to dabigatran, enoxaparin, rivaroxaban, and warfarin. These findings seem to indicate that the increasing use of aspirin in VTE prophylaxis has been accomplished in appropriately selected patients.

The incidence and risk factors of newly-diagnosed cancer after diagnosis of venous thromboembolism: from the COMMAND VTE Registry-2

Abstract Background/Introduction Venous thromboembolism (VTE) may be the earliest sign of cancer, although there are no established screening strategies for occult cancer. This could be partly due to lack of the real-world incidence and risk factors of occult cancer after diagnosis of VTE in the current era. Purpose The current study aimed to evaluate clinical characteristics and outcomes between patients who were newly diagnosed with cancer after diagnosis of VTE and those who were not, and investigate incidence and risk factors of newly-diagnosed cancer after diagnosis of VTE, using a large-scale multicenter observational database of patients with VTE. Methods The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. The current study population was consisted of 3706 patients without known active cancer at diagnosis of VTE, who were divided into patients with newly-diagnosed cancer after diagnosis of VTE (N=250, 6.7%) and those without (N=3456, 93.3%). To explore risk factors of newly-diagnosed cancer, we constructed the multivariable Cox proportional hazard model which consisted of variables with P values &amp;lt;0.05 in univariate analysis. Results The cumulative incidences of newly-diagnosed cancer were 1.5% at 30-day, 3.7% at 1-year, 7.0% at 3-year, 11.1% at 5-year, and 16.0% at 7-year. The most common types of newly-diagnosed cancer was colon (17.2%), followed by lung (14.8%) and blood (8.0%). Patients with newly-diagnosed cancer were older (71.6 vs. 67.2 years, P&amp;lt;0.001) and had lower body mass index (22.9 vs. 23.8 kg/m2, P=0.004) than those without. Patients with newly-diagnosed cancer more frequently had several comorbidities such as history of cancer (35% vs. 11%, P&amp;lt;0.001), hypertension (51% vs. 44%, P=0.04), diabetes mellitus (21% vs. 16%, P=0.03), and autoimmune disorder (20% vs. 13%, P=0.004), whereas they less frequently had transient provoking risk factors for VTE (29% vs. 39%, P&amp;lt;0.001). The cumulative incidence of all-cause death was significantly higher in patients with newly-diagnosed cancer than those without (59.3% vs. 21.0% at 7-year). The multivariable Cox proportional hazard model revealed that old age (hazard ratio [HR]: 1.02 per 1 year [1.01-1.03], P&amp;lt;0.001), history of cancer (HR: 3.60 [2.75-4.67], P&amp;lt;0.001), autoimmune disorder (HR: 1.51 [1.09-2.05], P=0.01), and absence of transient provoking risk factors for VTE (HR: 1.36 [1.03-1.80], P=0.03) were independently associated with newly-diagnosed cancer after diagnosis of VTE. Conclusions In the current era, the incidence of newly-diagnosed cancer was 3.7% at 1-year with initial acute increase followed by continuous increase, and several independent risk factors were identified, which might be useful for consideration of optimal screening strategies for occult cancer based on individual risk.Newly-diagnosed cancer

Prothrombotic Profile in Patients with Active Multiple Myeloma and the Impact of Immunomodulators: The Roadmap-MM Study

Backround: Thromboembolism occurs in about 10% of patients with multiple myeloma (MM). The incidence of VTE is higher in newly diagnosed MM patients as compared to those with relapsed or refractory disease and it is higher during the first 3 to 6 months after the initial diagnosis and treatment initiation. Some of the treatments administered to patients with MM are independent risk factors for VTE. Immunomodulatory agents (IMiDs) among anti-myeloma treatments stand out as having a considerable prothrombotic effect. Recognizing the significant risk associated with the use of immunomodulatory agents (the International Myeloma Working Group (IMWG) 2014 statement, and the European Myeloma Network Guidelines in 2015 both included guidance on the prevention of VTE in MM patients who receive IMiDs. The prospective, longitudinal observational study ROADMAP-MM CAT was designed to explore alternative strategies for the development of risk stratification tools in patients with multiple myeloma. To this target we evaluated the baseline profile of hypercoagulability in multiple myeloma patients with various disease status. Blood borne hypercoagulabity partly consisted of enhanced thrombin generation, a common phenomenon in patients with malignancies . It remains to be seen whether this phenomenon appears for multiple myeloma patients during the physical course of the disease. Aim: We conducted a study to explore the relationship between stages of MM and alterations of various thrombosis-related biomarkers in patients with MM and their relationship with MM therapy. Materials and Methods Patients with MM (n=162) were recruited and stratified to the following groups: 59 newly diagnosed treatment-naïve patients (ND), 49 patients receiving IMiDs (IM), 52 in complete remission (CR) and 12 patients in partial remission on IMiDs (PR/IM). Patients on anticoagulant treatment were excluded from the study. The control group (CG) consisted of 30 healthy age and sex-matched individuals. Samples of platelet-poor plasma (PPP) were assessed for thrombin generation (TG) with the TF 5pM PPP-Reagent® on Calibrated Automated Thrombogram (Diagnostica Stago, France). Plasminogen activator inhibitor-1 (PAI-1), soluble endothelial protein C receptor (sEPCR), and soluble vascular cell adhesion molecule-1 (sVCAM-1), Procoag-PPL were measured using antibody-based ELISA kits (Invitrogen International Inc., CA, USA, and Diagnostica Stago, France ). TF expression MPC-derived microparticles (MPC-dMPs) were detected using a Zymuphen MP-TF activity kit (Hyphen BioMed, Neuville sur Oise, France). The upper and lower normal limits (LNL and UNL) were calculated by the mean±2 SD. Results A total of 162 patients were enrolled (age 66.0±12.0 yrs; 53% male). Distribution of disease stage was as follows: 32% ISS I, 23% ISS II, 45% ISS III. Bone disease was present in 71% of patients and 19% of patients had high risk cytogenetic lesions. Patients with ongoing MM (ND, IM, PR/IM) had significantly lower Peak, ETP and MRI as compared to the CG. In contrast, patients in CR had Peak, ETP, MRI values similar to the CG. Patients with PR had lower ETP and MRI values as compared to the CR group. In ND 9% had TG &amp;gt;UNL and 22% had TG&amp;lt;LNL. In IM 10% had TG&amp;gt;UNL and 67% had TG&amp;lt;LNL. None in PR/IM had TG&amp;gt;UNL and 35% had TG&amp;lt;LNL. In CR, 23% had TG&amp;gt;UNL and 12% had TG&amp;lt;LNL. MP-TF levels and PPL were higher in untreated MM (CR) patients compared to control. MP-TF and PPL levels decreased significantly after chemotherapy in PR/IM but MP-TF remained high at CR. The plasma concentrations, PAI-1, sEPCR, and sVCAM-1 were higher in MM patients than controls. , Treatment with IMDs reduced all biomarker levels gradually from PR/IM to CR (Table 1). Conclusion Patients with active MM showed attenuated TG which was enhanced in the presence of IMiDs treatment. Complete remission was associated with normalization of TG. The plasma concentrations, TF-MP , PAI-1, sEPCR, and sVCAM-1 were increased in MM patients suggesting vascular aggression which is followed by release of these markers that could contribute to the procoagulant environment. Attention should be paid to therapy-related thrombosis indeed the effect the suggested role of IMiDs in hypercoagulability does not seem to be confirmed and requires further studies .

Evaluating the effect of immune checkpoint inhibitors on venous thromboembolism in non-small cell lung cancer patients

ABSTRACT Objective Currently, immune checkpoint inhibitors (ICIs) therapy is one of the main methods of treatment in non-small cell lung cancer (NSCLC). This study aimed to explore the risk factors of VTE and evaluate the effect of ICIs on VTE in patients with NSCLC. Research design and methods We retrospectively studied patients with NSCLC who were divided into VTE group and without VTE (Non-VTE) group. We identified the risk factors of VTE in NSCLC patients and evaluated the effect of ICIs on VTE in NSCLC patients. Results We found that clinical stage III-IV (P = 0.015) and Khorana score (KS) ≥ 2 (P = 0.047) were independent risk factors for the occurrence of VTE in NSCLC, and treatment with ICIs reduced the risk of VTE occurrence (P = 0.028). There were no differences of survival rates in the 12-month (P = 0.449), 24-month (P = 0.412), or 36-month (P = 0.315) between the VTE and non-VTE groups. History of anti-angiogenic therapy (P = 0.033) and chronic obstructive pulmonary disease (COPD) (P = 0.046) were independent risk factors for VTE in NSCLC patients who were treated with ICIs. Conclusion This study suggests that we should strengthen anticoagulant therapy when using ICIs for NSCLC patients with a history of anti-angiogenic therapy and COPD.

FRI110 Prevalence Of Thromboembolic Events In 51 Patients Treated For Cushing’s Disease With Pituitary Surgery At University Hospital Of Wales Over A 15-year Period

Abstract Disclosure: R. Suresh John: None. J. Witczak: None. A. Rees: None. C. Hayhurst: None. A. Lansdown: None. Background: Hypercortisolism is associated with a hypercoagulable state and both arterial and venous thromboembolic events (TE). Aim: To determine the prevalence of TE in our cohort of patients with Cushing’s Disease (CD) undergoing pituitary surgery. Methods: Patients with a clinical &amp; biochemical diagnosis of Cushing’s Disease who had undergone pituitary surgery at University Hospital of Wales between 2007-2022 were identified from a database. Clinical, biochemical and radiological data were studied from the time of diagnosis to the period of 6 months following pituitary surgery. Results: 51 patients were identified: 15 Male, 36 Female, median age 46 (11-77)y. Total group: 5/51 (9.8%) patients had a TE. Pre-surgery: 2/51 (3.9%) had a TE (Deep vein thrombosis (DVT) = 1; Aortic thrombus = 1), both at time of diagnosis. Mean 24-h Urinary Free Cortisol (UFC) was 1126nmol in TE group vs 662nmol in non-TE group (p=0.64) and mean cortisol after overnight dexamethasone suppression test (ODST) was 251nmol/L in the TE group vs 327nmol/L in the non-TE group (p=0.64). Post-surgery: All patients received standard thrombo-prophylaxis with low-molecular weight heparin peri-operatively. 3/51 (5.9%) had TE within 6-months post-surgery (DVT=1, pulmonary embolism (PE)=1, cavernous sinus thrombosis=1), all occurred within 21 days of surgery and none had other risk factors for VTE. Mean time from diagnosis to surgery was 187 days in TE group vs 127 in non-TE group (p=0.43). At diagnosis, mean 24-h UFC was 560nmol in TE group vs 699nmol in non-TE group (p=0.82), mean cortisol after ODST was 420nmol/L in TE group vs 321nmol/L in non-TE group (p=0.46). Mean post-op cortisol was 221nmol/L in TE group vs 257nmol/L in no TE group (p=0.85). No TE events occurred between 22 days-6 months post-surgery. Conclusion: In our cohort, 9.8% patients had a TE event. 3.9% occurred pre-surgery and 5.9% in the early post-operative period, which concurs with data from other studies. There was no correlation with level of hypercortisolism and TE events in our group. Timing, dose &amp; duration of prophylactic anticoagulation in CD patients needs careful consideration. Presentation: Friday, June 16, 2023

PB0082 VTE Incidence and Risk Factors among Hospitalized COVID-19 Patients in Salvador -Brazil

PB0082 VTE Incidence and Risk Factors among Hospitalized COVID-19 Patients in Salvador -Brazil