Risk Of Developing Venous Thromboembolism Research Articles

Thromboembolism risk in patients diagnosed with EGFR- and ALK-mutant lung adenocarcinoma

In this study, we investigated the incidence of venous thromboembolism (VTE), related risk factors for VTE, and the effect of VTE on overall survival in patients with non-small-cell lung cancer harboring epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations. The study included patients older than 18 years of age who were diagnosed with histologically proven locally advanced or advanced-stage adenocarcinoma and were followed in our center between January 2014 and December 2019. These patients were divided into two groups: one comprising mutation-positive individuals and the other mutation-negative individuals. We examined factors influencing the occurrence of VTE, assessed the incidence of VTE, and compared the differences in overall survival. Univariate Cox regression analysis revealed that the independent predictors of VTE were the number of metastases (Hazard ratio [HR]: 3.784; 95% confidence interval [CI]: 2.198 – 6.515; P < 0.001) and the presence of EGFR exon 21 mutations (HR: 2.386; 95% CI: 1.276 – 4.462; P = 0.006). However, in multivariate analysis, only the number of comorbidities was associated with an increased risk for VTE (HR: 3.462; 95% CI: 1.977 – 6.060; P < 0.001). It is essential to consider the risk of VTE development in patients with EGFR exon 21 mutation-positive lung adenocarcinoma. Physicians should be vigilant in terms of screening, prophylaxis, and follow-up for underlying VTE in these patients.

229. Using machine learning (ML) models to predict risk of venous thromboembolism (VTE) following spine surgery

229. Using machine learning (ML) models to predict risk of venous thromboembolism (VTE) following spine surgery

Immune activation and inflammatory biomarkers as predictors of venous thromboembolism in lymphoma patients

BackgroundLymphomas are characterized by elevated synthesis of inflammatory soluble mediators that could trigger the development of venous thromboembolism (VTE). However, data on the relationship between specific immune dysregulation and VTE occurrence in patients with lymphoma are scarce. Therefore, this study aimed to assess the association between inflammatory markers and the risk of VTE development in patients with lymphoma.MethodsThe erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase (LDH), total protein (TP), and albumin were assessed in 706 patients with newly diagnosed or relapsed lymphoma. Data were collected for all VTE events, while the diagnosis of VTE was established objectively based on radiographic studies. ROC (receiver operating characteristic) curve analysis was performed to define the optimal cutoff values for predicting VTE.ResultsThe majority of patients was diagnosed with aggressive non-Hodgkin lymphoma (58.8%) and had advanced stage disease (59.9%). Sixty-nine patients (9.8%) developed VTE. The NLR, PLR, ESR, CRP, and LDH were significantly higher in the patients with lymphoma with VTE, whereas the TP and albumin were significantly lower in those patients. Using the univariate regression analysis, the NLR, PLR, TP, albumin, LDH, and CRP were prognostic factors for VTE development. In the multivariate regression model, the NLR and CRP were independent prognostic factors for VTE development. ROC curve analysis demonstrated acceptable specificity and sensitivity of the parameters: NLR, PLR, and CRP for predicting VTE.ConclusionInflammatory dysregulation plays an important role in VTE development in patients with lymphoma. Widely accessible, simple inflammatory parameters can classify patients with lymphoma at risk of VTE development.

Prophylaxis for venous thromboembolism in liver disease: a narrative literature review

Background: Patients with liver disease have traditionally been regarded as auto-anticoagulated against developing blood clots due to haemorrhage being regarded as the most significant haemostatic complication. More recently, there has been increasing recognition that hypercoagulability is a prominent aspect of cirrhosis, with an increasing number of patients developing thromboembolisms. When prescribing prophylactic low molecular weight heparin for prevention, clinicians are often concerned about the risk of bleeding, including gastrointestinal bleeding, specifically in those with decompensated liver disease and cirrhosis, due to the altered coagulopathy associated with these patients. Aim: The aim of this review was to assess if the use of prophylaxis in patients with liver disease is effective in the prevention of venous thromboembolism (VTE) and whether its use is related to an increase in bleeding episodes. Methods: A review of the literature was conducted to identify the incidence of VTE and bleeding in liver patients when given prophylactic VTE treatment. Results: The majority of evidence was inconclusive; however, the main emerging theme was that administering prophylaxis to patients with decompensated liver disease results in an increased risk of bleeding, while having little effect on reducing the risk of VTE development. Conclusion: The bleeding risk associated with VTE prophylaxis treatment and liver disease remains uncertain. Thus the ideal methods of medical prophylactic VTE prevention and monitoring in this patient population have not yet been determined. It is suggested that additional consideration should be given to serum albumin, platelet count and international normalised ratio, as well as renal function, in conjunction with risk assessment tools, when deciding whether to prescribe VTE prophylaxis or not.

Venous thromboembolism risk and adequacy of thromboprophylaxis in surgical patients

Venous thromboembolism (VTE) is the most prevalent potentially preventable complication amongst surgical patients. Appropriate prophylaxis is quite effective in its prevention. Mechanical and pharmacological thromboprophylaxis can be instituted based on risk categorisation. This study was undertaken to assess the risk for development of VTE in surgical patients and to assess the adequacy of thromboprophylaxis. A descriptive research design was used and was conducted in the general surgical wards of a tertiary hospital in South India. All 385 patients who were admitted in the surgical wards during the data collection period were included in the study, and the VTE Risk Assessment Tool by the Department of Health (2008b), UK, was used to assess the VTE risk in these patients. Eighty per cent of the patients were at high risk for developing VTE, and majority (62.7%) of them were not on any method of thromboprophylaxis. Only a minority (11.7%) of those who belonged to moderate or low risk were found to be on thromboprophylaxis. Majority of the patients who were found to be at high risk and were on prophylaxis for VTE were on anti-embolism stockings. More than half of the patients who were at low or moderate risk for VTE were found to be on injection heparin administered subcutaneously. There was a statistically significant association between age, type of occupation, the number of days of hospital stay, type of surgery, mobility level of patients and the VTE risk. Implementation of VTE risk assessment tool and a protocol for thromboprophylaxis helps in prevention of VTE and the complications associated with thromboprophylaxis. Incorporating this topic as a regular in-service education can ensure its mandatory learning and practice by nurses – the front line caregivers.

NCMP-10. IDH MUTATION STATUS AND THE DEVELOPMENT OF VENOUS THROMBOEMBOLISM IN ASTROCYTOMA PATIENTS

Abstract OBJECTIVE Examine whether the status of the isocitrate dehydrogenase (IDH) gene is a risk factor for the development of venous thromboembolism (VTE) in astrocytoma patients. BACKGROUND The risk of venous thromboembolism (VTE) is high for patients with gliomas (10–30%). Unfortunately, biomarkers and predictive models for development of a VTE in brain cancer have not been validated. Prior research has suggested that IDH wildtype gliomas are at higher risk for development of VTE compared to IDH mutant tumors. DESIGN/METHODS We conducted a retrospective chart review of glioma patients enrolled in the PROACTIVE (Prospective Assessment of Correlative Biomarker) study at MD Anderson Cancer Center (MDACC). We obtained demographics, date of tumor diagnosis, initial pathology, IDH status (mutated or wildtype), extent of initial resection, KPS at time of initial resection, history of VTE, development of VTE, type of VTE (PE/DVT), KPS at time of VTE, treatment for VTE, bleeding complications, glioma treatments, date of last follow up and/or death. RESULTS We identified 282 astrocytoma patients consisting of 49 IDH mutant and 233 IDH wildtype astrocytomas. Glioblastoma was the histopathologic diagnosis in 30 (61.2%) of the IDH mutated astrocytomas compared to 227(97.4%) of the IDH wild type astrocytomas. VTE was identified in 52 (18.4%) of patients. VTE was diagnosed in 7 (14.3%) of the IDH mutated astrocytomas compared to 45 (19.3%) of the IDH wild type astrocytomas (p = 0.4094). Median time to VTE from diagnosis was 2.71 months. Median time to VTE from diagnosis was 2.6 months for IDH mutated astrocytomas compared to 3.06 months for the IDH wild type astrocytomas (p =0.8663). CONCLUSIONS IDH gene status did not appear as a significant risk factor for the development of venous thromboembolism (VTE) in our cohort of astrocytoma patients. Further research into potential biomarkers for VTE may be warranted.

A retrospective analysis of venous thromboembolism trends in chemotherapy-induced anemia.

e15515 Background: Anemia is a common and unfortunate consequence of chemotherapy. Patients receiving a variety of chemotherapy regimens often develop chemotherapy–induced anemia (CIA), which contributes to poor outcomes, including increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Despite the baseline coagulopathies present in patients with malignancy, administration of RBC transfusions is associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive single or multiple RBC transfusions. Methods: A retrospective study analyzed 10,269 University of Pennsylvania Health System patients with malignancies of various type, stage, and histopathology who developed CIA between 5/1/08-12/31/17. We analyzed rates of VTE development after adjusting for RBC intervention with a 95% confidence interval during the 90 days following CIA diagnosis. Results: Among the 10,269 patients with CIA, 2,008 patients (19.6%) received only RBC transfusion as anemia treatment; of that group, 545 (27.1%) developed a VTE. Transfusion of 2+ units RBC compared with 1 unit of RBC was associated with an increase in VTE development (RR = 1.37, 95% CI 1.09-1.72). The relationship of higher VTE development with increasing number of transfusions is displayed below. Conclusions: While RBC transfusion in patients with CIA is independently associated with VTE, our data further suggests an exponential risk of VTE development with increasing numbers of RBC transfusions. [Table: see text] [Table: see text]

A retrospective analysis of venous thromboembolism trends in chemotherapy-induced anemia: Red blood cell transfusion versus erythrocyte stimulating agent (ESA) administration.

e14685 Background: Anemia is a common and unfortunate consequence of chemotherapy; patients receiving a variety of chemotherapy regimens often develop chemotherapy–induced anemia (CIA), which contributes to poor outcomes including increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Optimal therapy of CIA is controversial and involves the solitary and combined use of intravenous iron, red blood cell (RBC) transfusions, and erythropoietin stimulating agents (ESAs). Despite the baseline coagulopathies present in patients with malignancy, administration of both RBC transfusions and ESAs is associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive RBC transfusions or ESAs. Methods: A retrospective single-institution study analyzed 7360 patients with varying malignancies who developed CIA and received ESAs and RBC transfusion from 1998-2017. These patients were evaluated for subsequent development of VTE and categorized by prior receipt of RBC transfusion or ESA. Results: Among the 7360 patients with CIA, 5503 received either RBC transfusion or ESA and 1857 received both. Among all patients, 3466/7360 (47.1%) developed a VTE. The absolute risk of developing a VTE with receipt of a RBC transfusion was 0.38 compared to 0.19 with ESA. Patients with CIA who received RBC had twice the risk of developing a VTE compared with those who received ESA (p < 0.0001). Conclusions: While both RBC transfusion and ESA administration are independently associated with VTE, our data suggests a greater risk of VTE development with RBC transfusion as compared with ESA administration.[Table: see text]

The value of Caprini thrombosis risk assessment in postoperative patients with lung cancer

Objective To analyze the effectiveness of Caprini thrombosis risk assessment model in the screening of patients with non-metastatic lung cancer after venous thromboembolism (VTE). Methods A retrospective analysis of 136 patients with postoperative lung cancer who were admitted to our department between October 2015 and October 2017 was followed up for 2 months. According to the follow-up results, the patients were divided into VTE group and non-VTE group. The VTE group was further divided into the PE group and the deep venous thrombosis (DVT) group according to the embolization type. Comparisons were made between the two groups for general clinical data, surgically related parameters, and differences in Caprini scores. Univariate analysis was used to assess the risk factors associated with postoperative VTE in the relevant clinical parameters in the Caprini thrombosis risk assessment model. Statistically significant parameters in the single factor were included in multivariate analysis to assess independent risk parameters for VTE. Results There were 39 cases in VTE group and 97 cases in non-VTE group. Among them, 28.2% (11/39) of VTE events occurred after discharge. The hospitalization time and Caprini risk scores in VTE group were (16.3±3.6) days, (10.5±2.4) points, which were significantly higher than (8.9±3.4) days, (9.3±2.1) points in non-VTE group (t=11.287, 2.891, P<0.01). In the VTE event, the onset time in the PE group was significantly advanced (P=0.019), and both the length of hospital stay and Caprini score were significant. It was worse than DVT group (P<0.05). When Caprini's high-risk risk cut-off was 9 points, the accuracy was 76.5%, the positive predictive value was 58.1%, the negative predictive value was 84.9%, and the sensitivity and specificity were 64.1% and 81.4%, respectively. Multivariate analysis of relevant clinical parameters in the caprini thrombosis risk assessment model showed swelling in the lower extremities (P<0.01), varices (P<0.01), sepsis (P<0.01), and severe acute lung disease (P<0.01). Congestive heart failure (P<0.01), central venous catheter (P<0.01), and VTE history (P<0.01) were all independent risk factors associated with VTE events. The risk of developing VTE in postoperative patients with moderate-and high-risk lung cancer was 3.5 and 8.4 times higher than that in low-risk patients. Conclusion Combining the Caprini thrombosis risk assessment model during postoperative care is most likely to predict the risk of developing VTE in postoperative patients with lung cancer, and the use of 9 points as a high-risk cutoff for the Caprini Thrombotic Risk Score has better sensitivity and Specificity. Key words: Lung neoplasms; Postoperative complicatlons; Venous thromboembolism; Caprini thrombosis risk assessment model

Compound Homozygous Factor V Leiden and Heterozygous Prothrombin Gene Mutation: The First Report in a Pregnant African with Extensive Thrombosis

Background: Factor V Leiden (FVL) mutation and Protein gene G20210A mutation (PGM) are the most common inherited thrombophilias in the world. (Limdi NA et.al, Blood Cells Mol Dis. 2006 Sep-Oct;37(2):100-6) Both are inherited in an autosomal recessive fashion with individuals who are homozygous having higher risk of thrombosis compared to those who are heterozygous.(Rodger MA et.al, PLoS Med. 2010 Jun 15;7(6):e1000292.) The global prevalence of FVL and PGM is variable with Caucasians carrying the highest prevalence and Africans living in Africa, Asians and Native Americans having the lowest rate of these mutations; it is zero in West and Southern African countries, 2.4%-3.9% in North African countries including Morocco, Tunisia, and Algeria. (Limdi NA et.al, Blood Cells Mol Dis. 2006 Sep-Oct;37(2):100-6, Dziadosz M et. al, Blood Coagul Fibrinolysis. 2016 Jul;27(5):481-9)Pregnancy increases the risk of developing venous thromboembolism (VTE) by 0.05-1.8 %, (Eldor A, Thromb Haemost. 2001 12.12.2017;86(07):104-11) which is 4 to 5 fold greater than in non-pregnant female.(Croles FN et.al, BMJ. 2017;359, Greer IA, N Engl J Med. 2015 Aug 6;373(6):540-7) Inheritance of FVL and PGM increases the risk for development of VTE in pregnancy, the risk is higher with homozygous than heterozygous mutations.(Rodger MA et.al, PLoS Med. 2010 Jun 15;7(6):e1000292.) Concurrent presentation of FVL and PGM in pregnancy presenting as thrombosis is not common.Aim: The aim of this case report is to present a patient of African descent with concurrent FVL and PGM mutation who had thrombosis during pregnancy.The Case: A 32-year-old Nigerian female who was 28 weeks pregnant presented to the gynecologist with a swollen left leg. Physical examination and the Wells score were very suggestive of a deep vein thrombosis (DVT). The Duplex Doppler performed confirmed a diagnosis of bilateral lower limb DVT. The patient was referred to a physician, who together with the haematologist performed a thrombophilia screen including FVL, PGM, Protein C, Protein S and Anticardiolipin antibody tests. The D-DIMERS were raised and the viral markers including HIV, HBV, and HCV were negative. The PT, APTT and full blood counts were normal. The thrombophilia tests revealed that the patient was homozygous for FVL and also heterozygous for the PGM mutations. The rest of the thrombophilia screen including Protein C, Protein S and Antithrombin tests were all negative. She has no family history of thrombosis; no past history of hormone based contraceptives. She was counselled on the need for using anticoagulation, low molecular weight heparin (LMWH) during the rest of her pregnancy period, and therapeutic anticoagulation with a LMWH at a dose of 1mg/kg twice a day until onset of labour was started. During labour LMWH was discontinued, delivery was per vaginal and was uncomplicated. Postpartum LMWH was continued at therapeutic doses for six weeks with no bleeding or thrombotic events. After six weeks, the patient was started on lifelong warfarin.Results (See Table)Discussion: To our knowledge this is a first case of a patient born and living in Africa presenting with thrombosis and found to have homozygous FVL and heterozygous PGM during pregnancy, the one report that is similar was in a second generation South African woman of German, Dutch and French ancestry. (Wilson J et. al, Medical Technology SA. [Case Report]. December 2011;25(2):4) Most reports have shown ethnic and regional affectation. (Limdi NA et.al, Blood Cells Mol Dis. 2006 Sep-Oct;37(2):100-6, Bavikatty NR, et.al, Am J Clin Pathol. 2000 Aug;114(2):272-5)There is no single agreed reason as to why the mutation is rare in Africa though founder effect is being studied to define how the mutation came about, it could have taken place before divergence of race. (Jadaon MM. [Thrombosis, Familiar Thrombophilia]. 2011 2011-11-28;3(1)We could not do family studies to help define the origin of this mutation whether it is denovo for Nigeria; this has to do with sentiments about genetic inheritance in Africa.Conclusion: Concurrent inheritance of both FVL and PGM is possible in Africa. This rare case has open opportunities to revisit the prevalence of thrombophilia in Nigeria and other African countries. DisclosuresMahlangu:Alnylam: Consultancy, Research Funding, Speakers Bureau; Biomarin: Research Funding, Speakers Bureau; Catalyst Biosciences: Consultancy, Research Funding; Chugai: Consultancy; Amgen: Consultancy; Bayer: Research Funding; Biogen: Research Funding, Speakers Bureau; CSL Behring: Consultancy, Research Funding, Speakers Bureau; NovoNordisk: Consultancy, Research Funding, Speakers Bureau; LFB: Consultancy; Roche: Consultancy, Research Funding, Speakers Bureau; Sanofi: Research Funding, Speakers Bureau; Shire: Consultancy, Research Funding, Speakers Bureau; Sobi: Research Funding, Speakers Bureau; Spark: Consultancy, Research Funding.

Pancreatic Cancer-Induced Neutrophil Extracellular Traps: A Potential Contributor to Cancer-Associated Thrombosis.

Pancreatic cancer (PaCa) is a highly metastatic cancer, and patients are at high risk of developing venous thromboembolism (VTE). Neutrophil extracellular traps (NETs) have been associated with cancer metastasis and cancer-associated thrombosis, but the ability of cancer to stimulate NET release is not known. The release of NETs has been shown to be a slow process and requires reactive oxygen species (ROS) production. Studies suggest that activated platelets are important mediators in the release. Here, we show that PaCa cells can stimulate the rapid release of NETs, independently of ROS production. We further assessed the role of platelets in PaCa-induced NETs and observed a trend of increased the NET release by PaCa-primed platelets. Additionally, NETs promoted thrombus formation under venous shear stress ex vivo. Taken together, our results suggest that PaCa-induced NETs can contribute to the high risk of venous thromboembolism development in PaCa patients, and reveal NETs as a potential therapeutic target.

A clinical audit on venous thromboembolism prophylaxis of medical patients in West Medical Ward, Mayo Hospital

Objective: To reduce risk of Deep Venous Thrombosis/ Pulmonary Embolism in an acutely ill hospitalized medical patient and the consequent clinical complications. Place and duration: The study was carried out in the West Medical Unit of Mayo Hospital, Lahore from January, 2005 to May, 2005. Subjects and methods: A total of 100 cases were selected from the patients hospitalized in the ward on the basis of presence of risk factors with no contraindications to heparin prophylaxis, taking into account the age, gender, final diagnosis of the patient, the existing risk factors, the risk stratification, the exclusion criteria, whether heparin prophylaxis was given or not, if given type of heparin administered, and whether patients receiving prophylaxis were monitored or not using Platelet Count, APTT or other monitoring techniques. Results: 19 cases were under Moderate Risk of developing Venous Thromboembolism (VTE) and 81 cases were under High Risk. 7 received Heparin prophylaxis. 3 of them were at Moderate Ri sk and 4 cases at High Risk of developing VTE. Conclusion: All acutely ill medical adult patients admitted should be adequately assessed and screened for presence of Risk Factors and categorized according to the SAVE Risk Stratification. In the absence of Exclusion factors, all cases of High Risk and Moderate Risk should be started on Heparin Prophylaxis as early as possible in hospital admission. The audit should be repeated for re-evaluation after adequate time.

Aspirin Increases the Risk of Venous Thromboembolism in Surgical Patients

The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.

Incidence of Venous Thromboembolism in the Setting of Hematopoietic Cell Transplantation

The underlying risk of venous thromboembolism (VTE) is unclear in patients undergoing hematopoietic cell transplantation (HCT). As such, these patients should still be considered at risk for development of VTE due to factors such as their underlying malignancy and the marked inflammatory state that develops from treatment. The purpose of this study was to characterize the incidence of VTE in patients undergoing HCT. Retrospective chart review of patients from the Indiana University Stem Cell Transplant Unit treated between January 1, 2008, and May 24, 2011. Patients were older than 18 years and had undergone HCT. The primary objective was to analyze the incidence of VTE in patients undergoing autologous HCT versus allogeneic HCT. Secondary objectives included documentation of VTE treatment strategies and time to occurrence of VTE. Of the 567 patients who underwent autologous HCT, 14 developed VTE (2.5%), whereas 5 of the 180 patients who underwent allogeneic HCT developed VTE (2.8%; P = 1.000). The median time to development of VTE from admission for HCT was 12 days in the autologous HCT arm versus 19 days in the allogeneic HCT arm (P = 0.610). The most commonly used VTE treatment strategy was enoxaparin (12 out of 19 VTEs). This study illustrates that VTE does occur rarely in patients who have undergone HCT. The optimal treatment regimen in this population requires further evaluation. Until a reliable protocol for treatment and evidence for risk factors are established, providers should be vigilant for occurrence of VTE in these patients.

Prophylactic use of low molecular weight heparin in combination with graduated compression stockings in post-operative patients with gynecologic cancer

The aim of this study was to compare the efficacy of low molecular weight heparin (LMWH) combined with graduated compression stockings (GCS) with GCS alone as prophylactic measures for venous thromboembolism (VTE) in post-operative patients with gynecologic cancer. Patients diagnosed with gynecologic cancer undergoing primary major surgery between 2010 and 2011 in our institute were randomized to receive LMWH+GCS or GCS as VTE prophylaxis post-operatively. Altogether 247 patients were enrolled. The incidence of VTE in patients treated with LMWH + GCS was significantly lower than that in patients using GCS alone (0.8% Vs. 8.1%, P = 0.01). There were no severe bleeding complications in the patients with prophylactic use of LMWH and the occurrence rate of wound dehiscence was comparable between the two groups (P > 0.05). Multivariable logistic regression analysis revealed that age over 60 years (P = 0.015) , duration of operation over 3 hours (P = 0.04) and without prophylactic use of LMWH (P = 0.02) were independent risk factors for VTE. Dual prophylaxis with LMWH and GCS should be recommended for gynecologic cancer patients undergoing major surgery for its better efficacy than GCS. Prophylactic use of LMWH is safe and convenient. Patients with older age and prolonged operation time are at highest risk of developing VTE post-operatively.

Thromboprophylaxis in Ambulatory Lung Cancer Treatment

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, are common problems experienced by patients with lung cancer that can impact treatment plans, prognoses, and survival. Patients with lung cancer are at greatest risk for development of VTE in the ambulatory care treatment setting. Literature does exist on VTE management for medical and surgical oncology inpatients, as well as clinical guidelines for inpatient prophylaxis; however, published evidence is lacking on outpatient risk and thromboprophylaxis in medical oncology outpatients, particularly patients with lung cancer. Because patients with lung cancer treated in the ambulatory setting have established risks for VTE, they may benefit from thromboprophylaxis. Clinical guidelines for outpatient thromboprophylaxis direct the clinical practice for thromboprophylaxis in lung cancer treatment. The purpose of the current article is to explore the VTE risks associated with ambulatory lung cancer treatment and to review the recommended guidelines for thromboprophylaxis to guide clinical decision making for patients with lung cancer.

Venous thromboembolism in cystic fibrosis

The incidence of venous thromboembolism (VTE) is increasing in the pediatric population. Individuals with cystic fibrosis (CF) have an increased risk of thrombosis due to central venous catheters (CVCs), as well as acquired thrombophilia secondary to inflammation, or deficiencies of anticoagulant proteins due to vitamin K deficiency and/or liver dysfunction. CVC-associated thrombosis commonly results in line occlusion, but may develop into serious life-threatening conditions such as deep venous thrombosis (DVT), superior vena cava syndrome or pulmonary embolism (PE). Post-thrombotic syndrome (PTS) may be a long complication. Local occlusion of the catheter tip may be managed with instillation of thrombolytics (such as tPA) within the lumen of the catheter; however, CVC-associated thrombosis involving the proximal veins is most often is treated with systemic anticoagulation. Initial treatment with heparin is a standard approach, but thrombolytic therapy, which may carry higher bleeding risks, should be considered for life and limb threatening episodes of VTE. Recommended duration of anticoagulation with low molecular weight heparin (LMWH) or warfarin ranges from 3 to 6 months for major removable thrombotic risks; longer anticoagulation is considered for recurrent thrombosis, major persistent thrombophilia, or the continued presence of a major risk factor such as a CVC. While CVCs are the most common risk for development of VTE in children, studies have not demonstrated a clear benefit with routine use of systemic thromboprophylaxis. The incidence and risk factors of VTE in CF patients will be reviewed and principles of diagnosis and management will be summarized.