Thromboembolism In Elderly Patients Research Articles

A nomogram model based on the systemic immune-inflammation index to predict the risk of venous thromboembolism in elderly patients after hip fracture: A retrospective cohort study

Background and objectivesVenous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and secondary pulmonary embolism (PE), represents a significant complication post-hip fracture in the elderly. It is a prevalent cause of VTE-related complications, prolonged hospitalization, and mortality. This study aimed to investigate the potential of the systemic immune-inflammation index (SII) as a predictive marker for VTE in older patients following hip fracture. MethodsThe study was structured as an observational, analytical, retrospective cohort analysis. A total of 346 elderly patients diagnosed with hip fracture were included. We retrospectively collated clinical and laboratory data for these patients. Using the bootstrap method, the patients were divided in a 7:3 ratio into a training cohort (DVT group = 170 patients; no-DVT group = 72 patients) and an internal validation cohort (DVT group = 81 patients; no-DVT group = 23 patients). In the training cohort, relevant indices were initially identified using univariate analysis. Subsequently, least absolute shrinkage and selection operator logistic analysis was employed to determine significant potential independent risk factors (P < 0.05). A dynamic online diagnostic nomogram was developed, with its discriminative ability assessed using the area under the receiver operating characteristic curve (AUC). The nomogram's accuracy was further appraised using calibration plots. The clinical utility of the nomogram was evaluated through decision curve analysis (DCA) and corroborated by internal validation within the training set. ResultsSII emerged as the sole independent risk factor identified from the multivariate logistic analysis of the training cohort and was incorporated into the VTE diagnostic nomogram for older patients' post-hip fracture. The nomogram demonstrated AUC values of 0.648 in the training cohort and 0.545 in the internal testing cohort. Calibration curves corroborated the close alignment of the nomogram's predicted outcomes with the ideal curve, indicating consistency between predicted and actual outcomes. The DCA curve suggested that all patients could derive benefit from this model. These findings were also validated in the validation cohort. ConclusionThe systemic immune-inflammation index is a robust predictor of venous thromboembolism in elderly patients following hip fracture, underscoring its potential as a valuable tool in clinical practice.

PB0944 Association of Chemotherapy and Other Therapeutic Agents with Venous Thromboembolism in Elderly Patients with Acute Lymphocytic Leukemia in the United States

PB0944 Association of Chemotherapy and Other Therapeutic Agents with Venous Thromboembolism in Elderly Patients with Acute Lymphocytic Leukemia in the United States

Padua prediction score-guided use of low-molecular-weight heparin calcium treatment for the prevention of venous thromboembolism in elderly patients with intracerebral hemorrhage: a clinical observation

This study used the Padua Prediction Score (PPS) to guide low-molecular-weight heparin calcium (LMWHC) treatment for the prevention of venous thromboembolism (VTE) in elderly patients with intracerebral hemorrhage (ICH). This study retrospectively analyzed 225 elderly patients who were admitted to the intensive care unit (ICU) between June 2016 and June 2022. Patients were divided into control (n = 124) and study (n = 101) groups. Control patients received routine prevention and treatment of VTE, while patients in the study group received PPS-guided LMWHC treatment for the prevention of VTE. Multiple analytical parameters were assessed including thromboelastography indices, coagulation function parameters, venous blood flow velocity, and the incidence of VTE and recurrent ICH. Thromboelastography indices, coagulation function parameters, and the venous blood flow velocity did not differ significantly between the control and study groups (p &gt; 0.05) before intervention and treatment. However, following PPS-guided LMWHC treatment, a significant improvement in these parameters was observed in the study group compared to the control group (p &lt; 0.05). Furthermore, the incidence of VTE was significantly lower in the study group (5.6%) than the control group (14.5%; p = 0.038). No significance differences in the incidence of recurrent ICH were observed (p &gt; 0.05). Our PPS data indicate that LMWHC treatment could significantly improve the coagulation function of elderly patients with ICH, as well as increase the venous blood flow velocity and prevent the occurrence of VTE.

Risk of venous thromboembolism in elderly patients with vertebral compression fracture: A population-based case-control study.

Vertebral compression fractures (VCFs) are common in elderly and are treated with immobilization. Moreover, immobilization and old age may increase venous thromboembolism (VTE) risk. However, the incidence of VCFs-related VTE is unknown in elderly. The purposes of this study were to determine the incidence of VTE among VCF patients, to explore whether percutaneous vertebroplasty (PV) intervention may reduce VTE risk in VCFs patients.We conducted a population-based case-control study by using the National Health Insurance Research Database. We identified 1407 patients aged ≥65 with VCF who received PV and 1407 VCFs patients who did not receive PV after developing a 1:1 propensity score-matched study cohort and were followed up for 5 years. Using PV intervention as the exposure factor, a cause-specific Cox's proportional hazards model was used to examine the association between PV and VTE.After propensity score matching, the mean age of the study participants was 78 years and ∼23% of the analyzed participants were men, incidence of VTE in the PV and control cohorts was 5.77 and 4.19 per 1000 person-years, respectively. Both groups were nonsignificant difference after examination with different adjustment models. Patients with VCF and a history of heart failure, coronary artery disease, receiving antihypertension medication were at a significantly increased VTE risk.Elderly patients with VCF who received PV had a neutral impact on risk of VTE. VCF patients with heart failure, coronary artery disease, and receiving antihypertension medication were prone to developing VTE should be monitored cautiously.

Analysis of efficacy and safety of new oral anticoagulants in the treatment of elderly patients with non-valvular atrial fibrillation

Objective To investigate the efficacy and safety of new oral anticoagulants in the treatment of elderly patients with non-valvular atrial fibrillation. Methods From March 2016 to September 2018, 176 elderly patients with non-valvular atrial fibrillation admitted to Lyucheng Cardiovascular Hospital of Zhejiang Province were selected and divided into warfarin group(56 cases), dabiga group(64 cases) and rivaroxaban group(56 cases) according to the treatment conditions.All three groups were treated for 6 months.The incidence of embolism and bleeding events, the changes of blood sugar and liver, kidney function before and after treatment in three groups were compared. Results The incidence rates of thromboembolism in the warfarin group, dabiga group and rivaroxaban group were 7.14%(4/56), 1.56%(1/64), 3.57%(2/56), respectively, there was no statistically significant difference among the three groups(U=2.457, P>0.05). The incidences of bleeding in the warfarin group, dabiga group and rivaroxaban group were 16.07%(9/56), 3.13%(2/64), 1.79%(1/56), respectively, there was statistically significant difference among the three groups(U=11.090, P 0.05). Conclusion Compared with warfarin, the new oral anticoagulant dapigatron ester and rivaroxaban have similar effects in preventing stroke and thromboembolism in elderly patients with non-valvular atrial fibrillation, while the risk of bleeding events during the administration of dapigatron ester and rivaroxaban is lower, suggesting that the new oral anticoagulant is effective in the treatment of stroke and thromboembolism in elderly patients with non-valvular atrial fibrillation.The therapy has high efficacy and safety, which is worthy of clinical promotion. Key words: Atrial fibrillation; Anticoagulants; Warfarin; Dabicarbonate; Rivaroxaban; Safety; Aged

Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants.

The incidence of venous thromboembolism (VTE) and VTE‑related morbidity and mortality increase with advancing age. Over the past decade, substantial advances in the treatment of VTE have been achieved. Most notably, direct oral anticoagulants (DOACs) were introduced, which offer simple treatment regimens across a broad spectrum of patients with VTE and have become the first‑choice anticoagulants in many individuals in this population. Even though elderly patients are underrepresented in clinical trials, the extrapolation of overall study results to the elderly subpopulation can be considered justified regarding acute VTE treatment and the choice of anticoagulant agent. In the elderly, DOACs are not only associated with a lower bleeding risk but they also appear to be even more efficacious than vitamin K antagonists in preventing recurrent VTE during the acute treatment period. Determining the optimal treatment duration is the most challenging aspect of VTE management in elderly patients. The risk of bleeding increases with advancing age, and several risk factors for recurrent VTE after stopping anticoagulation are also more frequent in the elderly. Clinical decision rules estimating the risk of recurrent VTE and bleeding have limited utility in elderly patients. Shared decision making considering patients' preferences and values is therefore crucial to help determine individual treatment duration in these patients.

Progress in research on venous thromboembolism in elderly patients with lung cancer

Venous thromboembolism(VTE)is one of the common and serious complications of malignant tumors.In elderly lung cancer patients, problems such as decreased autonomic activity, bed rest, poor performance status(PS), combined underlying diseases and the use of chemoradiotherapy are often considered as risk factors for high incidence of VTE.This article is aimed to review the clinical features and pathogenesis of lung cancer in the elderly combined with VTE, to investigate the risk factors and explore feasible evaluation and prevention strategies. Key words: Lung neoplasms; Venous thromboembolism; Risk factors

Association between the Level of Serum Vitamin B12 and Venous Thromboembolism in African American Population

Background Multiple risk factors have been linked to venous thromboembolism (VTE). It is well established that elevated level of homocysteine correlated with increased risk of VTE. Some studies showed that vitamin B12 deficiency may be the cause for homocysteinemia. Therefore, it is recommended by some groups that vitamin B12 should be supplemented in the patient with high homocysteine to prevent VTE. However, more recent study has shown that there is correlation between the high serum Vitamin B12 level and risk of VTE in cancer patients.[1] provoked VTE after orthopedic surgery was also shown to be associated with elevated vitamin B12 serum levels in elderly patients. The role of vitamin B12 in VTE patients is not fully understood. Our study is to see whether there is correlation between serum Vitamin B12 level and risk of VTE in general population. Methods 177 Patients admitted to Kingsbrook Jewish Medical Center between January 1st, 2015 to December 31st, 2018 with the diagnosis of VTE were identified. 95 cases had measured serum Vitamin B12 results within 3 months. 97 patients without any history of VTE who were seen in the hematology clinic during the same period time were used as control in this study. Demographic information and Vitamin B12 level were collected. T test and chi-square were used for statistical analysis. Results VTE patients had a median age of 70, which is significantly higher than the median age of 57 in the control group. The mean level of vitamin B12 in control group was 620 pg/mL, which was lower than the average vitamin B12 level (770 pg/mL, p=0.0344) in the VTE group. When we divided the patients into 3 groups based on Vitamin B12 level: Low B12 (&lt;250 pg/mL), Moderate B12 (250-800 pg/mL) and High B12 (&gt;800 pg/mL). We observed 41% of VTE patients have B12 level more than 800 pg/mL while only 20% of control patients have high B12 level (chi-square, p=0.006). Discussion Our study showed that vitamin B12 level is significantly elevated in patients diagnosed with VTE and more than 40% of those patients actually have vitamin b12 level more than 800 pg/mL. It is known that elevated vitamin B12 level is associated with inflammation and increased mortality.[2] An association between elevated B12 levels and cancer has been reported in several studies [3]. It is unclear elevated vitamin B12 levels predict undiagnosed cancer which is a known risk factor for VTE or vitamin B12 directly contribute hypercoagulation. Nevertheless, we should be cautious when supplementing vitamin B12 and the dosage may need to be titrated closely. More clinical studies are definitely warranted.

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

BackgroundLittle is known about predictors and outcomes of recurrent venous thromboembolism in elderly patients. MethodsWe prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was symptomatic recurrent venous thromboembolism. We explored the association between baseline characteristics and treatments and recurrent venous thromboembolism using competing risk regression, adjusting for periods of anticoagulation as a time-varying covariate. We also assessed the clinical consequences (case-fatality, localization) of recurrent venous thromboembolism. ResultsDuring a median follow-up period of 30 months, 122 patients developed recurrent venous thromboembolism, corresponding to a 3-year cumulative incidence of 14.8%. The case-fatality of recurrence was high (20.5%), particularly in patients with unprovoked (23%) and cancer-related venous thromboembolism (29%). After adjustment, only unprovoked venous thromboembolism (sub-hazard ratio, 1.67 compared with provoked venous thromboembolism; 95% confidence interval, 1.00-2.77) and proximal deep vein thrombosis (sub-hazard ratio, 2.41 compared with isolated distal deep vein thrombosis; 95% confidence interval, 1.07-5.38) were significantly associated with recurrence. Patients with initial pulmonary embolism were more likely to have another pulmonary embolism as a recurrent event than patients with deep vein thrombosis. ConclusionsElderly patients with acute venous thromboembolism have a substantial long-term risk of recurrent venous thromboembolism, and recurrence carries a high case-fatality rate. Only 2 factors, unprovoked venous thromboembolism and proximal deep vein thrombosis, were independently associated with recurrent venous thromboembolism, indicating that traditional risk factors for venous thromboembolism recurrence (eg, cancer) may be less relevant in the elderly.

Does preoperative mechanical prophylaxis have additional effectiveness in preventing postoperative venous thromboembolism in elderly patients with hip fracture?-Retrospective case-control study.

BackgroundElderly patients undergoing hip fracture surgery (HFS) are at increased risk of postoperative venous thromboembolism (VTE). To reduce this risk, combined postoperative mechanical and chemical thromboprophylaxis has been routinely performed after HFS in these patients. This retrospective case-control study was conducted to evaluate the additional effectiveness of preoperative mechanical thromboprophylaxis for the prevention of VTE following HFS in elderly patients.MethodsOf 539 consecutive patients aged 70 years or older undergoing HFS, 404 (control group) did not receive preoperative mechanical thromboprophylaxis, while 135 (study group) received mechanical thromboprophylaxis using an intermittent pneumatic compression device and graduated compression stockings from the time of admission until surgery. All patients received combined postoperative mechanical and chemical thromboprophylaxis following HFS in accordance with the same protocol. The incidence of symptomatic VTE confirmed based on clinical symptoms and 3-dimensional CT angiography within one month of surgery was investigated in both groups.ResultsThe American Society of Anesthesiologists grade was higher (p = 0.016) in the study group and more patients in this group had concomitant cardiovascular and neurologic diseases (p = 0.005 and p = 0.009, respectively). In addition, more patients in the study group had received anticoagulant medication preinjury owing to comorbidities (39% vs 28%, p = 0.025). The overall incidences of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) were 7.4% and 3.7%, and 2.2% and 1.5% in the control and study groups, respectively. According to multiple logistic regression, symptomatic DVT significantly reduced in the study group (OR 0.28, p = 0.042), while there was no significant difference in the incidence of symptomatic PE between the two groups (p = 0.223).ConclusionsPreoperative mechanical thromboprophylaxis may confer an additional benefit by preventing postoperative VTE without adding more risk of perioperative bleeding in elderly patients with hip fracture.

P5320Trimethylamine-N-oxide (TMAO) Predicts Total Mortality, but not Recurrent Venous Thromboembolism in Elderly Patients with Acute Venous Thromboembolism

P5320Trimethylamine-N-oxide (TMAO) Predicts Total Mortality, but not Recurrent Venous Thromboembolism in Elderly Patients with Acute Venous Thromboembolism

Do Factor V Leiden and Prothrombin G20210A Mutations Predict Recurrent Venous Thromboembolism in Older Patients?

BackgroundThe value of genetic thrombophilia testing in elderly patients with an unprovoked venous thromboembolism is unclear. We assessed whether the Factor V Leiden and the prothrombin G20210A mutation are associated with recurrent venous thromboembolism in elderly patients in a prospective multicenter cohort study. MethodsWe genotyped the Factor V Leiden and the prothrombin G20210A mutation in 354 consecutive in- and outpatients aged ≥65 years with a first unprovoked venous thromboembolism from 9 Swiss hospitals. Patients and managing physicians were blinded to testing results. The outcome was recurrent symptomatic venous thromboembolism during follow-up. We examined the association between the Factor V Leiden and the prothrombin G20210A mutation and venous thromboembolism recurrence using competing risk regression, adjusting for age, sex, and periods of anticoagulation as a time-varying covariate. ResultsOverall, 9.0% of patients had a Factor V Leiden and 3.7% had a prothrombin G20210A mutation. At 36 months of follow-up, patients with a Factor V Leiden and a prothrombin G20210A mutation had a cumulative incidence of recurrent venous thromboembolism of 12.9% (95% confidence interval [CI], 5.1%-30.8%) and 18.5% (95% CI, 4.9%-56.5%), respectively, compared with 16.7% (95% CI, 12.5%-22.1%) of patients without mutation (P = .91 by the log-rank test). After adjustment, neither the Factor V Leiden (sub-hazard ratio 0.98; 95% CI, 0.35-2.77) nor the prothrombin G20210A mutation (sub-hazard ratio 1.15; 95% CI, 0.25-5.19) was associated with recurrent venous thromboembolism. ConclusionOur results suggest that testing for genetic thrombophilia may not be beneficial in elderly patients with a first unprovoked venous thromboembolism.

Comparative assessment of the effectiveness of treatment of pulmonary thromboembolism in elderly patients

We compared the efficiency of treatment of 99 patientswith pulmonary thromboembolism using thrombolytic agents, surgical intervention, and anticoagulation therapy with heparin and vitamins K. The surgical treatment proved more efficient than the two other options.

OC-02 - Risk of arterial thromboembolism in patients with breast cancer

Breast cancer is the most common cancer in women and clearly increases the risk of venous thromboembolism. However, its association with arterial thromboembolism is less well defined. To determine the short-term cumulative incidence and relative hazard of arterial thromboembolism in elderly patients with incident breast cancer. Using the Surveillance Epidemiology and End Results-Medicare linked database, which includes approximately 28% of all patients diagnosed with cancer in the United States, we identified patients with a new primary diagnosis of breast cancer from 2002 through 2011. These patients were individually matched by age, sex, race, registry, and medical comorbidities to a group of Medicare enrollees without cancer, and each pair was followed through 2012. Validated diagnosis codes were used to identify a primary composite outcome of arterial thromboembolism defined as any ischemic stroke or myocardial infarction. Secondary outcomes included ischemic stroke alone and myocardial infarction alone. Cumulative incidence rates were calculated using competing risk survival statistics. The Gray test was used to compare rates between groups. The proportional hazard assumption was violated for the entirety of patient follow-up; therefore, Cox proportional hazard analysis was performed at discrete time points when the assumption was generally met. We identified 96,666 pairs of breast cancer patients and matched controls. Median age was 75 years and few cancers were advanced at diagnosis (12% stages 3/4). The 3-month cumulative incidence of arterial thromboembolism was 2.1% (95% confidence interval [CI] 2.0-2.2%) in cancer patients compared to 1.4% (95% CI 1.3-1.5%) in controls (hazard ratio [HR] 1.5, 95% CI 1.4-1.6, p<0.01). The short-term risk of each secondary outcome was heightened in the breast cancer group, although the relative hazard for myocardial infarction was higher than for ischemic stroke. The 3-month cumulative incidence of ischemic stroke was 1.3% (95% CI 1.2-1.4%) in cancer patients compared to 1.0% (95% CI 0.9-1.1%) in controls (HR 1.3, 95% CI 1.2-1.4, p<0.01), and the 3-month cumulative incidence of myocardial infarction was 0.9% (95% CI 0.8-0.9%) in cancer patients compared to 0.4% (0.4-0.5%) in controls (HR 2.0, 95% CI 1.8-2.3, p<0.01). Excess risks attenuated over time and were no longer present beyond 1 year. Patients with incident breast cancer face an increased short-term risk of ischemic stroke and myocardial infarction.

Analysis on risk factors for venous thromboembolism in elderly patients with lung cancer

Objective To investigate the risk factors for venous thromboembolism in elderly patients with lung cancer, in order to provide theoretical basis for clinical prevention and treatment. Methods A retrospective analysis was carried out in 869 elderly patients who were treated in our hospital from Mar. 2010 to Mar. 2014. And the venous thromboembolism and its related risk factors in elderly lung cancer patients were analyzed. Results 35 cases (4.35%) complicated with venous thromboembolism. Multivariate logistic regression analysis showed that adenocarcinoma, basic diseases, and D-dipolymer≥300 μg/L belonged to the independent risk factors for the complication of venous thromboembolism in elderly patients with lung cancer (OR=2.839, 1.586 and 10.514, respectively, P=0.007, 0.022 and 0.000). Conclusions The risk factors for the complication of venous thromboembolism should be monitored in the treatment of elderly patients with lung cancer. Early anticoagulation therapy should be performed to improve clinical effect and reduce the incidence of complications. Key words: Lung neoplasms; Venous thromboembolism; Risk factors

Antipsychotic Drug Use and the Risk of Venous Thromboembolism in Elderly Patients With Dementia

The aim of this study was to investigate the association between the use of antipsychotics and the risk of venous thromboembolism (VTE) in elderly patients with dementia. Based on data from the German Pharmacoepidemiological Research Database, a nested case-control study was conducted within a cohort of 72,591 patients with dementia aged at least 65 years at cohort entry. Cases were patients with a hospitalization due to VTE. Up to 4 controls were matched to each case according to age, sex, health insurance, and calendar time of the VTE. Users of antipsychotics were classified into current or former users, and in addition, all current users were categorized as prevalent or new users. For a further analysis, we distinguished between users of either conventional or atypical antipsychotics or concurrent users of both conventional and atypical antipsychotics. Multivariate conditional logistic regression was applied to calculate odds ratios (ORs) of VTE for all user groups compared with nonusers. The case-control data set comprised 1028 VTE cases and 4109 controls. An increased risk of VTE was found for current users (OR, 1.23; 95% confidence interval [CI], 1.01-1.50) and for users of a combination of atypical and conventional antipsychotics (OR, 1.62; 95% CI, 1.15-2.27). In current users, only new use was associated with an increased risk (OR, 1.63; 95% CI, 1.10-2.40). Increased attention to clinical signs of VTE should be paid during the first 3 months of treatment with antipsychotics and in patients receiving both conventional and atypical agents, especially if other risk factors for VTE exist.

Increased Risk of Chemotherapy-Associated Venous Thromboembolism in Elderly Patients with Cancer

Data on the relationship between aging, chemotherapy, and risk for venous thromboembolism (VTE) are controversial. We sought to evaluate the risk of chemotherapy-associated VTE in young to middle-aged (YMA) and elderly cancer patients and to analyze the VTE-free survival time in both groups. Patients with histologically confirmed diagnosis of solid malignancy receiving any type of systemic chemotherapy, no clinical diagnosis of VTE before chemotherapy initiation, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤2 were enrolled in this study. Of the 486 consecutive patients included in the study, 380 (78%) were classified as YMA (≤70 years of age) and 106 (22%) as elderly (>70 years of age). At a median follow-up of 1 year, the incidence of VTE events was almost two-fold greater in elderly than in YMA (11% vs. 6%). Age (≤70 years vs. >70 years (hazard ratio [HR], 2.42; 95% confidence interval [CI] 1.15-5.06; p=0.020), ECOG-PS (HR, 6.54; 95% CI 3.10-13.8; p<0.0001), and platinum-based chemotherapy (HR, 2.46; 95% CI 1.06-5.69; p=0.035) were independent risk factors for VTE. In the elderly subset, a trend toward an increased risk of VTE in patients receiving a platinum-based chemotherapy when compared with a non-platinum-containing regimen was observed (15% vs. 9.1%). The Kaplan-Meier analysis showed that elderly patients had a significantly shorter VTE-free survival time compared with younger cancer patients (log-rank test=2.0; p=0.045). Our study reports an increase incidence of VTE in elderly cancer patients treated with chemotherapy compared with the younger group, suggesting that aging is one of the most important risk factors for VTE. On the basis of the results of this study, we believe that a validated predictive model including age, ECOG-PS, and type of chemotherapy (platinum- vs. non-platinum containing regimen) would enable clinicians to target thromboprophylaxis to those patients considered to be at greatest risk.

Risk factors for venous thromboembolism in elderly patients with glioblastoma.

e13031 Background: Venous thromboembolism (VTE) is a common complication in glioblastoma (GBM) patients. Physicians are reluctant to administer anticoagulants to GBM patients with VTE, particularly to the elderly patients. Methods: After obtaining IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify patients with histologically confirmed GBM who were diagnosed with VTE and were ≥65 years of age at the time of diagnosis of GBM. Bivariate comparison of demographic and clinical features was performed by occurrence of DVT, using t-test for continuous data and fishers exact test for categorical variables. Multivariate proportional hazard model was developed adjusting for number of comorbidities (none, 1, 2-3, &gt;3), Karnofsky Performance Status (KPS) at presentation (&gt;70, ≤70), age (&gt;75, ≤75), race, treatment (chemotherapy, radiation therapy, tumor resection). All p-values were 2-sided and were considered significant when &lt;0.005. Results: Chart records of 517 patients diagnosed between 1990 and 2010 were included for analysis. Among 517 cases, 99 patients (54% male, median age at presentation 72 years, range 65-92 years) developed VTE. Median follow-up was 6.58 ± 9.58 months. Eighty-nine (90.8%) cases were diagnosed within 3 months of craniotomy. On univariable analysis, risk factors for VTE included lower KPS (HR 0.98, CI 0.96– 0.99, p = 0.001), thalamic tumors (HR 3.11, CI 1.14– 8.50, p = 0.027), and lower extremity paresis (HR 2.24, CI 1.46-3.46, p &lt; 0.0001). Caucasian patients had a lower trend for developing VTE, however this was not statistically significant. On multivariable analysis, lower KPS was found to be related with higher incidence of VTE (HR 0.35, CI 0.18 – 0.66, p = 0.001). Conclusions: Lower KPS is associated with higher incidence of VTE. Further studies are needed to determine risk stratification and whether the use of medical prophylaxis after neurosurgical intervention can lead to decrease in the rates of VTE in elderly GBM patients.

Prophylaxis of venous thromboembolism in elderly patients with multimorbidity

Pharmacological thromboprophylaxis (TP) is known to reduce venous thromboembolism (VTE) in medical inpatients, but the criteria for risk-driven prescription, safety and impact on mortality are still debated. We analyze data on elderly patients with multimorbidities admitted in the year 2010 to the Italian internal medicine wards participating in the REPOSI registry to investigate the rate of TP during the hospital stay, and analyze the factors that are related to its prescription. Multivariate logistic regression, area under the ROC curve and CART analysis were performed to look for independent predictors of TP prescription. Association between TP and VTE, bleeding and death in hospital and during the 3-month post-discharge follow-up were explored by logistic regression and propensity score analysis. Among the 1,380 patients enrolled, 171 (15.2 %) were on TP during the hospital stay (162 on low molecular weight heparins, 9 on fondaparinux). The disability Barthel index was the main independent predictor of TP prescription. Rate of fatal and non-fatal VTE and bleeding during and after hospitalization did not differ between TP and non-TP patients. In-hospital and post-discharge mortality was significantly higher in patients on TP, that however was not an independent predictor of mortality. Among elderly medical patients there was a relatively low rate of TP, that was more frequently prescribed to patients with a higher degree of disability and who had an overall higher mortality.

Abstract 498: Age-adjusted Cut-off Levels Improve Test Performance in the Diagnosis Strategy of Venous Thromboembolism in Elderly Patients With a Non-high Pre-test Probability

Background D-dimer levels below a well defined cut-off level enable to safely rule out VTE in patients with non-high PTP. Ageing is associated with higher levels of D-dimer. To address the issue of their usefulness in elderly patients, we firstly managed data from 644 out-patients with non-high PTP included in a multicenter management study of a D-dimer assay (C.Legnani et al. 2010). We then validated our results in a cohort of 1,042 consecutive patients investigated using another assay. Results In the first part, D-dimer level, evaluated using the HemosIL D-dimer HS500 assay (Instrumentation Laboratory), was above the cut-off level (500 ng/ml) in all 88 patients with VTE and in 299 of those without (53.8%). Test negative predictive value (NPV) and sensitivity were 100%. Overall test specificity was 46.2%, but decreased in an age-dependent manner over 70 y. ROC-analysis of test results obtained in patients classified according to age allowed us to propose an age- adjustment of the cut-off level calculated by increasing its level by 100 ng/ml per 10 y-increments in patients aged over 59 y e.g. 600 ng/ml between 60 et 69 y, 700 ng/ml between 70 et 79 y. Using those age-adjusted cut-off levels yielded to significantly improve test specificity (56.1%), particularly in old patients. If an 84 y old patient (D-dimer=625 ng/ml) was missed, NPV remained high (99.6%). That strategy was then validated by evaluating data from 1,042 consecutive out-patients, investigated using the Vidas D-dimer assay (BioMérieux). When applied, that age- adjusted cut-off levels leaded to improve test specificity 62.2% vs. 55.1% using the fixed cut-off level. 3 additional patients, with D-dimer &gt;500 ng/ml but below age- adjusted cut-off level, were missed but overall NPV remained high 99.0% vs. 99.4%. Conclusions Age-adjusted cut-off levels for D-dimer, calculated by increasing the traditional cut- off level (500 ng/ml) by 100 ng/ml per 10 y-increments in patients aged over 59 y, significantly increased the test specificity. Correlatively, NPV and sensitivity were slightly decreased, as some patients, with D-dimer above 500 ng/ml but below the age-adjusted cut-off level, could be misdiagnosed. However such a strategy was safe, as NPV remained above 99% in our studied populations.