Risk Factors For Venous Thromboembolism Research Articles

Brisk Walking Pace Offsets Venous Thromboembolism Risk Equivalent to Established Monogenic Mutations.

Mendelian mutations in the Prothrombin gene (F2) and the factor V Leiden gene (F5) genes are established risk factors for venous thromboembolism (VTE). Walking pace is associated with the risk of coronary artery diseases, but no study has investigated its association with VTE. This study aimed to investigate the association and causality between walking pace and VTE, compare its population risk with established Mendelian mutations, and determine if blood biomarkers mediate its effect. We followed up 445,261 UK Biobank participants free of VTE at baseline. Self-reported walking pace was collected via touchscreen questionnaire at baseline. The carrier status of two Mendelian mutations in F2 and F5 genes was determined by the genotypes of rs1799963 (G20210A, c.*97 G > A) and rs6025 (p.R534Q), respectively. Cox proportional hazard model was used to estimate the effect of walking pace on incident VTE. We conducted a bidirectional Mendelian randomization (MR) analysis, by using 70 single-nucleotide polymorphisms (SNPs) from a walking pace genome-wide association studies (GWAS) and 93 SNPs from a VTE GWAS as instrumental variables. We used both individual-level data and GWAS summary statistics for mediation analysis. Over a median follow-up period of 12.8 years, 11,155 incident VTE cases were identified. The 10-year incidence rates for brisk and slow walking pace were 1.32% (confidence interval [CI]: 1.27-1.37%) and 3.90% (CI: 3.71-4.09%), respectively. For noncarriers, F2 and F5 carriers, the 10-year incidence rates were 1.70% (CI: 1.66-1.73%), 2.94% (CI: 2.66-3.22%), and 3.62% (CI: 3.39-3.84%), respectively. The overall risk of VTE for F5 mutation carriers with a brisk walking pace (2.65%) was smaller than that for noncarriers with a slow walking pace (3.66%). For F5 mutation carriers, brisk pace (but not steady pace) reduces the risk of VTE (p interaction < 0.05). MR analyses displayed a causal relationship (inverse variance weighted: p = 3.21 × 10-5) from walking pace to VTE incidence. Mediation analysis showed that serum albumin (ALB) and cystatin C (CYS) levels partially mediated the effect of brisk walking pace on the risk of VTE incidence, with mediation proportions of 8.7 to 11.7%, respectively. On the population scale, the protective effect of brisk walking pace offsets the risk of VTE caused by Mendelian mutations. We provided preliminary evidence that a brisk walking pace causally reduces the risk of VTE. Serum ALB and CYS partially mediate this effect.

Effect of prophylactic doses of enoxaparin on antifactor Xa activity confirmed by rotational thromboelastometry in critically ill patients: a preliminary prospective cohort study

IntroductionCritically ill patients present multiple risk factors for venous thromboembolism (VTE). Underdosing of antithrombotic medications can result in VTE even as bleeding remains a significant concern for critically ill patients. On the other hand bleeding, remaining a significant concern for the critically ill, can be worsend by overdosing of antithrombotic medications. The present study aimed to assess the effects of prophylactic doses of enoxaparin on antifactor Xa activity (anti-Xa) and rotational thromboelastometry (ROTEM) parameters in critically ill patients.Materials and methodsIn this prospective single-center cohort study, the effects of enoxaparin were assessed via anti-Xa monitoring. Standard laboratory coagulation and ROTEM parameters were also determined using the same blood samples.ResultsA total of 61 patients (42.6% women) were enrolled in this study, whose median age was 59.0 (interquartile range: 43.0–70.0) years. Based on anti-Xa, the effects of enoxaparin were normal in 35 subjects (57.4%); in 17 patients (27.9%), the anti-Xa troughs and/or peaks were higher than the prophylactic range; in 9 patients (14.7%), the anti-Xa peak was lower than the prophylactic range. There were differences among the anti-Xa groups with respect to some ROTEM parameters. No VTE was detected among the study subjects. In 3 subjects (4.9%), there were signs of bleeding, and these patients presented with longer thrombin times.ConclusionAnti-Xa values may be within the prophylactic range in slightly more than half of the critically ill patients receiving enoxaparin at prophylactic doses. The dosing of low-molecular-weight heparin (LMWH) in critically ill patients may require individualization based on anti-Xa. Further studies are therefore required to establish a universal anti-Xa prophylactic range for LMWH, the timing of anti-Xa determination, and management of LMWH dosing.

Venous Thromboembolism Occurrence and Association with Gastrointestinal Disorders in Children with Cystic Fibrosis: An Analysis from the TriNetX Research Network Global Multicenter Real-World Dataset.

The purpose of this study is to (1) estimate and compare the prevalence of venous thromboembolism (VTE) in children (age 0 to ≤21) with versus without cystic fibrosis (CF); (2) investigate putative associations between specific gastrointestinal (GI) manifestations and the development of VTE among children with CF. This was a multicenter case-control analysis among patients aged 0 to ≤ 21 years between 2010 and 2020, using the TriNetX Research Network. Data queries included ICD-9/10 (International Classification of Diseases-9th/10th Revision) diagnosis codes. Bivariate associations with VTE among CF patients were compared using Chi-square testing for categorical variables and Student's t-test for continuous variables. We used multivariable logistic regression to test for independent associations of GI manifestations with VTE among children with CF, with adjustment for other salient covariates. There was a total of 7,689 children with and 22,327,660 without CF. The frequency of occurrence of VTE was increased nearly 20-fold among those with, as compared with without CF (130 vs. 7 per 10,000 patients). Acute pancreatitis (adjusted odd ratio [aOR] = 3.80, [95% confidence interval, CI: 2.00-7.22]), biliary disease (aOR = 2.17 [95% CI: 1.17-4.03]), gastrostomy status (aOR = 2.01 [95% CI: 1.27-3.18]), and malabsorption/malnutrition (aOR = 2.41 [95% CI: 1.52-3.82]) were each associated with a higher likelihood of VTE among children with CF. In conclusion, we found a significantly increased frequency of VTE occurrence and association of specific GI diseases as independent risk factors for VTE among children with CF compared with those without.

Predictors of Venous Thromboembolism Following Geriatric Distal Femur Fracture Fixation: Are These Patients at Higher Risk Compared With Hip Fracture Patients?

Venous thromboembolism (VTE) following injury and subsequent fixation of a distal femur fracture (DFFx) is associated with considerable morbidity. However, the incidence of VTE, associated factors, and the relative risk compared with hip fracture (HFx) fixation remains poorly characterized. Retrospective cohort study using the PearlDiver M165 database to identify geriatric patients who underwent DFFx and HFx fixation. Clinical risk factors of VTE within 90 days of DFFx and the risk modification associated with enoxaparin (Lovenox) and direct oral anticoagulants (DOACs) relative to aspirin/nonprescription agents were characterized. To determine the odds of VTE following fixation of DFFx relative to HFx, a matched comparison based on age, sex, and Elixhauser Comorbidity Index was done. Of 24,358 DFFx patients, 1684 (6.9%) developed VTE. Independent risk factors included a prior VTE (odds ratio [OR] 28.76), displaced DFFx morphologies (condylar [OR 5.44], and supracondylar without intracondylar extension [OR 3.96] and with extension [OR 3.75]), active cancer (OR 2.11), coagulopathy disorder (OR 1.15), and younger age (OR 1.03) (P < 0.05 for all). Lovenox and DOAC were both associated with reduced odds of VTE (OR 0.40 and OR 0.61, respectively) (P < 0.05 for both). Relative to HFx patients, DFFx patients demonstrated heightened odds of VTE (OR 1.25) (P < 0.001). This study identified a relatively high rate of VTE, 6.9% within 90 days, following surgical management of DFFx and heightened odds of VTE relative to HFx patients. Various factors demonstrated a notable association with increased odds of VTE, although both Lovenox and DOACs may be effective therapeutic options for risk mitigation.

Risk of venous thromboembolic complications in pregnant trauma patients: A matched cohort study.

Trauma and pregnancy are both risk factors for venous thromboembolism (VTE). We hypothesized that pregnant blunt trauma patients would have a higher incidence of VTE complications compared with matched nonpregnant females. We conducted a retrospective cohort study using National Trauma Data Bank data from 2017 to 2022. Female patients with blunt mechanism, age between 15 and 50years old, were eligible for inclusion. Patients who presented as transfers, hospitalized for less than 72h, discharged against medical advice, injury severity score <9, or abbreviated injury scale=6 of any region were excluded. Pregnant patients were matched 1:2 with nonpregnant female patients by age, injury characteristics, comorbidities, and type and timing of chemical VTE prophylaxis. The primary outcomes were the incidences of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE). Secondary outcomes included other complications and length of stay. We included 735 pregnant and 1470 matched nonpregnant controls. The median time to initiate chemical VTE prophylaxis was 33h in pregnant and 34h in nonpregnant patients (p=0.42). The incidence of VTE in pregnant blunt trauma patients was 27 (3.7%) versus 45 (3.1%) in matched controls (p=0.446). There were no significant differences in DVT, PE, or any other complication or mortality or in ICU or hospital length of stay. Unplanned admissions to the ICU were significantly more frequent in pregnant patients (3.8% vs. 2.2% and p=0.026). The incidence of VTE complications was similar in pregnant and matched nonpregnant female blunt trauma patients in this retrospective cohort study, supporting the safety of current VTE prophylaxis practices in pregnant patients.

High Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study.

High altitude may induce physiological changes that can predispose patients to venous thromboembolism (VTE), a relatively uncommon, but potentially fatal complication following total knee arthroplasty (TKA). The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA. A large claims database was queried for patients who underwent TKA at high-altitude (≥ 1,219-meters) and low-altitude (≤ 30-meters) using Current Procedural Terminology codes, International Classification of Disease codes, and zip codes. High- and low-altitude cohorts were matched 1:3 by 5-year age range, sex, Charlson comorbidity index (CCI), diabetes mellitus, obesity (body mass index ≥ 30), hypertension, and tobacco use. There were 57,135 patients included in the high-altitude group and 171,322 in the low-altitude group. Outcome measures included 30- and 90-day incidence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). Chi-square was used to determine differences in demographics. Binomial logistic regression was used to determine postoperative rates of VTE, DVT, and PE. The incidence of VTE was significantly greater in the high-altitude versus the low-altitude group at 30-days (OR [odds ratio] 1.15 [95% CI (confidence interval) 1.02 to 1.30], P = 0.022) and 90-days (OR 1.20 [95% CI 1.08 to 1.34], P = 0.0007). The incidence of DVT was significantly higher for the high-altitude cohort at both 30- (OR 1.30 [95% CI 1.10 to 1.54], P = 0.002) and 90-days (OR 1.36 [95% CI 1.18 to 1.57], P < 0.0001). The incidence of PE within 30- and 90-days was not significantly different between groups. High altitude (> 1,219-meters) is an independent risk factor for VTE following TKA. Patients who undergo TKA at surgical centers greater than 1,219-meters in elevation are more likely to develop VTE and DVT within 30- and 90-days postoperatively. Surgeons may account for high altitude as a risk factor and determine the most suitable postoperative prophylaxis method for their patients.

Newly Diagnosed Cancer After Diagnosis of Venous Thromboembolism - Insights From the COMMAND VTE Registry-2.

Previous randomized clinical trials did not support a benefit of screening for occult cancer after diagnosis of venous thromboembolism (VTE), although screening may be of potential benefit for selected high-risk patients. The COMMAND VTE Registry-2 enrolled consecutive patients with acute symptomatic VTE between 2015 and 2020 from 31 centers across Japan. The 3,706 patients in the registry without known active cancer at the time of VTE diagnosis were divided into 2 groups: those with (n=250) and without (n=3,456) newly diagnosed cancer during the follow-up period. The cumulative incidence of newly diagnosed cancer was 1.5% at 30 days, 3.7% at 1 year, and 7.0% at 3 years. The multivariable Cox proportional hazard model demonstrated that older age (hazard ratio [HR] 1.02 per 1 year increase; 95% confidence interval [CI] 1.01-1.03; P<0.001), a history of cancer (HR 3.57; 95% CI 2.73-4.64; P<0.001), autoimmune disorders (HR 1.48; 95% CI 1.06-2.02; P=0.02), a history of major bleeding (HR 1.64; 95% CI 1.04-2.48; P=0.04), and the absence of transient provoking risk factors for VTE (HR 1.44; 95% CI 1.08-1.92; P=0.01) were independently associated with newly diagnosed cancer. The incidence of newly diagnosed cancer after VTE diagnosis was 3.7% at 1 year, and several independent risk factors for newly diagnosed cancer after VTE diagnosis were identified.

Genetic correlation between genes targeted by lipid-lowering drugs and venous thromboembolism: A drug-target Mendelian randomization study.

Dyslipidemia has been established as a potential risk factor for venous thromboembolism (VTE) in several observational studies. Statins and novel lipid-modifying agents are being explored for their potential in VTE prevention, encompassing deep vein thrombosis (DVT), and pulmonary embolism (PE). Nonetheless, conclusive evidence supporting the effectiveness remains uncertain. Without definitive proof, the current recommendation of lipid-lowering drugs (LLDs) for preventing VTE, either primarily or secondarily, is not support. An investigation into the impact of 8 classes of LLDs on VTE was conducted using a drug-target Mendelian randomization approach. The drug categories examined included 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), apolipoprotein B, proprotein convertase subtilisin/kexin type 9, Niemann-Pick C1-like 1, lipoprotein lipase (LPL), angiopoietin-like 3, apolipoprotein C3 (APOC3), and peroxisome proliferator-activated receptor alpha. Leveraging genetic variants situated proximate to or within drug-target genes linked with low-density lipoprotein and triglycerides, we acted as proxies for LLDs. The UK Biobank study was the source of data on VTE, PE, and DVT of lower extremities (LEDVT). We employed the inverse-variance weighted method for the core analysis in Mendelian randomization, complemented by sensitivity analysis to investigate horizontal pleiotropy and heterogeneity. Employing genetic proxies to inhibit HMGCR revealed a notable correlation with reduced LEDVT risk (odds ratio [OR]: 0.995, 95% CI: 0.992-0.998, P = .002), VTE (OR: 0.994, 95% CI: 0.988-1.000, P = .033), but a no significant association with PE (OR: 1.000, 95% CI: 0.994-1.002, P = .246). The suppression of APOB was linked with an elevated risk of experiencing LEDVT (OR: 1.002, 95% CI: 1.001-1.004, P = .006), VTE (OR: 1.005, 95% CI: 1.002-1.007, P < .001), and PE (OR: 1.002, 95% CI: 1.000-1.004, P = .031). Similarly, the activation of LPL was associated with increased risks for VTE (OR: 1.003, 95% CI: 1.001-1.005, P = .003) and PE (OR: 1.003, 95% CI: 1.002-1.005, P < .001). Additionally, the inhibition of APOC3 was linked to a higher DVT risk (OR: 1.002, 95% CI: 1.000-1.004, P = .038). Research has shown that HMGCR, out of 8 lipid-lowering drug-targets evaluated, exhibited a significant correlation with VTE and LEDVT, highlighting its potential as an effective target for the treatment or prevention of these conditions. In contrast, APOB, LPL, and APOC3 each contribute to an increased risk of VTE, PE, and LEDVT in various degrees, pharmacovigilance for VTE, PE, and LEDVT risk among users of APOB inhibitors, LPL activation, and APOC3 inhibitors may be warranted.

Development of a thrombin-antithrombin complex detection kit and study in venous thromboembolism complicated by cervical cancer

ObjectiveOur study successfully developed an assay kit for thrombin-antithrombin complex (TAT) and demonstrated the predictive value of plasma TAT concentration in the development of venous thromboembolism (VTE) in patients with cervical cancer.MethodA retrospective analysis was conducted on 177 patients with cervical cancer who received treatment at the Affiliated Hospital of Jiangnan University in Wuxi City from July 1, 2023 to October 1, 2023. This study provides a comprehensive analysis of cervical cancer patients and their VTE risk factors. The patients were divided into two groups: 27 cases with VTE (Thrombosis group) and 150 cases without VTE (Non-thrombotic group). Additionally, the patients were classified into four stages based on tumor stage: 42 cases of stage I, 45 cases of stage II, 62 cases of stage III, and 28 cases of stage IV. The control group consisted of 80 healthy patients undergoing medical check-ups. Thrombin-antithrombin complex (TAT), fibrinolytic enzyme-α2-fibrinolytic inhibitor complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator inhibitor 1 complex (t-PAIC) were detected using quantitative chemiluminescence immunoassay. The study assessed the variations in thrombotic marker levels among cervical cancer patients of different stages through a receiver operating characteristic (ROC) curve.ResultThe TAT reagent demonstrated a detection limit of 0.048 ng/mL, with a linear R value of 0.9997, indicating high accuracy and precision. The reagent's accelerated stability was also excellent, with deviations of less than 10%. Furthermore, the correlation coefficient of this method with Hyson Mecon was R2 = 0.9683. Notably, in patients with cervical cancer, TAT and PIC levels were found to be elevated compared to those of the healthy population. Cervical cancer patients who developed thrombosis had significantly elevated levels of TAT and fibrinogen degradation products (FDP) compared to those who did not. Furthermore, patients with stage III-IV cervical cancer exhibited higher levels of the six markers than those with stage I-II during staging. Notably, the combination of four or six markers significantly improved the sensitivity and specificity of the diagnosis, as demonstrated by the ROC curves.ConclusionOur developed TAT test kit has excellent performance and low cost, making it a clinically valuable tool for widespread use. Elevated TAT levels have significant predictive value for thrombosis occurrence in cervical cancer patients. The combination of t-PAIC, TM, TAT, PIC, D-dimer(D-D), and FDP markers is superior to using a single marker for diagnosing VTE in patients with malignant tumors. Screening cervical cancer patients for the six markers is essential to aid in active prophylaxis, determine optimal treatment timing, and implement nursing interventions to improve prognosis, reduce venous thrombosis incidence and mortality, and prolong survival time.

Risk Factors for Venous Thromboembolism in Acute Promyelocytic Leukemia.

Acute promyelocytic leukemia (APL) is frequently associated with disseminated intravascular coagulation (DIC), leading to potentially life-threatening bleeding. Compared to bleeding, thromboses are a less commonly encountered problem. The objective of our study was to identify the incidence and predictive value of demographic data, clinical-laboratory parameters, and thrombosis risk assessment models (RAMs) for venous thromboembolism (VTE) in patients with APL. This study was a retrospective study conducted on adult patients with APL who were treated between 2006 and 2024 at the Clinic of Hematology UCCS with all-trans retinoic acid (ATRA) and anthracycline. The demographic and clinical-laboratory data related to VTE were collected and analyzed alongside the predictive value of two RAMs proposed by Al-Ani and Paterno and colleagues. Among the one-hundred-fifty-five adult patients with APL, VTE was diagnosed in twenty-eight cases (18.1%). The most common location for thrombosis was in the central venous catheter (CVC), which affected twelve (42.8%) patients. A total of six (21.4%) patients had deep vein thrombosis (DVT), one patient (3.6%) showed a pulmonary embolism (PE), and thrombosis at unusual sites was present in nine (32.1%) patients. Our analyses showed that neither Al-Ani's RAM nor the RAM proposed by Paterno and colleagues were predictive for VTE in patients with APL. The C statistics value for the Al-Ani model was ROC = 0.514, and, for Paterno's RAM, it was ROC = 0.521. The independent risk factors for VTE, identified via multivariate analysis, were CD114 expression (p = 0.005, OR = 6.4 IC 95%: [1.8-23.2]) and the absence of bleeding at presentation (p = 0.013, OR = 0.086 IC 95%: [0.01-0.59]). To the best of our knowledge, this is the first study showing that a higher expression of CD114 increases the risk of VTE. The absence of bleeding at presentation in patients with APL correlates with thrombosis. Further analyses are needed to confirm these findings and help to develop therapeutic strategies to prevent VTE complications. So far, no risk assessment model has been sufficient to stratify patients with APL according to their risk of VTE.

Risk Factors for Venous Thromboembolism Following Total Knee Arthroplasty: An Analysis of 3,052 Pulmonary Emboli.

Identifying risk factors for pulmonary embolism (PE) and deep vein thrombosis (DVT) following primary total knee arthroplasty (TKA) may improve risk stratification and guide surgeons in prophylaxis selection. This study aimed to identify factors associated with postoperative venous thromboembolism (VTE) following TKA. A national healthcare database was queried for adults who underwent primary, elective TKA from January 1, 2015 to December 31, 2020. Patients who developed PE or DVT within 90 days postoperatively were compared with patients who did not. Demographics, comorbidities, hospital factors, perioperative medications, and blood transfusion needs were assessed. A multivariate model was used to identify independent risk factors for VTE. Overall, 847,496 patients were identified, of whom 8,002 (0.94%) developed a VTE postoperatively (3,052 PE, 5,294 DVT). After controlling for confounders, an elevated risk of VTE was associated with increased age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI] = 1.01-1.01, P < 0.001), Black patients (aOR: 1.30, 95% CI=1.28-1.47, P < 0.001), and patients enrolled in Medicare (aOR: 1.18, 95% CI = 1.13-1.24, P < 0.001) or Medicaid (aOR: 1.24, 95% CI = 1.12-1.37, P < 0.001). Independent risk factors for PE included obesity (aOR: 1.25, 95% CI = 1.16-1.35, P < 0.001), pulmonary hypertension (aOR: 3.64, 95% CI = 3.05-4.35, P < 0.001), and history of VTE (aOR: 1.71, 95% CI = 1.54-1.91, P < 0.001). Risk factors associated with an increased risk of DVT included iron deficiency anemia (aOR:1.38, 95% CI = 1.14-1.66, P < 0.001) and abnormal weight loss (aOR: 1.67, 95% CI = 1.07-2.60, P = 0.023). Increasing age, Black race, Medicare, or Medicaid insurance were associated with increased risk of VTE. Obesity, history of VTE, and pulmonary hypertension were risk factors for both PE and DVT. These data can assist surgeons in the selection of a prophylactic regimen after TKA.

Preoperative risk factors for venous thromboembolism in major urologic cancer surgeries.

Venous thromboembolism (VTE) is a serious complication of urologic cancer surgeries. Incidence varies by procedure, with cystectomy carrying the highest risk. Our study aims to explore the preoperative risk factors for VTE development in major urologic cancer surgeries. Using the ACS-NSQIP database, cystectomy, prostatectomy or nephrectomy cases between 2011 and 2020 were identified. Patient characteristics and pre-operative variables were compared using χ2 test. Multivariate logistic regression was used to control for confounding variables. 207,861 patients were included. 2484 (1.2%) patients experienced VTE post-operatively, with a rate of 3.16% among cystectomy patients. The incidence of pulmonary embolism (PE) peaked at day 2, while that of deep venous thrombosis (DVT) peaked at days 2 and 8. On multivariate analysis, blood transfusion and cystectomy were associated with the highest risk of VTE (OR = 2.29 [1.64, 3.18], P = < 0.001 and OR = 2.96, 95%CI [2.62, 3.37], P < 0.0001; respectively). Other important risk factors included advanced age ≥ 80 years (OR = 1.98 [1.65, 2.40], P = 0.001), BMI ≥ 40kg/m2 (OR = 1.82 [1.43, 2.24], P = 0.001), congestive heart failure (OR = 1.75 [1.15, 2.66], P = 0.008), steroid use (OR = 1.55 [1.26, 1.94], P = < 0.001), thrombocytosis OR = 1.43 [1.16, 1.76], P = 0.001) and leukocytosis (OR = 1.41 [1.11, 1.54], P = < 0.001). Our study highlights important pre-operative risk factors for the development of VTE after urologic cancer surgeries. This stresses the importance of pre-operative risk assessment to guide counseling and thromboprophylaxis strategies especially among cystectomy patients who are older, obese, and requiring blood transfusion.

Venous thromboembolism treatment failure during use of factor Xa inhibitors—association with thoracic outlet syndrome and development of chronic thromboembolic pulmonary hypertension

Background Factor Xa inhibitors (FXaI) are recommended for treatment of venous thromboembolism (VTE). However, in FXaI trials there is a 2–3% treatment failure rate. This observational study aimed to elucidate factors associated with recurrent VTE during coagulation FXaI treatment. Methods Ten consecutive FXaI failure cases were included. Various thrombosis risk scores were assessed, thrombophilia was screened, and coagulation activity was followed-up, to tailor individual anticoagulation strategies. Results Our patients were young (mean age 37.5 years, range 22–55), six being women. Index VTE was pulmonary embolism (PE) in eight patients, and upon recurrent PE, six of them developed chronic thromboembolic pulmonary hypertension (CTEPH). Although initially many patients appeared to have unprovoked VTE, all had major VTE risk factors. Seven patients had chronic venous obstruction: five subclavian (thoracic outlet syndrome, TOS) even though only two had upper extremity deep vein thrombosis at index thrombosis, plus one common iliac, and one with chronic paraplegia. Five patients had multiple VTE risk factors and four had thrombophilia. VTE risk scores varied from the lowest (TOS patients) to the highest risk (multiple risk factors/thrombophilia). FXaI failure occurred on average at 97 days of therapy (range 15–279) without evident noncompliance. D-dimer levels declined from the index thrombosis to FXaI failure, and re-thrombosis resisted further anticoagulation, low D-dimer referring to impaired fibrinolysis. The majority (8/10) of patients required mechanical/surgical interventions. Conclusions Our results underline careful risk assessment upon PE and reoccurrence, with inclusion of TOS as a risk factor of VTE and CTEPH.

Incidence and risk factors of silent deep venous thromboembolism before interval debulking surgery in ovarian cancer patients, a tertiary centre experience

ObjectiveTo determine the prevalence and risk factors for the development of asymptomatic venous thromboembolism (VTE) in ovarian cancer patients who underwent interval cytoreductive surgery after finishing neoadjuvant chemotherapy. MethodsThis is a prospective observational trial. Female patients with pathologically proven ovarian cancer who received neoadjuvant chemotherapy without clinical evidence of VTE were included. ResultsA total of 107 patients were enrolled in this study. The mean age was 53.37 years, and the mean body mass index (BMI) was 34.11 kg/m2. Seven (6.5 %) patients suffered from silent VTE, as documented by bilateral Doppler ultrasound in the pre- and postoperative settings. The mean age of the patients in the VTE group was 56.17 years, and their mean body mass index was 31.71 Kg/m2. Their median serum CA125 concentration was elevated (325.6 units/ml). On the other hand, the median D-dimer level was elevated by 678 ng/ml fibrinogen equivalent units (FEUs) in the same group of patients. In the present study, comorbidities did not influence the incidence of VTE, as the 7 patients who were diagnosed with VTE did not have any comorbidities. Most of the patients who were diagnosed with serous adenocarcinoma (71.4 %) or stage IIIc disease (57.1 %) were most likely to develop VTE. ConclusionSilent VTE is more prevalent in patients with advanced-stage ovarian cancer and serous carcinomas

Incidence and risk factors for venous thromboembolism in gynecological cancer: the GOTIC-VTE trial.

Real-world data on venous thromboembolism (VTE) in Japanese patients with gynecological cancer are lacking. The GOTIC-VTE trial aimed to evaluate the frequency of VTE-associated events and risk factors at the time of cancer diagnosis and during 1-year follow-up. From July 2017 to February 2019, patients with endometrial, cervical, ovarian, tubal, or peritoneal cancer who underwent VTE screening within 2months before registration, were enrolled. Of the 1008 patients enrolled, 881 were included in the analysis set, 51 (5.8%) had VTE at the time of cancer diagnosis (baseline), 7 (0.8%) had symptomatic VTE, and the majority had asymptomatic VTE (n = 44; 5.0%). Patients with ovarian, tubal, or peritoneal cancer had a higher incidence of VTE (13.7%) than those with other cancer types. During the 1-year follow-up, 0.9% (n = 8) of the patients had symptomatic VTE, 3.5% (n = 31) had composite VTE (symptomatic VTE and incidental VTE requiring treatment), 0.2% (n = 2) had bleeding events, and 4.3% (n = 38) had all-cause death, all of which were significantly higher in the VTE group at baseline. In the multivariate analysis, chemotherapy was an independent risk factor for composite VTE during the 1-year follow-up (hazard ratio 3.85, 95% confidence interval 1.39-13.63, p = 0.018). Among gynecological cancers, VTE incidence is particularly high in ovarian, tubal, or peritoneal cancer, and patients undergoing chemotherapy should be cautioned against VTE occurrence during treatment.The GOTIC-VTE trial Unique identifier, jRCTs031180124; Registration date, April 06, 2017.

Risk factors for deep vein thrombosis and pulmonary embolism: a comparative study between acute hospital care and mental health inpatient settings for older people

Purpose This study aims to establish if risk factors for venous thromboembolism (VTE) in older hospitalized psychiatric patients differ from geriatric inpatients and if the current risk assessment tools being used are suitable. Design/methodology/approach The authors undertook a single centre retrospective review of 75 records for presence of predetermined risk factors. In total, 55 discharged patients with thrombotic events within geriatric settings were compared with 20 from mental health settings. Differences in risk factors were determined using t-test and Fisher’s exact test. Findings VTE patients in geriatric units were older and had reduced mobility. Psychiatric patients were more likely to be dehydrated and treated with psychotropics. Whilst rates of VTE screening were comparable in both settings, geriatric inpatients were more frequently prescribed thromboprophylaxis. Research limitations/implications Older psychiatric inpatients differ from those in medical/surgical settings in their profiles and risk factors for VTE. Approaches for VTE risk management also differed. Practical implications The study suggests the need for VTE screening tools and treatment protocols specific to older psychiatric settings. Social implications Targeted approaches may improve outcomes specific to each group. Originality/value To the best of the authors’ knowledge, this is the first attempt in comparing VTE risk factors across acute physical health care and mental health settings.

Development and validation of a predictive risk tool for VTE in women with breast cancer under chemotherapy: a cohort study in China.

The incidence of venous thromboembolism (VTE) is significantly elevated in breast cancer patients, with a three-to-fourfold increase, and further escalates to sixfold in those undergoing chemotherapy. This study aims to identify the risk factors for VTE and develop a Nomogram risk prediction model distinct from the traditional Khorana score. Univariate Cox regression analysis assessed the impact of each variable on the occurrence of VTE, while stepwise multivariate Cox regression analysis identified independent predictors. Based on these results, we constructed a Nomogram model. The model's performance was validated using the C-index, receiver-operating characteristic curve (ROC), calibration curves, and decision curve analysis (DCA). Comparisons were made with the Khorana score to evaluate the practical application value. Out of the 903 patients, 108 (11.96%) developed VTE. Cox regression analysis identified that Stage, undergoing surgery, age, white blood cells (WBC), D-dimer, and carcinoembryonic antigen (CEA) were significant risk factors for VTE (P < 0.05). The Nomogram model's C-index was 0.77 (95% CI 0.72-0.83) in the training set and 0.76 (95% CI 0.69-0.84) in the validation set. The model demonstrated excellent predictive accuracy and generalizability on the receiver-operating characteristic (ROC) curves and calibration curves. Compared to the traditional Khorana score, the Nomogram model showed superior predictive accuracy and greater clinical benefit. This study established a VTE risk prediction model for breast cancer patients undergoing chemotherapy. The model is characterized by its intuitive and straightforward application, making it highly suitable for rapid VTE risk assessment in clinical practice.

Clonal haemopoiesis and venous thromboembolism risk.

Many cases of venous thromboembolism (VTE) are idiopathic and clonal haemopoiesis, a risk factor for atherosclerotic vascular disease, may be a contributing factor to VTE. The report by Englisch and colleagues suggests that clonal haemopoiesis is a risk factor for recurrent VTE, especially in people without identifiable thrombotic predisposition. Commentary on: Englisch etal. Association of clonal hematopoiesis with recurrent venous thromboembolism: A case-control study. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19871.

Venous thromboembolism among gynecologic cancer patients in Zaria

Cancer is one of the most important acquired risk factors for Venous Thromboembolism (VTE) including Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). Patients with active malignancy have up to six-fold increased risk of symptomatic VTE than the general population. The risk of VTE in patients with gynecologic malignancy is especially high because of the nature of the tumor, its pelvic location, associated comorbidities, and systemic chemotherapy. The objective of this study was to determine other risk factors, incidence, clinical presentation, and immediate outcome of treatment of thromboembolism in patients with gynecologic cancers in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. It was a retrospective cross-sectional descriptive study of gynecologic cancer cases that were diagnosed with VTE while on admission from 2007-2016 in ABUTH. The overall prevalence of clinical VTE was 2.8% in gynaecologic malignancy. All were DVT. Most cases of DVT were present in ovarian cancers with left-sided preponderance. There is a need for the provision of modern imaging equipment to facilitate timely and highly sensitive diagnosis of VTE in low-resource settings. The main limitation of this study was the inability to find any confirmed case of PE.

Venous thromboembolism incidence and risk factors in patients undergoing hematopoietic stem cell transplantation

BackgroundMalignancy is a well-known risk factor for venous thromboembolism (VTE), and the Khorana risk score is effective for screening solid tumor patients. However, there is a lack of validated screening tools and established risk factors for patients undergoing hematopoietic stem cell transplant (HCT). Current literature reports VTE incidence in HCT patients ranging from 2.5% to 8.5%. Anticoagulation is difficult to manage post-transplant given prolonged thrombocytopenia and the likelihood of bleeding. By identifying risk factors, a predictive model may be developed to prospectively test prophylaxis strategies in patients at the highest thromboembolic event (TE) risk. ObjectivesThis study evaluated the cumulative incidence of TE at 6 months following allogeneic and autologous HCTs. This study also aimed to identify risk factors for developing TE, to evaluate time from HCT to TE, and to compare one-year survival following HCT between patients experiencing TE and those who did not. Study DesignThis is a retrospective single-center study evaluating the incidence of TE events in adult subjects undergoing HCT between March 2014 and December 2019. ICD-9 and ICD-10 codes were used to determine cancer diagnosis, TE events up 180 days after HCT, and comorbidities of interest. Each subject was reviewed for data accuracy by manual retrospective chart review. The study employed statistical tests such as the cumulative incidence method with competing risks, Gray's test, and univariate and multivariate Cox proportional hazards models to analyze the time to first thromboembolic (TE) event, evaluate risk factors, and assess 1-year survival post-HCT in relation to TE events within 180 days of HCT. Variables examined included age, sex, body mass index (BMI), transplant type, hospital length of stay, history of TE prior to transplant, active infections, graft-versus-host disease (GVHD), veno-occlusive disorder (VOD), cytomegaly virus (CMV) and other factors. ResultsThe study included 636 evaluable patients; the majority were male (57.9%), white (68.7%), and underwent an autologous HCT (68.4%). Twenty-nine patients (4.6%) experienced a TE event within 180 days post-transplant. TE events were more common in the allogeneic transplant group (n=13/201, 6.5%) than the autologous transplant group (n=16/435, 3.7%) (p=0.122). The cumulative incidence of TE was higher in patients who developed an active infection than those who did not (7.6% vs 3.1%, P=.011). Hospital LOS [HR 1.03, 95% CI 1.0-1.06, p=0.036] and active infection [HR 2.34, 95% CI 1.1-4.95, p=0.027] were significantly associated with TE in the univariate analysis but were not retained in the final multivariate model. There was no difference in one-year survival among all patients who experienced a TE event and those who did not; however, in the autologous HCT subgroup, one-year survival rate was significantly lower in those with TE compared to those without TE (Figure 3c, 80.4% vs 95.3%, P=.01). Examined variables, including history of TE event and GVHD, were not associated with TE event risk. ConclusionWhile the overall incidence of TE in our study was low, many patients received pharmacologic or mechanical prophylaxis, suggesting such strategies may be effective in mitigating TE risk. Factors such as infection and hospital LOS may further increase TE risk. Providers should continuously monitor for risk factors and signs and symptoms of TE post-transplant. It is also imperative to consider chemical prophylaxis if counts are recovered while hospitalized.