Crohn's disease, which typically affects individuals of reproductive age, has risen in prevalence over the past decades. The study objective was to determine the impact of maternal Crohn's disease on maternal and neonatal adverse outcomes. A retrospective cohort study was performed using the Healthcare Cost and Utilization Project-National Inpatient Sample from the UnitedStates. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify individuals who delivered between 2016 and 2021, and then those with Crohn's disease were identified (ICD-10 code K50). The effect of Crohn's disease on pregnancy was estimated using multivariable logistic regression adjusted for baseline maternal characteristics. There were 4,337,612 births between 2016 and 2021, of which 5,671 were associated with maternal Crohn's disease, for an overall period prevalence of 13.1/10,000 births. There was an upward trend in prevalence from 10.2/10,000 deliveries in 2016 to 15.6/10,000 deliveries in 2021 (p<0.0001). Individuals with Crohn's disease were at increased risk of preeclampsia (odds ratio 1.6, 95 % CI 1.4-1.7), chorioamnionitis (1.3, 1.1-1.5), placental abruption (1.4, 1.1-1.7), instrumental delivery (1.3, 1.1-1.4), cesarean delivery (1.6, 1.5-1.7), postpartum hemorrhage (1.3, 1.2-1.5), sepsis (2.0, 1.5-2.7), and venous thromboembolic events (2.1, 1.1-3.8). Neonates born to these mothers were more likely to be premature (1.6, 1.5-1.7), suffer from congenital anomalies (1.5, 1.2-1.8) and intrauterine growth restriction (1.7, 1.5-1.9). Crohn's disease in pregnancy was associated with adverse maternal and neonatal outcomes. Pregnant patients with Crohn's disease should therefore be closely monitored throughout their pregnancy to minimize these adverse outcomes.

To assess the concordance of results between paired target trial emulations and their benchmarking randomised controlled trials and to explore determinants of emulation success. Systematic review and meta-analysis. Medline, EMBASE, Scopus, PsycINFO, and Web of Science (2010 to 2025). Observational studies that explicitly aimed to emulate target randomised controlled trials of a health intervention were included. Data were extracted on study domain, target population, intervention, comparator, and main outcomes for each emulation and corresponding randomised controlled trial. For 21 predefined emulation design features, concordance was assessed using Pearson correlation coefficients, standardised difference agreement, and ratio of ratios, with subgroup and regression analyses of study characteristics and concordance. Among 107 target trial emulation-randomised controlled trial pairs, the Pearson correlation coefficient was 0.59 (95% confidence interval (CI) 0.45 to 0.70), standardised difference agreement was 79% (85/107), and summary ratio of ratios was 0.96 (95% CI 0.92 to 1.01; I2=36%). In 63 pairs with closer emulation of trial design, a higher level of agreement was observed, with a Pearson correlation coefficient of 0.83 (0.73 to 0.89) and standardised difference agreement of 87% (55/63). In subgroup analysis, trial emulations tended to systematically underestimate treatment effects from randomised controlled trials for specific outcomes related to venous thromboembolism and major adverse cardiovascular events, while overestimating those for respiratory outcomes, with pooled ratio of ratios of 0.76 (0.58 to 1.00; I2=40%), 0.91 (0.86 to 0.96; I2=32%), and 1.20 (1.03 to 1.40; I2=40%), respectively. Moreover, emulations based on claims data tended to underestimate the treatment effects (ratio of ratios 0.90, 0.82 to 0.99; I2=38%). In univariate regression analyses, poorer target trial emulation-randomised controlled trial concordance was associated with emulation designs with imbalanced baseline population characteristics, treatment started in hospital, and lower outcome emulation quality. Current target trial emulations achieve moderate concordance when replicating their corresponding randomised controlled trials. Concordance could be improved by better emulation design, including better baseline and outcome emulation and leveraging multisource linked databases. PROSPERO CRD42024619811.

Obese patients hospitalized for surgery are at high risk of venous thromboembolism (VTE). The optimal dose and duration of thromboprophylaxis with low molecular weight heparin for these patients are uncertain. To assess the time-course, rates and risk factors for VTE and major bleeding (MB) in a population of surgical patients with obesity receiving pharmacological thromboprophylaxis with enoxaparin. Patients with body mass index (BMI) > 30kg/m2 hospitalized with surgeries between 2010 and 2021 who received thromboprophylaxis with enoxaparin were selected from the US Optum database. Exclusion criteria were VTE, MB, or surgery in previous 90-days, and ongoing anticoagulant treatment or dual antiplatelet therapy. VTE and MB event rates over a 90-day follow-up post enoxaparin initiation were estimated via the Kaplan-Meier (KM) method. Risk factors associated with outcome events were identified via Cox proportional hazard models. A total of 30,492 patients met selection criteria, 12,058 patients received the standard dose, with 18,300 receiving higher doses. KM event rates at 90-days for VTE and MB were 2.5% and 1.2%, respectively. The highest VTE rates were observed in patients hospitalized for thoracic surgery (4.9%). History of VTE was the strongest predictor of post-surgery VTE (HR 5.62, 95% CI 4.71-6.7) while history of MB was the strongest predictor of post-surgery bleeding (HR 2.62, 95% CI 1.29-5.32). The rates of VTE are non-negligible in surgical patients with obesity receiving thromboprophylaxis with enoxaparin. Individual risk stratification is warranted to identify optimal doses/duration of pharmacologic thromboprophylaxis.

Cancer-associated thrombosis (CAT) is a relevant cause of morbidity and mortality in oncology patients. Although several venous thromboembolism (VTE) risk assessment models (RAMs) are recommended to guide thromboprophylaxis in ambulatory cancer patients, their performance varies across populations. Data from Brazilian cohorts are limited, and the real-world performance of these models in this setting remains unclear. We conducted a prospective external validation study of four established VTE RAMs-Khorana, PROTECHT, CONKO, and Vienna CATS-in ambulatory cancer patients from a Brazilian tertiary-care registry. A total of 803 adult patients with complete data were followed for 12 months for objectively confirmed symptomatic VTE. Predictors included baseline variables from each RAM, applied according to their original definitions. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), with 95% confidence intervals (CI) obtained by bootstrap resampling. Vienna CATS was evaluated in a biomarker-defined subcohort of 470 patients. During follow-up, 36 of 803 patients (4.5%) developed VTE. The Khorana (AUC 0.567; 95% CI 0.462-0.672), PROTECHT (AUC 0.575; 95% CI 0.470-0.680), and CONKO (AUC 0.567; 95% CI 0.464-0.671) scores showed limited and comparable discrimination, with sensitivities of approximately 30% at the conventional high-risk threshold (≥3 points). In the Vienna CATS subcohort, 24 of 470 patients (5.1%) developed VTE. Vienna CATS demonstrated modest but statistically significant discrimination (AUC 0.672; 95% CI 0.559-0.779) over chance. However, pairwise comparisons using DeLong's test showed no significant differences in AUC between the clinical-only scores and the same subcohort. Additional analyses suggested heterogeneity in risk across component combinations despite equal point weighting. Among patients with very-high-risk tumors plus one additional component, VTE incidence varied substantially depending on the specific factor present, ranging from 0% for BMI to 38.5% for low hemoglobin. Overall, current RAMs demonstrated limited sensitivity for identifying patients who developed VTE in this Brazilian cohort. These findings indicate that RAMs alone may be insufficient to guide thromboprophylaxis decisions in this setting, particularly given their limited sensitivity and the occurrence of VTE events among patients classified as low risk. Furthermore, the results support the need to develop locally validated models for Brazilian patients, as well as to explore novel biomarkers, alternative predictor thresholds, and potentially nonlinear approaches to variable weighting.

Patients with earlier SARS-CoV-2 variants are at increased risk of venous and arterial thromboembolic (VTE, ATE) events. Here we aimed to contextualise the incidence of thromboembolic events among patients with COVID-19 during the Omicron period. We conducted a population-based cohort study using electronic health records from the UK (CPRD GOLD), the Netherlands (IPCI), and Spain (SIDIAP) within the DARWIN EU® network. Two cohorts were included: a pre-pandemic population (2017-2019) and individuals infected with SARS-CoV-2 during the Omicron-dominant period. We estimated incidence rates (IRs) of VTE, ATE, and other cardiovascular events at 30-, 60-, 90-, and 180-days post-infection. Crude incidence rate ratios (IRRs) and age-sex standardized incidence ratios (SIRs) were calculated relative to the pre-pandemic cohort. Analyses were stratified by prior infection, vaccination status, and immunocompromised status. In total, we included over 7.6million individuals (CPRD GOLD: 5.28M; IPCI: 1.59M; SIDIAP: 0.75M) in the general population cohort, and about 0.8million individuals (CPRD GOLD: 248,847; IPCI: 330,200; SIDIAP: 200,563) in the COVID-19 Omicron cohort. Crude IRs varied by outcome and data source. For VTE, IRs per 100,000 person-years were 136 [95%CI 131-141] in SIDIAP, 167 [164-169] in CPRD GOLD, and 264 [259-270] in IPCI. Elevated SIRs for VTE and ATE were observed following SARS-CoV-2 infection, highest within 30 days and persisting up to 180 days. In CPRD GOLD, the VTE SIR was 3.61 [2.45-5.53] at 30 days, decreasing to 1.88 [1.52-2.34] at 180 days. Higher SIRs were observed among immunocompromised individuals and those without prior infection. Our findings indicate that among individuals diagnosed with SARS-CoV-2 infection during the Omicron-dominant period, observed rates of thromboembolic events exceeded expected background incidence, particularly in the early post-infection period.

The recent escalation of conflict in Gaza has resulted in a substantial burden of trauma-related injuries, particularly orthopedic trauma, with a total of 362 patients included in this study. This study presents a retrospective descriptive analysis of epidemiology, injury patterns, and clinical management of encountered orthopedic trauma cases during the conflict. This study aimed to characterize the mechanisms, patterns, and outcomes of orthopedic injuries sustained during the ongoing war in Gaza, with the goal of informing surgical response, resource allocation, and emergency preparedness in conflict settings. Data were retrospectively collected from the paper medical records of 362 patients with both direct conflict-related trauma and indirect conflict-affected orthopedic conditions, treated at the Jordanian Military Field Hospital – Southern Gaza (Khan Younis), between June 22 and October 2, 2024. Variables included demographic data, injury mechanisms, anatomical and injury types, surgical interventions, anesthesia modalities, perioperative care, and outcomes. Descriptive statistics were used to report frequencies, percentages, and means. The study included predominantly male patients (78.5%) with a mean age of 29.6 years. Blast injuries (48.3%) and gunshot wounds (31.2%) were the leading causes of trauma. The most common injuries were femur fractures (36.5%) and acute open fractures (36.2%). Frequent procedures included open reduction and internal fixation (34.8%) and fixation device removal (29.0%). General anesthesia (32.3%) and spinal anesthesia (29.8%) were commonly used, and all patients received antibiotics (100.0%). Anticoagulants were administered to 47.5% of patients, and 92.3% received physiotherapy. Surgical complications were low (4.4%), with no recorded venous thromboembolism events or deaths within 9 months. Orthopedic trauma during the Gaza conflict was primarily characterized by blast and gunshot injuries, with femur fractures being most prevalent. These findings underscore the importance of targeted trauma care protocols and resource planning in conflict zones. Despite relatively low short-term complications, only 30.1% of patients regained independent ambulation at 3 months, underscoring a substantial early disability burden. The high incidence of complex injuries, incomplete follow-up, and cohort heterogeneity limit definitive conclusions, but the findings point to an urgent need for sustained international support for trauma care and rehabilitation systems in Gaza.

Background:Osteosarcoma (OS) and Ewing sarcoma (EWS) are the most common primary bone cancers in children, but acute thrombosis is poorly characterized in this population. Our study evaluated the rates of venous thromboembolism (VTE) and associated risk factors in pediatric patients with bone sarcomas treated over a 10-year period encompassing the emergence of COVID-19.Procedure:Data were obtained via EMR review for patients diagnosed with OS and EWS at Texas Children’s Hospital from 2014–2023. Statistical analyses were performed using Fishers exact, Chi-squared, and Wilcoxon Rank-Sum tests. Change in VTE rate prior to and after 2020 was compared using interrupted time series analysis.Results:Among137 eligible patients; the majority were diagnosed with OS (n=85, 62%) compared to EWS (n=52, 38%). Twelve patients (8.8%) developed VTEs during primary cancer therapy. Femoral tumor location was associated with increased VTE occurrence (p=0.016) and there was a trend toward increased VTE in OS (p=0.13) and obese patients (p=0.2). VTE rates increased after the emergence of COVID-19, although only one affected patient tested positive. The incidence rate ratio pre- and post-COVID-19 emergence (2014–2019 vs 2020–2023) was 8.7 (95% CI: 2.29–56.61, p=0.005). This increase in VTEs after 2020 was sustained.Conclusion:Our cohort represents the largest population of pediatric patients with bone sarcomas studied to date. In our 10-year analysis, we observed a sustained increase in VTE events following the emergence of COVID-19. Additionally, our data suggests subsets of this patient population, specifically obese patients with OS and femoral tumors, should be closely monitored for thrombosis.

Relapsed/refractory (r/r) angioimmunoblastic T-cell lymphoma (AITL) is associated with a dismal prognosis, with historical overall survival (OS) < 6 months, underscoring the urgent need for novel therapies. We conducted the RCLARITY trial to evaluate the efficacy and safety of a chemotherapy-free regimen in this patient population. This single-arm, multicenter, prospective Phase II trial enrolled adult patients with r/r AITL. Patients received rituximab (375 mg/m2 intravenously on Day 1), lenalidomide (15 mg orally on Days 1-21), and chidamide (30 mg orally twice weekly) in 28-day cycles for up to 6 cycles. The primary endpoint was progression-free survival (PFS). Secondary endpoints included the overall response rate (ORR), OS, duration of response (DoR), and safety. In total, 28 patients were enrolled between August 2019 and June 2024. The median age was 64 years (range, 44-70), and 71.4% had refractory disease. The ORR was 71.4% (complete remission: 32.1%), median PFS was 5.5 months (95% confidence interval [CI], 3.5-7.6), median OS was 17.6 months (95% CI, 10.3-24.8), and median DoR among responders was 10.7 months (95% CI, 2.7-16.0). Notably, 50% of patients with clonal Ig heavy- or light-chain rearrangements achieved PFS > 16 months. All nine patients with baseline serum EBV-DNA positivity converted to undetectable levels after two cycles. No Grade 5 adverse events or venous thromboembolic events occurred. The most common hematological adverse events per cycle were leukopenia (14.3%), thrombocytopenia (12.4%), and neutropenia (11.4%). Overall, the RLC regimen induced clinically meaningful anti-tumor activity with manageable toxicity in patients with r/r AITL. Trial Registration: ClinicalTrials.gov identifier: NCT04319601.

To compare venous thromboembolism (VTE) events in patients undergoing open reduction and internal fixation (ORIF) of acetabular fractures who did and did not receive weight-based dosing of prophylactic enoxaparin. This retrospective cohort study included patients with acetabular fractures treated with ORIF between 2013 and 2020 at a single level-1 trauma center. Patients with pre-existing VTE, allergy, no enoxaparin use, or receipt of other prophylactic agents were excluded. Patients were categorized as having received appropriate or inappropriate weight-based enoxaparin dosing based on institutional BMI-tiered protocol. The primary outcome was incidence of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Group comparisons were performed with Pearson's Chi-square, and binomial logistic regression was used to adjust for additional VTE risk factors. Among 363 patients, 198 (54.5%) received appropriate weight-based dosing and 165 (45.5%) did not. Overall, 20 patients (5.5%) developed VTE (4 PE, 11 DVT, 3 both PE and DVT). Of these, 13 had received appropriate dosing. VTE incidence did not differ significantly between groups (6.6% vs. 4.2%, p = 0.334). Rates of isolated PE, isolated DVT, and combined events were also not significantly different (all p > 0.05). Logistic regression confirmed no significant association between weight-based dosing and VTE when adjusting for patient and clinical risk factors. Only half of patients with operative acetabular fractures received appropriate weight-based dosing of enoxaparin. Weight-based dosing was not associated with reduced VTE incidence, suggesting that receipt of prophylaxis itself may be the most important factor. Larger studies are warranted to verify these findings.

Objectives To develop a random survival forest (RSF) machine learning (ML) model for predicting venous thromboembolism (VTE) risk in rheumatoid arthritis (RA) patients initiating biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) and compare its model performance with a regularized Cox regression (RegCox) model. Methods This retrospective cohort study using the 5% Medicare data (2012-2020) identified older RA patients (≥ 65 years) initiating b/tsDMARDs (index date), including tumor necrosis factor inhibitors (TNFi) bDMARDs, non-TNFi bDMARDs, and tsDMARDs between January 1, 2013, through December 31, 2019. Study cohort was followed until an incident composite VTE event or censoring. Data were divided into training (75%) and testing (25%) sets. The RSF model was trained to predict VTE events during the follow-up period in the training set, with the RegCox model as the reference model. The performance of these models was evaluated in the testing data using the C-index. Variable importance of the predictors was assessed. Results Of 3,648 RA patients, 360 (9.87%) experienced any VTE event. The RSF model had better performance (C-index [95% CI] = 0.609[0.602-0.617]) than the RegCox model (C-index [95% CI] = 0.599[0.597-0.602], p = 0.0021). Variables commonly identified as the top influential variables were varicose veins, inpatient visits, Elixhauser score, emergency room visits, and outpatient visits. Conclusions The RSF model performed slightly better in identifying VTE in RA patients after b/tsDMARDs initiation than RegCox. Incorporating additional clinical and contextual information beyond claims data may further enhance predictive accuracy in future studies.

Incident venous thromboembolism in biopsy-proven metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study.

Venous thromboembolism (VTE) is a disorder due to the interaction between genetic, individually acquired and environmental factors. The aim of this narrative review is to summarize advances in genetic susceptibility to first and recurrent VTE, focusing on GWAS-derived polygenic risk scores and sequencing-based approaches, and to discuss current barriers to clinical implementation. Testing for the classical inherited thrombophilias, such as the deficiencies of natural anticoagulants antithrombin, protein C and S and the Factor V Leiden variant and the G20210A of Factor II could improve risk stratification and therapeutic decisions in VTE, although their role in VTE management remains controversial. The knowledge regarding genetic susceptibility for VTE progressed in the last two decades, beyond the classical thrombophilias, thanks to the evolution from single-gene Sanger sequencing to genome wide sequencing (GWAS) and next generation sequencing. GWAS has allowed to construct polygenic risk scores (PRS) combining the effects of multiple single-nucleotide polymorphisms. PRS could significantly improve VTE risk prediction beyond clinical factors. The integration of genetic and clinical data could improve predictive accuracy. In addition, combining GWAS with transcriptome-wide association studies and Mendelian randomization has shown that genetic risk may change across different clinical presentations of VTE and that recurrent VTE differs genetically and biologically from the initial VTE event, being associated with variants such as those of kininogen 1 and fibrinogen. PRS can stratify VTE risk beyond traditional factors in European-ancestry cohorts; recurrence may have a partially distinct genetic / proteomic architecture, but prospective clinical utility remains to be established and integrating this advanced knowledge into clinical practice remains a future challenge in VTE management.

SARS-CoV-2 infection is associated with an increased risk of venous thromboembolism. Data are lacking on how this risk altered during the COVID-19 pandemic and following vaccination. We aimed to evaluate the 90-day risk of postoperative venous thromboembolism during the pandemic. We performed a retrospective cohort study of patients having abdominal, obstetric, orthopaedic, cardiac, thoracic or vascular surgical procedures using the OpenSAFELY-TPP platform. Crude 90-day risks of venous thromboembolism were calculated and crude and adjusted hazard ratios were derived from individual Cox proportional hazards models. In total, 1,800,540 procedures were performed with 15,390 individual venous thromboembolic events recorded within 90 days. The highest crude absolute risk was in the Alpha wave at 1.2%. Postoperative SARS-CoV-2 infection was associated with a 4.4-fold increase in relative risk of 90-day venous thromboembolism (adjusted hazard ratio 4.42, 95%CI 4.21-4.64) compared with those without. Recent SARS-CoV-2 infection was associated with an increased risk of venous thromboembolism (adjusted hazard ratio 4.03, 95%CI 3.78-4.30) compared with those without. Patients who were unvaccinated had the highest relative risk for 90-day venous thromboembolism. A single dose of vaccine was associated with a 20% relative risk reduction of venous thromboembolism (adjusted hazard ratio 0.80, 95%CI 0.76-0.84). SARS-CoV-2 infection status and vaccination history were associated with 90-day venous thromboembolism risk, with both recent and postoperative SARS-CoV-2 infection associated with an increased risk, whilst one dose of vaccine reduced the risk.

Prevalence of venous thromboembolic disease among patients with patent foramen ovale-related arterial ischemic events.

Venous and arterial thromboembolic events (TEEs) represent a substantial threat for melanoma patients treated with immune checkpoint inhibition (ICI) and have a significant impact on quality of life, therapy outcome, and survival. Existing risk assessment models for predicting TEE risk have been developed for other patient collectives and show poor performance in melanoma patients treated with ICI. In this cohort analysis, 358 AJCC stage III/IV melanoma patients treated with ICI between April 2013 and July 2024 at the University Skin Cancer Center Hamburg and the University Medical Center Mannheim were included. TEEs were recorded and classified as thrombosis including vein thrombosis, pulmonary embolism, stroke, or transient ischemic attack. Clinical and laboratory data were determined before the start and prospectively during the treatment. We identified elevated serum baseline D-Dimer (p = 0.0098) and elevated C-reactive protein (p = 0.0042) concentrations and measurable tumor burden (p = 0.0039) as main risk factors for the occurrence of TEE. For the final model, points were assigned for the Cancer Immunotherapy Thromboembolism Assessment (CITA) according to the impact of those variables using multiple logistic regression. The score was calculated for each patient. For the high-risk group, the negative predictive value (NPV) was 97.2%; sensitivity and specificity were 83.3% and 62%, respectively. The CITA risk score provides a simple and easily calculated risk assessment tool for stratifying melanoma patients based on their risk for TEE after ICI initiation, but prospective validation is needed before clinical use can be recommended.

Factor XII Deficiency and Thrombosis Risk: A Systematic Review and Meta-Analysis.

Venous thromboembolism (VTE) risk is elevated in acute exacerbations of COPD (AECOPD), especially with coexisting atrial fibrillation (AF). However, the Caprini and Padua scores, validated in surgical or general medical populations, may not capture thrombotic risk in AECOPD-AF patients, and their predictive performance in this subgroup remains unclear. In this multicenter prospective cohort study, we analyzed 13,108 AECOPD patients (including 755 with AF and 12,353 without AF) from ten tertiary hospitals in China. Propensity score matching (1:4 ratio) was performed based on age, gender, smoking status, hypertension, stroke, and chronic renal insufficiency. Multivariable logistic regression was used to assess VTE risk factors, and the discriminatory performance of the Caprini and Padua scores was evaluated through receiver operating characteristic analysis. AF independently increased VTE risk (adjusted OR 1.55, 95% CI 1.03-2.33). Both scores showed suboptimal discrimination (Caprini AUC 0.616; Padua AUC 0.593), with no significant difference (DeLong's P = 0.349). AECOPD-AF patients exhibited higher VTE events (72/755, 9.5% vs. 150/3020, 5.0%, P < 0.001). AF constitutes an independent risk factor for VTE in the AECOPD-AF population. However, the Caprini and Padua scores show limited predictive value in this subgroup, underscoring the need for a tailored risk assessment tool specifically designed for AECOPD-AF patients.Trial registration: Chinese clinical trial registry, ChiCTR2100044625.

Preoperative antifibrinolytics association with reduced blood transfusions after vascular surgery procedures.

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT), pulmonary embolism (PE), and post-thrombotic syndrome (PTS), affects up to 900,000 people in the United States each year and as many as 60,000 to 100,000 of these patients may die. More than half of the VTE events occurring after hospital discharge are directly linked to a recent hospitalization or surgery. Sudden death is the first symptom in 25% of those who experience a PE, so prevention of VTE is of paramount importance. Several professional organizations have published perioperative guidelines for VTE prevention and accreditation organizations have incorporated VTE risk assessment and prophylaxis in their standards. Ambulatory anesthesiologists, by being part of multidisciplinary teams to establish enhanced recovery pathways at their outpatient facilities, play a pivotal role in identifying patients at risk for developing VTE, customizing risk assessment tools, and establishing thromboprophylaxis protocols for patients at their centers. In addition, anesthesiologists can play a key role in patient education, which is an important component of VTE prevention. With increased migration of complex procedures and patients to the outpatient setting, VTE risk in the high-risk groups of patients approaches inpatient levels. This position statement from the Society for Ambulatory Anesthesia (SAMBA) is tailored toward ambulatory surgery centers and summarizes and synthesizes existing VTE risk assessment and prophylaxis tools into an easy-to-use algorithm.

Background. Venous thromboembolism (VTE) is a common complication in patients with cancer. Central venous catheters (CVCs) are frequently required for the application of systemic anti-cancer treatments. Although CVCs are known risk factors for VTE, researchers have limited prospective data on the risk of VTE—and especially catheter-related thrombosis (CRT)—in patients with cancer. Aim. We aimed to assess the incidence rate of all VTE events and CRTs in patients with cancer receiving contemporary anti-cancer treatment during catheter dwell time. Methods. This analysis was conducted within the framework of the Vienna Cancer, Thrombosis, and Bleeding (CAT-BLED) Study. Patients with newly diagnosed or recurrent cancer who initiated systemic anti-cancer treatment between May 2019 and December 2022 and had a CVC in place at inclusion or inserted during follow-up were included, while patients who were receiving anticoagulation already at inclusion were excluded. CVCs were classified as Port-a-Cath (PAC), Peripherally-Inserted-Central-Catheter (PICC), or non-tunnelled CVC. Patients were screened for VTEs prospectively during catheter dwell time. VTEs were defined as deep vein thrombosis (DVT), pulmonary embolism (PE), concomitant DVT and PE, splanchnic vein thrombosis (SVT), or CRT. All VTEs were adjudicated by an independent adjudication committee. Incidence rates per 1,000 catheter-days were calculated. Results. This analysis included a total of 358 patients (52.5% female), with a median age of 60 years (interquartile range [IQR]: 52-67). At the time of inclusion, 248 (70.5%) patients had metastatic disease. Over a median follow-up of 13.7 months (IQR: 8.2-25.4), a total of 404 CVCs were implanted among the study cohort. Most patients received a single CVC (n=325), followed by two (n=27) and three or more (n=6). CVCs were most commonly PACs (82.2%), followed by PICCs (17.3%) and non-tunnelled CVCs (0.5%). Median catheter dwell time was 250 days (IQR: 78-582) with a total of 61 confirmed VTEs (details on VTE characteristics are in Table 1). The incidence rates per 1,000 catheter-days were 0.41 for any VTE and 0.26 for CRT alone. No CRT was recorded with a PICC in place. CRTs were observed in both patients with non-tunnelled CVCs. Conclusions. VTE occurred at clinically relevant rates during CVC dwell time, with CRT accounting for a substantial proportion. Device-specific differences warrant further investigations.