Venous Thromboembolism Formation Research Articles

Association between diabetes and venous thromboembolism: A systematic review and meta-analysis.

Diabetes mellitus (DM) plays a vital role in the development of cardiovascular disease. However, its association with venous thromboembolism (VTE) remains unclear, for the published study results are conflicting. We performed a meta-analysis of published cohort studies and case-control studies to assess the role of DM in the formation and prognosis of VTE. PubMed and EMBASE databases were searched for articles from the database's establishment until September 15, 2022. Of the 15,754 publications retrieved, 50 studies were identified that met the selection criteria. The New castle-Ottawa Scale was used to evaluate the quality of the literature. Pooled odds ratios (ORs) and 95% confidence intervals were calculated using fixed- or random-effect models. We combined OR using a random-effects or fixed-effects model: patients with DM had an increased risk of VTE (OR 1.27, 95% confidence interval [CI]: 1.15-1.41), which still showed a partial association in studies adjusted by confounding factors (OR 1.20, 95% CI: 1.07-1.35). DM was not significantly associated with VTE when analyzed in studies adjusted by body mass index (OR 1.04, 95% CI: 0.94-1.15). VTE patients with DM had a higher risk of short-term and long-term mortality than those without DM (OR 1.58 [95% CI: 1.26-1.99] for long-term mortality and OR 1.20 [95% CI: 1.19-1.21] for short-term mortality). There was no significant association between DM and VTE risk, and body mass index may be a significant confounding factor between DM and VTE risk. However, DM can still lead to an increased risk of long-term and short-term mortality in patients with VTE.

Elevated ratio of C-type lectin-like receptor 2 level and platelet count (C2PAC) aids in the diagnosis of post-operative venous thromboembolism in IDH-wildtype gliomas

IntroductionPodoplanin (PDPN) is known to induce platelet aggregation via interacting with the C-type lectin-like receptor-2 on platelets and is involved in postoperative venous thromboembolism (VTE) formation. In this study, we investigate the correlation between soluble C-type lectin-like receptor (sCLEC-2) levels and PDPN expression in patients with high grade gliomas and the relationship between sCLEC-2 levels and the occurrence of VTE. Materials and methodsForty-four patients harboring high grade gliomas, treated surgically at the Department of Neurosurgery, Niigata University from April 2018 to August 2020, were included. Patients with high grade gliomas were divided into isocitrate dehydrogenase (IDH)- wildtype and mutant groups, and the presence or absence of VTE and the intensity of PDPN by immunohistochemistry were confirmed. Platelet counts, as well as plasma sCLEC-2 and PDPN were measured in these patients. Furthermore, the levels of sCLEC-2 concentration were divided by the platelet count (C2PAC index) for comparison. ResultsIDH-wildtype glioma patients highly expressed PDPN (P < 0.001) compared to IDH-mutant glioma patients. In total, 9 (20.5 %) patients were diagnosed with VTE during the follow-up period, of which 8 patients harbored IDH-wildtype gliomas, and one patient an IDH-mutant glioma. Mean sCLEC-2 levels and C2PAC index in patients with IDH-wildtype gliomas were significantly higher than that of low or no PDPN expression group, which included patients with IDH-mutant gliomas (P = 0.0004, P = 0.0002). In patients with IDH-wildtype gliomas, the C2PAC index in patients with VTE was significantly higher than in patients without VTE (P = 0.0492). The optimal cutoff point of C2PAC for predicting VTE in IDH-wildtype glioma patients was 3.7 with a sensitivity of 87.5 % and specificity of 51.9 %. ConclusionPlatelet activation is strongly involved in the development of VTE in patients with IDH-wildtype high grade gliomas, and C2PAC index is a potential marker to detect VTE formation after surgery.

NCMP-06. VENOUS THROMBOEMBOLISM INCIDENCE AND THE IMPACT OF PRE-DISEASED ANTICOAGULATION THERAPY IN GLIOBLASTOMA PATIENTS

Abstract Glioblastoma (GBM) patients have a 24-30% risk of developing venous thromboembolism (VTE), including deep vein thrombosis or pulmonary embolism, over the course of their diagnosis. However, very little data exists regarding the impact of VTE on survival in GBM patients, with or without anticoagulation. This study aimed to investigate 1) the demographic factors associated with VTE incidence in GBM patients, 2) any correlation between VTE incidence and length of survival and, and 3) the impact of pre-diagnosis antiplatelet/anticoagulation therapy on VTE development and survival. A total of 150 GBM patients treated at University Hospital Seidman Cancer Center were included and retrospectively analyzed. Information was collected regarding history of aspirin, clopidogrel, DOAC, heparin, and/or warfarin use. The diagnosis of VTE both prior to GBM diagnosis and at various time points following diagnosis was determined followed by calculating overall survival and progression free survival (PFS). Of the 150 GBM patients, 53 (35.3%) developed a VTE overall. VTE incidence correlated with a lower KPS at presentation (r = -.225, p =.027) and a decrease in overall survival among GBM patients (r = -.191, p =.041). Antiplatelet/anticoagulation therapy prior to GBM diagnosis correlated with decreased VTE formation overall, as well as longer PFS among non-VTE patients (r =.261, p = .026) but not among patients who later developed VTE (r = .165, p = .302). Our findings demonstrate that patients with lower KPS are at a higher risk for developing VTE. Among GBM patients who did not develop VTEs, those on antiplatelet/anticoagulation therapy prior to diagnosis had longer PFS compared to those who were not on anticoagulants. These preliminary studies highlight the need for better VTE prophylaxis and therapy among GBM patients. These results further suggest the potential benefit of anticoagulation therapy in GBM patients irrespective of VTE formation.

C-reactive protein, immunothrombosis and venous thromboembolism.

C-reactive protein (CRP) is a member of the highly conserved pentraxin superfamily of proteins and is often used in clinical practice as a marker of infection and inflammation. There is now increasing evidence that CRP is not only a marker of inflammation, but also that destabilized isoforms of CRP possess pro-inflammatory and pro-thrombotic properties. CRP circulates as a functionally inert pentameric form (pCRP), which relaxes its conformation to pCRP* after binding to phosphocholine-enriched membranes and then dissociates to monomeric CRP (mCRP). with the latter two being destabilized isoforms possessing highly pro-inflammatory features. pCRP* and mCRP have significant biological effects in regulating many of the aspects central to pathogenesis of atherothrombosis and venous thromboembolism (VTE), by directly activating platelets and triggering the classical complement pathway. Importantly, it is now well appreciated that VTE is a consequence of thromboinflammation. Accordingly, acute VTE is known to be associated with classical inflammatory responses and elevations of CRP, and indeed VTE risk is elevated in conditions associated with inflammation, such as inflammatory bowel disease, COVID-19 and sepsis. Although the clinical data regarding the utility of CRP as a biomarker in predicting VTE remains modest, and in some cases conflicting, the clinical utility of CRP appears to be improved in subsets of the population such as in predicting VTE recurrence, in cancer-associated thrombosis and in those with COVID-19. Therefore, given the known biological function of CRP in amplifying inflammation and tissue damage, this raises the prospect that CRP may play a role in promoting VTE formation in the context of concurrent inflammation. However, further investigation is required to unravel whether CRP plays a direct role in the pathogenesis of VTE, the utility of which will be in developing novel prophylactic or therapeutic strategies to target thromboinflammation.

Establishment of a mouse model for ovarian cancer-associated venous thromboembolism.

Patients with ovarian cancer are at increased risk of venous thromboembolism (VTE), and the cumulative incidence is high, particularly at advanced stages of this disease. Nevertheless, it is challenging to investigate the molecular mechanisms of ovarian cancer-associated VTE (OC-VTE), mainly due to the lack of a well-developed animal model for this disease. We generated a mouse model for developing OC-VTE using ovarian cancer cell injection in combination with the inferior vena cava stenosis method. The rate of thrombosis in the OC-VTE group was 50%, compared with 0 in the control group. Moreover, we conducted a proteomic analysis using platelets from these models and revealed differentially expressed proteins between the OC-VTE and control groups, including upregulated and downregulated proteins. Gene Ontology analysis revealed that these differentially expressed proteins were mostly enriched in the biological process of negative regulation of fibrinolysis and the cellular component of the fibrinogen complex, both of which play key roles in thrombosis. In conclusion, this study lays the foundation for further investigation of the underlying mechanisms of how ovarian cancer promotes VTE formation.

Rate of Development of Venous Thromboembolism in Lateral Skull Base Surgery.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality for surgical patients. This article aims to determine factors that may have contributed to the development of VTE in patients undergoing lateral skull base surgery, to assess the validity of the Caprini Risk Assessment Model (RAM) score in this subset of patients, and to determine the efficacy of mechanical DVT prophylaxis alone in preventing VTE. Retrospective chart review. A retrospective chart review was conducted of patients who underwent skull base surgery for vestibular schwannoma, and the rate of VTE was assessed. Patient demographics, comorbidities, and treatment factors were examined to determine risk factors associated with the development of a postoperative thrombotic event. Caprini RAM scores were compared for patients who developed a VTE. Among 197 patients, the rate of VTE formation was 3.5%. No individual risk factor independently contributed to the development of a thrombotic event. The mean Caprini RAM score was 4.06 in patients who did not develop a VTE and 5.14 in the patients that did develop a VTE (P=.005). The Caprini score was significant for the risk of VTE formation, with an odds ratio of 2.8 (P=.009, 95% CI=1.3-6.2). Venous thromboembolism rates are relatively low following lateral skull base surgery. While there is no individual risk factor associated with increased VTE risk, the Caprini RAM score appears to be a useful predictor of risk. The Caprini score may be useful in identifying high-risk patients who may benefit from chemoprophylaxis for VTE prevention. 3 Laryngoscope, 132:662-667, 2022.

Rosacea and subsequent diagnosis of venous thromboembolism: A large, urban academic center case-control study

To the Editor: Venous thromboembolism (VTE) is a potentially fatal disease that includes deep vein thrombosis (DVT) and pulmonary embolism. Chronic inflammation is a key mediator of VTE formation, and patients with psoriasis and rheumatoid arthritis are at increased risk of VTE.1 Given the growing evidence of the association between rosacea and the systemic diseases associated with chronic inflammation,1-3 we conducted a case-control study to investigate the potential relationship between rosacea and VTE.

Inflammation, Infection and Venous Thromboembolism.

The association between inflammation, infection, and venous thrombosis has long been recognized; yet, only in the last decades have we begun to understand the mechanisms through which the immune and coagulation systems interact and reciprocally regulate one another. These interconnected networks mount an effective response to injury and pathogen invasion, but if unregulated can result in pathological thrombosis and organ damage. Neutrophils, monocytes, and platelets interact with each other and the endothelium in host defense and also play critical roles in the formation of venous thromboembolism. This knowledge has advanced our understanding of both human physiology and pathophysiology, as well as identified mechanisms of anticoagulant resistance and novel therapeutic targets for the prevention and treatment of thrombosis. In this review, we discuss the contributions of inflammation and infection to venous thromboembolism.

Association of immune checkpoint inhibitors (ICI) and venous thromboembolism (VTE): A single healthcare system experience.

e14567 Background: Cancer and some anti-cancer therapies increase risk of VTE. ICIs cause immune activation and inflammation which are known to potentiate VTE formation. The risk of VTE associated with ICI is unclear, with conflicting evidence of association. Our study assessed the risk of VTE in patients treated with ICI compared to those receiving other cancer treatments. Methods: EPIC Slicer Dicer was used to collect data from three university-affiliated hospitals in New Orleans, LA. All patients &gt;17 years of age, with an oncology treatment plan (TP) between January 1 2012 – January 31 2021 were considered the base population (n=6,894) for the study. The base population was divided into two cohorts - those that received ICI (n=794) versus those who did not (n=6,100). ICIs included pembrolizumab, nivolumab, avelumab, atezolizumab, durvalumab, cemiplimab, ipilimumab. An encounter diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE) which was preceded by a TP in the last 1 year was used to identify patients with VTE after initiation of a TP. Categorical covariates compared across VTE groups using Chi-squared tests of independence. Two sample t-tests were used to compare continuous covariates based on VTE status. Logistic regression used to predict VTE as a function of ICIs and other potential confounders including age, BMI, gender, race and cancer subtypes. Results: Patients who experienced VTE were significantly more likely to have received ICI (1.43 times odds of VTE (95% CI = 1.12-1.83; p &lt;0.005), be black or African American (p &lt; 0.05 compared with White and Asian races), and have GI cancer (1.82 times odds, 95% CI= 1.41 – 2.36, p&lt; 0.001), GU cancer (1.7 times odds, 95% CI = 1.3 – 2.23; p&lt;0.001). Patients with VTE were significantly less likely to have breast cancer or other cancer types. Males had a decreased odd of VTE (0.73 odds, 95% CI= 0.62 – 0.85, p&lt; 0.001). Conclusions: Based on the above results, there appears to be an increased likelihood of VTE in patients that receive ICI when compared to other types of cancer treatment. This study is a preliminary analysis and has limitations. At this time, it is unclear if prophylactic anticoagulation can reduce risk of VTE after ICI initiation. Further investigation is warranted in the form of individual chart review, or a prospective study.

Venous Thromboembolism Prevention in COVID-19: A Review of Latest Evidences

COVID-19 has become major public health problems, with new cases and deaths growing around the world. COVID-19 has been reportedly associated with hypercoagulable state which can lead to venous thromboembolism (VTE) formation. This condition is also associated with worse outcomes in COVID-19 patients, therefore, it is critical for clinicians to identify this condition and manage it accordingly. VTE formation in COVID-19 occurs through several mechanisms, such as inflammatory reaction leading to hypercoagulable state and vascular dysfunction, direct vascular injury by the virus, and immobilization of the patients. The rate of VTE formation is as high as 31% in ICU patients and 9.2% in general wards patients, and it is also associated with poorer prognosis. Thromboprophylaxis with heparin, particularly low molecular weight heparin (LMWH), has been shown to improve the prognosis in these patients. A careful individual assessment is required to determine which patients will benefit from this therapy, as there are still no sufficient prospective trials to establish guidelines for VTE thromboprophylaxis in COVID-19. The assessment includes laboratory parameters such as PT, platelet count, D-dimer, fibrinogen, and other risk factors incorporated in PADUA risk assessment model (RAM), versus the risk of bleeding incorporated in IMPROVE bleeding RAM.

Venous thromboembolism after penetrating femoral and popliteal artery injuries: an opportunity for increased prevention.

BackgroundTrauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.MethodsA retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013–2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. Statistical comparisons were accomplished using Fisher’s exact tests, and parametric two-sample t-tests or non-parametric Wilcoxon rank-sum tests for categorical and continuous variables, respectively.ResultsOf the 865 patients with penetrating extremity vascular injuries, 207 had femoral or popliteal artery injuries. Patients with isolated arterial injuries (n=131) had a significantly lower deep venous thrombosis (DVT) rate compared with those with concurrent venous injuries (n=76) (3.1% vs. 13.2%, p=0.008). There were 14 patients in the study who developed DVTs. Among the four patients with isolated femoral or popliteal arterial injuries who had developed DVTs, three had an open repair. Among patients with isolated arterial injuries, those with DVT spend significantly more time on the ventilator (median=2 vs. 0, p=0.0020) compared with patients without DVT. Patients with DVT also had longer stay in the hospital (median=17.5 vs. 8, p=0.0664) and in the ICU (median=3 vs. 1, p=0.0585).ConclusionsRisk of DVT exists in patients with penetrating isolated femoral and popliteal artery trauma. Open repair was associated with significantly higher DVT rates in isolated arterial injuries.Level of evidenceLevel IV therapeutic care/management.

The role of inflammation in a rat model of chronic thromboembolic pulmonary hypertension induced by carrageenan.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition arising from the thrombus and obstructive remodeling of the pulmonary arteries, which causes a significant morbidity and mortality. Although the modern treatment in CTEPH has been significant advanced both in surgical and medical treatment, none can claim to cure the disease, largely because of our limited understanding of the underlying pathogenesis of the disease and lack of a reliable CTEPH animal model to study for. Recently, inflammation has been accepted as a common pathway through which various risk factors trigger venous thrombo-embolism (VTE) formation, we describe a novel mouse model of CTEPH which reproduces a frequent trigger and resembles the time course, histological features, and clinical presentation of CTEPH in humans, to open a new horizons of inflammation in CTEPH.MethodsBy administering a pulmonary embolism (PE) protocol (comprising 3 sequential left jugular vein injections of autologous blood clots) to 8-week-old male Sprague Dawley (SD) rats using tranexamic acid (200 mg/kg.d) to inhibit fibrinolysis and injecting additional carrageenan (20 mg/kg, once a week) to create perivascular inflammation, we successfully generated a CTEPH animal model. By monitoring the mean pulmonary artery pressure (mPAP) and the histopathological change to evaluate the CTEPH model. By detecting the RT-PCR, western blot, TUNEL, and immunohistochemistry in the sub-groups to find the potential mechanism of inflammation may work in the pulmonary vascular remolding.ResultsIn this study, rats with CTEPH exhibited pronounced pulmonary vascular remolding with higher vessel wall area/total area (WA/TA) ratio in comparison to the control rats (85.41%±7.37% vs. 76.41%±5.97%, P<0.05), the mPAP (25.51±1.13 vs. 15.92±1.13 mmHg, P<0.05). Significant differences in mean pulmonary artery pressure (mPAP) values were observed between rats injected solely with clots and those injected with both clots and carrageenan (25.51±1.13 vs. 29.82±1.26 mmHg, P<0.05, respectively). Furthermore, following the third embolization, thrombi and intimal hyperplasia occurred in the pulmonary artery. In addition, repeated embolization elevated mRNA and protein levels of tumor necrosis factor-α (TNF-α), NF-κB/p65, and B-cell lymphoma-2 (BCL-2), but decreased BAX expression in a time-dependent manner.ConclusionsTake advantage of the inflammation to trigger VTE formation, we successfully generated a CTEPH animal model. Inflammation may play a crucial role in the pathogenesis and progression of CTEPH by inhibiting endothelial cell apoptosis. Understanding the role of inflammation in CTEPH may not only help to determine the optimal treatment options but also may aid in the development of future preventative strategies, since current anticoagulation treatment regimens are not designed to inhibit inflammation.

Factors in the feasibility and safety of outpatient robotic-assisted hysterectomy for endometrial or cervical carcinoma

ObjectiveIdentify factors influencing the feasibility and safety of outpatient robotic-assisted hysterectomy for endometrial or cervical carcinoma. MethodsA single-institution retrospective chart review of patients who underwent robotic hysterectomy for cervical or endometrial cancer between 2012 and 2016 was performed. Outcomes were measured by length of stay (LOS), which was categorized as an admit-to-discharge time of >12 h or <12 h. Past medical history, surgical history, social history, patient demographics, intraoperative course, and postoperative events were examined as possible factors associated with LOS >12 h. These factors were evaluated using multivariate logistic regression. Readmission rates were compared between the two groups using an independent-samples t-test. ResultsOf the 254 patients, 150 (59.1%) had a LOS >12 h and 104 (40.9%) had a LOS < 12 h. The factors associated with a LOS >12 h (p < 0.05) included: Postoperative emesis, inadequate pain control, operating room (OR) time > 180 min, uterine mass > 150 g, start time after 15:00, history of venous thromboembolism (VTE), age > 75 years, body mass index (BMI) 35–40, and post-operative VTE formation. Patients discharged in <12-hours were not more likely than those discharged in >12-hours to be re-admitted (p = 0.92). ConclusionsRobotic hysterectomy for the treatment of endometrial and cervical carcinoma is both feasible and safe in the outpatient setting, as >40% of patients were successfully discharged within 12 h with no increase in readmission. Multiple risk factors were identified for extended hospitalization, offering potential for the development of a risk stratification model to improve the efficacy of outpatient robotic hysterectomy.

Gamer's Thrombosis: A Review of Published Reports.

Background: Thrombosis, well known as a condition of the elderly, is occurring in the otherwise healthy adolescent population. Immobility is a significant risk factor for venous thromboembolism (VTE), and adolescents who play video games are immobile for extended periods of time. Some are presenting with VTE. When other risk factors such as obesity are present, the risk of VTE formation increases. We provide a review of published case reports regarding gaming and thrombosis.Methods: We searched PubMed, Scopus, Web of Science, and EBSCO for articles published through July 2019, using the keywords “computer game thrombosis,” “computer game pulmonary embolism,” “computer game deep vein thrombosis,” “video game thrombosis,” “video game pulmonary embolism,” and “video game deep vein thrombosis.”Results: Of the 26 articles we identified, we included 12 articles in our review that report a total of 15 cases, of which 2 resulted in fatalities. Modifiable risk factors included cigarette use, being overweight, birth control use, and prolonged immobility. Anticoagulation was the principal treatment modality in patients presenting with gaming thrombosis.Conclusion: We strongly encourage screening gamers for possible VTEs if clinically warranted.

Time-to-event analyses of lower-limb venous thromboembolism in aged patients undergoing lumbar spine surgery: a retrospective study of 1620 patients

After spine surgery, venous thromboembolism (VTE) is not uncommon in aged patients. This study investigates time-to-event risk factors of postoperative VTE based on medical records of aged patients (age≥60 yr) between January 2013 and December 2018. All participants had undergone lower extremity ultrasonography pre- and postoperatively at the first, second, fourth, eighth, and twelfth weeks. Mann-Whitney U tests and chi-square tests were used for univariate analyses, and Cox regression was utilized for multivariate analyses. A total of 1620 cases were recruited, VTE group (N=382, 23.6%) and non-VTE group (N=1238, 76.4%), aged 67 (IQR 11) years and 65 (IQR 6) years, respectively. The univariate analyses indicated significant differences between the VTE and non-VTE groups regarding advanced age, VTE history, hypertension, fusion, hospital stay, FIB, HDL, D-dimer, and TC (all P<0.05). The Cox regression showed that advanced age (OR=1.108; 95% CI, 1.091–1.126), VTE history (OR=4.962; 95% CI, 3.849–6.397), and hypertension (OR=1.344; 95% CI, 1.084–1.667) were the risk factors for postoperative VTE (P<0.05). The time-to-event analyses indicated that the hazard of VTE formation was highest in the first postoperative week. In conclusion, advanced age, VTE history, and hypertension are main risks for VTE formation, particularly in the first postoperative week.

Venous Thromboembolism as an Adverse Effect During Treatment With Olanzapine: A Case Series.

Objective: Venous thromboembolism (VTE) is a serious multifactorial disorder. Patients with severe mental illness have a higher risk of developing the condition compared to the general population. Methods: We observed 10 cases of VTE in patients with mental illness who were treated with the antipsychotic drug olanzapine. The diagnosis of VTE was made at the University Hospital Hradec Kralove (UH HK) from 2004 to 2013. VTE was objectively determined by imaging techniques (duplex ultrasonography, CT angiography) and laboratory tests (D-dimer). The average age was 46 years. The clinical manifestation of VTE was deep vein thrombosis in nine cases, including one case of simultaneous pulmonary embolism and one case of a concurrent ischemic cerebrovascular accident (iCVA). None of our patients had a history of malignant disease, trauma, or surgery. Results: Apart from antipsychotic medication, all the patients had clinical or laboratory risk factors for VTE. The most frequent clinical risk factors were obesity (n = 7) and smoking (n = 6). The most frequent laboratory risk factors were increased levels of FVIII (n = 4), mild hyperhomocysteinemia (n = 3), and factor V Leiden mutation (n = 2). VTE developed within 3 months after antipsychotic drug initiation in three patients and within 6 months in three patients. Conclusion: Olanzapine can be considered a precipitating factor for VTE formation. When olanzapine is administered, we need to monitor for clinical signs and symptoms of VTE, especially when other risk factors are present.

Priame perorálne antikoagulanciá v onkológii v klinickej praxi

Relation between oncological diseases and venous thrombo-embolism (VTE) is well known for almost 2 centuries. In 1823 Bouillaud assumed by three patients with tumor and recent deep vein thrombosis (DVT), that peripheral edema of lower limbs emerges as a result of „obturation“ of veins by „fibrinous coagulum“ (caillot fibrineux), which was induced by oncological disease. French physician Armand Trousseau wrote about this relation in his book „Phlegmasia alba dolens” again in the year 1865. Many studies were developed in times of Bouillaud a Trousseau, which just confirmed existence of relation between tumor and VTE. Oncological disease presents a significant risk factor of formation of VTE. Recent references favorising the use of light molecular weight heparin (LMWH) in long-term anticoagulation therapy of patients with cancer. Recently we have just few clinical data about efficiency and safety of direct oral anticoagulants (DOACs) in oncological patients, however many meta-analysis of clinical studies has shown benefit of therapy with DOACs towards conventional therapy. Key words: direct oral anticoagulants (DOACs) - oncology - venous thromboembolism.

Influencing factors of venous thromboembolism in hospitalized patients of intensive care unit

Objective To analyze the influencing factors of venous thromboembolism (VTE) in intensive care units, and provide evidence for corresponding clinical decisions. Methods A case-control study was carried out: 224 VTE patients admitted to the ICUs of tertiary hospitals in Kunshan from Nov. 2011 to Nov. 2016 were included in the case group, and 224 non-VTE patients admitted during the same period were randomly selected as the control. The patients’ medical history, laboratory tests, prophylaxis and treatment of VTE, and other relevant data were retrieved. Logistic aggression analysis was utilized to identify the influencing factors of VTE in hospitalized critically ill patients. Results The univariate analysis showed that gender, age, hypertension, smoking, D-dimer, Caprini scaling, prophylaxis and treatment of VTE were associated with VTE. The multivariate analysis indicated that except hypertension, the other varieties were independent influencing factors of VTE in hospitalized critically ill patients: female (OR=1.68, 95%CI: 1.09-2.61, P=0.02), higher age (OR=1.03, 95%CI: 1.01-1.04, P< 0.01) , smoking (OR=6.82, 95%CI: 1.70-27.46, P=0.007) , smoking (OR=6.82, 95%CI: 1.70-27.46, P=0.007) , D-dimer (OR=0.94, 95% CI: 0.92-0.96, P<0.01) , higher Caprini scaling (OR=1.80, 95%CI:1.33-2.44, P <0.01) , prophylaxis and treatment of VTE (OR=0.34, 95%CI: 0.15-0.79, P=0.01) . Conclusions Those ICU patients who are female, elder, with smoking history, have higher test value of D-dimer should be screened and assessed for VTE, and those with higher Caprini scaling should be given closer attention, and receive corresponding prophylaxis and treatment to reduce the formation of VTE and its damage. Key words: Venous thromboembolism; ICU patients; Influencing factors

Venous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge?

Patients undergoing emergency general surgery (EGS) operations experience high rates of venous thromboembolism (VTE). The rates at which thrombus formation occurs after discharge, and whether VTE prophylaxis at discharge might be warranted to prevent readmission, are unknown. This analysis aimed to determine risk factors associated with VTE formation after discharge for EGS operations. An analysis of the American College of Surgeons NSQIP database from 2013 and 2014 of patients undergoing 10 common EGS operations in an emergent fashion. Multivariable logistic regression modeling was used to determine factors that predicted VTE after discharge. A total of 130,036 patients were included. The 30-day VTE rate was 1.30%, with 35% of all VTEs occurring after discharge. Of those who had VTE develop after discharge, 69.4% required readmission. Predictive factors for post-discharge VTE included prolonged length of stay (odds ratio [OR] 5.25; p < 0.001), presence of metastatic cancer (OR 2.23; p < 0.001), urinary tract infection (OR 1.91; p < 0.001), and postoperative sepsis (OR 1.55; p < 0.001). Identified high-risk groups had a rate of readmission with thrombus 6 times greater than that of average-risk EGS patients. More than 30% of VTEs in the EGS population occur after discharge; of these, a vast majority require readmission. Select high-risk EGS subgroups might benefit from prophylactic anticoagulation at discharge.

Venous thromboembolism after major venous injuries: Competing priorities.

Venous thromboembolism (VTE) after major vascular injury (MVI) is particularly challenging because the competing risk of thrombosis and embolization after direct vessel injury must be balanced with risk of bleeding after surgical repair. We hypothesized that venous injuries, repair type, and intraoperative anticoagulation would influence VTE formation after MVI. A multi-institution, retrospective cohort study of consecutive MVI patients was conducted at three urban, Level I centers (2005-2013). Patients with MVI of the neck, torso, or proximal extremities (to elbows/knees) were included. Our primary study endpoint was the development of VTE (DVT or pulmonary embolism [PE]). The 435 major vascular injury patients were primarily young (27 years) men (89%) with penetrating (84%) injuries. When patients with (n = 108) and without (n = 327) VTE were compared, we observed no difference in age, mechanism, extremity injury, tourniquet use, orthopedic and spine injuries, damage control, local heparinized saline, or vascular surgery consultation (all p > 0.05). VTE patients had greater Injury Severity Score (ISS) (17 vs. 12), shock indices (1 vs. 0.9), and more torso (58% vs. 35%) and venous (73% vs. 48%) injuries, but less often received systemic intraoperative anticoagulation (39% vs. 53%) or postoperative enoxaparin (47% vs. 61%) prophylaxis (all p < 0.05). After controlling for ISS, hemodynamics, injured vessel, intraoperative anticoagulation, and postoperative prophylaxis, multivariable analysis revealed venous injury was independently predictive of VTE (odds ratio, 2.7; p = 0.002). Multivariable analysis of the venous injuries subset (n = 237) then determined that only delay in starting VTE chemoprophylaxis (odds ratio, 1.3/day; p = 0.013) independently predicted VTE after controlling for ISS, hemodynamics, injured vessel, surgical subspecialty, intraoperative anticoagulation, and postoperative prophylaxis. Overall, 3.4% of venous injury patients developed PE, but PE rates were not related to their operative management (p = 0.72). Patients with major venous injuries are at high risk for VTE, regardless of intraoperative management. Our results support the immediate initiation of postoperative chemoprophylaxis in patients with major venous injuries. Therapeutic/care management, level IV.