scholarly journals Cytoreductive treatment in real life: a chart review analysis on 1440 patients with polycythemia vera

2021 ◽  
Author(s):  
Carl C. Crodel ◽  
Kathleen Jentsch-Ullrich ◽  
Marcel Reiser ◽  
Lutz Jacobasch ◽  
Annette Sauer ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Acetylsalicylic Acid ◽  
Chart Review ◽  
Real Life ◽  
Therapy Resistance ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Healthy Individuals ◽  
Cytoreductive Treatment

Abstract Purpose Patients with polycythemia vera (PV) show an elevated incidence of thromboembolic complications and decreased survival when compared to age-matched healthy individuals. Hypercellularity as indicated by elevated hematocrit, pathophysiological changes induced by the JAK2 driver mutation and cardiovascular risk factors contribute to the increased incidence of thromboembolic events. Higher age and a history of thromboembolic events define a high-risk population of PV patients. Depending on the individual risk profile, phlebotomy or pharmacologic cytoreduction is recommended in combination with low-dose acetylsalicylic acid. Stringent cytoreduction is required for effective risk reduction. However, in recent reports, the rate of thromboembolic complications in PV patients under cytoreductive therapy appears still elevated compared to healthy individuals. This study reports on a chart review to assess for cytoreductive therapy of 1440 PV patients in real life. Methods Forty-two eligible hematologists/oncologists in private practice treating patients with MPN were recruited to participate in a paper–pencil-based survey conducted between January 2019 and March 2020 in Germany. Physicians were asked to report primary documented data obtained from patient charts. Descriptive analyses were conducted to assess for patient characteristics, treatment modalities, risk factors and thromboembolic complications. Results Data were collected from the patient charts of 1440 individuals diagnosed with PV. The patient population was older than those reported in multicenter trials with a median age of 72.2 years at the time of reporting and 63.5 years at diagnosis. Age was the main factor accounting for high-risk status with 84.7% of patients being above the age of 60 followed by thromboembolic complications reported in 21.3% of patients. The use of pharmacologic cytoreduction was highly variable between participating centers with an average of 60.7% and a range of 10.1–100%. Hydroxyurea was the most frequently used drug followed by ruxolitinib, while interferons were reported for a minority of patients. For 35.4% of patients a persistent need for phlebotomy in addition to cytoreductive treatment was reported. Although presence of high-risk criteria and insufficient disease control were reported as main triggers to initiate pharmacologic cytoreduction, 28.1% had elevated hematocrit values (> 45%) and 38.6% showed persistence of elevated leukocyte count (> 109/l) while on cytoreductive treatment. In contrast, physician-reported symptom burden was lower than published in clinical trials and patient-reported outcomes. The rate of patients experiencing thromboembolic complications was 32.2% at any time and 14.3% after diagnosis with most patients receiving acetylsalicylic acid and 10.8% remaining on oral anticoagulants or heparin. Conclusions Cytoreductive treatment of high-risk PV in real life is highly variable regarding indication for cytoreduction and definition of therapy resistance. This study highlights the need for (i) improved risk stratification for thromboembolic events, (ii) consequent indication of pharmacologic cytoreduction in high-risk PV and (iii) attention to signs of therapy resistance that can trigger an earlier and stringent switch to second line agents.

AB1231 2019 LUPUS CLASSIFICATION CRITERIA SCORE PREDICTS FUTURE LUPUS HOSPITAL ADMISSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1906.1-1907
Author(s):  
S. Suman ◽  
M. Eissa ◽  
H. Rogers ◽  
A. Lenert ◽  
A. Stromberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
High Risk ◽  
Lupus Erythematosus ◽  
Chart Review ◽  
Classification Criteria ◽  
Inclusion Criteria ◽  
Systemic Lupus ◽  
University Of Kentucky ◽  
Index Study

Background:There are several validated tools to quantitate lupus disease activity, end-organ damage and overall fragility. An algorithm to predict the hospitalization risk in lupus patients was proposed by Li et al1. That algorithm was able to effectively screen patients at increased risk of hospitalization using EHR information only. Recently, the new 2019 Lupus classification criteria score has been noted to accurately predict 10 year mortality2.Objectives:To test the above 2 algorithms with potential to predict lupus related hospital admissions.First, we attempted to validate the existing algorithm from the index study of Li et al to predict lupus hospitalization.Second, we tested the 2019 lupus clinical classification score for its ability to predict hospitalizations.Methods:A retrospective chart review was performed using EHR data collected from 2013 to 2018 at University of Kentucky (UK) Medical Center. Inclusion criteria were 18 years or older at first outpatient rheumatology appointment at UK, at least 3 outpatient rheumatology visits at UK, and ICD 9/10 code for Lupus. A total of 217 patients met inclusion criteria. Variables similar to the index study were extracted from patients’ first outpatient rheumatology visit at UK. Additionally, 2019 Lupus Classification Criteria score was calculated. Patients who were subsequently hospitalized, manual chart review was done to determine if the hospitalization was attributable to lupus or not.Results:Table 1 shows differences between the variables predicting hospitalization in patients in this study (UK) and the Ohio State University (OSU) cohort from whom the admission predicting algorithm was derived1. All the risk factors that were found to predict lupus hospitalization in the index study, failed to achieve a statistical significance in our validation study.Table 1.Differences in the variables predicting hospitalization between Index and Validation CohortVariables predicting Lupus HospitalizationIndex Study (Ohio State),% of patients(n=226)Validation Study(University of Kentucky)% of patients; (n=217)African American33%18%Creatinine > 1.217%7%Hemoglobin < 11g/dl79%18%Platelets < 180 / uL75%22%High Risk immunosuppression35%9. 2%Missed appointment27%25%There was more success predicting lupus hospitalization using the 2019 lupus classification criteria score (CCS) (Figure 1). A CCS >=19 predicted higher risk of lupus related hospitalization vs CCS < 19 over the ensuing 2 years (p-0.05).Figure 1.Kaplan- Meier Survival Analysis comparing the risk of hospitalization between the groups with 2019 Lupus classification criteria score (CCS) of less than 19 (red) and more/equal to 19 (blue). A time-dependent effect, with the admission free survival curves crossing at two years (Figure 1), indicated a 1 out of 3 chance of lupus related admission during the first 6 months for a high CCS score > =19.Conclusion:We failed to validate the EHR algorithm identifying patients at high risk for lupus hospitalization in our less severely affected cohort with fewer admission events to analyze. Nonetheless, “criteria counting” using the weightings of the 2019 lupus classification criteria was granular enough to make these case finding criteria themselves prognostic for future hospitalization risk. It is likely that existing EHRs, using protocols based upon classification criteria scores, are now capable of predicting survival, costs, and admissions automatically.References:[1]D Li et al. Determining risk factors that increase hospitalizations in patients with systemic lupus erythematosus, Lupus (2018) 27, 1321–1328[2]Carneiro et al. A comparison of three classification criteria sets for Systemic Lupus Erythematosus – a study looking at links to outcome and mortality; Arthritis Care Res (Hoboken). 2019 Sep 10. doi: 10.1002/acr.24061Disclosure of Interests:Saurav Suman: None declared, Mervat Eissa: None declared, Heidi Rogers: None declared, Aleksander Lenert: None declared, Arnold Stromberg: None declared, william roberts Shareholder of: Own Stocks of Pfizer and Novartis

scholarly journals Atrial arrhythmias and thromboembolic complications in adults post Fontan surgery

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001224
Author(s):  
Darryl Wan ◽  
Jasmine Grewal ◽  
Amanda Barlow ◽  
Marla Kiess ◽  
Derek Human ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adult Population ◽  
Fontan Operation ◽  
Fontan Circulation ◽  
Atrial Arrhythmia ◽  
Atrial Arrhythmias ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Lateral Tunnel ◽  
Fontan Surgery

ObjectivePatients with Fontan surgery experience late complications in adulthood. We studied the factors associated with the development and maintenance of atrial arrhythmias and thromboembolic complications in an adult population with univentricuar physiology post Fontan surgery.MethodsSingle centre retrospective cohort study of patients ≥18 years of age with Fontan circulation followed at our quaternary care centre for more than 1 year were included. Univariate and multivariate regression models were used where applicable to ascertain clinically significant associations between risk factors and complications.Results93 patients were included (age 30.2±8.8 years, 58% men). 28 (30%) had atriopulmonary Fontan connection, 35 (37.6%) had lateral tunnel Fontan and 29 (31.1%) had extracardiac Fontan pathway. After a mean of 7.27±5.1 years, atrial arrhythmia was noted in 37 patients (39.8%), of which 13 developed had atrial fibrillation (14%). The presence of atrial arrhythmia was associated with the number of prior cardiac surgeries/procedures, increasing age and prior atriopulmonary Fontan operation. Thromboembolic events were present in 31 patients (33%); among them 14 had stroke (45%), 3 had transient ischaemic attack (9.7%), 7 had pulmonary embolism (22.6%) and 5 had atrial thrombus with imaging (16.1%). The presence of thromboembolic events was only associated with age and the presence of cirrhosis in multivariate analysis.ConclusionsAtrial arrhythmias are common in adults with Fontan circulation at an early age, and are associated with prior surgical history and increasing age. Traditional risk factors may not be associated with atrial arrhythmia or thromboembolism in this cohort.

scholarly journals VTE Incidence in RRMM Patients Treated with NOVEL Agents: A Monocentric Real Life Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4972-4972
Author(s):  
Gaetano Giuffrida ◽  
Concetta Conticello ◽  
Valeria Calafiore ◽  
Enrica Antonia Martino ◽  
Silvia Giamporcaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Research Funding ◽  
Real Life ◽  
Low Risk ◽  
Novel Agents ◽  
Vte Prophylaxis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Low Incidence

INTRODUCTION: Venous thromboembolism (VTE) is very common in patients with malignancies. Compared to the general population, patients with multiple myeloma (MM) have a 9-fold increased risk of developing VTE. In patients treated with thalidomide or lenalidomide, current guidelines recommend systematic VTE prophylaxis with ASA in low risk patients while vitamin K antagonists (VKA) or low weight molecular heparin (LWMH) or unfractionated heparin (UFH) in high-risk patients, based on the type of anti-MM treatment that patients receive and patient-related individual risk factors (e. g. history of VTE). However, little is known on VTE prophylaxis in patients treated with next generation anti-myeloma drugs, such as pomalidomide, carfilzomib and monoclonal antibodies daratumumab and elotuzumab. Here, we describe the incidence of VTE in MM patients treated with third generation novel agents in real life. In addition, we stratify patients on drugs category-based regimens to evaluate strategy of VTE prophylaxis between different groups of patients. MATERIALS AND METHODS: A retrospective cohort of 137 patients affected by relapsed and/ or refractory multiple myeloma treated with novel agents was analyzed. Patients were followed at the Division of Hematology of Catania from April 2013 to June2019. Our series includes 75 patients exposed to Pomalidomide and Dexametasone (PomaD), 46 patients receiving Carfilzomib, Lenalidomide and desamethasone regimen (KRd), 14 patients exposed to Daratumumab(Dara), 27 patients to Daratumumab, Bortezomib and desamethasone (DaraVD), 4 patients to Daratumumab lenalidomide and desamethasone (DaraRd), and12 patients exposed to Elotuzumab and Lenalidomide (EloRd). Several patients were exposed to multiple lines of treatment with novel agents: the total number of analyzed treatments are 178. Patients were stratified to high or low risk for VTE: risk factors taken into account were obesity, history of VTE, central venous catheter, inhered thrombophilia, surgical procedures and comorbidities such as infections, immobilization, cardiac disease, chronic renal disease. Low risk patients had no or one risk factor; in case of two or more risk factors, the patients were classified as high risk. Low-dose aspirin (ASA 100 mg per os once daily) or equivalent was prescribed in low risk patients, low-molecular-weight heparin (LMWH) or equivalent was given to high risk patients. Only Dara treatment did not include standard prophylaxis in patients without risk factors. RESULTS: Real life observation revealed a low incidence of VTE (6 VTE-4,3%) in patients exposed to novel agents together with a standard prophylaxis in case of risk of thromboembolic complications. Forty patients were at high risk of VTE, while 97 patients were classified as low risk; VTE/PE occurred in 2 high risk patients who refused to make correct LMWH prophylaxis due to the discomfort of the subcutaneous administration, developing distal DVT respectively after cycle 1 and 2 of KRd. Two low risk patients treated with PomaD developed DVT of lower extremities during cycle 2 and 4; 2 low risk patients had pulmonary embolism during PomaD cycle 8. CONCLUSIONS: Low incidence of VTE in patients with RRMM receiving PomaD, KRd, EloRd, DaraVD, DaraRd, Dara or EloRd treatment is probably due to a correct risk assessment and subsequent prophylaxis in case of therapies including immunomodulators or in case of patients with high risk for thromboembolic complications. These data support the use of VTE risk stratification-based prophylactic strategies in myeloma patients treated with new drugs. Disclosures Conticello: Celgene: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding. Di Raimondo:Takeda: Consultancy; Amgen: Consultancy, Honoraria, Research Funding.

scholarly journals Acute Pulmonary Embolism at Tanta University Hospital: Single Centre Registry

2021 ◽  
pp. 23-32
Author(s):  
Alaa Raafat Elesawi Elkhateeb ◽  
Ahmed Farouk Alarag ◽  
Taymoor Mostafa Abdallah ◽  
Seham Fahmy Badr
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Acute Pulmonary Embolism ◽  
Previous History ◽  
Real Life ◽  
University Hospital ◽  
Treatment Modalities ◽  
Increased Risk ◽  
Active Cancer

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide, and has significant negative impacts on quality of life, healthcare costs, and longevity. Registries have been created to record ‘real-life’ clinical features and management of patients with PE. Aim: We aimed to describe a comprehensive view of the clinical presentation, demographic data, treatment modalities and short-term outcome at hospital discharge and 3 months after discharge for patients presented with acute pulmonary embolism at Tanta university hospital to improve the level of care of those patients. Methods: This study was conducted on 150 patients with confirmed acute PE presented to Tanta university hospitals. The study duration was 1 year from April 2019 to May 2020. Results: We focused on a group of common risk factors for PE and determined prevelance of each in our enrolled patients, we found increase some risk factors obesity and bed rest > 3 days were the most prevalent risk factors followed by active cancer, estrogen use and lower limb fracture. Symptoms in this study are near to other registries and ESC guidelines 2019 with the commonest symptom was dyspnea and chest pain and the least symptom was hemoptysis. Certain ECG signs more prevalent in our patients and these signs related to RV strain with sinus tachycardia the commonest sign followed by S1Q3T3 sign and the least was right axis deviation. Conclusion: Presence of active cancer and patients with high risk stratification were independent predictors of mortality. Other factors associated with increased mortality were impaired RV systolic function, high PESI score, presence of RBBB in ECG and presence of congestive heart failure. Increased risk of bleeding in male patients with intermediate high or high risk category especially those received UFH and fibrinolytic therapy. Previous history of VTE was independent predictors of VTE recurrence.

Rate of Late Venous Thromboembolism Events In High-Risk Medical Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 82-82
Author(s):  
Russell Hull ◽  
Duane Bates ◽  
Cynthia Brocklebank ◽  
Nelly Komari ◽  
Tazmin Merali
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Acute Infection ◽  
Diagnostic Testing ◽  
Real Life ◽  
Respiratory Illness ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Inflammatory Bowel ◽  
Current Guidelines

Abstract Abstract 82 Background: Current guidelines recommend that venous thromboembolism (VTE) prophylaxis should be given to high-risk medical inpatients based on evidence of reduced VTE events and reduced mortality. However, current guidelines do not specify the appropriate length of VTE prophylaxis in this population, especially after discharge. The EXCLAIM study showed a 90 day VTE incidence of 4.2% in those patients who received enoxaparin for 10 days in the hospital, with 1.1% being symptomatic VTE. However, real world data is needed to understand the risk of VTE for this patient population after they are discharged from acute care and the prevalence of symptomatic VTE. Objective: To determine the incidence of late VTE events in high-risk medical patients in every day clinical practice and in the absence of systematic screening for VTE. Methods: Charts from 1134 consecutive high-risk medical patients who were hospitalized in the Calgary region and discharged between January and February 2008 were abstracted using standardized case record forms. All hospitals in the region use a common unique patient identifier number, thus enabling the tracking of subsequent patient visits to the emergency room, inpatient admissions or outpatient visits occurring anywhere in the region's acute care system. High-risk medical patients were defined as age > 60 years and having at least one of the following risk factors: malignancy, respiratory illness, neurological illness, inflammatory bowel disease, previous VTE, acute infection or heart failure. Records excluded were those of patients who were admitted for VTE or to rule out VTE, those receiving chronic anticoagulation, those with acute coronary syndromes, patients whose hospital stay was ≤ 3 days, surgical patients, orthopedic patients, and pregnant patients. Data was collected on patient risk factors, thromboprophylaxis received in hospital and at discharge, VTE related events for up to 100 days post discharge. Results: 989 patients met criteria over the review period. 74% (733/989) of all patients received mechanical or pharmacological prophylaxis in hospital: 28% (281) received unfractionated heparin, 28% (281) received LMWH and 4% (40) received mechanical prophylaxis and 13% (131) received a combination of modalities. The prevailing medical risk factors were malignancy (46%), respiratory illness (44%), neurological illness (15%), inflammatory bowel disease (6%), previous VTE (4%), acute infection (17%), heart failure (9%). Only 2% (95% CI, 1.6% to 3.6%) of all patients received anticoagulation prophylaxis at discharge. Twenty one percent of patients in the population studied received medical care for symptoms associated with VTE. Of these, 4% (95% CI, 2.7% to 5.2%) had confirmation of VTE by diagnostic testing while the other 17% (95% CI, 15.0% to 19.8%) had diagnostic tests that were negative or inconclusive. The mean length of time to confirmed VTE was 34.1 days post hospital admission. Conclusion: This study demonstrates that in a real life setting 21% of high-risk patients would develop symptoms of VTE requiring a health professional's attention with 4% having VTE confirmed by diagnostic testing. These events occurred despite prophylaxis in hospital and suggest that the risk of symptomatic VTE could be higher in real life compared to that reported in randomized clinical trials where patients are screened for asymptomatic VTE. These findings show that the prevalence of VTE warrants consideration of extended thromboprophylaxis in selected high-risk medical patients, as the benefits of extended prophylactic therapy may outweigh the risks in this population. Disclosures: Hull: sanofi-aventis Canada Inc: Consultancy, Research Funding. Brocklebank:sanofi-aventis Canada Inc: Honoraria; Bayer, Inc.: Honoraria; Leo Pharma: Honoraria. Komari:sanofi-aventis Canada Inc: Employment. Merali:sanofi-aventis Canada Inc: Consultancy, Research Funding.

Time Course of Venous Thromboembolism Events and Influence of Risk Factors in High Risk Medical Patients,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4182-4182
Author(s):  
Russell D Hull ◽  
Tazmin Merali ◽  
Allan Mills ◽  
Jane Liang ◽  
Nelly Komari
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Time Course ◽  
Diagnostic Testing ◽  
Real Life ◽  
High Risk Population ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
The Mean

Abstract Abstract 4182 Background: Venous thromboembolism (VTE) prophylaxis has been identified in clinical guidelines as an appropriate strategy for high-risk medical inpatients as it results in reduced VTE events and reduced mortality. However, real life data regarding the timing of VTE events and the relationship between risk factors and VTE in this population is lacking. Further knowledge of the time course of recurrence and influence of risk factors in actual practice may help clinicians determine strategies regarding the frequency of clinical surveillance and the appropriate duration of treatment. Objective: To document the time course of symptomatic VTE events in high-risk medical patients in every day clinical practice and to relate the frequency of risk factors to the likelihood of VTE development. Methods: Charts from 1134 consecutive high-risk medical patients who were hospitalized in the Calgary region and discharged between January and February 2008 were abstracted using standardized case record forms. All hospitals in the region use a common unique patient identifier number, thus enabling the tracking of subsequent patient visits to the emergency room, inpatient admissions or outpatient visits occurring anywhere in the region's acute care system. Any identified patient was followed for a subsequent visit related to VTE. High-risk medical patients were defined as age > 60 years and having at least one of the following risk factors: malignancy, respiratory illness, neurological illness, inflammatory bowel disease, previous VTE, acute infection or heart failure. Records were excluded if the patient was admitted for VTE or to rule out VTE, receiving chronic anticoagulation, experiencing acute coronary syndromes, had a hospital stay ≤ 3 days, was a surgical or orthopedic patient, or pregnant. Data was collected on the timing of VTE related events for up to 100 days post discharge. Results: A total of 989 patients met criteria over the review period. Seventy-four percent (732/989) of all patients received mechanical or pharmacological prophylaxis in hospital. Only 2% (95% CI, 1.6% to 3.6%) of all patients received anticoagulation prophylaxis at discharge. Twenty-one percent of patients in the population studied were identified as requiring medical care for symptoms associated with VTE. Confirmation of VTE by diagnostic testing occurred in 4% (95% CI, 2.7% to 5.2%) while the other 17% (95% CI, 15.0% to 19.8%) had diagnostic tests that were negative or inconclusive. The mean length of time to confirmed first VTE event was 33.5 days. Eighty percent of first events occurred by day 57 and 90% of first VTE events occurred by day 69 post hospital admission. Patients with more than 2 risk factors had a rate of confirmed symptomatic VTE events of 6.1%, increasing to 8.7% for those with more than 3 risk factors while only 2.9% of patients with 2 or less risk factors developed a confirmed VTE. (p=0.015) Conclusion: This study demonstrates that in a real life setting, 6% of those hospitalized medical patients with more than 2 risk factors would develop symptomatic VTE event confirmed by diagnostic testing, increasing to 8.7% for those with more than 3 pre-specified risk factors. The mean time to first VTE event of 33.5 days along with 80% of VTE events occurring by day 57 suggest that more consideration needs to be given to prolonged VTE prophylaxis in this high risk population. The frequency and timing of the VTE events coupled with the results of the EXCLAIM study suggest that this high risk population may benefit from prolonged thromboprophylaxis. Disclosures: Hull: LEO Pharma: Consultancy; sanofi-aventis: Consultancy; Pfizer: Consultancy; Portola: Consultancy; Merck: Consultancy; Bayer: Consultancy; Johnson & Johnson: Consultancy. Merali:LEO Pharma: Consultancy; Genzyme: Consultancy; Boehringer Ingelheim: Consultancy; Abbott: Consultancy; BMS: Consultancy; Pfizer: Consultancy; Amgen: Consultancy; sanofi-aventis: Consultancy; Nycomed: Consultancy; Otsuka: Consultancy. Mills:Pfizer: Consultancy; sanofi-aventis: Research Funding. Komari:sanofi-aventis: Employment.

scholarly journals Thrombocytopenia and thrombosis in hospitalized patients with COVID-19

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Heng Mei ◽  
Lili Luo ◽  
Yu Hu
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Activated Partial Thromboplastin Time ◽  
Thromboembolic Complications ◽  
Respiratory Condition ◽  
High Risk Factors ◽  
Per Se ◽  
Immune Inflammation ◽  
Risk For Thrombosis ◽  
D Dimer

AbstractAs our understanding on coronavirus disease 2019 (COVID-19) deepens, it is increasingly recognized that COVID-19 is more than a respiratory condition. Thrombocytopenia and thromboembolic complications are a composite factor associated with critical COVID-19 and increased mortality. Immune-inflammation-mediated destruction, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection per se and increased consumption are proposed to be responsible for thrombocytopenia. Multiple concomitant conditions or results caused by SARS-CoV-2 infection are high risk factors for thrombosis. Recently, platelet activation and platelet-mediated immune inflammation induced by SARS-CoV-2 infection were also found to be the contributors to the thrombosis in COVID-19 patients. In addition to thrombus scoring system, D-dimer is an excellent indicator for monitoring thrombosis. COVID-19 patients with high risk for thrombosis should be subjected to early thromboprophylaxis, and prolonged activated partial-thromboplastin time should not be a barrier to the use of anticoagulation therapies in the control of thrombosis in COVID-19 patients.

Thromboembolic Events During Chemotherapy for Germ Cell Cancer: A Cohort Study and Review of the Literature

2000 ◽  
Vol 18 (10) ◽  
pp. 2169-2178 ◽  
Author(s):  
Nir I. Weijl ◽  
Marc F. J. Rutten ◽  
Aeilko H. Zwinderman ◽  
H. Jan Keizer ◽  
Marianne A. Nooy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Germ Cell ◽  
Cancer Patients ◽  
Odds Ratio ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
High Doses

PURPOSE: To evaluate the risk of major thromboembolic complications in male germ cell cancer patients receiving cisplatin-based chemotherapy and to review the literature on this subject. PATIENTS AND METHODS: One hundred seventy-nine germ cell cancer patients treated between January 1979 and May 1997 in our hospital were analyzed with respect to risk factors for developing thromboembolic events, such as baseline tumor characteristics, prior tumor therapy, administration of cytostatic agents, and the use of antiemetic drugs. The patients were treated with a variety of combination chemotherapy regimens, primarily cisplatin-containing combination regimens. RESULTS: Of the 179 patients, 15 patients (8.4%) were identified who developed a total of 18 major thromboembolic complications in the time period between the start of chemotherapy and 6 weeks after administration of the last cytostatic drug in first-line treatment. Of these 18 events, three (16.7%) were arterial events, including two cerebral ischemic strokes, and 15 (83.3%) were venous thromboembolic events, including 11 pulmonary embolisms. One (5.6%) of the 18 events was fatal. Liver metastases (odds ratio, 4.9; 95% confidence interval, 1.1 to 20.8) and the administration of high doses of corticosteroids (≥ 80 mg dexamethasone per cycle; odds ratio, 3.5; 95% confidence interval, 1.2 to 10.3) as antiemetic therapy were identified as risk factors for the development of major thromboembolic complications. CONCLUSION: Germ cell cancer patients who receive chemotherapy, in particular those who have liver metastases or receive high doses of corticosteroids, are at considerable risk of developing thromboembolic complications.

Thrombosis as a complication of the Klippel-Trénaunay syndrome and other vascular malformations

Phlebologie ◽  
2009 ◽  
Vol 38 (03) ◽  
pp. 115-121
Author(s):  
A. Geyer ◽  
F. Benedix ◽  
A. Strölin ◽  
V. Lichte
Keyword(s):  
Risk Factors ◽  
Vascular Malformations ◽  
Post Partum ◽  
Clinical Development ◽  
Young Age ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Deep Vein ◽  
Klippel Trenaunay Syndrome ◽  
Deep Vein Thromboses

SummaryThe Klippel-Trénaunay syndrome (KTS) is a congenital disorder of vascular malformations characterized by the clinical trias of naevi flammei, varicosis and hypertrophy of the affected limb. According to its clinical development KTS can be diagnosed directly post partum or becomes apparent in the course of the development particularly regarding incomplete forms. The most described symptoms next to swelling are pain and augmented sweating of the affected extremity. Complications of KTS are bleeding from mechanically traumatised vascular malformations or widened vessels, but also thromboembolic events are reported. We report on two patients with KTS and one patient with angiodysplasia, who developed deep vein thromboses in the affected limb at young age. None of the patients suffered from thrombophilia or other predisposing risk factors for thrombosis. KTS and other angiodysplastic disorders seem to be a risk factor for thromboembolic complications even at young age. A comprehensive counceling of the patients concerning the prevention of complications and especially the symptoms of thromboembolic events is important for early diagnosis and immediate therapy.

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