Venous Thrombosis in Patients with Solid Tumors: Determination of Frequency and Characteristics

2002 ◽  
Vol 87 (04) ◽  
pp. 575-579 ◽  
Author(s):  
Jim Wan ◽  
Nam Nguyen ◽  
Sabah Sallah
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Solid Tumors ◽  
Current Knowledge ◽  
Patients With Cancer ◽  
Venous Thromboembolic ◽  
Patients At Risk ◽  
The Impact

SummaryDeep venous thrombosis (DVT) and pulmonary embolism (PE) are well recognized complications of cancer. However, our current knowledge of this association is derived from studies conducted more than a decade ago. In light of the changes in medical practice and the improvement in cancer care in recent years, a re-evaluation of the relationship between malignancy and venous thrombosis is in order. Of a total of 1041 patients with solid tumors admitted to 3 major medical centers, there were 81 (7.8%) diagnosed with DVT/PE. Patients were more likely to develop DVT/PE during chemotherapy (p = .0001). Advanced malignancies (p = .001), renal carcinoma (p = .005), pancreatic (p = .001), gastric (p = .014) and brain tumors (p = .001) were independent variables strongly associated with the occurrence of venous thrombosis. The occurrence of thrombotic events in the population tested in this study did not adversely affect survival (p = .082).The study identifies subset of patients with cancer at high risk for venous thrombosis. Early prophylaxis with anticoagulants in these patients may be warranted. Most importantly, further clinical trials are desperately awaited to detect possible new trends in the frequency and types of thrombotic events and to better define prevention strategies in cancer patients at risk for thrombosis.The association between venous thromboembolic disease (VTD) and malignant neoplastic disorders is well known and has been the subject of several reports for more than a century (1–8). There is a general agreement among investigators that thrombotic complications in patients with cancer occur at a rather high frequency, and that other circumstantial factors such as surgery or chemotherapy potentiates this risk (9,10). However, several important considerations pertaining to cancer and thrombosis continue to be shrouded in controversy. For example, there are inexplicable differences in the proportion of patients with cancer diagnosed with deep venous thrombosis (DVT) or pulmonary embolism (PE) reported in the literature (2, 4, 5, 11). In the absence of large well-controlled studies, one may only postulate on the reasons that contributed to these differences. The inclusion of different types of VTD such as superficial, venous, arterial or vascular access device-induced thrombosis may have led to overestimation of the incidence of these events in patients with underlying malignancy. Another possible explanation for this discrepancy relates to the use of a variety of diagnostic and methodological criteria ranging from observation and clinical suspicion to more invasive procedures resulting in considerable differences in the rate of reported clotting events (12). Along the same line of discussion, one may argue whether VTD is a random event or constitutes a complication that occurs more commonly in patients with distinct characteristics and certain tumor types. To further investigate the association between malignancy and thrombosis, we evaluated 1041 patients with solid tumors for the risk of DVT/PE. The main objectives of the study were to determine the frequency of DVT/PE based on validated diagnostic criteria and to identify patients with cancer at high risk for developing these thrombotic episodes. Also, we evaluated the impact of VTD on the survival of these patients.

scholarly journals Upper extremity deep venous thrombosis: risk factors, diagnosis, treatment

2016 ◽  
Vol 11 (1) ◽  
pp. 28-32
Author(s):  
Camelia C. DIACONU ◽  
◽  
Mădălina ILIE ◽  
Mihaela Adela IANCU ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Brachiocephalic Vein ◽  
Risk Of Death ◽  
Thrombosis Risk ◽  
Effort Thrombosis

Upper extremity deep venous thrombosis is a condition with increasing prevalence, with high risk of morbidity and mortality, due to embolic complications. In the majority of the cases, thrombosis involves more than one venous segment, most frequently being affected the subclavian vein, followed by internal jugular vein, brachiocephalic vein and basilic vein. Upper extremity deep venous thrombosis in patients without risk factors for thrombosis is called primary deep venous thrombosis and includes idiopathic thrombosis and effort thrombosis. Deep venous thrombosis of upper extremity is called secondary when there are known risk factors and it is encountered mainly in older patients, with many comorbidities. The positive diagnosis is established only after paraclinical and imaging investigations, ultrasonography being the most useful diagnostic method. The most important complication, with high risk of death, is pulmonary embolism. Treatment consists in anticoagulant therapy, for preventing thrombosis extension and pulmonary embolism.

Fibrinogen Proteolysis and Deep Venous Thrombosis (DVT)

1979 ◽  
Author(s):  
H.L. Nossel
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Fibrinopeptide A ◽  
Terminal Portion ◽  
Two Stage ◽  
Normal Individuals

Thrombin cleaves fibrinogen in a two-stage reaction first producing fibrin I (fl) and fibrinopeptide A (FPA) and then fibrin II (fill and fibrinopeptide B (FPU). FI forms thinner strands than fil, a property which may be important in the pathogenesis of thrombosis. In the initial stages of plasmin proteolysis of fibrinogen the C-terminal portion of the Aα chain and the N-terminal portion of the EB chain are removed, leaving a molecule called fragment X (X). Release of the N-termlnal peptide Bβ1-42 serves as an index of X formation, llcnco plasma FPA levels serve as an index of X formation by thrombin action and Bβ1-42 levels as an index of X formation by plasmin action. In normal individuals Bβ1-42 levels were approvimately three times higher than FPA levels. In patients with symptoms of DVT, which was confirmed by venogram, PPA levels were almost invariably elevated. Bβ1-42 levels were not significantly elevated in these patients in the absence of complicating pulmonary embolism. Initial studies on patients at high risk for DVT studied prospectively have shown signigicant elevation of the plasma FPA level and little change in the Bβ1-42 level for several days preceding the onset of DVT as indicated by 125I-fibTinogen scan and confirmed by venogram. Bβ1-42 levels became elevated several days later inassociation either with pulmonary embolism or with resolution of the thrombosis. These data suggest_ that the development of DVT is associated with and preceded by imbalance between thrombin action as indicated by plasma FPA levels and plasmin action as indicated by Bβ1-42 levels.

Detection and Prevention of Deep Venous Thrombosis

1988 ◽  
Vol 22 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Andra J. Melamed ◽  
Jeanette Suarez
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Low Dose ◽  
Diagnostic Techniques ◽  
Prior History ◽  
Dose Heparin ◽  
Prophylactic Measures ◽  
Patients At Risk ◽  
Low Dose Heparin

Deep venous thrombosis (DVT) is a significant problem in the postoperative course of high-risk patients. Risk factors that further predispose patients to DVT include obesity, age over 40 years, smoking, dehydration, and a prior history of thromboembolism. Diagnosis of DVT by physical examination and medical history is difficult; objective diagnostic techniques are often required. Considerable emphasis has been placed on the cost-effectiveness of implementing prophylactic measures in patients who are at high risk for developing DVT. Physical maneuvers attempt to reduce stasis and enhance venous return and pharmacologic approaches alter blood coagulability. The drug therapy used in preventing DVT consists of dextran, low-dose heparin, a combination of low-dose heparin and dihydroergotamine, and warfarin. Effective prophylactic regimens differ according to the type of patients at risk. Prophylactic therapy should be tailored according to the patient's disease and degree of risk.

scholarly journals Prevention of fatal pulmonary embolism in a patient with stomach cancer

2013 ◽  
Vol 94 (6) ◽  
pp. 903-905
Author(s):  
I A Kamalov ◽  
I R Aglullin ◽  
M G Tukhbatullin ◽  
I R Safin ◽  
A Yu Rodionova
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Inferior Vena Cava ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Set Up

A clinical case of a 71-year old patient with stomach cancer and concomitant lower extremity deep venous thrombosis diagnosed before the surgical treatment is presented. The patient was administered anticoagulants, and despite the treatment, a diagnosis of deep venous thrombosis with high risk for thromboembolism was set up. Considering high risk for pulmonary embolism, an inferior vena cava filter was implanted in infrarenal part of inferior vena cava at the first stage. On the second day after the cancer surgery (subtotal stomach resection with lymphadenectomy), clot detachment and its dislocation from the left common femoral vein to the area where the cava filter was implanted with further fixation were diagnosed. Accurate diagnosis of lower extremity deep venous thrombosis with high risk for thromboembolism set up by ultrasonography and timely inferior vena cava filter implantation saved the patient with cancer from developing pulmonary embolism.

PREVENTION OF DEEP VENOUS THROMBOSIS: CONCLUSIONS OF A CONSENSUS DEVELOPMENT CONFERENCE

1987 ◽  
Author(s):  
H R Roberts
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Low Dose ◽  
Dose Heparin ◽  
Prophylactic Measures ◽  
Risk Patients ◽  
Patient Groups ◽  
Low Dose Heparin

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are major health problems that lead to significant morbidity and mortality. In the United States, it is estimated that these two problems result in over 300,000 hospitalizations annually and available data indicate that 50,000 to 100,000 patients per year die of pulmonary embolism.The advent of several diagnostic tests has permitted the identification of groups of patients at high risk for development of deep venous thrombosis and subsequent pulmonary embolism. Identification of these patient groups has led to therapeutic measures designed to prevent both deep venous thrombosis and subsequent embolic episodes. However, the efficacy of these preventive measures have not been widely adopted and reservations have been expressed regarding use of low dose anticoagulant drugs for prevention of DVT and PE, especially in surgical patients. Because of the apparent reluctance to adopt putative preventive measures for DVT and PE, the National Heart, Lung and Blood Institute convened a Consensus Development Conference on the issue of prevention in 1986. Experts from North America, Europe, and South Africa presented data, both pro and con, on prevention of DVT and PE, using one or more therapeutic regimens. An impartial Panel was then asked to arrive at a consensus statement on the following questions: 1) the level of risk of DVT and PE in different patient groups; 2) the efficacy and safety of prophylactic measures in these groups; 3) the recommended prophylactic regimens for different patient groups, and 4) remaining questions related to prevention of DVT and PE. Recommendations for prevention were based on the assumption that reduction in DVT would also result in reduction of pulmonary embolism. Furthermore, the consensus was based, at least in part, upon data combined from multiple clinical trials. Thus, combined data on 12,000 individuals in randomized clinical trials indicated that in appropriate patient groups, treated with low dose heparin, there was a 68 percent reduction in DVT, as measured by the 125I-fibrinogen uptake test and venography, and that there was a reduction of 49% in pulmonary embolism and a significant decrease in overall mortality resulting from pulmonary embolism.Prophylactic measures for the following different patient groups were assessed: 1) general surgery; 2) orthopedic surgery; 3) urology; 4) gynecology-obstetrics; 4) neurosurgery and neurology; 5) trauma; and 6) medical conditions.Basically, the following prophylactic regimens were considered: 1) low dose heparin; 2) low dose dihydroergotamine heparin; 3) dextran; 4) low dose warfarin; and 5) external pneumatic compression. In general terms, low dose heparin appears to be one of the more effective prophylactic regimens in certain groups of high risk patients. This regimen is not useful in orthopedic or certain neurosurgical procedures where heparin has been shown to be of little value or hazardous. In these cases, dextran, warfarin, or external pnuematic compression may be more beneficial. In some groups of high risk patients, combination of mechanical measures with anticoagulant agents appear to be of value in prevention of DVT and PE.The recommendations of the Consensus Panel for Prevention of DVT and PE for each patient group will be assessed.

scholarly journals Novel Biomarkers Associated with Deep Venous Thrombosis: A Comprehensive Review

2008 ◽  
Vol 3 ◽  
pp. 117727190800300 ◽  
Author(s):  
Dawn M Barnes ◽  
Thomas W Wakefield ◽  
John E Rectenwald
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Duplex Ultrasound ◽  
Interleukin 10 ◽  
Serum Marker ◽  
Specific Objective ◽  
Venous Thromboembolic ◽  
Novel Biomarkers ◽  
D Dimer

Primary and recurrent venous thromboembolic disease (VTE, deep venous thrombosis and pulmonary embolism) remain a significant source of morbidity and mortality in the hospitalized patient. Non-specific subjective complaints and lack of specific objective findings related to acute deep venous thrombosis (DVT) and pulmonary embolism (PE) complicate the diagnosis. There remains no single serum marker available to exclusively confirm the diagnosis of VTE. While D-dimer is highly sensitive and useful for diagnostic exclusion, it lacks the specificity necessary for diagnostic confirmation resulting in the need for a variety of additional studies (i.e.: duplex ultrasound, venography, V/Q scanning, helical thoracic and pelvic CT scans and pulmoary angiography). There is evolving research supporting the utility of various plasma markers as novel “biomarkers” for VTE including selectins, microparticles, interleukin-10 and other cytokines. This review attempts to examine recent literature assessing the utility of P-selectin, microparticles, D-dimer, E-selectin, thrombin, interleukins and fibrin monomers in the diagnosis and guidance of therapy for VTE.

scholarly journals Risk Factors for Pulmonary Embolism in Patients with Paralysis and Deep Venous Thrombosis

2021 ◽  
Vol 10 (22) ◽  
pp. 5412
Author(s):  
Karsten Keller ◽  
Jens Wöllner ◽  
Volker H. Schmitt ◽  
Mir A. Ostad ◽  
Ingo Sagoschen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Strong Predictor ◽  
Acute Paraplegia ◽  
The Impact

Background. Venous thromboembolism is a frequent complication and an important cause of death in patients with paralysis. We aimed to investigate predictors of pulmonary embolism (PE) and the impact of PE on the survival of patients with paralysis in comparison to those with deep venous thrombosis or thrombophlebitis (DVT). Methods: Patients were selected by screening the German nationwide inpatient sample (2005–2017) for paralysis, and were stratified for venous thromboembolism (VTE) and the VTE-sub-entity PE (ICD-code I26). Impact of PE on mortality and predictors for PE were analyzed. Results: Overall, 7,873,769 hospitalizations of patients with paralysis were recorded in Germany 2005–2017, of whom 1.6% had VTE and 7.0% died. While annual hospitalizations increased (2005: 520,357 to 2017: 663,998) (β 12,421 (95% CI 10,807 to 14,034), p < 0.001), in-hospital mortality decreased from 7.5% to 6.7% (β −0.08% (95% CI −0.10% to −0.06%), p < 0.001). When focusing on 82,558 patients with paralysis hospitalized due to VTE (51.8% females; 58.3% aged ≥ 70 years) in 2005–2017, in-hospital mortality was significantly higher in patients with paralysis and PE than in those with DVT only (23.8% vs. 6.3%, p < 0.001). Cancer (OR 2.18 (95% CI 2.09–2.27), p < 0.001), heart failure (OR 1.83 (95% CI 1.76–1.91), p < 0.001), COPD (OR 1.63 (95% CI 1.53–1.72), p < 0.001) and obesity (OR 1.42 (95% CI 1.35–1.50), p < 0.001) were associated with PE. PE (OR 4.28 (95% CI 4.07–4.50), p < 0.001) was a strong predictor of in-hospital mortality. Conclusions: In Germany, annual hospitalizations of patients with paralysis increased in 2005–2017, in whom VTE and especially PE substantially affected in-hospital mortality. Cancer, heart failure, COPD, obesity and acute paraplegia were risk factors of PE.

Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients: An Overstatement of the Problem?

2005 ◽  
Vol 71 (5) ◽  
pp. 387-391 ◽  
Author(s):  
Stanislaw P. Stawicki ◽  
Michael D. Grossman ◽  
James Cipolla ◽  
William S. Hoff ◽  
Brian A. Hoey ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Injury Severity ◽  
Clinical Importance ◽  
Trauma Patients ◽  
Lower Extremity Fracture ◽  
Cord Injury ◽  
Level I

Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEFx), severe head injury (CHI) (AIS – head ≥3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score (ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEFx; highest was 5.4% for combined PFx, LEFx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of ≥5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.

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