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Falanga A, Lorusso D, Colombo N, Cormio G, Cosmi B, Scandurra G, Zanagnolo V, Marietta M. Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention. Cancers (Basel) 2024; 16:1769. [PMID: 38730721 PMCID: PMC11083004 DOI: 10.3390/cancers16091769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
The prevention and appropriate management of venous thromboembolism in cancer patients is of paramount importance. However, the literature data report an underestimation of this major problem in patients with gynecological cancers, with an inconsistent venous thromboembolism risk assessment and prophylaxis in this patient setting. This narrative review provides a comprehensive overview of the available evidence regarding the management of venous thromboembolism in cancer patients, focusing on the specific context of gynecological tumors, exploring the literature discussing risk factors, risk assessment, and pharmacological prophylaxis. We found that the current understanding and management of venous thromboembolism in gynecological malignancy is largely based on studies on solid cancers in general. Hence, further, larger, and well-designed research in this area is needed.
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Affiliation(s)
- Anna Falanga
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy; (A.F.); (N.C.)
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy; (A.F.); (N.C.)
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine (DIM), University “A. Moro”, 70124 Bari, Italy
| | - Benilde Cosmi
- Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
- Angiology and Blood Coagulation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppa Scandurra
- Unità Operativa Oncologia Medica, Ospedale Cannizzaro di Catania, 95126 Catania, Italy;
| | | | - Marco Marietta
- Hematology Unit, Azienda Ospedaliero-Universitaria, 41125 Modena, Italy;
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Boo M, Simcock B, Sykes P, Brand A. Direct oral anticoagulants (DOACs) use for prolonged venous thromboembolism prophylaxis following surgery for gynaecological malignancies in Australia and New Zealand - A clinician survey. Aust N Z J Obstet Gynaecol 2024; 64:36-41. [PMID: 37434425 DOI: 10.1111/ajo.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Current international guidelines recommend 28 days of enoxaparin as venous thromboembolism (VTE) prophylaxis after surgery for gynaecologic cancer. Direct oral anticoagulants (DOACs) have been investigated as an alternative to enoxaparin for post-operative VTE prophylaxis. High-quality evidence to demonstrate safety and efficacy is lacking. AIMS We aim to investigate the current practice regarding VTE prophylaxis among gynaecological oncologists in Australia and New Zealand following laparotomy for gynaecological malignancy, in particular the use of DOACs for VTE prophylaxis. MATERIALS AND METHODS Sixty-seven practising gynaecologic oncologists (GO) were identified through Royal Australia and New Zealand College of Obstetricians and Gynaecologists database and emailed online surveys that asked about VTE prophylaxis practice and views of DOACs in this setting. Data were then collected through Survey Monkey and evaluated. RESULTS The majority (77.1%) routinely prescribed 28 days of enoxaparin following laparotomy for gynaecological malignancies. In clinical circumstance such as laparoscopy for gynaecological malignancies and surgery for vulva malignancies, there was variation in thromboprophylaxis practices. No GO reported routine use of DOACs in any clinical circumstance. There were 56% of GOs who used a DOAC in their practice at some point. Barriers to routine use of DOACs in current practice included insufficient evidence (68%), issue with cost (40.4%) and concerns about safety (29.7%). CONCLUSIONS Enoxaparin prescribed for 28 days remains the current clinical practice in preventing VTE following laparotomy for gynaecological malignancy. The main barrier to routine DOAC use as post-operative thromboprophylaxis is a lack of evidence which reflects the need for a larger prospective study.
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Affiliation(s)
- Marilyn Boo
- Westmead Hospital, Gynaecology Oncology Department, Sydney, New South Wales, Australia
| | - Bryony Simcock
- Christchurch Women's Hospital, Gynaecology Oncology Department, Christchurch, New Zealand
| | - Peter Sykes
- Christchurch Women's Hospital, Gynaecology Oncology Department, Christchurch, New Zealand
| | - Alison Brand
- Westmead Hospital, Gynaecology Oncology Department, Sydney, New South Wales, Australia
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McAlarnen LA, Small C, Tostrud L, Pan AY, Erickson B, Bedi M, Bradley WH. Considerations for pharmacologic thromboprophylaxis following inpatient brachytherapy for gynecologic malignancies. Brachytherapy 2023; 22:630-639. [PMID: 37394350 PMCID: PMC10757857 DOI: 10.1016/j.brachy.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/13/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Brachytherapy irradiation carries risks of both bleeding and venous thromboembolism (VTE). No screening or management recommendations for VTE in this setting have been developed. Our study aims to understand the incidence of VTE, compile published anticoagulation guidelines, and call for future guidelines to address thromboprophylaxis in this population. METHODS AND MATERIALS A retrospective, single institution study of patients undergoing brachytherapy irradiation between 2012 and 2022 was undertaken. We analyzed 2 cohorts: 87 patients undergoing brachytherapy with an inpatient admission, and 66 patients assessed for risk of VTE or bleeding after discharge from an inpatient admission for brachytherapy. Caprini risk scores were calculated for each patient, and statistical analyses were performed. RESULTS Eighty-seven patients were included, and 25% had a VTE diagnosis. Forty-seven (54%) of patients included underwent brachytherapy as definitive treatment of cervical cancer, and 16 (18%) received brachytherapy irradiation to treat recurrent endometrial cancer. In the cohort of 66 patients assessed for risk of VTE or bleeding after brachytherapy discharge, 23 (34.8%) were discharged with thromboprophylaxis, and 43 (65.2%) were discharged without thromboprophylaxis. None of the patients discharged on thromboprophylaxis were diagnosed with a VTE within 90 days of discharge after brachytherapy, whereas 3 of 43 (7%) discharged without thromboprophylaxis were diagnosed with a VTE, OR and 95% CI: 0.25 (0.01-5.29), p = 0.37. Of the 23 patients discharged on thromboprophylaxis, 1 was readmitted for bleeding OR and 95% CI: 5.8 (0.22-155.18), p = 0.29. The median Caprini score was 11. CONCLUSIONS VTE is a common occurrence in patients undergoing brachytherapy. Patients undergoing brachytherapy irradiation who require inpatient admission represent a unique population, and specialty organizations should develop consensus recommendations to address these clinical challenges.
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Affiliation(s)
- Lindsey A McAlarnen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI.
| | - Christina Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Lauren Tostrud
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Amy Y Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - William H Bradley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
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Wu L, Cheng B. A nomogram to predict postoperative deep vein thrombosis in patients with femoral fracture: a retrospective study. J Orthop Surg Res 2023; 18:463. [PMID: 37370139 DOI: 10.1186/s13018-023-03931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The implementation of more active anticoagulant prevention and treatment measures has indeed led to a significant reduction in the incidence of perioperative deep vein thrombosis (DVT) among patients with bone trauma. However, it is important to note that despite these efforts, the incidence of DVT still remains relatively high. According to the Caprini score, all patients undergoing major orthopedic surgery were defined as the high-risk group for DVT. Stratifying the risk further within high-risk groups for DVT continues to present challenges. As a result, the commonly used Caprini score during the perioperative period is not applicable to orthopedic patients. We attempt to establish a specialized model to predict postoperative DVT risk in patients with femoral fracture. METHODS We collected the clinical data of 513 patients undergoing femoral fracture surgery in our hospital from May 2018 to December 2019. According to the independent risk factors of DVT obtained by univariate and multivariate logistic regression analysis, the corresponding nomogram model was established and verified internally. The discriminative capacity of nomogram was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC). The calibration curve used to verify model consistency was the fitted line between predicted and actual incidences. The clinical validity of the nomogram model was assessed using decision curve analysis (DCA) which could quantify the net benefit of different risk threshold probabilities. Bootstrap method was applied to the internal validation of the nomogram model. Furthermore, a comparison was made between the Caprini score and the developed nomogram model. RESULTS The Caprini scores of subjects ranged from 5 to 17 points. The incidence of DVT was not positively correlated with the Caprini score. The predictors of the nomogram model included 10 risk factors such as age, hypoalbuminemia, multiple trauma, perioperative red blood cell infusion, etc. Compared with the Caprini scale (AUC = 0.571, 95% CI 0.479-0.623), the calibration accuracy and identification ability of nomogram were higher (AUC = 0.865,95% CI 0.780-0.935). The decision curve analysis (DCA) indicated the clinical effectiveness of nomogram was higher than the Caprini score. CONCLUSIONS The nomogram was established to effectively predict postoperative DVT in patients with femoral fracture. To further reduce the incidence, more specialized risk assessment models for DVT should take into account the unique risk factors and characteristics associated with specific patient populations.
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Affiliation(s)
- Linqin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Lobastov K, Urbanek T, Stepanov E, Lal BK, Marangoni J, Krauss ES, Cronin M, Dengler N, Segal A, Welch HJ, Gianesini S, Chen X, Caprini JA. The Thresholds of Caprini Score Associated With Increased Risk of Venous Thromboembolism Across Different Specialties: A Systematic Review. Ann Surg 2023; 277:929-937. [PMID: 36912040 DOI: 10.1097/sla.0000000000005843] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Estimation of the specific thresholds of the Caprini risk score (CRS) that are associated with the increased incidence of venous thromboembolism (VTE) across different specialties, including identifying the highest level of risk. BACKGROUND Accurate risk assessment remains an important but often challenging aspect of VTE prophylaxis. One well-established risk assessment model is CRS, which has been validated in thousands of patients from many different medical and surgical specialties. METHODS A search of MEDLINE and the Cochrane Library was performed in March 2022. Manuscripts that reported on (1) patients admitted to medical or surgical departments and (2) had their VTE risk assessed by CRS and (3) reported on the correlation between the score and VTE incidence, were included in the analysis. RESULTS A total of 4562 references were identified, and the full text of 202 papers was assessed for eligibility. The correlation between CRS and VTE incidence was reported in 68 studies that enrolled 4,207,895 patients. In all specialties, a significant increase in VTE incidence was observed in patients with a CRS of ≥5. In most specialties thresholds of ≥7, ≥9, and ≥11 to 12 were associated with dramatically increased incidences of VTE. In COVID-19, cancer, trauma, vascular, general, head and neck, and thoracic surgery patients with ≥9 and ≥11 to 12 scores the VTE incidence was extremely high (ranging from 13% to 47%). CONCLUSION The Caprini score is being used increasingly to predict VTE in many medical and surgical specialties. In most cases, the VTE risk for individual patients increases dramatically at a threshold CRS of 7 to 11.
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Affiliation(s)
- Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Eugeniy Stepanov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Brajesh K Lal
- University of Maryland School of Medicine, Baltimore, MD
| | | | - Eugene S Krauss
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - MaryAnne Cronin
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - Nancy Dengler
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - Ayal Segal
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - Harold J Welch
- Division of Vascular Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | | | - Xiaolan Chen
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Norris LA, Saadeh FA. "Risk of venous thromboembolism and bleeding after major surgery for ovarian cancer: standard in-hospital versus extended duration of thromboprophylaxis": Comment. J Thromb Haemost 2023; 21:1681-1683. [PMID: 37179077 DOI: 10.1016/j.jtha.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Lucy A Norris
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin, Ireland.
| | - Feras Abu Saadeh
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin, Ireland; Department of Gynaecology Oncology, St James's Hospital, Dublin, Ireland
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Li S, Wang L, Lu Q. Comparison of the predictive power of the 2005 and 2010 Caprini risk assessment models for deep vein thrombosis in Chinese orthopedic patients at admission: A prospective cohort study. Thromb Res 2023; 222:1-6. [PMID: 36542941 DOI: 10.1016/j.thromres.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Several DVT risk assessment tools have been developed and validated to stratify the patients. The 2005 and 2010 Caprini risk assessment models (RAMs) proved reliable in detecting deep vein thrombosis (DVT) and are widely used worldwide. Although the 2010 version was recently modified, the 2005 version is still more exact and popular in the surgical population. This study aimed to compare the predictive power of the 2005 and 2010 Caprini RAMs in Chinese orthopedic patients at admission and describe the incidence of DVT during hospitalization. STUDY DESIGN This prospective cohort study involved 2733 patients from the Arthritis Clinic and Research Center, Orthopedics and Traumatology Department, Orthopedic Oncology Department, and Spinal Surgery Department of Peking University People's Hospital from September 2018 to January 2019. The DVT risk scores and levels were determined for all patients using the 2005 and 2010 Caprini RAMs at admission. The sensitivity and specificity of the two tools were calculated. The patients were divided into the screened and unscreened groups according to whether or not a Doppler ultrasound (DUS) was performed. Depending upon the DUS results, the patients were divided into the DVT and non-DVT groups. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. RESULTS Eighty-four patients had DVT in the four orthopedic departments, and the incidence of DVT was 3.1 %-17.2 %. The scores between the 2005 and 2010 Caprini RAMs differed (P < 0.001) among orthopedic patients at admission. Among DVT patients, the highest-risk patients accounted for 63.5 % and 52.9 % based on the 2005 and 2010 Caprini RAMs, respectively. The AUCs of the 2005 and 1020 Caprini RAMs were 0.669 ± 0.030 and 0.648 ± 0.032, respectively. There were no significant differences between the two ROC curves (P = 0.164). CONCLUSION The 2005 and 2010 Caprini RAMs showed a similar predictive power in detecting DVT, but neither met the high sensitivity criteria for screening DVT in orthopedic patients. The incidence of DVT in orthopedic patients was relatively high during hospitalization.
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Affiliation(s)
- Shuo Li
- Breast Surgery, Peking University People's Hospital, Beijing, China.
| | - Ling Wang
- Nursing Department, Peking University People's Hospital, Beijing, China.
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China.
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Postoperative venous thromboembolism risk stratification in patients with uterine cancer. Am J Obstet Gynecol 2022; 228:555.e1-555.e8. [PMID: 36574873 DOI: 10.1016/j.ajog.2022.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Uterine cancers are associated with a high risk for venous thromboembolisms. The American Society of Clinical Oncology practice guidelines recommend that all patients undergoing pelvic surgery for cancer should receive extended pharmacologic thromboprophylaxis with the duration being dependent on risk. However, risk stratification for patients with uterine cancer is not clearly defined. The Caprini score is the most widely used risk assessment model but it has been found to have limited use in the gynecologic oncology population. A modified Caprini score has been explored in other populations. The Khorana score is an additional risk assessment model that has not been studied in this context. OBJECTIVE Our objective was to evaluate the ability of a modified Caprini model and the Khorana score to risk stratify patients with uterine cancer for postoperative venous thromboembolisms within 90 days of surgery. STUDY DESIGN Following institutional review board approval, a retrospective cohort study was performed, and all patients with uterine cancer who underwent a hysterectomy over a 4-year period were included. The Caprini and Khorana scores were calculated for each patient. The Caprini score cutoff for highest risk was evaluated at ≥7, ≥8, and ≥9 (modified Caprini) and the Khorana score cutoff was evaluated at ≥2 and ≥3. To determine the prognostic use of each score and other clinico-pathologic criteria related to the development of a venous thromboembolism, univariate analyses were performed using independent t tests, chi-square tests, or Fisher's exact tests; a multivariate analysis was performed using logistic regression. RESULTS A total of 954 patients were included. The rate of venous thromboembolism development was 1.7% (16/954). A minimally invasive surgical approach was used in 90.5% (863/954) of patients. The mean Caprini score for patients with a venous thromboembolism was 10.3 compared with 8.1 for patients without a venous thromboembolism (95% confidence interval, 1.17-3.33; P<.0001). The mean Khorana score for the venous thromboembolism group was 2.4 vs 1.9 for those without (95% confidence interval, 0.04-0.82; P=.03). Both the Caprini and Khorana scores were found to be associated with venous thromboembolisms, but only a Caprini score with a cutoff of ≥8 or ≥9 was statistically significant (risk ratio, 31.25; 95% confidence interval, 1.88-519.49; risk ratio, 4.59; 95% confidence interval, 1.49-14.13, respectively), with high accuracy based on the area under the curve (0.75 and 0.68, respectively). Of the minimally invasive subgroup, 11.7% (101/863) of patients had same-day discharge with no postoperative thromboprophylaxis; none of these patients developed venous thromboembolisms. Despite extended prophylaxis among the laparotomy patients (30 days), the rate of venous thromboembolisms was more than 3 times that of the minimally invasive group (5.49% vs 1.7%). Advanced tumor stage and leukocytosis were noted to be independent risk factors for venous thromboembolisms. CONCLUSION Our study suggests that using a modified Caprini score could help to identify the highest-risk patients who would benefit from prolonged thromboprophylaxis, could reduce the incidence of postoperative venous thromboembolisms, and could minimize the cost and harm of overtreatment. These findings need to be validated in a prospective manner, and further research is needed to determine the optimal duration of therapy.
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Hayssen H, Cires-Drouet R, Englum B, Nguyen P, Sahoo S, Mayorga-Carlin M, Siddiqui T, Turner D, Yesha Y, Sorkin JD, Lal BK. Systematic review of venous thromboembolism risk categories derived from Caprini score. J Vasc Surg Venous Lymphat Disord 2022; 10:1401-1409.e7. [PMID: 35926802 PMCID: PMC9783939 DOI: 10.1016/j.jvsv.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/11/2022] [Accepted: 05/03/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Hospital-acquired venous thromboembolism (VTE, including pulmonary embolism [PE] and deep vein thrombosis [DVT]) is a preventable cause of hospital death. The Caprini risk assessment model (RAM) is one of the most commonly used tools to assess VTE risk. The RAM is operationalized in clinical practice by grouping several risk scores into VTE risk categories that drive decisions on prophylaxis. A correlation between increasing Caprini scores and rising VTE risk is well-established. We assessed whether the increasing VTE risk categories assigned on the basis of recommended score ranges also correlate with increasing VTE risk. METHODS We conducted a systematic review of articles that used the Caprini RAM to assign VTE risk categories and that reported corresponding VTE rates. A Medline and EMBASE search retrieved 895 articles, of which 57 fulfilled inclusion criteria. RESULTS Forty-eight (84%) of the articles were cohort studies, 7 (12%) were case-control studies, and 2 (4%) were cross-sectional studies. The populations varied from postsurgical to medical patients. There was variability in the number of VTE risk categories assigned by individual studies (6 used 5 risk categories, 37 used 4, 11 used 3, and 3 used 2), and in the cutoff scores defining the risk categories (scores from 0 alone to 0-10 for the low-risk category; from ≥5 to ≥10 for high risk). The VTE rates reported for similar risk categories also varied across studies (0%-12.3% in the low-risk category; 0%-40% for high risk). The Caprini RAM is designed to assess composite VTE risk; however, two studies reported PE or DVT rates alone, and many of the other studies did not specify the types of DVTs analyzed. The Caprini RAM predicts VTE at 30 days after assessment; however, only 17 studies measured outcomes at 30 days; the remaining studies had either shorter or longer follow-ups (0-180 days). CONCLUSIONS The usefulness of the Caprini RAM is limited by heterogeneity in its implementation across centers. The score-derived VTE risk categorization has significant variability in the number of risk categories being used, the cutpoints used to define the risk categories, the outcome being measured, and the follow-up duration. This factor leads to similar risk categories being associated with different VTE rates, which impacts the clinical and research implications of the results. To enhance generalizability, there is a need for studies that validate the RAM in a broad population of medical and surgical patients, identify standardized risk categories, define risk of DVT and PE as distinct end points, and measure outcomes at standardized follow-up time points.
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Affiliation(s)
- Hilary Hayssen
- Department of Vascular Surgery, University of Maryland, Baltimore, MD; Surgery Service, VA Medical Center, Baltimore, MD
| | | | - Brian Englum
- Department of Vascular Surgery, University of Maryland, Baltimore, MD
| | - Phuong Nguyen
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, MD
| | - Shalini Sahoo
- Department of Vascular Surgery, University of Maryland, Baltimore, MD; Surgery Service, VA Medical Center, Baltimore, MD
| | - Minerva Mayorga-Carlin
- Department of Vascular Surgery, University of Maryland, Baltimore, MD; Surgery Service, VA Medical Center, Baltimore, MD
| | | | | | - Yelena Yesha
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, MD; Department of Computer Science, University of Miami, Miami, FL
| | - John D Sorkin
- Department of Medicine, Division of Gerontology and Palliative Care, University of Maryland School of Medicine, Baltimore, MD; Baltimore VA Geriatric Research, Education, and Clinical Center, Baltimore, MD
| | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland, Baltimore, MD; Surgery Service, VA Medical Center, Baltimore, MD.
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Tafur AJ, Moore ED. Direct Oral Anti-Coagulants Continue to Bud into Gynecological Cancer-Thrombosis Prevention. Clin Appl Thromb Hemost 2022; 28:10760296221133792. [PMID: 36262075 PMCID: PMC9585564 DOI: 10.1177/10760296221133792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alfonso J. Tafur
- Department of Medicine, Vascular Medicine, NorthShore University Health System, Evanston, IL, USA
- Alfonso J. Tafur, Department of Medicine, Vascular Medicine, NorthShore University Health System, Evanston, IL, USA.
| | - Elena Diaz Moore
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, IL, USA
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Chen Q, Cai Y, Zhang Z, Dong H, Miao J, Li H, Hu B. Prevalence of venous thromboembolism and evaluation of a modified caprini risk assessment model: a single-centre, prospective cohort study involving patients undergoing lung resections for bronchiectasis. Thromb J 2022; 20:43. [PMID: 35915486 PMCID: PMC9341115 DOI: 10.1186/s12959-022-00402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a common postoperative complication in general thoracic surgery, but the incidence of patients undergoing surgery for bronchiectasis was not known. The purpose of our study was to investigate the incidence of VTE in bronchiectasis patients undergoing lung resection and to evaluate the risk stratification effect of the modified caprini risk assessment model (RAM). Methods We prospectively enrolled patients with bronchiectasis who underwent lung resection surgery between July 2016 and July 2020.The postoperative duplex lower-extremity ultrasonography or(and) computed tomographic pulmonary angiography (CTPA) was performed to detect VTE. The clinical characteristics and caprini scores of VTE patients and non-VTE patients would be compared and analyzed. Univariate logistic regression was performed to evaluate whether higher Caprini scores were associated with postoperative VTE risk.In addition, We explored the optimal cutoff for caprini score in patients with bronchiectasis by using the receiver operating characteristic (ROC) curve. Results One hundred and seventeen patients were eligible based on the prospective study criteria. The postoperative VTE incidence was 8.5% (10/117). By comparing the clinical characteristics and Caprini scores of VTE and non-VTE patients, the median preoperative hospitalization (7 vs 5 days, P = 0.028) and Caprini score (6.5 vs 3,P < 0.001) were significantly higher in VTE patients. In univariate logistic regression, a higher Caprini score was associated with higher odds ratio (OR) for VTE of 1.7, 95% confidence interval (CI) was from 1.2 to 2.5 (P = 0.001), C-statistics was 0.815 in the modified caprini RAM for predicting VTE. In a multivariable analysis adjusting for preoperative hospitalization, a higher Caprini score was associated with higher odds OR for VTE of 1.8 (95%CI: 1.2–2.6, P = 0.002), C-statistics was 0.893 in the caprini RAM for predicting VTE. When taking the Caprini score as 5 points as the diagnostic threshold, the Youden index is the largest. Conclusions The postoperative VTE incidence in patients undergoing lung resection for bronchiectasis was 8.5%.The modified caprini RAM effectively stratified bronchiectasis surgery patients for risk of VTE and showed excellent predictive power for VTE. The patients with postoperative caprini scores = 5, should be recommended to take positive measures to prevent postoperative VTE. Trial Registration Chinese Clinical Trial Register: ChiCTR-EOC-17010577.
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Affiliation(s)
- Qingshan Chen
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - YongSheng Cai
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhirong Zhang
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Honghong Dong
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Hui Li
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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12
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Optimizing Perioperative Venous Thromboembolism Chemoprophylaxis on a Gynecologic Oncology Service. J Am Coll Surg 2022; 235:306-314. [PMID: 35839408 DOI: 10.1097/xcs.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perioperative venous thromboembolism (VTE) is a significant cause of morbidity and mortality after gynecologic cancer surgery. Here we report a quality improvement intervention to increase perioperative VTE chemoprophylaxis compliance. STUDY DESIGN All operations performed by a gynecologic oncologist at a tertiary urban university medical center admitted to the hospital for at least one midnight were included. Using a pre/post design with a washout period, we sought to increase perioperative VTE chemoprophylaxis compliance from 22% in the historical control (HC) cohort to 90% in the quality improvement (QI) cohort. The perioperative VTE chemoprophylaxis process was standardized by addressing four domains: preoperative VTE chemoprophylaxis, surgical time-out, postoperative VTE chemoprophylaxis, and intervention education and compliance tracking. Pearson's chi-square test was used to compare HC vs QI cohort compliance. RESULTS There were 130 surgical cases in the HC cohort and 131 in the QI cohort. Forty-two percent underwent laparotomy, and 57% had cancer at the time of operation. VTE chemoprophylaxis compliance improved from 22% in the HC cohort to 82% in the QI cohort (p < 0.001). Preoperative VTE chemoprophylaxis compliance improved from 76% in the HC cohort to 94% in the QI cohort (p < 0.001), and postoperative VTE chemoprophylaxis compliance improved from 27% to 87% (p < 0.001). Thirty-day postoperative VTE occurred in three patients (2%) in the HC cohort and none in the QI cohort (p = 0.08). CONCLUSIONS A low-cost and low-technology QI initiative intervention improved perioperative compliance with VTE chemoprophylaxis.
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13
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Risk assessment and primary prevention of VTE in patients with cancer: Advances, challenges, and evidence gaps. Best Pract Res Clin Haematol 2022; 35:101347. [DOI: 10.1016/j.beha.2022.101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
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14
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Zhen K, Dong F, Fang F, Gao Q, Zhang Z, Xia L, Wang W, Yang P, Jia C, Liu P, Zhai Z, Wang C. Evaluation of In-Hospital Venous Thromboembolism Prevention and Management System Using Hospital-Level Metrics: A Nationwide Cross-Sectional Survey in China. J Patient Saf 2022; 18:e626-e632. [PMID: 34569994 DOI: 10.1097/pts.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Countries in the world have taken actions to prevent venous thromboembolism (VTE) in hospitals. We have conducted a study in China to assess the establishment of hospital-based systems for VTE prevention and management. METHODS A nationwide hospital survey was conducted in China to collect hospital-level metrics on their system for VTE prevention between 2019 and 2020. We analyzed hospital-level metrics potentially influencing the implementation of thromboprophylaxis using a multivariable regression model. Characteristics of the hospital, organizational structure, quality control, and staff training were analyzed. RESULTS Among 435 hospitals responding to the survey, 328 (75.4%) were able to implement thromboprophylaxis. They performed VTE and bleeding risk assessments and had prophylactic interventions. Institutional VTE steering committee and unit-based working group were set up in 317 (72.9%) and 339 (77.9%) hospitals, respectively. More than 80% of the hospitals performed quality control and staff training. In contrast, digitalization of risk assessment was only accomplished in 196 (45.1%) hospitals. Proportions of the aforementioned metrics were consistently higher in tertiary hospitals than secondary hospitals (P < 0.01) except for quality control. There were geographical disparities in the establishment of VTE steering committees (P = 0.0004). In multivariable analysis, VTE steering committee was an independent factor for the implementation of thromboprophylaxis (odds ratio, 2.22, 95% confidence interval, 1.17-4.23). Working group, quality control, and training on VTE were also positively associated with the implementation of thromboprophylaxis. CONCLUSIONS In-hospital VTE prevention has been undertaken in China, but system establishment remains suboptimal. Implementation of VTE prevention programs was associated with a decrease in thrombolytic events. Hospitals with VTE steering committees performed better on implementing preventive strategies. Suboptimal adoption of information digitization was identified, and the implementation of computer supporting techniques would be expected to improve the implementation of thromoboprophylaxis.
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Affiliation(s)
| | - Fen Dong
- From the Institute of Clinical Medical Sciences
| | | | | | | | - Lei Xia
- Medical Affairs Department of China-Japan Friendship Hospital
| | - Wei Wang
- Department of Nursing, China-Japan Friendship Hospital
| | - Peiran Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College
| | | | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital
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15
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Krauss ES, Segal A, Dengler N, Cronin M, Pettigrew J, Simonson BG. Utilization of the Caprini Score for Risk Stratification of the Arthroplasty Patient in the Prevention of Postoperative Venous Thrombosis. Semin Thromb Hemost 2022; 48:407-412. [PMID: 35226947 DOI: 10.1055/s-0042-1742739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Venous thromboembolism (VTE) is a serious and predictable complication following arthroplasty. It has been recognized that a strategy utilizing individualized anticoagulation choices based on patient risk stratification results in improved patient outcomes. A 2013 version of the Caprini Risk Score has previously been validated for use in total joint arthroplasty. A Caprini score of 10 or greater assesses the patient as "high risk" while 9 or less is considered "low risk." Patients scored as "low risk" for postoperative VTE receive enteric coated aspirin 81 mg twice a day for 6 weeks. Patients scored as "high risk" for VTE are prescribed apixaban. This retrospective cohort study was conducted to assess the safety and efficacy of the thromboprophylaxis treatment prescribed based on a standardized risk assessment protocol for the calendar year 2020. Patients having total hip arthroplasty, total knee arthroplasty, revision total hip arthroplasty, revision total knee arthroplasty, or bilateral arthroplasties by 13 surgeons (N = 873) were reviewed. Patients were risk assessed using the Caprini Risk Score and thromboprophylaxis was prescribed based on the score obtained. The annual rate of VTE was 0.2%. The Caprini Risk Score is an effective approach to individualize thromboprophylaxis choices after total joint arthroplasty.
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Affiliation(s)
- Eugene S Krauss
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, New York.,Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York.,New York Orthopaedic and Spine Center, Great Neck, New York
| | - Ayal Segal
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, New York.,New York Orthopaedic and Spine Center, Great Neck, New York
| | - Nancy Dengler
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, New York
| | - MaryAnne Cronin
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, New York
| | - Janelle Pettigrew
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, New York
| | - Barry G Simonson
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, New York.,Orthopaedic Institute of Great Neck, Syosset Hospital, Northwell Health, Great Neck, New York
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16
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Ke L, Cui S, Yang M, Chen J, Xu S, Jiang G, Zhang Y, Chen S, Zheng E, Zhao H, Fan X, Li Y, Zhi X, Hu B, Li H. Validation of a modified Caprini risk assessment model in lung cancer patients undergoing surgery: Results of a multicenter cross-sectional observational study. J Surg Oncol 2022; 125:933-942. [PMID: 35041203 DOI: 10.1002/jso.26794] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/24/2021] [Accepted: 01/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Lung cancer patients slated for surgery are at high risk of venous thromboembolism (VTE). Precise risk assessment is necessary for providing proper thromboprophylaxis and reducing morbidity and mortality of VTE. METHODS A multicenter, observational, cross-sectional cohort study, involving patients with primary lung cancer undergoing surgery, was carried out from August 2016 to December 2019. All patients were assessed according to the Caprini risk assessment model (RAM) and a modified scoring system incorporating elevated D-dimer and new stratification of surgical time. The endpoint was confirmed VTE or patient discharge. RESULTS Out of 1205 patients, 87 (7.2%) were diagnosed with VTE. The area under the curve of modified scores for VTE was 0.759, which was larger than that of the original one (0.589) (p < 0.05). By modified Caprini scoring system, a higher score was associated with increased VTE risk (odds ratio [OR], 1.345; 95% confidence interval [CI], 1.197-1.512; p < 0.001), and there was an increased OR of 4.090 (95% CI, 2.472-6.768, p < 0.001) for VTE in high-risk category patients. CONCLUSION Modified Caprini RAM showed an improved prediction of high-risk patients with an elevated likelihood of postoperative VTE compared to the original one.
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Affiliation(s)
- Lihui Ke
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Songping Cui
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mei Yang
- Department of Thoracic Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Thoracic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shuo Chen
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - E Zheng
- Department of Thoracic Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoxi Fan
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuping Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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17
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Wang Y, Zhou H, Zhong G, Fu Z, Peng Y, Yao T. Development and Validation of a Nomogram to Predict the Probability of Venous Thromboembolism in Patients with Epithelial Ovarian Cancer. Clin Appl Thromb Hemost 2022; 28:10760296221095558. [PMID: 35549519 PMCID: PMC9112682 DOI: 10.1177/10760296221095558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To identify predictive factors and develop a nomogram to predict the probability of venous thromboembolism for epithelial ovarian cancer patients. Methods: Our study cohort was composed of 208 EOC patients who had received initial treatment in Sun Yat-sen Memorial Hospital from January 2016 to March 2020. Clinicopathological variables predictive of VTE were identified using univariate logistic analysis. A multivariate logistic regression model was used to select the predictive factors used for nomogram. The accuracy of nomogram was evaluated by the Concordance index (C-index), the area under the receiver–operator characteristic (ROC) curve, area under concentration-time curve (AUC) and the calibration curve. Results: Advancing age (hazard ratio [HR], 1.042; 95% confidence interval [CI], 1.000-1.085; P = .048), higher D-dimer level (HR, 1.144; 95%CI, 1.020-1.283; P = .022), lower PR immunohistochemical positive rate (HR, 0.186; 95%CI, 0.034-1.065; P = .059) and higher Ki67 immunohistochemical positive rate (HR, 4.502; 95%CI, 1.637-12.380; P = .004) were found to be independent risk factors for VTE, and were used to construct the nomogram. The C-index for VTE prediction of the nomogram was 0.75. Conclusions: We constructed and validated a nomogram able to quantify the risk of VTE for EOC patients, which can be applied in recognizing EOC patients with high risk of VTE.
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Affiliation(s)
- Yuhan Wang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haijian Zhou
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guanglei Zhong
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaojie Fu
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Peng
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of malignant tumor gene regulation and target therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou 510120, People's Republic of China.
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18
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Tafler K, Kuriya A, Gervais N, Leyland N. Guideline No. 417: Prevention of Venous Thromboembolic Disease in Gynaecological Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:82-96.e1. [PMID: 33878456 DOI: 10.1016/j.jogc.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the use of thromboprophylaxis in gynaecological surgery. TARGET POPULATION All patients undergoing gynaecological surgery for benign or malignant indications. BENEFITS, HARMS, AND COSTS The implementation of this guideline will benefit patients undergoing gynaecological surgery and provide physicians with a standard algorithm for the use of perioperative thromboprophylaxis. EVIDENCE The following search terms were entered into MEDLINE, Google Scholar, and Cochrane in 2017 and 2018: VTE, PE, DVT, thromboprophylaxis, gynaecological surgery, heparin, graduated compression stocking, intermittent pneumatic stocking, obesity, pediatrics, minimally invasive surgery, heparin induced thrombocytopenia, regional anesthesia). Articles included were randomized controlled trials, meta-analyses, systematic reviews, and observational studies. Additional publications were identified from the reference lists of these articles. There were no date limits, but search results were limited to English language articles only. Searches were updated and incorporated into the guideline up to September 2018. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED USERS Gynaecologists and other members of the surgical team. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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19
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Abu Saadeh F, Marchocki Z, O'Toole SA, Ibrahim N, Gleeson N, Norris LA. Extended thromboprophylaxis post gynaecological cancer surgery; the effect of weight adjusted and fixed dose LMWH (Tinzaparin). Thromb Res 2021; 207:25-32. [PMID: 34530386 DOI: 10.1016/j.thromres.2021.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Gynaecological cancer surgery is associated with high rates of venous thromboembolism (VTE) despite recommended prophylaxis. We sought to investigate the impact of extended prophylaxis with fixed dose and weight based LMWH in patients undergoing gynaecological cancer surgery. METHODS VTE rates were recorded in patients who received LMWH prophylaxis (4500 IU Tinzaparin once daily) for the duration of hospital stay (2006-2012) (n = 610) and were compared with VTE rates in patients who underwent surgery after the introduction of extended prophylaxis (3500/4500 IU Tinzaparin for patients with BMI < 40kg/m2 and 75 IU/kg for BMI > 40 kg/m2) (2012-2017) (n = 651). Peak (4 h) anti-Xa levels in a subset of patients were also evaluated. RESULTS 73 (5.7%) cases of VTE were recorded during 1 year of follow-up. 20 cases occurred during hospital stay. There was no significant difference in the rate of VTE between the extended prophylaxis cohort and the standard prophylaxis cohort. 23/24 patients who developed VTE in the extended prophylaxis cohort received a fixed (4500 units) dose of Tinzaparin. 63% of patients who received a fixed LMWH dose had peak anti-Xa levels below the target range (0.2-0.4 IU/ml). Peak anti-Xa was lower in patients who subsequently developed VTE compared with those who received either fixed dose (P = 0.041) and weight adjusted Tinzaparin (P = 0.0006). CONCLUSIONS Extended prophylaxis with Tinzaparin does not significantly reduce VTE rates in gynaecological cancer patients post surgery. Peak anti-Xa levels may be suboptimal in many patients receiving a fixed LMWH dose. Further studies are required to determine whether weight adjusted doses of Tinzaparin may provide more effective prophylaxis following gynaecological cancer surgery.
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Affiliation(s)
- F Abu Saadeh
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland; Division of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.
| | - Z Marchocki
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland; Division of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.
| | - S A O'Toole
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland; Dept of Histopathology, Trinity College Dublin, Ireland.
| | - N Ibrahim
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland; Division of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland.
| | - N Gleeson
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland; Division of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.
| | - L A Norris
- Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland; Trinity St. James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.
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20
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Chen X, Deng H, Tong X, Gu B, Liu J, Huang H, Ye L, Pan L, Caprini JA, Wang Y. Clinical Validation of the Chinese Version of Patient Completed Caprini Risk Assessment Form. Clin Appl Thromb Hemost 2021; 26:1076029620945038. [PMID: 32816523 PMCID: PMC7444100 DOI: 10.1177/1076029620945038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To create and validate patient-completed Caprini risk score (CRS) tools for Chinese people. We revised Chinese patient-completed CRS form according to previously published studies. We prospectively recruited 70 internal medical patients and 70 surgical patients. The average age of these patients was 54.26 ± 15.29 years, 54.29% of them were male and 80% of them had education beyond high school. The study compared: (1) patient-completed CRS and physician-completed CRS; (2) the final value of physician-completed CRS (physician-completed CRS + body mass index) and CRS in the electronic medical record (EMR) system. Patient-completed CRS was 3.71 ± 3.63, patients spent 3.60 ± 1.24 minutes, 57.14% patients were at high-highest risk; physician-completed CRS was 3.84 ± 3.63, physicians spent 2.11 ± 1.13 minutes, 59.28% patients were at high-highest risk; the final value of physician-completed CRS was 4.12 ± 3.62, 63.58% patients were at high-highest risk; CRS value in the EMR system was 4.07 ± 3.58, 65% patients were at high-highest risk. There were strong positive correlations (P < .0001) between patient-completed CRS and physician-completed CRS (r = 0.978, κ = 0.76) and between the final value of physician-completed CRS and CRS in EMR (r = 0.994, κ = 0.97). This study successfully developed and validated a Chinese patient-completed CRS that we found can replace physician-completed CRS. This results in considerable time saving for physicians and this process should increase the percentage of patients having complete risk assessment when they are admitted to the hospital.
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Affiliation(s)
- Xiaolan Chen
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hui Deng
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xinjie Tong
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bei Gu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jingxuan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - He Huang
- Department of Hospital Affairs, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liwei Ye
- Department of Hospital Affairs, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Joseph A Caprini
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA.,NorthShore University HealthSystem, Evanston, IL, USA
| | - Yong Wang
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Emergency Medical Center, Beijing, People's Republic of China
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21
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A quality improvement initiative to reduce venous thromboembolism on a gynecologic oncology service. Gynecol Oncol 2021; 162:120-127. [PMID: 33994013 DOI: 10.1016/j.ygyno.2021.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe and evaluate the effects of implementation of a venous thromboembolism (VTE) prophylaxis quality improvement (QI) initiative on a gynecologic oncology service at a single institution. METHODS Prior to 2018, no consensus gynecologic oncology VTE prophylaxis protocol existed at the authors' academic institution. Published, evidence-based guidelines were reviewed to create a standardized VTE risk stratification algorithm. Interventions to improve perioperative heparin administration and sequential compression device (SCD) compliance as well as provider/patient education efforts were introduced in January 2018. Initial efforts included nursing and patient SCD education, internal dissemination of VTE prophylaxis guidelines, and creation of a VTE 'dashboard' to track performance. During a second phase, VTE prophylaxis guidelines were reviewed and further refined, non-compliant operative cases reviewed weekly, and guidelines incorporated into the electronic medical record. Performance was measured using Tableau data software (www.tableau.com) and by separately evaluating adherence to the developed guidelines in three retrospective cancer-enriched surgical cohorts (2016-2017, 2018, 2019). RESULTS Compared to the baseline period, we observed a reduction in VTE rate during the 2018-2019 VTE QI implementation period from 2.1% (19/905) to 1.0% (20/2015, p = 0.02) among gynecologic oncology inpatients. In the retrospective cancer-enriched cohorts, adherence to evidence based guidelines improved: 31.0% in 2016-2017, 69.1% in 2018, and 82.4% in 2019 (p < 0.001). There were no significant differences in rates of peri-operative blood transfusion, surgical site infections, hematomas, or vaginal cuff dehiscences. CONCLUSIONS Implementation of a robust VTE prophylaxis QI initiative has resulted in improved VTE prophylaxis guideline adherence and higher rates of pre-operative heparin administration.
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Tafler K, Kuriya A, Gervais N, Leyland N. Directive clinique no 417 : Prévention de la maladie thromboembolique veineuse en chirurgie gynécologique (In English : Prevention of Venous Thromboembolic Disease in Gynaecological Surgery). JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:97-113.e1. [PMID: 33887446 DOI: 10.1016/j.jogc.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wang L, Wei S, Zhou B, Wu S. A nomogram model to predict the venous thromboembolism risk after surgery in patients with gynecological tumors. Thromb Res 2021; 202:52-58. [PMID: 33735691 DOI: 10.1016/j.thromres.2021.02.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is a common post-surgical complication of gynecological malignant tumors that has serious implications on the prognosis and quality-of-life of patients. However, there exists only a few recognized specific evaluation models for the occurrence of VTE after gynecological malignant tumor surgery. We aimed to establish a nomogram model that could predict the probability of post-surgical VTE in patients with gynecological malignancies. METHODS We collected the clinical information of 673 patients who underwent surgery for gynecological malignant tumor in our hospital between January 2014 and May 2020. To reduce bias from confounding factors between groups, a 1:1 ratio propensity score matching (PSM) method was performed; meanwhile, univariate and multivariate analyses were applied to analyze the risk factors of VTE after surgeries. A nomogram prediction model was accordingly established and internally validated. RESULTS The predictors contained in the nomogram model included age, D-dimer value, body mass index (BMI), and surgical approach. The C-index of the model was 0.721 (95% confidence interval: 0.644-0.797), with good discrimination and calibration effect. The internally verified C-index value was 0.916. Decision curve analysis confirmed that the nomogram model was clinically useful when the incidence of thrombosis in patients was 10-75%. CONCLUSIONS Considering the risk factors of VTE after surgery for gynecological malignant tumor, a high-performance nomogram model was established and then validated to provide individual risk assessment and guide treatment decisions.
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Affiliation(s)
- Li Wang
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), Taiyuan, Shanxi, China
| | - Shanchen Wei
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), Taiyuan, Shanxi, China
| | - Bohui Zhou
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), Taiyuan, Shanxi, China
| | - Suhui Wu
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), Taiyuan, Shanxi, China.
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Feng Y, Zheng R, Fu Y, Xiang Q, Yue Z, Li J, Yu C, Jiang Y. Assessing the thrombosis risk of peripherally inserted central catheters in cancer patients using Caprini risk assessment model: a prospective cohort study. Support Care Cancer 2021; 29:5047-5055. [PMID: 33594508 DOI: 10.1007/s00520-021-06073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE There was no optimal risk assessment tool to stratify the risk of peripherally inserted central catheter-related venous thromboembolism (PICC-RVT) in cancer patients. We currently use the Caprini risk assessment model for thrombotic risk assessment, but no evidence exists on the effectiveness of Caprini in such patients. This study was to assess the validity of the Caprini in Chinese cancer patients with PICCs. METHODS We conducted a prospective study of 468 participants. Following calculating the Caprini score, color Doppler ultrasonography was performed every 7 days for 3 weeks to confirm PICC-RVT. RESULTS There was a correlation between PICC-RVT and the Caprini score. Compared with scores of 5, the risk was 2.089-fold greater (95% CI 1.165-3.743, P = 0.012) in patients with a score of 6 and 7, and 7.156-fold greater (95% CI 3.157-16.217, P < 0.001) in patients with scores ≥8. The area under the receiver-operating characteristic curve was 0.636 (95% CI 0.590-0.680; P < 0.001). 6 was the best cutoff point for Caprini, with a sensitivity of 0.76 and a specificity of 0.44. CONCLUSIONS The Caprini can be used for high-risk screening of the PICC-RVT in cancer patients, and classification of the highest risk level using a score of 6 can be more clinically significant compared to 5 as recommended. The results provide evidence for the practitioner's early use of the Caprini to assess the thrombotic risk in patients with PICCs and take timely prevention measures. But pharmacological prevention should be considered seriously for its low specificity.
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Affiliation(s)
- Yue Feng
- West China School of Nursing/Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Rujun Zheng
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Fu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiufen Xiang
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiying Yue
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Li
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
| | - Chunhua Yu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.
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Perez SA, Reddy SB, Meister A, Pinjic E, Suzuki K, Litle VR. Venous thromboembolism in benign esophageal surgery patients: potential cost effectiveness of Caprini risk stratification. Surg Endosc 2021; 36:764-770. [PMID: 33492505 DOI: 10.1007/s00464-020-08269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Caprini risk assessment model (RAM) stratifies surgical patients for prescription of post-discharge extended heparin prophylaxis to reduce post-operative venous thromboembolism (VTE) events. The average cost for treatment of a VTE event is $15,123. The 30-day post-operative VTE rate after benign esophageal procedures is < 0.8% per the Society of Thoracic Surgeons database. We hypothesized that the financial cost of selective extended prophylaxis in patients undergoing surgery for benign esophageal disease would exceed the cost of treating these rare events and therefore use of risk stratification for extended prophylaxis would not be beneficial. METHODS All patients undergoing operations for benign esophageal pathology from July 2014 to May 2019 were reviewed. Patients designated as moderate or high risk for VTE were prescribed a 10- or 30-day post-operative course of extended prophylaxis with low-molecular weight heparin (LMWH). VTE and adverse bleeding events were recorded for the 60-day post-operative period. The cost of LMWH was provided by the institution pharmacy. RESULTS Records from 154 patients were eligible for review. Caprini RAM was used for all patients with the following distribution of risk categories: low = 64.9% (100/154); moderate = 31.8% (49/154); and high = 3.2% (5/154). The average cost of extended prophylaxis at discharge for the moderate-risk group was $121.23, while the high-risk group was $446.46. There were no 60-day VTE or adverse bleeding events recorded. CONCLUSIONS The majority of patients undergoing surgical therapy were at low risk of post-operative VTE event, with only 35% requiring extended VTE prophylaxis at time of discharge. When compared with the average cost of treatment for a VTE event, the cost of extended prophylaxis per patient in moderate or high-risk groups is substantially lower. In the era of cost-containment, risk stratification and extended prophylaxis may reduce healthcare costs and warrant future investigations.
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Affiliation(s)
- Sean A Perez
- School of Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Shriya B Reddy
- School of Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Amanda Meister
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Emma Pinjic
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Kei Suzuki
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA. .,Division of Thoracic Surgery, Department of Surgery, Boston University, 88 East Newton Street, Collamore Building, Suite 7380, Boston, MA, 02118, USA.
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Update on extended prophylaxis for venous thromboembolism following surgery for gynaecological cancers. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc 2020; 95:2775-2798. [PMID: 33276846 DOI: 10.1016/j.mayocp.2020.06.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/09/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022]
Abstract
Venous thromboembolism (VTE) is a preventable cause of postoperative morbidity and mortality; however, audits suggest that the use of thromboprophylaxis is underused. In this review, we describe our approach to prevention of postoperative VTE and provide guidance on how to formulate an optimal VTE prophylaxis plan. We recommend that all patients undergo thrombosis- and bleeding-risk assessment as part of their preoperative evaluation. The risk of thrombosis can be estimated based on patient- and procedure-specific factors, using validated risk-assessment models such as the Caprini score. There are no validated models to predict perioperative bleeding; however, several risk factors have been proposed. Patients should ambulate early and frequently after surgery. We recommend no additional prophylaxis in patients at very low risk of VTE (Caprini score 0). Patients at low risk of VTE (Caprini 1 to 2) are recommended to receive either mechanical or pharmacological prophylaxis. Patients at moderate (Caprini 3 to 4) to high risk of VTE (Caprini ≥5) are recommended pharmacological prophylaxis either alone or combined with mechanical prophylaxis. Patients at high risk of bleeding should receive mechanical prophylaxis until their risk of bleeding is reduced and pharmacological prophylaxis can be reconsidered. Populations for which the Caprini score has not been validated (such as orthopedic surgery) are recommended prophylaxis based on individual and procedure-specific risk factors. Prophylaxis is typically continued until the patient is ambulatory or until hospital dismissal; however, longer durations can be considered in certain circumstances (high-risk patients undergoing malignant abdominopelvic operations, bariatric operations, and certain orthopedic operations).
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Affiliation(s)
- Matthew A Bartlett
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Ravindra Ganesh
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Paul R Daniels
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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Zambelli R, Bastos MD, Rezende SM. Prophylaxis of Venous Thromboembolism in Ankle and Foot Surgeries. Rev Bras Ortop 2020; 56:697-704. [PMID: 34900096 PMCID: PMC8651438 DOI: 10.1055/s-0040-1715512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
Venous thromboembolism (VTE) is among the most feared complications by orthopedists both for due to its potentially lethal outcome and the uncertainties related to its prevention. Despite the vast literature on VTE prevention in major orthopedic surgeries, little is known about it in ankle and foot procedures. In orthopedics, adequate thromboprophylaxis requires a careful assessment of the thrombotic and hemorrhagic risks based on the procedure to be performed, as well as and knowledge on anticoagulant agents. The presentis review has the goal of assessing the risk of developingdiscusses VTE risk assessment, the modalities of thromboprophylaxis modalities, and the drugs used, with an emphasis on foot and ankle surgeries.
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Affiliation(s)
- Roberto Zambelli
- Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.,Serviço de Ortopedia, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brasil
| | - Marcos de Bastos
- Assessoria de Políticas de Saúde e Informações (ASPASI), Hospital Governador Israel Pinheiro (HGIP), Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Belo Horizonte, Minas Gerais, Brasil.,Faculdade da Saúde e Ecologia Humana (FASEH), Vespasiano, Minas Gerais, Brasil
| | - Suely Meireles Rezende
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
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Cassidy MR, Kim NE, McAneny D. Surveillance and Therapeutic Anti-Coagulation Do Not Constitute Venous Thromboembolism Prevention: In Reply to Swanson and colleagues. J Am Coll Surg 2020; 231:784-786. [PMID: 32951983 DOI: 10.1016/j.jamcollsurg.2020.08.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 11/15/2022]
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Meta-Analysis of VTE Risk: Ovarian Cancer Patients by Stage, Histology, Cytoreduction, and Ascites at Diagnosis. Obstet Gynecol Int 2020; 2020:2374716. [PMID: 32963543 PMCID: PMC7486642 DOI: 10.1155/2020/2374716] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
Venous thromboembolisms (VTEs) have been a leading secondary cause of death among ovarian cancer patients, prompting multiple studies of risk factors. The objective of this meta-analysis is to quantify the associations between VTE and the most commonly reported risk factors among ovarian cancer patients. PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were used to identify observational studies. Two reviewers independently abstracted data and assessed quality via the Newcastle–Ottawa tool. A random effects model was used to calculate the pooled odds ratios for VTE with each of the following exposures: advanced cancer stage, clear cell histology, serous histology, ascites at diagnosis, and complete cytoreduction. The I2 and Q tests were used to evaluate heterogeneity. Twenty cohort studies with 6,324 total ovarian cancer patients, 769 of whom experienced a VTE, were included. The odds of VTE in ovarian cancer patients were higher among patients with cancer stage III/IV (versus cancer stage I/II, pooled odds ratio (OR) 2.73; 95% CI 1.84–4.06; I2= 64%), clear cell (versus nonclear cell) histology (OR 2.11; 95% CI 1.55–2.89; I2 = 6%), and ascites (versus no ascites) at diagnosis (OR 2.12; 95% CI 1.51–2.96; I2 = 32%). Serous (versus nonserous) histology (OR 1.26; 95% CI 0.91–1.75; I2 = 42%) and complete (versus incomplete) cytoreduction (OR 1.05; 95% CI 0.27–4.11; I2 = 88%) were not associated with VTE. This meta-analysis quantifies the significantly elevated odds of VTE in ovarian cancer patients with advanced stage at diagnosis, clear cell histology, and ascites at diagnosis. Further studies are needed to account for confounders and inform clinical decision-making tools.
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Norris LA, Ward MP, O'Toole SA, Marchocki Z, Ibrahim N, Khashan AS, Abu Saadeh F, Gleeson N. A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score. Res Pract Thromb Haemost 2020; 4:848-859. [PMID: 32685894 PMCID: PMC7354387 DOI: 10.1002/rth2.12342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/26/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Gynecologic cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. OBJECTIVES The aim of this study was to develop and validate a risk score for VTE in patients with gynecologic cancer and to test the predictive ability of the score following addition of procoagulant biomarker data. PATIENTS AND METHODS Clinical and laboratory variables were used to develop a risk score for the prediction of VTE in patients with gynecological cancer (n = 616), which was validated in a separate cohort of patients (n = 406). Endogenous thrombin potential and D-dimer levels were determined in a subset (n = 290) of patients and used to produce an extended score in the validation cohort. RESULTS Multivariable regression analysis identified BMI >30, hemoglobin <11.5 g/dL and chemotherapy as independent predictors of VTE, which formed the Thrombogyn score. Following competing risk regression analysis, subdistribution hazard ratios (SHRs), adjusted for cancer stage, were 8.16 (95% confidence interval [CI], 1.69-43.77) in the high-risk group (score = 2-3) and 4.12 (95% CI, 0.85-20.15) in the intermediate-risk group (score = 1) compared with the low-risk group (score = 0). SHRs for the validation cohort were 6.26 (95% CI, 1.24-31.39) and 3.00 (95% CI, 0.67-13.32), respectively. Cumulative incidence of VTE in the validation cohort high-risk group was 10.34% (95% CI, 6.51-16.41) per women-years compared with 1.06% (95% CI, 0.26-4.26) in the low-risk group. Using the extended Thrombogyn score, adjusted SHRs were 16.83 (95% CI, 4.20-67.37) in the high-risk group with a cumulative incidence of 21.15% (95% CI, 10.32-45.24). External validation of the score is required. CONCLUSIONS The Thrombogyn score identifies patients with gynecologic cancer at high and low risk of VTE. Addition of biomarker data improves the predictive power of the score.
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Affiliation(s)
- Lucy A. Norris
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
| | - Mark P. Ward
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
| | - Sharon A. O'Toole
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
| | - Zibi Marchocki
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
- Department of Gynaecology OncologySt James’s HospitalDublin 8Ireland
| | - Nadia Ibrahim
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
- Department of Gynaecology OncologySt James’s HospitalDublin 8Ireland
| | - Ali S. Khashan
- School of Public HealthUniversity College CorkCorkIreland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT)University College CorkCorkIreland
| | - Feras Abu Saadeh
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
- Department of Gynaecology OncologySt James’s HospitalDublin 8Ireland
| | - Noreen Gleeson
- Department of Obstetrics and GynaecologyTrinity College DublinTrinity Centre for Health SciencesSt. James's HospitalDublin 8Ireland
- Department of Gynaecology OncologySt James’s HospitalDublin 8Ireland
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Yang X, Yu L, Yu T, Li F, Zhang Y, Yu Z, Zhang B, Ke J, Li H. Venous thromboembolism after adult thymus or thymic tumor resection: A single-center experience. Thorac Cancer 2020; 11:2291-2296. [PMID: 32558357 PMCID: PMC7396359 DOI: 10.1111/1759-7714.13543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a common postoperative complication. Previous studies have shown that the VTE incidence after major thoracic surgery is high. However, there have been no exclusive data after thymectomy thus far. To investigate the incidence of postoperative VTE, we conducted a single‐center, prospective cohort study. Methods Patients who underwent thymectomy between December 2017 and January 2020 were enrolled. None of the patients received any prophylaxis perioperatively. Subjects were risk stratified into groups of low risk (0–4), moderate risk (5–8), and high risk (≥9). Occurrence of VTE events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), were identified by imaging. Results There were 192 patients who underwent thymectomy enrolled into the study. The overall VTE incidence was 8.9%. All the patients were diagnosed with DVT, and none were diagnosed with PE. The VTE incidence was 4.6% in patients with benign thymic diseases and 14.5% with malignant diseases. The VTE incidence was 4.7% in patients undergoing thoracoscopic surgery and 22.7% undergoing median sternotomy. The VTE incidence increased with Caprini score. Scores in the low, moderate, and high risk groups were associated with a VTE incidence of 0%, 10.3% and 37.5%, respectively. In patients with thymic malignancy, the VTE incidence in the moderate and high risk groups were 8.8% and 31.8%, respectively. Conclusions VTE occurred frequently in patients after thymectomy without VTE prophylaxis. The median sternotomy procedure and malignant tumor may be the major risk factors for the development of VTE. Aggressive VTE screening/treatment protocols should be implemented in patents after thymectomy.
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Affiliation(s)
- Xingguo Yang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fei Li
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yunfeng Zhang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhen Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Baoxun Zhang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ji Ke
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Henke PK, Kahn SR, Pannucci CJ, Secemksy EA, Evans NS, Khorana AA, Creager MA, Pradhan AD. Call to Action to Prevent Venous Thromboembolism in Hospitalized Patients: A Policy Statement From the American Heart Association. Circulation 2020; 141:e914-e931. [PMID: 32375490 DOI: 10.1161/cir.0000000000000769] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Venous thromboembolism (VTE) is a major preventable disease that affects hospitalized inpatients. Risk stratification and prophylactic measures have good evidence supporting their use, but multiple reasons exist that prevent full adoption, compliance, and efficacy that may underlie the persistence of VTE over the past several decades. This policy statement provides a focused review of VTE, risk scoring systems, prophylaxis, and tracking methods. From this summary, 5 major areas of policy guidance are presented that the American Heart Association believes will lead to better implementation, tracking, and prevention of VTE events. They include performing VTE risk assessment and reporting the level of VTE risk in all hospitalized patients, integrating preventable VTE as a benchmark for hospital comparison and pay-for-performance programs, supporting appropriations to improve public awareness of VTE, tracking VTE nationwide with the use of standardized definitions, and developing a centralized data steward for data tracking on VTE risk assessment, prophylaxis, and rates.
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Frankel J, Belanger M, Tortora J, McLaughlin T, Staff I, Wagner J. Caprini score and surgical times linked to the risk for venous thromboembolism after robotic-assisted radical prostatectomy. Turk J Urol 2020; 46:108-114. [PMID: 31922483 DOI: 10.5152/tud.2019.19162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the Caprini score as an independent predictor of venous thromboembolism (VTE) in patients undergoing robotic-assisted radical prostatectomy (RARP) and to identify appropriate cut-points for clinical use. MATERIAL AND METHODS We performed a retrospective review of patients who underwent RARP for prostate cancer between December 2003 and February 2016. VTE cases developed the condition within 90 days of discharge. The control group was comprised of patients whose RARP most closely preceded and followed each VTE case in time and who were matched on lymph node dissection and surgeon. The Caprini score was calculated for each patient, and the groups were compared on a number of clinical variables. Multiple logistic regression was used to evaluate whether the Caprini score was an independent predictor of VTE. Receiver operating characteristics (ROC) curves were used to establish appropriate clinical cutpoints. RESULTS A total of 3719 patients underwent RARP during the study period. A total of 52 (1.4%) of patients met the criteria for cases. Data were available for 97 patients who met the criteria for controls. Multiple logistic regression indicated that the Caprini score and operative time were independently both significant predictors of VTE (p=0.005 and p=0.044, respectively). ROC indicated that the Caprini score showed a significant but moderate relationship to VTE (area under curve [AOC]=0.64; p=0.004). A Caprini score >6 was the best arithmetic balance for sensitivity (61.5; 95% confidence interval [CI]: 47.0-74.7) and specificity (59.8; 95% CI: 49.3-69.6). CONCLUSION The Caprini score predicts postoperative VTE in patients undergoing RARP.
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Affiliation(s)
- Jason Frankel
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, USA
| | - Matthew Belanger
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, USA
| | - Joseph Tortora
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, USA
| | - Ilene Staff
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, USA
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, USA
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Trugilho IDA, Renni MJP, Medeiros GC, Thuler LCS, Bergmann A. Incidence and factors associated with venous thromboembolism in women with gynecologic cancer. Thromb Res 2020; 185:49-54. [DOI: 10.1016/j.thromres.2019.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022]
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Wang X, Huang J, Bingbing Z, Li S, Li L. Risk factors, risk assessment, and prognosis in patients with gynecological cancer and thromboembolism. J Int Med Res 2019; 48:300060519893173. [PMID: 31885320 PMCID: PMC7645363 DOI: 10.1177/0300060519893173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate a suitable risk assessment model to predict deep vein thrombosis (DVT) in patients with gynecological cancer. METHODS Data from 212 patients with gynecological cancer in the Affiliated Tumor Hospital of Guangxi Medical University were retrospectively analyzed. Patients were risk-stratified with three different risk assessment models individually, including the Caprini model, Wells DVT model, and Khorana model. RESULTS The difference in risk level evaluated by the Caprini model was not different between the DVT and control groups. However, the DVT group had a significantly higher risk level than the control group with the Wells DVT or Khorana model. The Wells DVT model was more effective for stratifying patients in the DVT group into the higher risk level and for stratifying those in the control group into the lower risk level. Receiver operating curve analysis showed that the area under the curve of the Wells DVT, Khorana, and Caprini models was 0.995 ± 0.002, 0.642 ± 0.038, and 0.567 ± 0.039, respectively. CONCLUSION The Wells DVT model is the most suitable risk assessment model for predicting DVT. Clinicians could also combine the Caprini and Wells DVT models to effectively identify high-risk patients and eliminate patients without DVT.
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Affiliation(s)
- Xindan Wang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.,Department of Gynecology, Liuzhou Maternity and Child Healthcare Hospital, Guangxi University of Science and Technology, Liuzhou, China
| | - Jing Huang
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Zhao Bingbing
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Shape Li
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Li Li
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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Chamoun N, Matta S, Aderian SS, Salibi R, Salameh P, Tayeh G, Haddad E, Ghanem H. A Prospective Observational Cohort of Clinical Outcomes in Medical Inpatients prescribed Pharmacological Thromboprophylaxis Using Different Clinical Risk Assessment Models(COMPT RAMs). Sci Rep 2019; 9:18366. [PMID: 31797897 PMCID: PMC6892868 DOI: 10.1038/s41598-019-54842-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022] Open
Abstract
The Caprini and Padua venous thromboembolism (VTE) risk assessment models (RAMs) are used to assess VTE risk in surgical and in medical patients respectively. This study aims to compare the proportion of medical inpatients eligible for VTE prophylaxis using the hospital Caprini-based RAM to using the Caprini and Padua RAMs and to assess the associated clinical outcomes. In a prospective observational study, we assessed 297 adult medical inpatients for whom VTE thromboprophylaxis was initiated according to the hospital Caprini-based RAM, referred to as the Lebanese American University Medical Center RAM (LAUMC-RAM). The Padua, Caprini and IMPROVE bleeding risk scores were also assessed for all patients. Bleeding and thromboembolism were evaluated at 14 and 30 days post VTE risk assessment. Pharmacologic thromboprophylaxis was warranted in 97.6%, 99.7%, and 52.9% of patients using the Caprini-based, Caprini, and Padua RAMs respectively. The Caprini-based and Caprini RAMs were highly correlated (r = 0.873 p < 0.001) and were significantly less correlated with the Padua RAM. Major and overall bleeding occurred in 1.4% and 9.2% respectively. VTE was reported in 0.4% with no VTE related mortality. In hospitalized medical patients, the Caprini-based RAM can accurately distinguish low and high VTE risk without resulting in increased risk of bleeding.
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Affiliation(s)
- Nibal Chamoun
- Lebanese American University School of Pharmacy, Byblos, Lebanon.
| | - Stephanie Matta
- Pharmacy Department, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | | | - Rami Salibi
- Department of Pulmonary/Critical Care/Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Pascale Salameh
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon.,Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Gaby Tayeh
- Lebanese American University School of Pharmacy, Byblos, Lebanon
| | - Elie Haddad
- Department of Cardiology, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Hady Ghanem
- Department of Hematology/Oncology, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
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Ali NES, Alyono JC, Song Y, Kouhi A, Blevins NH. Postoperative Venous Thromboembolism after Neurotologic Surgery. J Neurol Surg B Skull Base 2019; 82:378-382. [PMID: 34026416 DOI: 10.1055/s-0039-3400223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022] Open
Abstract
Objective This study aimed to determine the incidence of postoperative venous thromboembolism (VTE) in adults undergoing neurotologic surgery at a single center. Methods The records of adults undergoing neurotologic surgery from August 2009 to December 2016 at a tertiary care hospital were reviewed for VTE within 30 postoperative days. Particular attention was focused on postoperative diagnosis codes, imaging, and a keyword search of postoperative notes. Caprini risk scores were calculated. Results Among 387 patients, 5 experienced postoperative VTE including 3 cases of pulmonary embolism (PE) and 2 cases of isolated deep vein thrombosis (DVT). All patients were given sequential compression devices perioperatively, and none received preoperative chemoprophylaxis. Patients with Caprini score > 8 had a significantly higher rate of VTE compared with those < 8 (12.5 vs. 1%, p = 0.004). Receiver operating characteristic analysis revealed the Caprini risk assessment model to be a fair predictor of VTE, with a C-statistic of 0.70 (95% confidence interval [CI]: 0.49-0.92). Conclusion While no specific validated VTE risk stratification scheme has been widely accepted for patients undergoing neurotologic surgery, the Caprini score appears to be a useful predictor of risk. The benefits of chemoprophylaxis should be balanced with the risks of intraoperative bleeding, as well as the potential for postoperative intracranial hemorrhage.
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Affiliation(s)
- Noor-E-Seher Ali
- Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Jennifer C Alyono
- Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Yohan Song
- Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Ali Kouhi
- Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Nikolas H Blevins
- Department of Otolaryngology, Stanford University, Stanford, California, United States
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Soisson S, Ganz PA, Gaffney D, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Hanson HA, Wu YP, Stanford J, Al-Sarray A, Werner TL, Setiawan VW, Hashibe M. Long-term Cardiovascular Outcomes Among Endometrial Cancer Survivors in a Large, Population-Based Cohort Study. J Natl Cancer Inst 2019; 110:1342-1351. [PMID: 29741696 DOI: 10.1016/j.ygyno.2017.12.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/20/2017] [Accepted: 03/16/2018] [Indexed: 12/24/2022] Open
Abstract
Background Endometrial cancer is the second most common cancer among female cancer survivors in the United States. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Studies that examine long-term cardiovascular outcomes among endometrial cancer survivors are critical. Methods Cohorts of 2648 endometrial cancer survivors diagnosed between 1997 and 2012 and 10 503 age-matched women from the general population were identified. Cardiovascular disease diagnoses were identified from electronic medical records and statewide ambulatory surgery and statewide inpatient data. Cox regression models were used to estimate hazard ratios (HRs) at one to five years, more than five to 10 years, and more than 10 years after cancer diagnosis. Results Between one and five years after diagnosis, increased cardiovascular risks among endometrial cancer survivors were observed for phlebitis, thrombophlebitis, and thromboembolism (HR = 2.07, 99% confidence interval [CI] = 1.57 to 2.72), pulmonary heart disease (HR = 1.74, 99% CI = 1.26 to 2.40), and atrial fibrillation (HR = 1.50, 99% CI = 1.07 to 2.11). At more than five to 10 years, some elevated risk persisted for cardiovascular diseases. Compared with patients who had surgery, patients who additionally had radiation therapy and/or chemotherapy were at increased risk for heart and circulatory system disorders between one and five years after cancer diagnosis. Older age and obesity were also risk factors for hypertension and heart disease among endometrial cancer survivors. Conclusions Endometrial cancer survivors are at higher risk for various adverse long-term cardiovascular outcomes compared with women from the general population. This study suggests that increased monitoring for cardiovascular diseases may be necessary for endometrial cancer patients for 10 years after cancer diagnosis.
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Affiliation(s)
- Sean Soisson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Yuan Wan
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Mike Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Alison Fraser
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Ken Smith
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Heidi A Hanson
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Yelena P Wu
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ali Al-Sarray
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Theresa L Werner
- Division of Oncology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
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Cronin M, Dengler N, Krauss ES, Segal A, Wei N, Daly M, Mota F, Caprini JA. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost 2019; 25:1076029619838052. [PMID: 30939900 PMCID: PMC6714938 DOI: 10.1177/1076029619838052] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The Caprini risk assessment model (RAM) has been validated in over 250 000 patients in
more than 100 clinical trials worldwide. Ultimately, appropriate treatment options are
dependent on precise completion of the Caprini RAM. As the numerical score increases, the
clinical venous thromboembolism rate rises exponentially in every patient group where it
has been properly tested. The 2013 Caprini RAM was completed by specially trained medical
students via review of the presurgical assessment history, medical clearances, and medical
consults. The Caprini RAM was completed for every participant both preoperatively and
predischarge to ensure that any changes in the patient’s postoperative course were
captured by the tool. This process led to the development of completion guidelines to
ensure consistency and accuracy of scoring. The 2013 Caprini scoring system provides a
consistent, thorough, and efficacious method for risk stratification and selection of
prophylaxis for the prevention of venous thrombosis.
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Affiliation(s)
- MaryAnne Cronin
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Nancy Dengler
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Eugene S Krauss
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Ayal Segal
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Nicole Wei
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Madison Daly
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Frank Mota
- 1 Department of Orthopaedic Surgery, Syosset Hospital, Syosset, NY, USA
| | - Joseph A Caprini
- 2 Emeritus, NorthShore University HealthSystem, Evanston, IL, USA.,3 University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Pannucci CJ. Venous Thromboembolism in Aesthetic Surgery: Risk Optimization in the Preoperative, Intraoperative, and Postoperative Settings. Aesthet Surg J 2019; 39:209-219. [PMID: 29846505 DOI: 10.1093/asj/sjy138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this Continuing Medical Education (CME) article is to provide a framework for practicing surgeons to conceptualize and quantify venous thromboembolism risk among the aesthetic and ambulatory surgery population. The article provides a practical approach to identify and minimize venous thromboembolism risk in the preoperative, intraoperative, and postoperative settings.
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Affiliation(s)
- Christopher J Pannucci
- Division of Plastic Surgery, Division of Health Services Research, at the University of Utah, Salt Lake City, UT
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42
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Soisson S, Ganz PA, Gaffney D, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Hanson HA, Wu YP, Stanford J, Al-Sarray A, Werner TL, Setiawan VW, Hashibe M. Long-term Cardiovascular Outcomes Among Endometrial Cancer Survivors in a Large, Population-Based Cohort Study. J Natl Cancer Inst 2018; 110:1342-1351. [PMID: 29741696 PMCID: PMC6292788 DOI: 10.1093/jnci/djy070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/13/2018] [Accepted: 03/16/2018] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Endometrial cancer is the second most common cancer among female cancer survivors in the United States. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Studies that examine long-term cardiovascular outcomes among endometrial cancer survivors are critical. METHODS Cohorts of 2648 endometrial cancer survivors diagnosed between 1997 and 2012 and 10 503 age-matched women from the general population were identified. Cardiovascular disease diagnoses were identified from electronic medical records and statewide ambulatory surgery and statewide inpatient data. Cox regression models were used to estimate hazard ratios (HRs) at one to five years, more than five to 10 years, and more than 10 years after cancer diagnosis. RESULTS Between one and five years after diagnosis, increased cardiovascular risks among endometrial cancer survivors were observed for phlebitis, thrombophlebitis, and thromboembolism (HR = 2.07, 99% confidence interval [CI] = 1.57 to 2.72), pulmonary heart disease (HR = 1.74, 99% CI = 1.26 to 2.40), and atrial fibrillation (HR = 1.50, 99% CI = 1.07 to 2.11). At more than five to 10 years, some elevated risk persisted for cardiovascular diseases. Compared with patients who had surgery, patients who additionally had radiation therapy and/or chemotherapy were at increased risk for heart and circulatory system disorders between one and five years after cancer diagnosis. Older age and obesity were also risk factors for hypertension and heart disease among endometrial cancer survivors. CONCLUSIONS Endometrial cancer survivors are at higher risk for various adverse long-term cardiovascular outcomes compared with women from the general population. This study suggests that increased monitoring for cardiovascular diseases may be necessary for endometrial cancer patients for 10 years after cancer diagnosis.
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Affiliation(s)
- Sean Soisson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Yuan Wan
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Mike Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Alison Fraser
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Ken Smith
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Heidi A Hanson
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Yelena P Wu
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ali Al-Sarray
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Theresa L Werner
- Division of Oncology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
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Twice-Daily Enoxaparin among Plastic Surgery Inpatients: An Examination of Pharmacodynamics, 90-Day Venous Thromboembolism, and 90-Day Bleeding. Plast Reconstr Surg 2018; 141:1580-1590. [PMID: 29608533 DOI: 10.1097/prs.0000000000004379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low anti-factor Xa level, indicative of inadequate enoxaparin dosing, has a significant association with 90-day venous thromboembolism events. The authors examined the pharmacodynamics of enoxaparin 40 mg twice daily and its correlation with anti-factor Xa level, postoperative venous thromboembolism, and bleeding. METHODS Adult patients were admitted after plastic and reconstructive surgery and received enoxaparin 40 mg twice daily. Peak anti-factor Xa levels, which quantify enoxaparin's antithrombotic effect, were drawn, with a goal level of 0.2 to 0.4 IU/ml. Ninety-day symptomatic venous thromboembolism and clinically relevant bleeding were identified. RESULTS The authors enrolled 118 patients who received enoxaparin 40 mg twice daily. Of these patients, 9.6 percent had low peak anti-factor Xa levels (<0.2 IU/ml), 62.6 percent had in-range peak anti-factor Xa levels (0.2 to 0.4 IU/ml), and 27.8 percent had high anti-factor Xa levels (>0.4 IU/ml). With enoxaparin 40 mg twice daily, 90.4 percent of patients received at least adequate prophylaxis. Patient weight predicted the rapidity of enoxaparin metabolism. Zero acute 90-day venous thromboembolism occurred. Eight patients (6.8 percent) had clinically relevant 90-day bleeding: clinical consequences ranged from cessation of enoxaparin prophylaxis to transfusion to operative hematoma evacuation. CONCLUSIONS When enoxaparin 40 mg twice daily is provided, 90 percent of patients receive at least adequate venous thromboembolism prophylaxis (anti-factor Xa level >0.2 IU/ml). However, 27 percent of the overall population is overtreated (anti-factor Xa level >0.4 IU/ml). These pharmacodynamics data likely explain the low rate of 90-day acute venous thromboembolism (0 percent) and the high rate of clinically relevant bleeding (6.8 percent) observed. Future studies are needed to better optimize the risks and benefits of enoxaparin prophylaxis in plastic and reconstructive surgery patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Marques de Marino P, Rial Horcajo R, Garcia Grandal T, Sanchez Hervas L, Serrano Hernando FJ, Herraiz Martinez MA, Coronado Martin PJ. Thromboprophylaxis in gynecologic cancer surgery: Is extended prophylaxis with low molecular weight heparin justified? Eur J Obstet Gynecol Reprod Biol 2018; 230:90-95. [DOI: 10.1016/j.ejogrb.2018.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/21/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022]
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Cairo SB, Lautz TB, Schaefer BA, Yu G, Naseem HUR, Rothstein DH. Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis. J Pediatr Surg 2018; 53:1996-2002. [PMID: 29370891 DOI: 10.1016/j.jpedsurg.2017.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/24/2017] [Accepted: 12/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. STUDY DESIGN The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. RESULTS From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). CONCLUSION VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202.
| | - Timothy B Lautz
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
| | - Beverly A Schaefer
- Department of Pediatric Hematology and Oncology, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263; Department of Pediatrics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
| | - Guan Yu
- Department of Biostatistics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
| | - Hibbut-Ur-Rauf Naseem
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Surgery, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214
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Ebina Y, Uchiyama M, Imafuku H, Suzuki K, Miyahara Y, Yamada H. Risk factors for deep venous thrombosis in women with ovarian cancer. Medicine (Baltimore) 2018; 97:e11009. [PMID: 29879062 PMCID: PMC5999475 DOI: 10.1097/md.0000000000011009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aim to clarify the incidence of deep venous thrombosis (DVT) before treatment in women with ovarian cancer and identify risk factors for DVT.In this prospective study, 110 women underwent venous ultrasonography before cancer treatment and D-dimer levels were measured. We investigated factors predicting DVT by logistic regression.DVT was detected in 25 of 110 women (22.7%) and pulmonary thromboembolism was coexisted in 2 women (1.8%). A total of 21 women (84.4%) with DVT were asymptomatic. D-dimer levels in women with DVT (median, 10.9; range, <0.5-98.2 μg/mL) were significantly higher than those in women without DVT (2.0; <0.5-60.8 μg/mL; P < .01). When 10.9 μg/mL was used as a cutoff value for D-dimer levels to predict DVT, specificity, sensitivity, and positive and negative predictive values were 92.9%, 52.0%, 68.4%, and 86.8%, respectively. The multivariate analysis demonstrated that D-dimer level (odds ratio [OR], 19.7; 95% confidence interval [CI], 5.89-76.76) and clear cell histology (OR, 7.1; 95% CI, 2.12-25.67) were independent factors predicting DVT.Asymptomatic DVT occurred with great frequency before treatment in patients with ovarian cancer. High D-dimer level and clear cell pathology is associated with a higher DVT risk.
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Zhou H, Hu Y, Li X, Wang L, Wang M, Xiao J, Yi Q. Assessment of the Risk of Venous Thromboembolism in Medical Inpatients using the Padua Prediction Score and Caprini Risk Assessment Model. J Atheroscler Thromb 2018. [PMID: 29540637 PMCID: PMC6224205 DOI: 10.5551/jat.43653] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: The optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in medical inpatients is not known. We examined and compared how well the Padua Prediction Score (PPS) and the Caprini RAM stratify VTE risk in medical inpatients. Methods: We undertook a retrospective case-control study among medical inpatients admitted to a large general hospital in China during a 4-year period. In total, 902 cases were confirmed to have VTE during hospitalization and 902 controls were selected randomly to match cases by medical service. Results: The VTE risk increased significantly with an increase of the cumulative PPS or Caprini RAM score. A PPS and Caprini RAM “high risk” classification was, respectively, associated with a 5.01-fold and 4.10-fold increased VTE risk. However, the Caprini RAM could identify 84.3% of the VTE cases to receive prophylaxis according to American College of Chest Physicians guidelines, whereas the PPS could only identify 49.1% of the VTE cases. In the medical inpatients studied, five risk factors seen more frequently in VTE cases than in controls in the Caprini RAM were not included in the PPS. The Caprini RAM risk levels were linked almost perfectly to in-hospital and 6-month mortality. Conclusions: Both the PPS and Caprini RAM can be used to stratify the VTE risk in medical inpatients effectively, but the Caprini RAM may be considered as the first choice in a general hospital because of its incorporation of comprehensive risk factors, higher sensitivity to identify patients who may benefit from prophylaxis, and potential for prediction of mortality.
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Affiliation(s)
- Haixia Zhou
- Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University
| | - Yuehong Hu
- Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University
| | - Xiaoqian Li
- Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University
| | - Lan Wang
- Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University
| | - Maoyun Wang
- Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University
| | - Jun Xiao
- Intensive Care Unit, West China Hospital, Sichuan University
| | - Qun Yi
- Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University
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Zaher GF. Underutilization of pharmacological thromboprophylaxis in obstetrics and gynaecology patients in the absence of a risk assessment tool. J Taibah Univ Med Sci 2018; 13:10-15. [PMID: 31435297 PMCID: PMC6694994 DOI: 10.1016/j.jtumed.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was conducted to determine the risk factors for developing venous thromboembolism and to evaluate adherence to thromboprophylaxis guidelines among patients hospitalized in Obstetrics and Gynaecology units. METHODS A retrospective cohort study was conducted from December 2015 to March 2016 in the haematology department of a teaching hospital. A total of 188 hospitalized female patients with a hospital length of stay greater than 1 day were included. Patient data were reviewed to assess the risk score for developing venous thromboembolism by an independent expert haematologist. Patients eligible for thromboprophylaxis were compared to patients who had already received thromboprophylaxis. RESULTS A total of 188 patients were included, with age ranging from 17 to 81 years. Of these, 61% percent (n = 116) were gynaecological patients, while the remainder were pregnant women admitted to the obstetrics ward (38%, n = 72). Based on independent expert decision, 54% of gynaecological patients and 37% of obstetrics patients were eligible for thromboprophylaxis; however, only 48% of gynaecological and 26% of obstetrics patients were given thromboprophylaxis by their treating physician. CONCLUSIONS Venous thromboembolism is associated with substantial mortality and is largely preventable. Our study reports underutilization of thromboprophylaxis in clinical practice. Different modalities are necessary to improve adherence to thromboprophylaxis, such as implementation of a risk stratification tool at the time of hospital admission.
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Affiliation(s)
- Galila F. Zaher
- Hematology Department, King Abdulaziz University, Jeddah, KSA
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49
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Robinson R, Wirt C, Barbosa C, Amidi A, Chen S, Joseph R, Fleischer A. Routine Use of Low-Molecular-Weight Heparin For Deep Venous Thrombosis Prophylaxis After Foot and Ankle Surgery: A Cost-Effectiveness Analysis. J Foot Ankle Surg 2018; 57:543-551. [PMID: 29685566 PMCID: PMC6392007 DOI: 10.1053/j.jfas.2017.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to determine whether certain foot/ankle surgeries would benefit from the routine use of low-molecular-weight heparin (LMWH) as postoperative deep venous thrombosis prophylaxis. We conducted a formal cost-effectiveness analysis using a decision analytic tree to explore the healthcare costs and health outcomes associated with a scenario of no prophylaxis and a scenario of routine LMWH prophylaxis for 4 weeks. The 2 scenarios were compared for 5 procedures: (1) Achilles tendon repair (ATR), (2) total ankle arthroplasty (TAA), (3) hallux valgus surgery (HVS), (4) hindfoot arthrodesis (HA), and (5) ankle fracture surgery (AFS). The outcomes assessed included short- and long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. The costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2015 price base. In the short term, routine prophylaxis was always associated with greater costs compared with no prophylaxis. For ATR, TAA, HA, and AFS, prophylaxis was associated with slightly better health outcomes; however, the gain in QALYs was minimal compared with the cost of prophylaxis (incremental cost-effectiveness ratio well above $50,000/QALY threshold). For HVS, prophylaxis was associated with both worse health outcomes and greater costs. In the long term, routine prophylaxis was always associated with worse health outcomes and either cost more (HA, AFS, HVS) or saved very little (ATR, TAA). We concluded that policies encouraging the routine use of LMWH after foot/ankle surgery are unlikely to be cost-effective. Decisions to perform prophylaxis should be on a case-by-case basis and should emphasize individual patient risk factors.
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Affiliation(s)
- Richmond Robinson
- Assistant Professor, Department of Medicine and Radiology, Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. 3333 Green Bay Road, North Chicago, IL 60064. United States.
| | - Craig Wirt
- Podiatry Student, Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. 3333 Green Bay Road, North Chicago, IL 60064. United States.
| | - Carolina Barbosa
- Health Economist, RTI International. 230 West Monroe St. #2100. Chicago, IL 60606. United States.
| | - Arezou Amidi
- PGY3, Advocate Illinois Masonic Medical Center Podiatric Residency Program. 836 W Wellington Ave, Chicago, IL 60657. United States.
| | - Shirley Chen
- Podiatry Student, Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. 3333 Green Bay Road, North Chicago, IL 60064. United States.
| | - Robert Joseph
- Chairman, Department of Medicine and Radiology, Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. 3333 Green Bay Road, North Chicago, IL 60064. United States.
| | - Adam Fleischer
- Associate Professor, Department of Medicine and Radiology, Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. 3333 Green Bay Road, North Chicago, IL 60064. United States.
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Paz Rios LH, Fuentes HE, Oramas DM, Andrade XA, Al-Ogaili A, Iskander M, Iskander F, Iskandar ANA, Kowacz W, Iwanski A, Acob C, Diaz Quintero L, Salazar-Adum JP, Tafur A, Caprini JA. Validation of a Patient-Completed Caprini Risk Assessment Tool for Spanish, Arabic, and Polish Speakers. Clin Appl Thromb Hemost 2017; 24:502-512. [PMID: 29258392 PMCID: PMC6714665 DOI: 10.1177/1076029617746505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Targeted prophylaxis for venous thromboembolism (VTE) using the Caprini risk score (CRS)
is effective reducing postoperative VTE. Despite its availability as preventive strategy,
risk scoring remains underutilized. Critics to the CRS contend the time it takes to
complete, and its limitation to English language. Aim is to create and validate
patient-completed CRS tools for Spanish, Arabic, and Polish speakers. We translated the
first patient-completed CRS to Spanish, Arabic, and Polish. We conducted a pilot study
followed by the validation study. Using PASS version 11, we determined that a sample size
of 37 achieved a power of 80%, to detect a difference of 0.1 between the null hypothesis
correlation of 0.5 and the alternative hypothesis correlation of 0.7 using a 2-sided
hypothesis test, significance level of .05. We tabulated and categorized scores using SPSS
version 23 to estimate κ, linear correlation, and Bland Altman test. κ value >0.8 was
defined as “almost perfect agreement.” From 129 recruited patients, 50 (39%) spoke
Spanish, 40 (31%) spoke Arabic, and 39 (30%) spoke Polish; average age 51 (16.69) years,
58 (45%) were men, with less than college education (67%). Mean (standard deviation) CRS
was 5 (3.90), the majority (63%) above moderate VTE risk. We report excellent agreement
comparing physician and patient results (κ = 0.93) and high correlation 0.97
(P < .01) for the overall score. Bland Altman did not show trend for
extreme values. We created and validated the first Spanish, Arabic, and Polish versions of
the patient-completed CRS, with excellent correlation and agreement when compared to
CRS-trained physician-completed form. Based on these results, the physician needs to
calculate the body mass index. Completing the form was not time-consuming.
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Affiliation(s)
- Luis H. Paz Rios
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
- Luis H. Paz Rios, Department of Internal Medicine,
John Stroger Jr. Hospital of Cook County, 1900 West Polk Street, Chicago, IL 60612, USA.
| | - Harry E. Fuentes
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Diana M. Oramas
- Department of Pathology, University of Illinois at Chicago, Chicago, IL,
USA
| | - Xavier A. Andrade
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Ahmed Al-Ogaili
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Mina Iskander
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Fady Iskander
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | | | - Wictoria Kowacz
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Adam Iwanski
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Christine Acob
- Department of Internal Medicine, John H. Stroger Jr, Hospital of Cook
County, Chicago, IL, USA
| | - Luis Diaz Quintero
- Department of Internal Medicine, Northshore University Healthsystem,
Evanston, IL, USA
| | | | - Alfonso Tafur
- Department of Cardiology-Vascular Medicine, Northshore University
Healthsystem, Evanston, IL, USA
| | - Joseph A. Caprini
- Pritzker School of Medicine, NorthShore University HealthSystem, IL,
USA
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