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Wang P, He L, Yuan Q, Lu J, Ji Q, Peng A, Liu W. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J 2024; 22:6. [PMID: 38178101 PMCID: PMC10768137 DOI: 10.1186/s12959-023-00574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE The purpose of this study was to understand and analyze the risk factors of peripherally inserted central catheter (PICC)-related venous thrombosis in adult patients with cancer. METHODS This observational cohort study included adult patients with cancer who underwent color Doppler ultrasound at the Xiangya Hospital of Central South University, Hunan Provincial Maternal and Child Healthcare Hospital, and Xiangya Changde Hospital, Hunan Province, from January 1, 2017 to December 31, 2021. Univariate and multivariate logistic regression analyses were performed to determine the risk factors of PICC-related venous thrombosis. RESULTS After risk adjustment, multivariate logistic regression analysis revealed statistically significant associations between PICC-related venous thrombosis and age > 65 years old (OR: 1.791, CI: 1.343-2.389), male sex (OR: 1.398, CI: 1.057-1.849), white blood cell count > 9.5 × 109 /L (OR: 1.422, CI: 1.041-1.942), APTT < 25 s (OR: 2.006, CI: 1.431-2.811), gastrointestinal tumor (OR: 2.191, CI: 1.406-3.414), infection (OR:7.619, CI: 5.783-10.037), the use of cisplatin (OR: 2.374, CI: 1.714-3.214), vincristine (OR: 2.329, CI: 1.447-3.749), the use of polyurethane (OR: 2.449, CI: 1.863-3.219) and open-ended catheters (OR:1.660, CI: 1.131-2.439), keeping time of the catheter (days) (OR: 1.003, CI: 1.001-1.005) were associated with PICC-related venous thrombosis. CONCLUSION We identified that the presence of age > 65 years old, male sex, white blood cell count > 9.5 × 109 /L, APTT < 25 s, gastrointestinal tumor, infection, the use of cisplatin and vincristine, the use of polyurethane, open-ended catheters and keeping time of the catheter (days), were associated with PICC-related venous thrombosis.
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Affiliation(s)
- Pinghu Wang
- Breast Surgery Department, Hunan Provincial Maternal and Child Healthcare Hospital, Changsha, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Qiong Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Juan Lu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Qingqiong Ji
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - An Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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Chen Y, Chen H, Yang J, Jin W, Fu D, Liu M, Xu Y, Tao Z, Li Y, Lu L, Wang M, Zhu C, Chen Y. Patterns and risk factors of peripherally inserted central venous catheter-related symptomatic thrombosis events in patients with malignant tumors receiving chemotherapy. J Vasc Surg Venous Lymphat Disord 2020; 8:919-929. [DOI: 10.1016/j.jvsv.2020.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022]
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Encke A, Haas S, Kopp I. The Prophylaxis of Venous Thromboembolism. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:532-8. [PMID: 27581506 DOI: 10.3238/arztebl.2016.0532] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008. More recent publications and drug approvals have made a thorough revision necessary. METHODS A systematic search was carried out in the MEDLINE and Embase databases for publications that appeared from 1 January 2008 to 7 August 2013. Updates of 5 national and international reference guidelines and 2 new Health Technology Assessment (HTA) reports were considered as well. A structured consensus-finding process was carried out with delegates from 27 scientific medical societies and from the Union of Medical Specialist Associations. RESULTS 46 randomized controlled trials (RCTs) were included for critical appraisal. New findings led to re-evaluation of the value of compression stockings in combination with pharmacological prophylaxis (open recommendation), and suggest equal value of non-vitamin K antagonist oral anticoagulants (NOACs) and low molecular weight heparins (LMWH) or fondaparinux in elective hip and knee replacement (strong recommendation). For patients undergoing hip fracture surgery, we recommend LMWH or fondaparinux. CONCLUSION Further research is needed to assess the value of NOACs for pharmacological prophylaxis in orthopedic/trauma patients undergoing surgical procedures other than the ones mentioned above, and into the benefit and harm of new devices available for mechanical prophylaxis. The stringent implementation of basic measures such as early mobilization, movement exercises, and patient instruction is a key point to prevent venous thrombo - embolism.
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Affiliation(s)
- Albrecht Encke
- Association of Scientific Medical Societies in Germany (AWMF)
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Zhang X, Huang JJ, Xia Y, Li CF, Wang Y, Liu PP, Bi XW, Sun P, Lin TY, Jiang WQ, Li ZM. High risk of deep vein thrombosis associated with peripherally inserted central catheters in lymphoma. Oncotarget 2016; 7:35404-11. [PMID: 27078849 PMCID: PMC5085238 DOI: 10.18632/oncotarget.8639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/28/2016] [Indexed: 12/30/2022] Open
Abstract
Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients. Although PICC is a convenient tool, its use is associated with an obvious increase in the incidence of venous thrombosis. The risk factors for deep vein thrombosis associated with the use of PICCs in cancer patients are largely unexplored. This study aimed to investigate the incidence of PICC-associated thrombosis in lymphoma compared with its incidences in other types of cancer. A total of 8028 adult cancer patients inserted with PICC between June 2007 and June 2015 were included in this study. A total of 249 of the 8028 included patients (3.1%) inserted with PICC developed upper extremity deep vein thrombosis (PICC-UEDVT). Patients with lymphoma were more likely to have PICC-UEDVT than those with other types of malignancies (7.1% vs. 2.80%; P < 0.001). Logistic analysis revealed that a lymphoma diagnosis was a risk factor for UEDVT in cancer patients inserted with PICC (OR: 3.849, 95% CI: 2.334-6.347). Patients with lymphoma may be more predisposed to developing PICC-UEDVT than those with other types of malignancies. Identifying the mechanism underlying the relationship between PICC-UEDVT and lymphoma requires further study.
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Affiliation(s)
- Xi Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Jia-Jia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Yi Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Chao-Feng Li
- Department of Information, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Yu Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Pan-Pan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Xi-Wen Bi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Tong-Yu Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
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Influence of acquired and genetic risk factors on the prevention, management, and treatment of thromboembolic disease. Int J Vasc Med 2014; 2014:859726. [PMID: 25057415 PMCID: PMC4099036 DOI: 10.1155/2014/859726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/11/2014] [Indexed: 11/29/2022] Open
Abstract
Prevention, management, and treatment of venous thromboembolism requires understanding
of the epidemiology and associated risk factors, particularly in recognizing populations warranting
prophylaxis, in evaluating patients with high risk situations, and in determining the duration of
anticoagulation required to minimize recurrent thrombosis and to avoid postthrombotic
syndrome. The present paper reviews recent advances concerning acquired and genetic risk factors for
venous thrombosis, analyses individual risks related to age, and focuses on thrombotic genetic risk
factors and the synergistic gene-environment and gene-gene interactions and their importance in
the management and treatment of venous thromboembolic disease.
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Shi Y, Wen L, Zhou Y, Tao S. Thrombotic risk factors in patients undergoing chemotherapy via peripherally inserted central catheter. J Int Med Res 2014; 42:863-9. [PMID: 24781722 DOI: 10.1177/0300060514527061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/14/2014] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate risk factors for venous thrombosis in patients undergoing chemotherapy via peripherally inserted central catheter (PICC). Methods Data regarding age, sex, body mass index (BMI), smoking history, diagnosis, medical history, family history of thrombosis, haemoglobin level, and white blood cell (WBC) and platelet counts were prospectively collected from consecutively recruited patients. Patients were evaluated using six thrombotic risk-assessment scales prior to PICC. Assessments of the general venous system and the catheterized vein and limb were made. Deep vein thrombosis (DVT) was diagnosed by colour Doppler ultrasonography. Thrombosis risk factors were identified by logistic regression analysis. Results Thrombosis occurred in 12/188 patients (6.38%). Age >60 years, BMI >25 kg/m2 and WBC >11.4 × 109/l were identified as independent risk factors for thrombosis. The incidence of thrombosis was 16.6% (12/72) in patients with one or more risk factors, and 55.5% (five of nine) in those with two or more risk factors. Conclusions Age >60 years, BMI >25 kg/m2 and WBC >1.4 × 109/l are major risk factors for thrombosis in Chinese patients undergoing PICC chemotherapy.
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Affiliation(s)
- Yulan Shi
- Department of Surgical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Wen
- Department of Surgical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanyan Zhou
- Department of Surgical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sifeng Tao
- Department of Surgical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Yi X, Lin J, Han Z, Zhou X, Wang X, Lin J. The incidence of venous thromboembolism following stroke and its risk factors in eastern China. J Thromb Thrombolysis 2012; 34:269-75. [DOI: 10.1007/s11239-012-0720-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Epidemiology of thrombotic risk factors: the difficulty in using clinical trials to develop a risk assessment model. Crit Care Med 2010; 38:S10-7. [PMID: 20083908 DOI: 10.1097/ccm.0b013e3181c9cc3b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is a paucity of data assessing the risks and prevention of venous thromboembolism in critical care settings. Consequently, it is difficult to estimate the risk of venous thromboembolism for a typical patient, on an individual basis, and this difficulty leads to underuse of thromboprophylaxis, especially in intensive care unit patients. Thrombosis is a multifactorial disease and patients may present multiple risk factors simultaneously. The problem in quantifying risk factors is to combine these risk factors even when they are not detected in the same multivariate analysis. A model for predicting the risk of venous thromboembolism in hospitalized medical patients has yet to be developed and validated. Meanwhile, other approaches have been proposed to replace the ideal study utilizing a large prospective cohort of hospitalized medical patients. In this context, several scoring systems based on risk assessment models have been proposed, some including the use of computerized electronic prompts, to help physicians prescribe appropriate prophylaxis. This article reviews evidence on the risk of venous thromboembolism associated with different medical conditions and risk factors, and presents a tentative risk-assessment model for risk stratification in hospitalized medical patients.
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Pottier P, Hardouin J, Lejeune S, Jolliet P, Gillet B, Planchon B. Immobilization and the risk of venous thromboembolism. A meta-analysis on epidemiological studies. Thromb Res 2009; 124:468-76. [DOI: 10.1016/j.thromres.2009.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/27/2009] [Accepted: 05/03/2009] [Indexed: 10/20/2022]
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Persson LM, Lapidus LJ, Lärfars G, Rosfors S. Asymptomatic deep venous thrombosis is associated with a low risk of post-thrombotic syndrome. Eur J Vasc Endovasc Surg 2009; 38:229-33. [PMID: 19482491 DOI: 10.1016/j.ejvs.2008.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 03/29/2009] [Indexed: 11/28/2022]
Abstract
UNLABELLED Post-thrombotic syndrome (PTS) is a well-recognized condition that develops after symptomatic deep venous thrombosis, but the clinical significance and late complications of asymptomatic deep venous thrombosis (ADVT) are unclear. OBJECTIVE To determine whether ADVT following minor surgery affects venous function and contributes to the later development of PTS. PATIENTS/METHODS The study included 83 patients operated on for Achilles tendon rupture; 38 patients with postoperative ADVT and 45 patients without (control group). The follow-up examinations five years after the operation comprised computerised strain-gauge plethysmography, colour duplex ultrasonography, clinical scoring of venous disease, and quality of life (QOL). RESULTS Villalta scores, CEAP classification and QOL did not differ between groups. PTS (=Villalta score > or =5) was found in three ADVT patients (8%) and in two controls (4%). Ultrasonography revealed post-thrombotic changes in 55% of ADVT patients and in none of the controls. Deep venous reflux occurred in 22 ADVT patients and in three controls (P<0.001). There was no difference between groups in plethysmographic variables, demonstrating that the ultrasonographic abnormalities were of negligible haemodynamic significance. CONCLUSIONS PTS is not a common sequel to ADVT after minor surgery. Although more than 50% of patients with ADVT developed post-thrombotic changes according to ultrasound, these changes did not result in haemodynamically significant venous dysfunction.
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Affiliation(s)
- L M Persson
- Section of Clinical Physiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, SE-118 83 Stockholm, Sweden.
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Polk HC, Mccafferty MH, Mahid SS, Naidu DK, Lewis JN. Attitudes of Surgical Specialists toward Venous Thromboembolism Prophylaxis in Surgical Patients. Am Surg 2008; 74:189-94. [DOI: 10.1177/000313480807400301] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Venous thromboembolism (VTE) and pulmonary embolism are serious and potentially life-threatening complications in surgical patients; however, the risk can effectively be lessened using appropriate pharmaceutical and mechanical prophylaxis. Due to the variability in opinions and indications for VTE prophylaxis, proposed guidelines for VTE prophylaxis stratified according to patient- and procedure-oriented risk factors were widely circulated. We investigated to what extent these guidelines were accepted by 147 university and community-based surgeons in mid-America and how the recommendations for prophylaxis compared with recent past surgical practice performed on 5285 patients in Kentucky in 2004. Attitudes varied widely with respect to practice sites, modes, and specialty. Actual practices used in the Surgical Care Improvement Project 2004 varied even more widely and were at substantial variance from recommendations and current Centers for Medicare and Medicaid Services quality measures.
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Affiliation(s)
- Hiram C. Polk
- Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
- University of Louisville Hospital, Louisville, Kentucky
- Price Institute of Surgical Research, Louisville, Kentucky
- Quality Surgical Solutions, P.L.L.C., Louisville, Kentucky; and
| | - Michael H. Mccafferty
- Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
- University of Louisville Hospital, Louisville, Kentucky
- Quality Surgical Solutions, P.L.L.C., Louisville, Kentucky; and
| | - Suhal S. Mahid
- Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
- University of Louisville Hospital, Louisville, Kentucky
| | - Deepak K. Naidu
- Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
- University of Louisville Hospital, Louisville, Kentucky
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Acute venous disease: Venous thrombosis and venous trauma. J Vasc Surg 2007; 46 Suppl S:25S-53S. [DOI: 10.1016/j.jvs.2007.08.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 08/15/2007] [Accepted: 08/19/2007] [Indexed: 10/22/2022]
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Hull RD, Schellong SM, Tapson VF, Monreal M, Samama MM, Turpie AGG, Wildgoose P, Yusen RD. Extended-duration thromboprophylaxis in acutely ill medical patients with recent reduced mobility: Methodology for the EXCLAIM study. J Thromb Thrombolysis 2006; 22:31-8. [PMID: 16786230 DOI: 10.1007/s11239-006-7732-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a significant cause of mortality and morbidity in medical patients. Although thromboprophylaxis with enoxaparin reduces the risk of VTE in these patients, the optimal duration of therapy is not currently known. The EXCLAIM (EXtended CLinical prophylaxis in Acutely Ill Medical patients) study is designed to compare the efficacy and safety of extended-duration thromboprophylaxis using enoxaparin with the standard regimen of enoxaparin in acutely ill medical patients with recent reduced mobility. METHODS All enrolled acutely ill medical patients receive enoxaparin 40 mg subcutaneously once daily for 10 +/- 4 days. Eligible patients are then randomized in a blinded manner to receive either extended-duration thromboprophylaxis with enoxaparin 40 mg subcutaneously once daily or placebo subcutaneously once daily for an additional 28 +/- 4 days. The primary efficacy endpoint is the incidence of VTE during the 28 +/- 4 days after randomization. This study utilizes a standardized bilateral compression ultrasonography examination protocol that consists of an intensive interrogation of the deep veins of the lower extremities for proximal deep-vein thrombosis. The secondary efficacy endpoints are the rate of symptomatic VTE during the 3 months after randomization and mortality at 3 and 6 months after enrollment. The primary safety endpoint is the incidence of major hemorrhagic complications during the 28 +/- 4 days after randomization. RESULTS To date, 3,983 patients, with a broad range of medical conditions, have been included in the study. Almost one third of the enrolled patients with reduced mobility are acutely ill due to respiratory insufficiency and one third have infectious diseases. CONCLUSIONS The EXCLAIM study is designed to show the efficacy and safety of extended-duration thromboprophylaxis using enoxaparin in acutely ill medical patients with recent reduced mobility, which may potentially lead to a reduction in the incidence of late VTE events in these patients. The EXCLAIM (EXtended CLinical prophylaxis in Acutely Ill Medical patients) study, involving 4,726 acutely ill medical patients with recent reduced mobility, is designed to compare the efficacy and safety of extended-duration thromboprophylaxis using 40 mg once daily enoxaparin (38 +/- 4 days) with the standard regimen for enoxaparin (40 mg once daily for 10 +/- 4 days). The objective of this study is to demonstrate that the extended-duration enoxaparin regimen is an effective and safe thromboprophylaxis regimen out of hospital.
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Affiliation(s)
- Russell D Hull
- Thrombosis Research unit, Foothills Hospital, University of Calgary, Room 601 South Tower, 1403 29th Street NW, Calgary, T2N 2T9, Alberta, Canada.
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Sevestre MA, Labarere J, Brin S, Carpentier P, Constans J, Degeilh M, Deslandes B, Elgrishi I, Lanoye P, Laroche JP, Le Roux P, Pichot O, Quéré I, Bosson JL. Optimisation de l’interrogatoire dans l’évaluation du risque de maladie thromboembolique veineuse : l’étude OPTIMEV. ACTA ACUST UNITED AC 2005; 30:217-27. [PMID: 16292199 DOI: 10.1016/s0398-0499(05)88206-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Venous thromboembolism (VTE) is a frequent disease and remains a major cause of mortality and morbidity among our patients. During the 20 past years, clinical description, diagnostic tools, and treatment have changed dramatically. Most published data describing risk factors for VTE no longer apply to the patients seen in daily practice. We present here the rationale, aims, and methodology of the OPTIMEV Study (OPTimisation de l'Interrogatoire pour la Maladie thromboEmbolique Veineuse). RATIONALE Risk factors for VTE are numerous, complex and interactions between them and their clinical importance is difficult to measure (table I). For example, odds ratios for VTE recurrence vary greatly across longitudinal studies. We searched the National Library of Medecine (PubMed) and the Amedeo website using the following keywords: "venous thromboembolism", "pulmonary embolism", "deep vein thrombosis", "risk factors". We selected 84 relevant articles published between 1972 and 2005. Based on this literature analysis, we identified the following major risk factors: VTE recurrence, surgery, cancer, immobilization, age, biological factors. For these factors, data are lacking and some questions are proposed. OBJECTIVES The broad objective of the study is to better evaluate clinical risk factors that fit today's practice against VTE. Specific aims are: 1) to determine whether risk factors are different between proximal and distal deep vein thrombosis (DVT); 2) to develop and prospectively validate a new prediction rule for outpatients. The primary hypothesis is that careful assessment of VTE recurrence, adequate surgical thromboprophylaxis, cancer staging, and varicose vein stratification according to the CEAP classification, is mandatory for accurate evaluation of thromboembolic disease risk. METHODS We conducted a multicenter, prospective, cohort study of 10000 patients. Enrollees are inpatients and outpatients presenting with a clinical suspicion of VTE in Emergency Departments and outpatient clinics in France. 4173 patients have been enrolled at this time (Figure 2). All eligible patients are enrolled during a selected period of time through different seasons. Data are collected by physicians in charge of the patients using an electronic case recording form. Collected data include baseline characteristics, risk factors, results of diagnostic investigations. Outcome measures obtained through telephone interview at 3 and 12 months include cancer diagnosis, VTE recurrence, haemorrhagic events, treatments, death. Univariate and multivariate analysis will be performed using multilevel logistic regression. The study organization is performed by the Centre d'Investigation Clinique de Grenoble and is sponsored by the French Society of Vascular Medicine. First results, to be published in 2006, will allow development of new prediction rules for VTE diagnosis.
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Affiliation(s)
- M A Sevestre
- Conseil Scientifique D'OPTIMEV, CHU Grenoble, 38043 Grenoble.
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Di Minno G, Mannucci PM, Tufano A, Palareti G, Moia M, Baccaglini U, Rudelli G, Giudici GA. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism. J Thromb Haemost 2005; 3:1459-66. [PMID: 15978103 DOI: 10.1111/j.1538-7836.2005.01458.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the prevalence of risk factors for venous thromboembolism (VTE) and the prevalence of recent (<1 year) VTE [including superficial vein thrombosis (SVT), deep vein thrombosis (DVT) and pulmonary embolism (PE)] amongst patients attending general practitioner (GP) surgeries. DESIGN Multicentre, cross-sectional, observational study. SETTING A total of 1536 GP surgeries. PARTICIPANTS A total of 15 180 adult, co-operative subjects, who had consulted their GP for a health disorder and signed the informed consent form. INTERVENTIONS None. MAIN OUTCOME MEASURES Prevalence of known VTE risk factors graded according to importance and prevalence of recent (<1 year) VTE events (including SVT), based on interviews. RESULTS About 1:5 patients had at least one strong risk factor and about 1:20 had at least two risk factors, with no difference between sexes. The prevalence of strong risk factors increased with age. Most were related to medical conditions: history of SVT and/or DVT/PE, heart failure and malignancy. About 3:4 women and 2:3 men had at least one moderate to weak risk factor; nearly 1:2 women and 1:3 men had at least two moderate to weak risk factors. The most common were: history of VTE, smoking, history of miscarriage, estrogen therapy, obesity, and varicose veins. Overall, 80% women and 67% men had at least one risk factor, and 50% women and 35% men had at least two risk factors. The prevalence of recent (<1 year) VTE was 3.4% in women and 2.4% in men, and increased with age. The majority of cases were SVT in both sexes (2.5% in women and 1.5% in men). CONCLUSIONS The prevalence of risk factors for VTE amongst patients attending GP surgeries is high. GPs should bear this in mind during their daily practice.
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Affiliation(s)
- G Di Minno
- Department of Experimental and Clinical Medicine, Policlinico Federico II, University of Naples, Naples, Italy.
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Abstract
Although the factors leading to venous thrombosis have been known for over a century, Virchow's initial model of thrombosis has been extensively refined. Activated coagulation is now recognized to be of primary importance in venous thrombogenesis; the concept of venous injury has been expanded to include molecular changes in the endothelium; and stasis has been redefined as a largely permissive factor. Furthermore, it is now clear that venous thrombi undergo a dynamic evolution beginning early after their formation. The natural history of acute deep venous thrombosis (DVT) is a balance between recurrent thrombotic events and processes that restore the venous lumen, both of which have important implications for the development of complications. Although pulmonary embolism (PE) is clearly the most life threatening complication of acute DVT, the long term socio-economic consequences of the post thrombotic syndrome (PTS) have perhaps been underemphasized in clinical trials. The development of post-thrombotic manifestations is related to both residual venous obstruction and valvular incompetence. Recognition of the factors contributing to a poor outcome, including recurrent thrombotic events, the rate of recanalization, the global extent of venous reflux, and the anatomic distribution of reflux and obstruction is important, as there may be therapeutic alternatives to alter the natural history of acute DVT. The treatment alternatives will continue to expand with the introduction of new therapeutic drugs, for both systemic and catheter-directed therapy, and mechanical thrombectomy devices. The primary care physician is challenged with the task of correctly evaluating deep vein thrombosis and providing his patient with access to the most clinically appropriate, and cost-effective, diagnostic and management options available. This article will review the epidemiology of DVT, its risk factors and major complications.
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Affiliation(s)
- Christopher M Bulger
- Section of Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, Section of Vascular Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL., USA
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Patel NH. Limitations of Medical/Surgical Management of DVT. J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Patel NH. DVT—Incidence, Pathogenesis, Clinical Features and Current Systemic Therapy. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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