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  • 1
    Online Resource
    Online Resource
    Survival Implications of Thrombus Recurrence or Bleeding in Cancer Patients Receiving Anticoagulation for Venous Thromboembolism Treatment
    Georg Thieme Verlag KG ; 2023
    In:  Thrombosis and Haemostasis Vol. 123, No. 05 ( 2023-05), p. 535-544
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 123, No. 05 ( 2023-05), p. 535-544
    Abstract: Background Study aims were to analyze prospectively collected data from patients with cancer-associated venous thromboembolism (VTE) to determine the impact of VTE recurrence and anticoagulant-related bleeding on all-cause mortality. Patients/Methods Consecutive cancer patients with acute VTE treated with anticoagulants (March 1, 2013–November 30, 2021) were included in this analysis. Anticoagulant therapy-associated VTE recurrences, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) were assessed for their impact on all-cause mortality outcomes. Results This study included 1,812 cancer patients with VTE. Of these, there were 97 (5.4%) with recurrent VTE, 98 (5.4%) with major, and 104 (5.7%) with CRNMB while receiving anticoagulants. Recurrent VTE (hazard ratio [HR]: 1.52; 95% confidence interval [CI] : 1.16–2.00; p = 0.0028), major bleeding (HR: 1.82; 95% CI: 1.41–2.31; p = 0.006), and CRNMB (HR; 1.38; 95% CI: 1.05–1.81; p = 0.018) each adversely influenced mortality outcomes. Deep vein thrombosis as the incident thrombotic event type was associated with VTE recurrence (HR: 1.78; 95% CI: 1.08–2.89; p = 0.02). Neither cancer type nor stage, chemotherapy, or Ottawa risk category influenced VTE recurrence. Higher body weights (HR: 1.01; 95% CI: 1.00–1.01; p = 0.005) were associated with increased major bleeding, while high Ottawa scores (HR: 0.66; 95% CI: 0.46–0.96; p = 0.03) and apixaban treatment (HR: 0.62; 95% CI: 0.45–0.84; p = 0.002) were associated with fewer major bleeding outcomes. Conclusion Among cancer patients receiving anticoagulant therapy for VTE, adverse outcomes such as VTE recurrence, major bleeding, or CRNMB increase mortality risk by 40 to 80%. Identifying variables predicting these outcomes may help risk-stratify patients with poor prognosis.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1055/s-0042-1758835
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
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  • 2
    Online Resource
    Online Resource
    Comparison of Venous Thromboembolism Outcomes after COVID-19 and Influenza Vaccinations
    Georg Thieme Verlag KG ; 2023
    In:  TH Open
    Details
    In: TH Open, Georg Thieme Verlag KG
    Abstract: Background: Published data on the risk of venous thromboembolism (VTE) with COVID-19 vaccines is scarce and inconclusive, leading to an unmet need for further studies. Methods: Retrospective, multicentered study of adult patients vaccinated for one of the three approved COVID-19 vaccines in the United States of America and a pre-COVID-19 cohort of patients vaccinated for influenza at two institutions: Mayo Clinic Enterprise sites and the Medical College of Wisconsin, looking at rate of VTE over 90 days. VTE was identified by applying validated natural language processing algorithms to relevant imaging studies. Kaplan-Meier Curves were used to evaluate rate of VTE and Cox proportional hazard models for incident VTE after vaccinations. Sensitivity analyses were performed for age, sex, outpatient vs inpatient status and type of COVID-19 vaccine. Results: 911,381 study subjects received COVID-19 vaccine [mean age 56.8 (SD 18.3) years, 55.3% females] and 442,612 received influenza vaccine [mean age 56.5 (SD 18.3) years, 58.7% females] . VTE occurred within 90 days in 1,498 (0.11%) of the total 1,353,993 vaccinations: 882 (0.10%) in the COVID-19 and 616 (0.14%) in the influenza vaccination cohort. After adjusting for confounding variables, there was no difference in VTE event rate after COVID-19 vaccination compared to influenza vaccination [adjusted hazard ratio 0.95 (95% confidence interval 0.85-1.05)]. No significant difference in VTE rates was observed between the two cohorts on sensitivity analyses. Conclusion: In this large cohort of COVID-19 vaccinated patients, risk of VTE at 90-days was low and no different than a pre-COVID-19 cohort of influenza vaccinated patients.
    Type of Medium: Online Resource
    ISSN: 2512-9465
    URL: Article
    DOI: 10.1055/a-2183-5269
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2893939-6
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  • 3
    Online Resource
    Online Resource
    Calf Vein Thrombosis Comparison of Outcomes for Axial and Muscular Venous Thrombosis
    Georg Thieme Verlag KG ; 2021
    In:  Thrombosis and Haemostasis Vol. 121, No. 02 ( 2021-02), p. 216-223
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 121, No. 02 ( 2021-02), p. 216-223
    Abstract: Background The objective of this study was to characterize clinical features and outcomes among patients with calf deep vein thrombosis (DVT) limited to the muscular veins compared with axial veins. Methods Consecutive patients with ultrasound confirmed acute DVT involving the calf veins (January 1, 2016–August 1, 2018) were identified from the Gonda Vascular Center ultrasound database. Patients were divided into axial or muscular groups based on thrombus location. Demographics, management, and outcomes were compared. Results Over the study period, there were 647 patients with calf DVT equally distributed between axial (n = 321) and muscular (n = 326) locations. Within these groups, peroneal and soleal veins were most commonly involved. Nearly all cases were provoked (97%). Synchronous pulmonary embolism (PE) were more common for axial (30.8%) compared to muscular groups (20.2%; p = 0.001); nearly one-third had no pulmonary symptoms. Anticoagulation for a median of 3 months was initiated for 85.5% of both groups. Venous thromboembolism (VTE) recurrence was more common in the axial group (15.9% vs. 7.1%, p = 0.0015) including more frequent DVT propagation (9.4% vs. 3.1%; p = 0.0017) and PE (3.4% vs. 0.6%; p = 0.0168). Major bleeding, clinically relevant nonmajor bleeding, and mortality rates did not differ between groups. Withholding anticoagulation led to more frequent thrombus propagation in the axial group (3.4% vs. 0.9%; p = 0.029). Conclusion Several important features distinguish muscular from axial DVT. Axial DVT are more likely to have an associated PE and are more likely to experience recurrent VTE, particularly if anticoagulation is withheld.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1055/s-0040-1715646
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
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