Incidence of Venous Thromboembolism Following Laparoscopic Surgery for Gastrointestinal Cancer: A Single-Center, Prospective Cohort Study
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ABSTRACT:
DISEASE(S): Gastric Cancer, Colorectal Cancer
PROVIDER: 2632789 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of unresolved organised pulmonary emboli/thrombi obstructing the major pulmonary arteries. The aim of this study was to estimate the incidence and risk factors of CTEPH in a cohort with first venous thromboembolism (VTE). This was a population-based cohort study of patients with first VTE and no active cancer in England between 2001 and 2012. CTEPH was assessed using a rigorous case-ascertainment algorithm. Risk factors for CTEPH were studied using a nested case-control approach by matching CTEPH cases to VTE patients without CTEPH. Adjusted odds ratios (OR) of comorbidities were estimated from conditional logistic regression. During 81,413 person-years of follow-up among 23,329 patients with first VTE (mean follow-up 3.5 years; maximum 11.0 years) 283 patients were diagnosed with CTEPH (incidence rate 3.5 per 1000 person-years); cumulative incidence was 1.3% and 3.3% at 2 and 10 years after pulmonary embolism, and 0.3% and 1.3% following deep vein thrombosis (DVT), respectively. Risk factors for CTEPH included age over 70, OR 2.04 (95% CI 1.23 to 3.38), female gender, 1.44 (1.06 to 1.94), pulmonary embolism at first VTE, 3.11 (2.23 to 4.35), subsequent pulmonary embolism and DVT, 3.17 (2.02 to 4.96) and 2.46 (1.34 to 4.51) respectively, chronic obstructive pulmonary disease 3.17 (2.13 to 4.73), heart failure 2.52 (1.76 to 3.63) and atrial fibrillation, 2.42 (1.71 to 3.42). CTEPH develops most commonly after pulmonary embolism and less frequently after DVT. Awareness of risk factors may increase referrals to specialised centres for confirmation of CTEPH and initiation of specific treatment.
| S-EPMC6066824 | biostudies-other
Project description:BackgroundPatients with polycythemia vera with high hematocrit have increased risk of venous thromboembolism (VTE).ObjectiveTo determine whether high hematocrit in the general population is also associated with elevated VTE risk.MethodsThe prospective Atherosclerosis Risk in Communities Study performed a complete blood count in 13 891 adults aged 45 to 64 in 1987 to 1989. We identified incident hospitalized VTEs through 2015 and performed proportional hazards regression analyses using race-sex-specific categorization of hematocrit percentiles (ie, <5th, 5th to <25th, 25th to <75th, 75th to <95th, and 95th-100th percentiles, with the 25th to <75th percentile serving as the reference).ResultsOver a median follow-up of 26 years, 800 participants had an incident venous thrombosis of the leg and/or a pulmonary embolism. There was a nonlinear association of hematocrit with VTE incidence, with risk elevated 72% for participants above the 95th percentile of hematocrit compared with the reference. Specifically, hazard ratios (95% confidence intervals) of incident VTE were 1.27 (0.91-1.76), 1.06 (0.87-1.28), 1 (reference), 1.17 (0.98-1.40) and 1.72 (1.30-2.27) across the 5 hematocrit percentiles, adjusted for age, race, sex, body mass index, smoking status and pack-years, and other confounding variables. The association of high hematocrit with VTE was limited to provoked VTE, with little evidence for unprovoked VTE. Hemoglobin above the 95th percentile also was associated with an increased risk of VTE. In contrast, there were no significant associations of platelet, leukocyte, neutrophil, or lymphocyte counts with VTE incidence.ConclusionHigh hematocrit and hemoglobin in a general middle-aged population sample were associated with increased long-term risk of VTE, particularly provoked VTE.
| S-EPMC7086464 | biostudies-literature
Project description:Interventions: Once daily fondaparinux (2.5mg or 1.5mg) for 4 to 8 days after 24 hours of surgery
Intermittent pneumatic compression according to the institutional guidelines
Primary outcome(s): Incidence of venous thromboembolism (VTE)
Study Design: Parallel Randomized
| 2623843 | ecrin-mdr-crc
Project description:Interventions: Enoxaparin group Subcutaneous injection of enoxaparin 2000U twice daily (postoperative day 2 to discharge) Intermittent pneumatic compression (IPC) prophylaxis (after surgery to postoperative day 1)
Control group IPC prophylaxis alone (after surgery to postoperative day 1)
Primary outcome(s): Incidence of venos thromboembolism until postoperative day 28
Study Design: Parallel Randomized
| 2633931 | ecrin-mdr-crc
Project description:Venous thromboembolism (VTE) has harmful effects on morbidity and mortality of cancer patients. In Western VTE guidelines, all solid cancer patients receiving abdominal major surgery are strongly recommended to receive pharmacologic prophylactic anticoagulation such as low molecular weight heparin (LMWH) in the perioperative periods. These recommendations are based on the high incidence of postoperative VTE development in Western cancer patients. However, there have been many cumulative data about the effect of different ethnicity on the VTE development and more and more investigators and clinicians admit that Asian ethnicity has lower incidence of VTE than Western ethnicity. Therefore, it may not be advisable to apply Western guidelines as it is to the clinical situation of Asian cancer patients.
Although colorectal cancer (CRC) is one of the common cancers and the incidence is rapidly increasing in Asia, there have been few prospective data on the incidence of VTE development during the postoperative period in Asian CRC patients. To our knowledge, there have been a few small-sized prospective studies in Asia and thus clear conclusions could have not been drawn based on those studies. Most Korean colorectal surgeons think that the incidence of postoperative VTE development is very rare based on their own clinical experiences. They also have much concern about the complications such as bleeding that might be caused by routine use of pharmacologic thromboprophylaxis during the perioperative periods. Therefore, in most clinical situation, many Korean colorectal surgeons do not perform perioperative pharmacologic thromboprophylaxis using LMHW. Considering these clinical situations in Asia including Korea, the uncritical acceptance of Western guidelines may be inappropriate. The necessity of pharmacologic thrombo-prophylaxis can be answered only from our own prospective study on the incidence of postoperative VTE development after CRC surgery. Moreover, current surgical trend in cancer patients is minimally invasive approach such as laparoscopic surgery. However, the necessity of pharmacologic thromboprophylaxis in patients receiving laparoscopic cancer surgery has not been evaluated even in Western countries. Western guidelines also cannot exactly answer whether pharmacologic thromboprophylaxis is really necessary in cancer patients receiving laparoscopic cancer surgery. On above backgrounds, this study was designed.
| 2123017 | ecrin-mdr-crc
Project description:ObjectiveTo evaluate the risk of venous thromboembolism (VTE, i.e. deep vein thrombosis or pulmonary embolism, or both) following new use of NSAIDs in a long-term cohort of U.S. women.MethodsWe investigated initiation of coxibs and traditional NSAIDs (excluding aspirin) and incident VTE in 39 876 women enrolled in the Women's Health Study from 1993-95 and followed with yearly questionnaires until 2012. We defined initiation as the first reported use of NSAIDs for ≥4 days per month. Incident VTE was confirmed by an end point committee. We estimated hazard ratios (HRs) and risk differences (RDs, expressed as percentages) comparing NSAID initiation with non-initiation and acetaminophen initiation (active comparator) via standardization using a propensity score that incorporated age, BMI, calendar time, and relevant medical, behavioural, and socioeconomic variables updated over time.ResultsThe HR (95% CI) for risk of VTE in the as treated analyses comparing initiation with non-initiation, was 1.5 (1.2, 1.8) for any NSAID, 1.3 (1.1, 1.7) for traditional NSAIDs, and 2.0 (1.3, 3.1) for coxibs, with 2-year RDs 0.11, 0.08 and 0.32, respectively. When comparing the risk of VTE after initiation of any NSAID with that after acetaminophen initiation, the HRs were 0.9 (0.6, 1.5), 0.9 (0.5, 1.5) and 1.4 (0.6, 3.4), with 2-year RDs 0.03, -0.01, and 0.13, respectively.ConclusionNew use of NSAIDs was associated with increased VTE risk compared with non-use, but the association was null or diminished when compared with acetaminophen initiation. Elevated VTE risks associated with NSAID use in observational studies may in part reflect different baseline risks among individuals who need analgesics and may overstate the risk patients incur compared with pharmacologic alternatives.
| S-EPMC7449805 | biostudies-literature
Project description:Reasons for trends in venous thromboembolism (VTE) incidence are uncertain. It was our objective to determine VTE incidence trends and risk factor prevalence, and estimate population-attributable risk (PAR) trends for each risk factor. In a population-based cohort study of all residents of Olmsted County, Minnesota from 1981-2010, annual incidence rates were calculated using incident VTE cases as the numerator and age- and sex-specific Olmsted County population estimates as the denominator. Poisson regression models were used to assess the relationship of crude incidence rates to year of diagnosis, age at diagnosis, and sex. Trends in annual prevalence of major VTE risk factors were estimated using linear regression. Poisson regression with time-dependent risk factors (person-years approach) was used to model the entire population of Olmsted County and derive the PAR. The age- and sex-adjusted annual VTE incidence, 1981-2010, did not change significantly. Over the time period, 1988-2010, the prevalence of obesity, surgery, active cancer and leg paresis increased. Patient age, hospitalisation, surgery, cancer, trauma, leg paresis and nursing home confinement jointly accounted for 79?% of incident VTE; obesity accounted for 33?% of incident idiopathic VTE. The increasing prevalence of obesity, cancer and surgery accounted in part for the persistent VTE incidence. The PAR of active cancer and surgery, 1981-2010, significantly increased. In conclusion, almost 80?% of incident VTE events are attributable to known major VTE risk factors and one-third of incident idiopathic VTE events are attributable to obesity. Increasing surgery PAR suggests that concurrent efforts to prevent VTE may have been insufficient.
| S-EPMC5597250 | biostudies-literature
Project description:Background/Objectives:Higher resting heart rate is a risk factor for arterial cardiovascular diseases. We assessed whether higher heart rate is a risk factor for venous thromboembolism (VTE). Methods:In a prospective epidemiologic cohort, the Atherosclerosis Risk in Communities (ARIC) Study, we associated resting heart rate by electrocardiogram with physician-validated incident hospitalized VTE through 2015. We also examined whether lower heart rate variability (HRV), a marker of cardiac autonomic imbalance, might be a risk factor for VTE. Results:Resting heart rate at Visit 1 (1987-1989), when participants were 45 to 64 years old (mean, 54 years), was not associated with incidence of VTE (n = 882 cases). However, heart rate at Visit 4 (1996-1998; mean age, 63 years) was associated positively with VTE (n = 557 cases). The adjusted hazard ratios (95% confidence intervals) of VTE across Visit 4 heart rate categories of <60, 60 to 69, 70 to 79, and ?80 bpm were 1 (reference), 1.22 (1.01-1.49), 1.39 (1.09-1.78), and 1.44 (1.01-2.06), respectively, and when evaluated continuously 1.11 (1.02-1.21) per 10 bpm greater heart rate. For the most part, HRV indices were not associated with VTE or associations were explained by inverse correlations of HRV indices with heart rate. Conclusion:We found a significant positive and independent association of resting heart rate at ARIC Visit 4 with incidence of VTE. The reason why high heart rate is a risk marker for VTE warrants further exploration.
| S-EPMC7040544 | biostudies-literature
Project description:BackgroundCancer immunotherapy is associated with several immune-related adverse events, but the relationship between immunotherapy and venous thromboembolism has not been thoroughly studied.MethodsWe conducted a retrospective cohort study of 1,686 patients who received immunotherapy for a variety of malignancies to determine the incidence of venous thromboembolism and the impact of venous thromboembolism on survival. To examine the potential role of inflammation in venous thromboembolism, we also profiled immune cells and plasma cytokines in blood samples obtained prior to initiation of immunotherapy in a sub-cohort of patients treated on clinical trials who subsequently did (N = 15), or did not (N = 10) develop venous thromboembolism.FindingsVenous thromboembolism occurred while on immunotherapy in 404/1686 patients (24%) and was associated with decreased overall survival [HR=1.22 (95% CI 1.06-1.41), p<0.008]. Patients that developed venous thromboembolism had significantly higher pretreatment levels of myeloid-derived suppressor cells (5.382 ± 0.873 vs. 3.341 ± 0.3402, mean ± SEM; p=0.0045), interleukin 8 (221.2 ± 37.53 vs. 111.6 ± 25.36, mean ± SEM; p=0.016), and soluble vascular cell adhesion protein 1 (1210 ± 120.6 vs. 895.5 ± 53.34, mean ± SEM; p=0.0385).ConclusionsThese findings demonstrate that venous thromboembolism is an underappreciated and important immune-related adverse event associated with cancer immunotherapy, and may implicate an interleukin 8 and myeloid-derived suppressor cell-driven pathway in pathogenesis.
| S-EPMC8143033 | biostudies-literature
Project description:ObjectivesVenous thromboembolism (VTE) continues to be a frequent medical emergency requiring rapid recognition so as to reach diagnosis and initiate anticoagulation therapy. The use of statins in addition to reducing the incidence of arterial thrombosis for decreasing the incidence and reoccurrence of VTE is reported. The aim of our study was to explore the association between statin usage and the incidence of new VTE at the population level during a 10-year follow-up.DesignPopulation-based historic cohort.SettingThe Health 2000 Survey was based on a nationally representative sample.Participants8028 individuals aged 30 years or over in Finland.Primary and secondary outcome measuresThe primary end point event was the first ever hospitalisation due to one of the following causes: pulmonary embolism (International Classification of Diseases-10 I26), cerebral venous non-pyogenic thrombosis (I63.6), or venous thrombosis (I80.9-189).ResultsThe preselected explanatory variables applied to the Poisson regression model were statin usage (no/yes) during follow-up (2000-2011) and several baseline data (age, sex; usage of blood glucose lowering drugs, vitamin K antagonists and antiplatelet agents). We observed 136 VTE events, the incidence of 1.72 (95% CI 1.44 to 2.04) per 1000 person-years. Current statin usage did not associate with the incidence of VTE according to the univariate model (rate ratio (RR) 0.93, 0.56 to 1.52), but when adjusted with baseline variables (age, sex, medications) the RR declined to 0.60 (0.36 to 1.00, p=0.04).ConclusionsStatin use offers protection against first ever VTE events and appears as a primary prevention tool in patients without anticoagulation or antiplatelet medication.
| S-EPMC4225235 | biostudies-literature