News Update on Thromboembolism Research: April – 2019
Apixaban to Prevent Venous Thromboembolism in Patients with Cancer
BACKGROUND
Patients with active cancer have Associate in Nursing augmented risk of blood vessel occlusion, which ends in substantial morbidity, mortality, and health care expenditures. The Khorana score (range, 0 to 6, with higher scores indicating a better risk of blood vessel thromboembolism) has been valid to spot patients with cancer at elevated risk for this complication and will facilitate choose those that may gain advantage from thromboprophylaxis.
METHODS
We conducted a irregular, placebo-controlled, double-blind trial assessing the efficaciousness and safety of apixaban (2.5 mg doubly daily) for thromboprophylaxis in mobile patients with cancer WHO were at intermediate-to-high risk for blood vessel occlusion (Khorana score, ≥2) and were initiating therapy. the first efficaciousness outcome was objectively documented blood vessel occlusion over a follow-up amount of a hundred and eighty days. the most safety outcome was a significant hemorrhage episode.
RESULTS
Of the 574 patients WHO underwent randomisation, 563 were enclosed within the changed intention-to-treat analysis. blood vessel occlusion occurred in twelve of 288 patients (4.2%) within the apixaban cluster and in twenty eight of 275 patients (10.2%) within the placebo cluster (hazard quantitative relation, 0.41; ninety five confidence interval [CI], 0.26 to 0.65; P [1]
Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy
Background:
The frequency of knee surgical process procedures is increasing in medicine and adolescent patients. In general, complications when these procedures in adolescents are uncommon. the needs of this study are to report the incidence of blood vessel occlusion (VTE) in adolescent patients when knee surgical process procedures, moreover establish risk factors during this patient population.
Methods:
Medical records were reviewed all told medicine associate degreed adolescent patients (≤19 y) World Health Organization underwent an arthroscopic knee procedure from 2010 to 2014 and were diagnosed with a symptomatic VTE within the operative amount. Demographic options were recorded, and enclosed age, sex, body mass index, clinical characteristics (diagnosis, form of surgical intervention, patch time), VTE risk factors [family history of VTE, blubber (body mass index >30), contraceptive pill use, and smoking use/exposure] and treatment (anticoagulation type/duration).
Results:
Out of 2783 patients World Health Organization underwent knee surgical process throughout the 5-year study amount, seven patients (3 males, 4 females, mean age, 16.9 y, range, fifteen to 18) developed a symptomatic operative VTE (incidence, 0.25%, ninety five confidence interval, 0.11%-0.54%). there have been half-dozen unilateral deep phlebothrombosis, and one bilateral deep phlebothrombosis. Arthroscopic procedures performed during this cohort enclosed anterior cruciform ligament reconstruction (3), isolated lateral unharness (1), ablation (2), and sesamoid bone realignment with arthroscopic lateral unharness, open leg bone tubercle surgical process, and open proximal medial retinacular reefing (1). VTE was diagnosed a mean of nine days following surgery (range, 3 to 16). All patients were at first treated with low–molecular-weight decoagulant, and a pair of were regenerate to Coumadin. Mean length of medical care treatment was sixty four days (range, 28 to 183). All patients had a minimum of one identifiable medical or surgical risk issue, together with contraceptive pill use (2), smoking (2), blubber (2), associate degree arthroscopically motor-assisted open procedure (4), or patch time >60 minutes (3).
Conclusions:
VTE when adolescent knee surgical process has not been well represented. The incidence is ∼0.25%. antecedently established risk factors for VTE were gift in a thousandth of the affected population. Low–molecular-weight decoagulant was accustomed with success treat this complication.
Level of Evidence:
Level IV. [2]
Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases
Objective To assess the association between risk of blood vessel occlusion and use of various sorts of internal secretion replacement medical aid.
Design 2 nested case-control studies.
Setting Great Britain general follows contributory to the QResearch or Clinical follow analysis Datalink (CPRD) databases, and coupled to hospital, mortality, and social deprivation knowledge.
Participants 80 396 ladies aged 40-79 with a primary identification of blood vessel occlusion between 1998 and 2017, matched by age, general practice, and index date to 391 494 feminine controls.
Main outcome measures blood vessel occlusion recorded on general follow, mortality, or hospital records. Odds ratios were adjusted for demographics, smoking standing, alcohol consumption, comorbidities, recent medical events, and different prescription drugs.
Results Overall, 5795 (7.2%) ladies United Nations agency had blood vessel occlusion and 21 670 (5.5%) controls had been exposed to internal secretion replacement medical aid inside ninety days before the index date. of those 2 teams, 4915 (85%)and 16 938 (78%) ladies used oral medical aid, severally, that was related to a considerably accrued risk of blood vessel occlusion compared with no exposure (adjusted odds magnitude relation one.58, ninety five confidence interval one.52 to 1.64), for each steroid solely preparations (1.40, 1.32 to 1.48) and combined preparations (1.73, 1.65 to 1.81). Estradiolhad a lower risk than conjugated equine steroid for oestrogen solely preparations (0.85, 0.76 to 0.95) and combined preparations (0.83, 0.76 to 0.91). Compared with no exposure, conjugated equine steroid with progestin acetate had the best risk (2.10, 1.92 to 2.31), and oestradiol with dydrogesterone had rock bottom risk (1.18, 0.98 to 1.42). percutaneous preparations weren’t related to risk of blood vessel occlusion, that was consistent for various regimens (overall adjusted odds magnitude relation zero.93, ninety five confidence interval zero.87 to 1.01).
Conclusions within the gift study, percutaneous treatment was the safest form of internal secretion replacement medical aid once risk of blood vessel occlusion was assessed. percutaneous treatment seems to be underused, with the overwhelming preference still for oral preparations. [3]
Variant alleles in factor V, prothrombin, plasminogen activator inhibitor-1, methylenetetrahydrofolate reductase and risk of thromboembolism in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab
Single-nucleotide polymorphisms (SNPs) associated with hereditary thrombophilia were investigated as risk factors for occlusion in cancer patients. Their impact in pathologic process large intestine cancer (mCRC) has ne’er been explored thus far. Our aim was to analyse the impact of clotting factor V (FVL G1691A), clotting factor (PT G20210A), methylenetetrahydrofolate enzyme (MTHFR C677T and A1298C) and proteolytic enzyme substance kind one (PAI-1 5G/4G) allelomorphic variants during this setting. lii patients treated with first-line therapy and bevacizumab World Health Organization developed a thromboembolic event in their period of time were at first genotyped. a up to date cohort of 127 patients World Health Organization failed to expertise any thromboembolic event was additionally analysed. polymer was extracted from peripheral blood and genotypes were determined by time period PCR, victimisation LightSNiP (TIB MOLBIOL) on LightCcler 480 (Roche). The association between occlusion and SNPs was investigated by univariable and multivariable analyses. All SNPs were in Hardy–Weinberg equilibrium (χ2 check P>0.20). FVL G1691A and platinum G20210A were gift solely in heterozygosis in four (2.2%) and seven (3.9%) patients, respectively; MTHFR C677T in homozygosis in twenty nine (16.2%), MTHFR A1298C in homozygosis in thirteen (7.3%); PAI-1 5G/4G in ninety eight (54.7%) and 4G/4G in forty one (23%) patients. At univariable analysis, treatment period was considerably related to occlusion (P [4]
Evaluation of Risk Factors Associated with Venous Thromboembolism in the Lebanese Population
Background: blood vessel occlusion (VTE) may be a complex illness with a preventable characteristic. The information of its prophetic risk factors can facilitate in preventing it. Therefore, the aim of this study is to assess the prophetic risk factors of VTE within the Lebanese population in order that effective recommendations may be drawn out.
Methodology: A retrospective case-control study was carried between the periods of March until Gregorian calendar month 2017 in 2 tertiary care hospitals in Beirut-Lebanon. Patients with a confirmed official designation of VTE between the amount going from 2008 until 2016 were taken as cases. every case was at random matched with a pair of hospitalized controls. Questionnaires regarding VTE risk factors and symptoms were crammed. knowledge were then entered into SPSS version twenty one to explore the association between the chance factors and VTE. Bi-variate and variable supply regression were done and a p-value but zero.05 was thought of.
Results: 430 patients were enclosed in our study. Among these, one hundred forty were cases of deep vein occlusion and/or embolism and 290 were matched controls. The results of the bi-variate analysis was vital for history of VTE, active cancer, general surgery, thrombophilia, immobility, active/recent respiratory illness, trauma, and internal secretion replacement therapy/contraceptives use (p-value [5]
Reference
[1] Carrier, M., Abou-Nassar, K., Mallick, R., Tagalakis, V., Shivakumar, S., Schattner, A., Kuruvilla, P., Hill, D., Spadafora, S., Marquis, K. and Trinkaus, M., 2019. Apixaban to prevent venous thromboembolism in patients with cancer. New England Journal of Medicine, 380(8), pp.711-719. (Web Link)
[2] Murphy, R.F., Heyworth, B., Kramer, D., Naqvi, M., Miller, P.E., Yen, Y.M., Kocher, M.S. and Shore, B.J., 2019. Symptomatic venous thromboembolism after adolescent knee arthroscopy. Journal of Pediatric Orthopaedics, 39(3), pp.125-129. (Web Link)
[3] Vinogradova, Y., Coupland, C. and Hippisley-Cox, J., 2019. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. bmj, 364, p.k4810. (Web Link)
[4] Variant alleles in factor V, prothrombin, plasminogen activator inhibitor-1, methylenetetrahydrofolate reductase and risk of thromboembolism in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab
F S Falvella, C Cremolini, R Miceli, F Nichetti, S Cheli, C Antoniotti, G Infante, A Martinetti, F Marmorino, E Sottotetti, R Berenato, M Caporale, A Colombo, F de Braud, M Di Bartolomeo, E Clementi, F Loupakis & F Pietrantonio
The Pharmacogenomics Journal volume 17, pages 331–336 (2017) (Web Link)
[5] Sara, R., Nour, H., Salam, Z., Sanaa, A., Samar, R. and Hajje Amal, A. (2018) “Evaluation of Risk Factors Associated with Venous Thromboembolism in the Lebanese Population”, Cardiology and Angiology: An International Journal, 7(1), pp. 1-12. doi: 10.9734/CA/2018/38854.(Web Link)