Context: Venous thromboembolism (VTE) risk assessment for adults admitted to hospital is commonplace, but the utility of assessment tools in patients admitted to hospices or palliative care units and prediction of symptomatic VTE is unknown.
Objectives: To investigate the relationship between risk of VTE and development of symptoms.
Methods: Retrospective consecutive admission, case-note data from seven U.K. hospices were collected during an evaluation of a VTE risk assessment protocol using the Pan Birmingham Cancer Network palliative-modified Thromboembolic Risk Factors (THRIFT) Consensus Group criteria and presence/absence of a temporary elevated risk (TER) of VTE. Symptoms/signs during admission consistent with possible VTE were documented.
Results: A total of 1164 case-notes were analyzed (age range 23-99; men 627). THRIFT risk was high in 13%, medium in 83%, and low in 4%; a TER was identified in 24%. In the "clinically relevant group" (no contraindication, not anticoagulated), where primary thromboprophylaxis could have been prescribed (n = 528), TER and symptoms were associated (21% symptoms with TER vs. 9% symptoms without TER: Chi-squared, P < 0.001). A high/moderate THRIFT score had a sensitivity of 98.4% (95% CI 91.3%-99.9%) and specificity of 5.8% (95% CI 3.9%-8.3%). The TER assessment had a more evenly balanced sensitivity (41.9%; 95% CI 29.5%-55.2%) and specificity (79%; 95% CI 75.0%-82.6%).
Conclusion: Hospice inpatients are at risk for VTE. TER alone is simpler to use and may be more useful in this population than the THRIFT but still has limitations regarding ability to predict symptoms.
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http://dx.doi.org/10.1016/j.jpainsymman.2013.08.016 | DOI Listing |
Cureus
January 2025
Critical Care Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE.
Aim We aimed to determine the incidence of thrombotic complications and outcomes of critically ill COVID-19 patients admitted to the intensive care unit (ICU) and evaluate the association between combined antithrombotic therapy and mortality in ICU patients admitted for COVID-19 pneumonia. Methods We retrospectively collected data of adult critically ill patients with COVID-19 admitted to the ICU in a major hospital in Dubai during the COVID-19 pandemic. The primary outcome was in-hospital mortality.
View Article and Find Full Text PDFLancet Haematol
January 2025
Department of Medicine, McGill University, Montreal, QC, Canada.
Background: Despite the morbidity and mortality of venous thromboembolism, there is little evidence to guide postpartum thromboprophylaxis in patients at moderate risk. We aimed to assess the feasibility of conducting a double-blind, randomised trial of aspirin versus placebo in postpartum individuals with two or more venous thromboembolism risk factors, mild-to-moderate thrombophilia, or both.
Methods: The pilot PARTUM trial, a multi-national, randomised, double-blind, placebo-controlled trial, was conducted in seven centres across Canada, France, Ireland, and the Netherlands.
Obstet Gynecol
January 2025
University of Utah Health, Salt Lake City, Utah; Inova Health, Vienna, and Eastern Virginia Medical School, Norfolk, Virginia; University of Texas Medical Branch, Galveston, Texas; University of Alabama at Birmingham, Birmingham, Alabama; and Denver Health and Hospital Authority, Denver, Colorado.
Objective: To evaluate the effect of administering postpartum heparin-based pharmacologic thromboprophylaxis on the incidence of postpartum venous thromboembolism (VTE) and complications.
Methods: This was a multicenter retrospective cohort study of all individuals delivering at more than 20 weeks of gestation at four U.S.
Gynecol Oncol
January 2025
Department of Radiation-Oncology, Catharina Hospital, Eindhoven, the Netherlands.
Objective: To determine the incidence of clinical and subclinical venous thromboembolic events (VTE) in patients with locally advanced cervical cancer (LACC) treated with high-dose thromboprophylaxis during definitive chemoradiation and brachytherapy.
Methods: A prospective observational study was undertaken from August 2021 to December 2023 in patients with primary LACC treated with definitive chemoradiation in two Dutch tertiary hospitals. Patients received high-dose thromboprophylaxis during chemoradiation and brachytherapy.
Arab J Urol
September 2024
Department of Surgery, Sabah Al-Ahmad Urology Center, Kuwait City, Kuwait.
Purpose: To compare the outcomes of using prophylactic direct oral anti-coagulants (DOAC) and low-molecular-weight heparin (LMWH) after major urologic surgery.
Materials And Methods: Systematic literature searches of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL were performed up to 9 November 2023, and protocols were registered on PROSPERO (CRD42024494424). The primary outcomes were post-operative incidence of VTE and bleeding.
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