The Experts below are selected from a list of 49287 Experts worldwide ranked by ideXlab platform
Henrik Toft Sørensen - One of the best experts on this subject based on the ideXlab platform.
-
risk factors for venous Thromboembolism in patients undergoing total hip replacement and receiving routine thromboprophylaxis
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Alma B Pedersen, Henrik Toft Sørensen, Frank Mehnert, Soren Overgaard, S P JohnsenAbstract:Background: Data on the risk factors for venous Thromboembolism among patients undergoing total hip replacement and receiving pharmacological thromboprophylaxis are limited. The purpose of this study was to examine potential patient-related risk factors for venous Thromboembolism following total hip replacement in a nationwide follow-up study. Methods: Using medical databases, we identified all patients who underwent primary total hip replacement and received pharmacological thromboprophylaxis in Denmark from 1995 to 2006. The outcome measure was hospitalization with venous Thromboembolism within ninety days of surgery. We considered age, sex, indication for primary total hip replacement, calendar year of surgery, and comorbidity history as potential risk factors. Results: The overall rate of hospitalization for venous Thromboembolism within ninety days following a primary total hip replacement was 1.02% (686 hospitalizations after 67,469 procedures) at a median of twenty-two days. The incidence of symptomatic deep venous thrombosis and of nonfatal pulmonary embolism was 0.7% (499 of 67,469) and 0.3% (205 of 67,469), respectively. The incidence of death due to venous Thromboembolism or from all causes was 0.05% (thirty-eight patients) and 1.0% (678 patients), respectively. Patients with rheumatoid arthritis had a reduced relative risk for venous Thromboembolism compared with patients with primary osteoarthritis (adjusted relative risk = 0.47; 95% confidence interval, 0.25 to 0.90). Patients with a high score on the Charlson comorbidity index had an increased relative risk for venous Thromboembolism compared with patients with a low score (adjusted relative risk = 1.45; 95% confidence interval, 1.02 to 2.05). Patients with a history of cardiovascular disease (relative risk = 1.40; 95% confidence interval, 1.15 to 1.70) or prior venous Thromboembolism (relative risk = 8.09; 95% confidence interval, 6.07 to 10.77) had an increased risk for venous Thromboembolism compared with patients without that history. Conclusions: The cumulative incidence of a venous Thromboembolism within ninety days of surgery among patients with total hip replacement receiving pharmacological thromboprophylaxis was 1%. This information on the associated risk factors could be used to better anticipate the risk of venous Thromboembolism for an individual patient. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
-
arterial cardiovascular events statins low dose aspirin and subsequent risk of venous Thromboembolism a population based case control study
Journal of Thrombosis and Haemostasis, 2009Co-Authors: Paolo Prandoni, Henrik Toft Sørensen, Erzsebet Horvathpuho, Kirstine Kobberoe Sogaard, Steffen Christensen, Soren Paaske Johnsen, Reimar W Thomsen, John A. BaronAbstract:Summary. Background: Atherosclerotic disease has been associated with the risk of venous Thromboembolism, but the available data are conflicting. There are similar confusions regarding the association of the use of aspirin and statins with venous Thromboembolism. Objectives: To determine whether arterial cardiovascular events, use of statins and low-dose aspirin were associated with the risk of venous Thromboembolism. Patients and methods: In this population-based case–control study, we identified 5824 patients with venous Thromboembolism and 58 240 population controls with a complete hospital and prescription history. We used logistic regression to estimate the relative risk of venous Thromboembolism, adjusted for potentially confounding factors. Results: Patients with a history of arterial cardiovascular events had a clearly increased relative risk. An event within 3 months before the index date conferred large increases in risk [relative risk 4.22 (95% confidence interval (CI), 2.33–7.64) after myocardial infarction, 4.41 (95% CI, 2.92–6.65) after stroke]. Myocardial infarction more than 3 months before the index date was not significantly associated with risk, although there was a relative risk of 1.29 (95% CI, 1.05–1.57) for myocardial infarction more than 60 months previously. A history of stroke was associated with small increases in risk after 3 months. Current use of statins was associated with a reduced risk of venous Thromboembolism [relative risk = 0.74 (95% CI, 0.63–0.85)]. Aspirin use was not associated with risk. Conclusions: Patients with cardiovascular events are at a short-term increased risk of venous Thromboembolism. Statins might prevent venous Thromboembolism but aspirin does not. However, as the study is non-randomized residual confounding cannot be excluded.
-
Prognosis of cancers associated with venous Thromboembolism.
The New England journal of medicine, 2000Co-Authors: Henrik Toft Sørensen, Lene Mellemkjær, Jørgen H. Olsen, John A. BaronAbstract:Background Little is known about the prognosis of cancer discovered during or after an episode of venous Thromboembolism. Methods We linked the Danish National Registry of Patients, the Danish Cancer Registry, and the Danish Mortality Files to obtain data on the survival of patients who received a diagnosis of cancer at the same time as or after an episode of venous Thromboembolism. Their survival was compared with that of patients with cancer who did not have venous Thromboembolism (control patients), who were matched in terms of type of cancer, age, sex, and year of diagnosis. Results Of 668 patients who had cancer at the time of an episode of deep venous Thromboembolism, 44.0 percent of those with data on the spread of disease (563 patients) had distant metastasis, as compared with 35.1 percent of 5371 control patients with data on spread (prevalence ratio, 1.26; 95 percent confidence interval, 1.13 to 1.40). In the group with cancer at the time of venous Thromboembolism, the one-year survival rate was...
-
the cumulative incidence of venous Thromboembolism during pregnancy and puerperium
Acta Obstetricia et Gynecologica Scandinavica, 1998Co-Authors: Birthe S Andersen, Flemming Hald Steffensen, Gunnar Lauge Nielsen, Henrik Toft Sørensen, Jørn OlsenAbstract:OBJECTIVES: The aim of the study was to estimate the cumulative incidence of venous Thromboembolism during pregnancy and the puerperium. METHODS: All diagnoses concerning venous Thromboembolism in the Hospital Discharge Registry from a Danish County in women less than 49 years of age from 1984 to 1994 were included. The number of deliveries in the County during this period was obtained from The Medical Registry of Birth. RESULTS: The cumulative incidence of venous Thromboembolism during pregnancy and puerperium was 0.85 (95% CI: 0.64-1.11) per 1000 deliveries. The cumulative incidence was 0.49 (95% CI: 0.28-04).80) in 1984-89 but increased to 1.23 (95% CI: 0.87-1.69) after the introduction of ultrasound. CONCLUSION: The risk of diagnosed venous Thromboembolism is low but estimates of the incidence are probably procedure dependent.
James D Douketis - One of the best experts on this subject based on the ideXlab platform.
-
risk of recurrence after venous Thromboembolism in men and women patient level meta analysis
BMJ, 2011Co-Authors: James D Douketis, Paul A. Kyrle, Mary Cushman, Alberto Tosetto, Maura Marcucci, Trevor Baglin, Benilde Cosmi, Daniela Poli, Campbell R Tait, Alfonso IorioAbstract:Objective To determine the effect of sex on the risk of recurrent venous Thromboembolism in all patients and in patients with venous Thromboembolism that was unprovoked or provoked (by non-hormonal factors). Data source Comprehensive search of electronic databases (Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials) until July 2010, supplemented by review of conference abstracts and contact with content experts. Study selection Seven prospective studies investigating an association between D-dimer, measured after anticoagulation was stopped, and disease recurrence in patients with venous Thromboembolism. Data extraction Patient level databases were obtained, transferred to a central database, checked, and completed with further information provided by authors. Data synthesis 2554 patients with a first venous Thromboembolism had follow-up for a mean of 27.1 (SD 19.6) months. The one year incidence of recurrent venous Thromboembolism was 5.3% (95% confidence interval 4.1% to 6.7%) in women and 9.5% (7.9% to 11.4%) in men, and the three year incidence of recurrence was 9.1% (7.3% to 11.3%) in women and 19.7% (16.5% to 23.4%) in men. Among patients with unprovoked venous Thromboembolism, men had a higher risk of recurrence than did women (hazard ratio 2.2, 95% confidence interval 1.7 to 2.8). After adjustment for women with hormone associated initial venous Thromboembolism, the risk of recurrence remained higher in men (hazard ratio 1.8, 1.4 to 2.5). In patients with provoked venous Thromboembolism, occurring after exposure to a major risk factor, recurrence of disease did not differ between men and women (hazard ratio 1.2, 0.6 to 2.4). In women with hormone associated venous Thromboembolism and no other risk factors, recurrence was lower than that in women with unprovoked venous Thromboembolism and no previous hormone use (hazard ratio 0.5, 0.3 to 0.8). Conclusion In patients with a first unprovoked venous Thromboembolism, men have a 2.2-fold higher risk of recurrent venous Thromboembolism than do women, which remained 1.8-fold higher in men after adjustment for previous hormone associated venous Thromboembolism in women. In patients with a first provoked venous Thromboembolism, risk of recurrence does not differ between men and women with or without hormone associated venous Thromboembolism. Indefinite anticoagulation may be given greater consideration in men than in women after a first venous Thromboembolism.
-
risk of deep vein thrombosis following a single negative whole leg compression ultrasound a systematic review and meta analysis
JAMA, 2010Co-Authors: Stacy A Johnson, Scott M Stevens, Scott C Woller, Erica Lake, Marco P Donadini, Ji Cheng, Jose Labarere, James D DouketisAbstract:CONTEXT: In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-leg CUS may exclude proximal and distal DVT in a single evaluation. OBJECTIVE: To determine the risk of venous Thromboembolism after withholding anticoagulation in patients with suspected lower extremity DVT following a single negative whole-leg CUS result. DATA SOURCES: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, and Health Technology Assessments databases were searched for articles published from January 1970 through November 2009. Supplemental searches were performed of Internet resources, reference lists, and by contacting content experts. STUDY SELECTION: Included studies were randomized controlled trials and prospective cohort studies of patients with suspected DVT and a negative whole-leg CUS result who did not receive anticoagulant therapy, and were followed up at least 90 days for venous Thromboembolism events. DATA EXTRACTION: Two authors independently reviewed and extracted data regarding a single positive or negative whole-leg CUS result, occurrence of venous Thromboembolism during follow-up, and study quality. RESULTS: Seven studies were included totaling 4731 patients with negative whole-leg CUS examinations who did not receive anticoagulation. Of these, up to 647 patients (13.7%) had active cancer and up to 725 patients (15.3%) recently underwent a major surgery. Most participants were identified from an ambulatory setting. Venous Thromboembolism or suspected venous Thromboembolism-related death occurred in 34 patients (0.7%), including 11 patients with distal DVT (32.4%); 7 patients with proximal DVT (20.6%); 7 patients with nonfatal pulmonary emboli (20.6%); and 9 patients (26.5%) who died, possibly related to venous Thromboembolism. Using a random-effects model with inverse variance weighting, the combined venous Thromboembolism event rate at 3 months was 0.57% (95% confidence interval, 0.25%-0.89%). CONCLUSION: Withholding anticoagulation following a single negative whole-leg CUS result was associated with a low risk of venous Thromboembolism during 3-month follow-up.
-
Risk of Deep Vein Thrombosis Following a Single Negative Whole-Leg Compression Ultrasound: A Systematic Review and Meta-analysis.
Journal of the American Medical Association, 2010Co-Authors: Stacy A Johnson, Scott M Stevens, Scott C Woller, Erica Lake, Marco P Donadini, Ji Cheng, Jose Labarere, James D DouketisAbstract:CONTEXT: In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-leg CUS may exclude proximal and distal DVT in a single evaluation. OBJECTIVE: To determine the risk of venous Thromboembolism after withholding anticoagulation in patients with suspected lower extremity DVT following a single negative whole-leg CUS result. DATA SOURCES: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, and Health Technology Assessments databases were searched for articles published from January 1970 through November 2009. Supplemental searches were performed of Internet resources, reference lists, and by contacting content experts. STUDY SELECTION: Included studies were randomized controlled trials and prospective cohort studies of patients with suspected DVT and a negative whole-leg CUS result who did not receive anticoagulant therapy, and were followed up at least 90 days for venous Thromboembolism events. DATA EXTRACTION: Two authors independently reviewed and extracted data regarding a single positive or negative whole-leg CUS result, occurrence of venous Thromboembolism during follow-up, and study quality. RESULTS: Seven studies were included totaling 4731 patients with negative whole-leg CUS examinations who did not receive anticoagulation. Of these, up to 647 patients (13.7%) had active cancer and up to 725 patients (15.3%) recently underwent a major surgery. Most participants were identified from an ambulatory setting. Venous Thromboembolism or suspected venous Thromboembolism-related death occurred in 34 patients (0.7%), including 11 patients with distal DVT (32.4%); 7 patients with proximal DVT (20.6%); 7 patients with nonfatal pulmonary emboli (20.6%); and 9 patients (26.5%) who died, possibly related to venous Thromboembolism. Using a random-effects model with inverse variance weighting, the combined venous Thromboembolism event rate at 3 months was 0.57% (95% confidence interval, 0.25%-0.89%). CONCLUSION: Withholding anticoagulation following a single negative whole-leg CUS result was associated with a low risk of venous Thromboembolism during 3-month follow-up.
John A. Baron - One of the best experts on this subject based on the ideXlab platform.
-
arterial cardiovascular events statins low dose aspirin and subsequent risk of venous Thromboembolism a population based case control study
Journal of Thrombosis and Haemostasis, 2009Co-Authors: Paolo Prandoni, Henrik Toft Sørensen, Erzsebet Horvathpuho, Kirstine Kobberoe Sogaard, Steffen Christensen, Soren Paaske Johnsen, Reimar W Thomsen, John A. BaronAbstract:Summary. Background: Atherosclerotic disease has been associated with the risk of venous Thromboembolism, but the available data are conflicting. There are similar confusions regarding the association of the use of aspirin and statins with venous Thromboembolism. Objectives: To determine whether arterial cardiovascular events, use of statins and low-dose aspirin were associated with the risk of venous Thromboembolism. Patients and methods: In this population-based case–control study, we identified 5824 patients with venous Thromboembolism and 58 240 population controls with a complete hospital and prescription history. We used logistic regression to estimate the relative risk of venous Thromboembolism, adjusted for potentially confounding factors. Results: Patients with a history of arterial cardiovascular events had a clearly increased relative risk. An event within 3 months before the index date conferred large increases in risk [relative risk 4.22 (95% confidence interval (CI), 2.33–7.64) after myocardial infarction, 4.41 (95% CI, 2.92–6.65) after stroke]. Myocardial infarction more than 3 months before the index date was not significantly associated with risk, although there was a relative risk of 1.29 (95% CI, 1.05–1.57) for myocardial infarction more than 60 months previously. A history of stroke was associated with small increases in risk after 3 months. Current use of statins was associated with a reduced risk of venous Thromboembolism [relative risk = 0.74 (95% CI, 0.63–0.85)]. Aspirin use was not associated with risk. Conclusions: Patients with cardiovascular events are at a short-term increased risk of venous Thromboembolism. Statins might prevent venous Thromboembolism but aspirin does not. However, as the study is non-randomized residual confounding cannot be excluded.
-
Prognosis of cancers associated with venous Thromboembolism.
The New England journal of medicine, 2000Co-Authors: Henrik Toft Sørensen, Lene Mellemkjær, Jørgen H. Olsen, John A. BaronAbstract:Background Little is known about the prognosis of cancer discovered during or after an episode of venous Thromboembolism. Methods We linked the Danish National Registry of Patients, the Danish Cancer Registry, and the Danish Mortality Files to obtain data on the survival of patients who received a diagnosis of cancer at the same time as or after an episode of venous Thromboembolism. Their survival was compared with that of patients with cancer who did not have venous Thromboembolism (control patients), who were matched in terms of type of cancer, age, sex, and year of diagnosis. Results Of 668 patients who had cancer at the time of an episode of deep venous Thromboembolism, 44.0 percent of those with data on the spread of disease (563 patients) had distant metastasis, as compared with 35.1 percent of 5371 control patients with data on spread (prevalence ratio, 1.26; 95 percent confidence interval, 1.13 to 1.40). In the group with cancer at the time of venous Thromboembolism, the one-year survival rate was...
Jack Hirsh - One of the best experts on this subject based on the ideXlab platform.
-
edoxaban for the treatment of venous Thromboembolism in patients with cancer
The New England Journal of Medicine, 2018Co-Authors: Jack Hirsh, Jeffrey S. GinsbergAbstract:Cancer is a strong risk factor for venous Thromboembolism.1 For decades, standard treatment for all patients with venous Thromboembolism consisted of heparin followed by warfarin. The rate of recur...
-
reduction of out of hospital symptomatic venous Thromboembolism by extended thromboprophylaxis with low molecular weight heparin following elective hip arthroplasty a systematic review
JAMA Internal Medicine, 2003Co-Authors: Martin Odonnell, Loriann Linkins, Clive Kearon, Jim A Julian, Jack HirshAbstract:Background Numerous trials and meta-analyses have shown that extended out-of-hospital prophylaxis with low-molecular-weight heparin reduces asymptomatic and symptomatic venous Thromboembolism after total hip arthroplasty. We hypothesized that knowledge of the results of screening tests may have resulted in overdiagnosis of symptomatic venous Thromboembolism in many of these studies. The purpose of this analysis was to obtain an accurate estimate of the absolute risk reduction (ARR) of symptomatic venous Thromboembolism after discharge from hospital in controlled studies that avoided this potential bias for overdiagnosis. Methods Articles were identified using MEDLINE, EMBASE, and the Cochrane Library databases (January 1980–April 2002). Studies were eligible if the assessment of symptomatic venous Thromboembolism was standardized and performed independently of mandatory objective testing. Results Two studies (907 patients) were eligible for assessment of symptomatic venous Thromboembolism, 5 studies (1917 patients) for symptomatic pulmonary embolism, and 7 studies (2425 patients) for fatal pulmonary embolism. In controls vs extended treatment groups, after hospital discharge, the frequency of symptomatic venous Thromboembolism was 2.7% vs 1.1% (ARR, 1.56%; 95% confidence interval [CI], −0.21% to 3.3%; number needed to treat, 64); symptomatic pulmonary embolism was 0.36% vs 0% (ARR, 0.36%; 95% CI, −0.3% to 1.36%; number needed to treat, 278); and fatal pulmonary embolism was 0.09% vs 0% (ARR, 0.09%; 95% CI, −0.08% to 0.27%; number needed to treat, 1093). Conclusions The absolute reduction in symptomatic venous Thromboembolism attributed to extended prophylaxis in some studies and meta-analyses seems to have been overestimated.
Scott A. Flanders - One of the best experts on this subject based on the ideXlab platform.
-
assessing the caprini score for risk assessment of venous Thromboembolism in hospitalized medical patients
The American Journal of Medicine, 2016Co-Authors: Vineet Chopra, Paul J. Grant, Steven J. Bernstein, Todd M Greene, Timothy P Hofer, Scott A. FlandersAbstract:Abstract Background The optimal approach to assess risk of venous Thromboembolism in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model predicts venous Thromboembolism in hospitalized medical patients. Methods Between January 2011 and March 2014, venous Thromboembolism events and risk factors were collected from non-intensive care unit medical patients hospitalized in facilities across Michigan. After calculation of the Caprini score for each patient, mixed logistic spline regression was used to determine the predicted probabilities of 90-day venous Thromboembolism by receipt of pharmacologic prophylaxis across the Caprini risk continuum. Results A total of 670 (1.05%) of 63,548 eligible patients experienced a venous Thromboembolism event within 90 days of hospital admission. The mean Caprini risk score was 4.94 (range, 0-28). Predictive modeling revealed a consistent linear increase in venous Thromboembolism for Caprini scores between 1 and 10; estimates beyond a score of 10 were unstable. Receipt of pharmacologic prophylaxis resulted in a modest decrease in venous Thromboembolism risk (odds ratio, 0.85; 95% confidence interval, 0.72-0.99; P = .04). However, the low overall incidence of venous Thromboembolism led to large estimates of numbers needed to treat to prevent a single venous Thromboembolism event. A Caprini cut-point demonstrating clear benefit of prophylaxis was not detected. Conclusions Although a linear association between the Caprini risk assessment model and the risk of venous Thromboembolism was noted, an extremely low incidence of venous Thromboembolism events in non-intensive care unit medical patients was observed. The Caprini risk assessment model was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis.
-
Validation of Risk Assessment Models of Venous Thromboembolism in Hospitalized Medical Patients
The American journal of medicine, 2016Co-Authors: M. Todd Greene, Alex C Spyropoulos, Vineet Chopra, Paul J. Grant, Scott Kaatz, Steven J. Bernstein, Scott A. FlandersAbstract:Abstract Background Patients hospitalized for acute medical illness are at increased risk for venous Thromboembolism. Although risk assessment is recommended and several at-admission risk assessment models have been developed, these have not been adequately derived or externally validated. Therefore, an optimal approach to evaluate venous Thromboembolism risk in medical patients is not known. Methods We conducted an external validation study of existing venous Thromboembolism risk assessment models using data collected on 63,548 hospitalized medical patients as part of the Michigan Hospital Medicine Safety (HMS) Consortium. For each patient, cumulative venous Thromboembolism risk scores and risk categories were calculated. Cox regression models were used to quantify the association between venous Thromboembolism events and assigned risk categories. Model discrimination was assessed using Harrell's C-index. Results Venous Thromboembolism incidence in hospitalized medical patients is low (1%). Although existing risk assessment models demonstrate good calibration (hazard ratios for "at-risk" range 2.97-3.59), model discrimination is generally poor for all risk assessment models (C-index range 0.58-0.64). Conclusions The performance of several existing risk assessment models for predicting venous Thromboembolism among acutely ill, hospitalized medical patients at admission is limited. Given the low venous Thromboembolism incidence in this nonsurgical patient population, careful consideration of how best to utilize existing venous Thromboembolism risk assessment models is necessary, and further development and validation of novel venous Thromboembolism risk assessment models for this patient population may be warranted.