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Summary.  Background: Appropriate periprocedural management for chronically anticoagulated patients requires assessment of patient‐specific thrombosis and bleeding risks. However, predictors of post‐procedure bleeding are unknown. Objectives: To determine the 3‐month cumulative incidence and independent predictors of peri‐procedural bleeding in chronically anticoagulated patients requiring temporary warfarin interruption for an invasive procedure. Methods: In a protocol driven, cohort study design, all patients referred to the Mayo Clinic Thrombophilia Center for peri‐procedural anticoagulation management (1997–2007; n = 2182), were followed forward in time to determine the 3‐month cumulative incidence of peri‐procedural bleeding (Kaplan–Meier product limit) and potential predictors of bleeding (Cox proportional hazards). Decisions to ‘bridge’ with low‐molecular‐weight heparin were based on estimated thromboembolism and bleeding risk. Results: Indications for chronic anticoagulation included venous thromboembolism (38%), atrial fibrillation (30%) and mechanical heart valves (27%). Of these, 1496 (69%) patients received bridging therapy. The 3‐month cumulative incidence rates of major and overall bleeding were 2.1% and 5.1%, respectively. Major bleeding occurred more frequently in patients receiving bridging therapy (3% vs. 1%; P = 0.017). Independent predictors (hazard ratio; 95% confidence interval) of major bleeding included mitral mechanical heart valve (2.2; 1.1–4.3), active cancer (1.8; 1.0–3.1), prior bleeding history (2.6; 1.5–4.5) and re‐initiation of heparin therapy within 24 h after the procedure (1.9; 1.1–3.4). Conclusion: Factors predisposing to peri‐procedural bleeding are primarily patient‐specific. Premature heparin re‐initiation is an avoidable provider‐specific variable to consider.

When compared with Whites, Black-Americans may have a 40% higher incidence venous thromboembolism (VTE) incidence. However, whether other VTE characteristics and risk factors vary by race is uncertain. To compare demographic and baseline characteristics among White-and Black-Americans with VTE, we used data prospectively collected from consecutive consenting adults enrolled in seven Centers for Disease Control (CDC) Thrombosis and Hemostasis Centers from August 2003 to March 2009. These characteristics were compared among Whites (n 5 2002) and Blacks (n 5 395) with objectively diagnosed VTE, both overall, and by age and gender. When compared with Whites, Blacks had a significantly higher proportion with pulmonary embolism (PE), including idiopathic PE among Black women, and a significantly higher proportion of Blacks were women. Blacks had a significantly higher mean BMI and a significantly lower proportion with recent surgery, trauma or infection, family history of VTE, and documented thrombophilia (solely from reduced factor V Leiden and prothrombin G20210A prevalence). Conversely, Blacks had a significantly higher proportion with hypertension, diabetes mellitus, chronic renal disease and dialysis, HIV, and sickle cell disease. When compared with White women, Black women had a significantly lower proportion with recent oral contraceptive use or hormone therapy. We conclude that Whites and Blacks differ significantly regarding demographic and baseline characteristics that may be risk factors for VTE. The prevalence of transient VTE risk factors and idiopathic VTE among Blacks appears to be lower and higher, respectively, suggesting that heritability may be important in the etiology of VTE among Black-Americans. Am. J. Hematol. 85:467-471, 2010. V V C 2010 Wiley-Liss, Inc. IntroductionMost epidemiologic studies of venous thromboembolism (VTE) risk factors have been conducted within White-American and -European populations [1][2][3][4]. However, when compared with Whites, Black-Americans appear to have a higher risk for [5,6] and incidence of VTE [7][8][9][10]. Two single-nucleotide polymorphisms, factor V Leiden (G1691A) and prothrombin G20210A, have been identified as risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) in Europeans and White-Americans, [11][12][13][14][15][16] but not Black-Americans [6,17,18]. We hypothesized that the apparent higher VTE incidence among Blacks might be due to an increased prevalence of known VTE risk factors. To test this hypothesis, we compared demographic and baseline clinical characteristics from White-and Black-Americans with objectively diagnosed VTE who were seen in one of the seven CDC Thrombosis and Hemostasis Research and Prevention Network centers.

Previous research has suggested autoimmune diseases are risk factors for developing venous thromboembolism (VTE). We assessed whether having diagnoses of selected autoimmune diseases associated with anti-phospholipid antibodies—autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE)—were associated with having a VTE diagnosis among US adult hospitalizations. A cross-sectional study was conducted using the 2010 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. VTE and autoimmune diseases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification coded diagnoses information. The percentages of hospitalizations with a VTE diagnosis among all non-maternal adult hospitalizations without any of the four autoimmune diseases of interest and among those with AIHA, ITP, RA, and SLE diagnoses were 2.28, 4.46, 3.35, 2.65 and 2.77 %, respectively. The adjusted odds ratios (OR) for having a diagnosis of VTE among non-maternal adult hospitalizations with diagnoses of AIHA, ITP, RA, and SLE were 1.25 [95 % confidence interval (CI) 1.05–1.49], 1.20 (95 % CI 1.07–1.34), 1.17 (95 % CI 1.13–1.21), and 1.23 (95 % CI 1.15–1.32), respectively, when compared to those without the corresponding conditions. The adjusted OR for a diagnosis of VTE associated with a diagnosis of any of the four autoimmune diseases was 1.20 (95 % CI 1.16–1.24). The presence of a diagnosis of AIHA, ITP, RA, and SLE was associated with an increased likelihood of having a VTE diagnosis among the group of all non-maternal adult hospitalizations.

Background Contemporary incidence data for venous thromboembolism (VTE) from racially diverse populations are limited. The racial distribution of Oklahoma County closely mirrors that of the United States. Objective To evaluate VTE incidence and mortality, including demographic and racial subgroups. Design Population-based prospective study. Setting We conducted VTE surveillance at all relevant tertiary care facilities and outpatient clinics in Oklahoma County, Oklahoma during 2012 to 2014, using both active and passive methods. Active surveillance involved reviewing all imaging reports used to diagnose VTE. Passive surveillance entailed identifying VTE events from hospital discharge data and death certificate records. Measurements We used Poisson regression to calculate crude, age-stratified, and age-adjusted incidence and mortality rates per 1,000 population per year and 95% confidence intervals (CIs). Results The incidence rate of all VTE was 3.02 (2.92–3.12) for those age ≥18 years and 0.05 (0.04–0.08) for those <18 years. The age-adjusted incidence rates of all VTE, deep vein thrombosis, and pulmonary embolism were 2.47 (95% CI: 2.39–2.55), 1.47 (1.41–1.54), and 0.99 (0.93–1.04), respectively. The age-adjusted VTE incidence and the 30-day mortality rates, respectively, were 0.63 and 0.121 for Asians/Pacific Islanders, 3.25 and 0.355 for blacks, 0.67 and 0.111 for Hispanics, 1.25 and 0.195 for Native Americans, and 2.71 and 0.396 for whites. Conclusion The age-adjusted VTE incidence and mortality rates vary substantially by race. The incidence of three per 1,000 adults per year indicates an important disease burden, and is informative of the burden in the U.S. population.

have darker skin than White-Americans, they have lower serum D] levels, with mean value of 16 ng/mL compared with 26 ng/mL for White-Americans [2]. Lower serum 25(OH)D levels are a risk factor for cardiovascular disease in general [3] and venous thrombotic events in particular [4], as well as Type 2 diabetes mellitus [3]. A recent review concluded that the disparities in serum 25(OH)D levels can account for most of the 25% higher mortality rates for Black-Americans compared with White-Americans [5]. If Black-Americans were to supplement with 2,000-5,000 IU/day of vitamin D3, which would raise serum 25(OH)D levels from a mean value of 16 ng/mL to 30-50 ng/mL, they would significantly reduce their risk of venous thromboembolism, other cardiovascular diseases, Type 2 diabetes mellitus, many types of cancer, and a number of bacterial and infectious diseases [3,5]. Acute lymphoblastic leukemia in a patient with type 1 Gaucher disease developing 1 year after discontinuation of enzyme replacement therapy WILLIAM B. GRANTTo the editor: Gaucher disease (GD) is the commonest lysosomal storage disorder resulting because of the deficiency of an enzyme beta glucocerebrosidase. The progressive glucocerebroside accumulation in the macrophages provides a chronic antigenic stimulus to the immune system resulting in lymphoproliferation and impaired cellular immunity. This could lead to the pathogenesis of hematological malignancy; the mean age of presentation for which is reported to be 57 years [1]. Enzyme replacement therapy (ERT) is the standard of treatment in GD, but it is unknown if it has a role in mitigating cancer development. Our patient was a 31-year-old male with a family history of GD and was diagnosed to have type 1 GD at age 14. The patient had been relatively free from any significant complications associated with the disease. He presented

IDEAL-X, a novel information extraction software system, identified VTE from radiology reports with high accuracy, with specificity surpassing AHRQ PSI-12. IDEAL-X could potentially improve detection and surveillance of many medical conditions from free text of electronic medical records.