Venous thromboembolism: Why is it still a significant health problem?

Oleksiuk-Bójko, Monika; Lisowska, Anna

doi:10.1016/j.advms.2022.10.002

Cited by 9 publications

(5 citation statements)

References 99 publications

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“…Venous thromboembolic events (VTE), presenting as deep vein thrombosis (DVT) and pulmonary embolism (PE), impact millions of people worldwide each year (1)(2)(3) , ranking as the third leading cause of acute cardiovascular syndrome (4,5) . In the UK, the incidence rate is 1-2 per 1,000 people (6,7) and the crude mortality rate associated with VTE within 90 days following discharge from hospital is 99.4 per 100,000 people (8) .…”

Section: Introductionmentioning

confidence: 99%

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

Gallier,

Evison,

Hodson

et al. 2024

Preprint

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ObjectiveDespite recommendations, age adjusted thresholds (AAT) for D Dimers are not routinely used as part of venous thromboembolism (VTE) screening in many healthcare settings due to concerns about missing cases, especially in older and co-morbid adults. The National Institute for Health and Care Excellence in the UK has highlighted that evidence to support AAT is not plentiful. This study assessed the real-world use of AAT D-dimers for VTE in a large cohort of acutely hospitalised patients.MethodsThis retrospective data study included all adult patients attending a large hospital with a suspected VTE between January 2017 to December 2021. The predictive accuracy of D-dimer was assessed against gold standard imaging. Outcomes of false negative (with AAT) and false positives (with standard thresholds) cases were assessed.Results27,526 suspected VTE attendances were included, with a 4.3% confirmed VTE diagnosis rate. The ST D-dimer exhibited high sensitivity (91.1%) but modest specificity (65.2%). The AAT demonstrated slightly lower sensitivity (87.0%) but higher specificity (71.7%, p<0.001). The performance of ST thresholds declined with age, with false positive rates increasing from 17.4% to 80.0% in people aged < 50 years and > 90 years respectively. The AAT accurately identified 1,700 true negatives misclassified as false positives by the ST. 14 patients in this group were admitted with a bleed within 30 days. AAT misdiagnosed 24 cases as false negatives, with most being small sub-segmental pulmonary emboli or non-occlusive DVTs. Using AAT thresholds could have avoided 64 scans per 1,000 attendances, saving approximately £235,310 of imaging costs in this cohort.ConclusionThe age-adjusted D-dimer threshold enhances diagnostic precision and could decrease unnecessary imaging and anticoagulation, reducing investigations with time and cost savings with no significant safety signal.

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Section: Introductionmentioning

confidence: 99%

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

Gallier,

Evison,

Hodson

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…VTE, encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the third most common cardiovascular disease after acute coronary heart disease and stroke 7 . This global health concern is responsible for a significant number of deaths annually and imposes substantial economic and psychological burdens on individuals and society 8 .…”

Section: Introductionmentioning

confidence: 99%

Exploration of effective biomarkers for venous thrombosis embolism in Behçet’s disease based on comprehensive bioinformatics analysis

Liu,

Wang,

et al. 2024

Sci Rep

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Behçet’s disease (BD) is a multifaceted autoimmune disorder affecting multiple organ systems. Vascular complications, such as venous thromboembolism (VTE), are highly prevalent, affecting around 50% of individuals diagnosed with BD. This study aimed to identify potential biomarkers for VTE in BD patients. Three microarray datasets (GSE209567, GSE48000, GSE19151) were retrieved for analysis. Differentially expressed genes (DEGs) associated with VTE in BD were identified using the Limma package and weighted gene co-expression network analysis (WGCNA). Subsequently, potential diagnostic genes were explored through protein–protein interaction (PPI) network analysis and machine learning algorithms. A receiver operating characteristic (ROC) curve and a nomogram were constructed to evaluate the diagnostic performance for VTE in BD patients. Furthermore, immune cell infiltration analyses and single-sample gene set enrichment analysis (ssGSEA) were performed to investigate potential underlying mechanisms. Finally, the efficacy of listed drugs was assessed based on the identified signature genes. The limma package and WGCNA identified 117 DEGs related to VTE in BD. A PPI network analysis then selected 23 candidate hub genes. Four DEGs (E2F1, GATA3, HDAC5, and MSH2) were identified by intersecting gene sets from three machine learning algorithms. ROC analysis and nomogram construction demonstrated high diagnostic accuracy for these four genes (AUC: 0.816, 95% CI: 0.723–0.909). Immune cell infiltration analysis revealed a positive correlation between dysregulated immune cells and the four hub genes. ssGSEA provided insights into potential mechanisms underlying VTE development and progression in BD patients. Additionally, therapeutic agent screening identified potential drugs targeting the four hub genes. This study employed a systematic approach to identify four potential hub genes (E2F1, GATA3, HDAC5, and MSH2) and construct a nomogram for VTE diagnosis in BD. Immune cell infiltration analysis revealed dysregulation, suggesting potential macrophage involvement in VTE development. ssGSEA provided insights into potential mechanisms underlying BD-induced VTE, and potential therapeutic agents were identified.

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“…Venous thromboembolic disease (VTE) is the third leading cause of cardiovascular death globally, with a 30-day mortality rate of 5.2% in patients with pulmonary embolism (PE) and 3.3% in patients with proximal deep vein thrombosis (DVT). 1 , 2 The prevalence of VTE is especially high among patients with cancer, who have an approximately 9-fold higher risk than the general population. 3 , 4 Different studies have identified advanced-stage cancer as a strong independent risk factor for the development of VTE within the first year after diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with in-hospital and outpatient survival of patients with different types of stage IV cancer and venous thromboembolism

Reyes,

Ruiz-Talero,

Arenas

et al. 2023

J Int Med Res

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Objective To identify factors associated with in-hospital and outpatient survival of patients with different types of stage IV cancer who present with venous thromboembolic disease (VTE). Methods In this prospective cohort, in-hospital and outpatient survival rates up to 180 days were analyzed using Kaplan–Meier curves. Cox regression was used to identify factors associated with different survival functions. Results One hundred patients were analyzed (median age, 67.5 years; 75% with Charlson index of <10; 69% with Eastern Cooperative Oncology Group (ECOG) score of 3–4). In-hospital mortality was 18%, and the median time from admission to death was 11 days (interquartile range, 1–61 days). Factors significantly associated with in-hospital mortality were the ECOG score and thrombocytopenia. The 180-day mortality rate was 52%, with deaths mainly occurring in the first 90 days since VTE diagnosis. Additional factors significantly associated with outpatient mortality included male sex and neoplasms with a high risk of thrombosis (lung, pancreas, stomach, uterus, bladder, and kidney neoplasms). Conclusion Patients with stage IV cancer and acute VTE have short survival. Poor prognostic factors are thrombocytopenia, the ECOG score, and certain types of cancer. These results may help physicians individualize decisions regarding initiation and continuation of anticoagulant therapy.

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Venous thromboembolism: Why is it still a significant health problem?

Cited by 9 publications

References 99 publications

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

The safety and efficacy of using age-adjusted D-dimers in hospitalised patients in a diverse urban centre: a real-world data study

Exploration of effective biomarkers for venous thrombosis embolism in Behçet’s disease based on comprehensive bioinformatics analysis

Factors associated with in-hospital and outpatient survival of patients with different types of stage IV cancer and venous thromboembolism

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