肺癌合并静脉血栓栓塞症患者的危险因素及预后分析

目的探讨肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)发生的相关危险因素及VTE对预后生存的影响。方法回顾性收集2011年6月至2017年6月在中国医学科学院北京协和医学院肿瘤医院经细胞学或病理确诊为肺癌,接受系统性治疗的507例患者临床资料,分为VTE组(71例),非VTE组(436例)。单因素分析比较两组患者的临床特征、实验室检查结果,多因素logistic回归分析影响肺癌患者VTE发生的危险因素,Kaplan-Meier生存分析法绘制生存曲线。结果507例患者VTE发生率14.0%(71/507)。单因素分析示肺癌VTE组患者的Ⅲ~Ⅳ期、合并高血压病、心力衰竭、D-二聚体≥1.05mg/L、中心静脉置管(central venous catheter CVC)的比例显著高于非VTE组(P<0.05)。两组患者年龄、性别、卡氏体力状态评分(Karnofsky score,KPS)、体重指数(body mass index,BMI)、表皮生长因子(epidermal growth factor receptor,EGFR)基因突变、合并冠心病、糖尿病、心房颤动、化疗、放疗、白细胞计数、血小板计数、血红蛋白、甘油三酯、总胆固醇水平等变量比较,差异无显著性(P>0.05);多因素logistic回归分析显示:Ⅲ~Ⅳ期、合并高血压病、D-二聚体≥1.05mg/L、CVC是影响肺癌患者VTE发生的独立危险因素(P<0.05)。Kaplan-Meier生存分析法绘制生存曲线,VTE组患者中位生存时间42.0个月(95%CI:32.278~51.722),非VTE组为49.0个月(95%CI:44.234~53.766),差异有显著性(P=0.041)。结论临床分期Ⅲ~Ⅳ期、合并高血压病、D-二聚体≥1.05mg/L、CVC是肺癌患者VTE发生的独立危险因素,肺癌合并VTE的患者预后差,积极防治肺癌患者VTE相关危险因素,有助于降低VTE发生风险,改善患者预后。     

肺癌合并静脉血栓栓塞症的高危因素及预防性抗凝治疗分析

目的：分析肺癌合并静脉血栓栓塞症（VTE）的高危因素,了解预防性抗凝的重要性。方法：选取2018年2月~2021年2月收治的48例肺癌合并VTE患者作为VTE组,选取同期入院治疗的52例未合并VTE的肺癌患者作为非VTE组。收集两组患者一般临床资料,采用单因素和Logistic回归分析肺癌合并VTE的高危因素。结果：两组年龄、性别、是否合并心血管疾病、是否合并肺部疾病、是否合并糖尿病、是否靶向治疗比较,差异无统计学意义（P＞0.05）;VTE组ⅢB~Ⅳ期、腺癌、手术、放疗、化疗、高D-二聚体（D-dimmer, DD）、未行预防性抗凝治疗比例高于非VTE组,差异有统计学意义（P＜0.05）。ⅢB~Ⅳ期、腺癌、手术、放疗、化疗、高DD、未行预防性抗凝治疗均是VTE发生的独立危险因素（P＜0.05）。结论：ⅢB~Ⅳ、腺癌、手术、放疗、化疗、高DD、未行预防性抗凝治疗均是肺癌患者并发VTE的独立危险因素,临床应注重高危患者的识别,并进行预防性抗凝治疗,降低VTE发生率。     

肺癌合并静脉血栓栓塞症患者的临床特点及预后分析

目的分析肺癌合并静脉血栓栓塞症(VTE)患者的临床特点及其预后。方法选取2013年2月至2015年2月肺癌合并VTE患者62例,其中肺血栓栓塞(PTE)36例,深静脉血栓(DVT)26例。均采用溶栓+抗凝或单纯抗凝进行治疗,观察分析肺癌合并VTE患者的临床特点及预后。结果 44例接受化疗后采用溶栓+抗凝的VTE患者中,30例有效,9例无效自动出院,5例死亡,有效率为68.18%。18例单纯抗凝治疗者中,11例有效,5例无效自动出院,2例死亡,有效率为61.11%。所有患者住院期间有效41例,有效率为66.13%;死亡7例,病死率为11.29%。结论 VTE是肺癌的主要并发症之一,其主要临床特点表现为胸闷气短、胸痛、咯血、呼吸急促、咳嗽以及胸腔积液等症状,及时确诊加上有效的治疗措施可缓解患者的病情,改善临床症状。     

改良Wells评分对肺癌合并静脉血栓栓塞症的诊断价值

目的 评估改良Wells评分对肺癌合并静脉血栓栓塞症（VTE）的诊断价值。方法 选取住院的肺癌患者145例,评价Wells评分、血浆D 二聚体水平对肺癌合并VTE的诊断价值。结果 血浆D 二聚体诊断肺癌合并VTE的最佳截断值为2.51 mg/L,Wells评分诊断肺癌合并VTE的AUC为0.703［95%CI（0.621,0.776）］,Youden指数为0.407,最佳截断值为2分,其灵敏度为66.7%,特异度为74%;改良Wells评分诊断肺癌合并VTE的AUC为0.855［95%CI（0.787,0.908）］,Youden指数为0.543,最佳截断值为2分,其灵敏度为93.3%,特异度为61%。改良Wells评分与Wells评分在诊断肺癌合并VTE的AUC差异有统计学意义［Z=4.712,95%CI（0.088,0.215）,P<0.05］。结论 改良Wells评分对肺癌合并VTE 具有较高的诊断价值。     

Caprini血栓风险评估在电视胸腔镜肺癌根治术病人中的应用

目的:观察Caprini血栓风险评估模型用于预测电视胸腔镜(VATS)肺癌根治术后静脉血栓栓塞(VTE)的价值,以指导临床合理预防VTE发生.方法:选择2018年1月—2020年1月医院行VATS肺癌根治术的204例肺癌病人作为研究对象,于术后采用Caprini及Padua血栓风险评估模型评估病人VTE风险,并记录病人VTE发生情况,分析Caprini及Padua血栓风险评估模型对VATS肺癌根治术后VTE发生的预测价值.结果:204例VATS肺癌根治术病人的VTE发生率为10.78％;VTE病人Caprini及Padua血栓风险评分均高于无VTE病人(P<0.05);组间其他基线资料比较差异无统计学意义(P>0.05);经单项Logistic回归分析后建立Logistic多元回归模型行多因素分析,结果显示,VATS肺癌根治术病人病程、Caprini及Padua血栓风险评分是VATS肺癌根治术后病人VTE发生的影响因素(P<0.05);绘制受试者工作曲线(ROC)发现,术后6 h时Caprini血栓风险评分预测VATS肺癌根治术后VTE发生风险的曲线下面积(AUC)>0.90,有高预测性能,Padua血栓风险评分预测术后VTE发生风险的AUC>0.80,有一定预测性能.结论:Caprini血栓风险评分与VATS肺癌根治术后VTE的发生有定性关系,预测VTE的价值较Padua血栓风险评估模型高,可根据评分结果进一步制定针对性VTE预防措施,可能对改善VATS肺癌根治术病人预后有积极意义.     

髋关节置换术后症状性静脉血栓栓塞症的发生情况及危险因素

目的:探讨髋关节置换术后症状性静脉血栓栓塞症(venous thromboembolism,VTE)发生情况及危险因素。方法:选择2018年10月至2020年10月南京大学医学院附属鼓楼医院收治的行髋关节置换术患者300例,将术后发生症状性VTE患者纳入VTE组,将术后未发生症状性VTE患者纳入非VTE组。对比两组临床资料、D-二聚体水平,并对髋关节置换术后症状性VTE发生的危险因素进行单因素分析与logistic回归分析。结果:在300例患者中,15例发生症状性深静脉血栓,4例发生症状性肺栓塞,症状性VTE发生率为6.33%(19/300);与非VTE组比较,VTE组在年龄、手术类型、住院时间、有脑梗死病史、合并糖尿病等方面的差异均有统计学意义(均P<0.05);经多因素logistic回归分析,年龄≥72岁、住院时间>14 d、有脑梗死病史、糖尿病是引发髋关节置换术后症状性VTE发生的危险因素(P<0.05)。非VTE组术后第1天、第3天、第7天的D-二聚体水平均高于VTE组,差异均有统计学意义(均P<0.05)。结论:髋关节置换术患者术后发生症状性VTE的主要危险因素为年龄高、住院时间长、存在脑梗死病史、合并糖尿病,临床应密切观察高危人群,并密切监测术后7 d内D-二聚体水平变化,便于及时采取有效措施,减少症状性VTE的发生。     

Caprini与Khorana风险评估量表对恶性肿瘤患者发生静脉血栓栓塞症的预测价值

目的 探讨Caprini与Khorana量表对恶性肿瘤患者静脉血栓栓塞症(VTE)发病风险的预测价值。方法 回顾性分析安岳县人民医院2019年1月至2021年12月收治的恶性肿瘤患者的临床资料,观察组为合并VTE的98例患者,对照组为按照接近1:2比例选取的未合并VTE的173例患者。采用ROC曲线探讨Caprini评分与Khorana评分对恶性肿瘤患者发生VTE的预测效果。结果 两组患者在Caprini评分和Khorana评分分级中的人数占比差异有统计学意义(P<0.05),Logistic多元回归分析结果显示肿瘤分期、年龄、血小板计数、近2周内化疗史是恶性肿瘤患者发生VTE的危险因素(P<0.05);ROC曲线分析显示,联合预测模型的AUC(0.820,95%CI:0.767～0.872)高于Caprini评分(0.796,95%CI:0.743～0.849)或Khorana评分(0.761,95%CI:0.698～0.823)单独预测的结果(P<0.05)。联合预测模型的敏感度、特异度分别为81.5%和74.8%。结论 使用Caprini与Khorana风险评估...     

抗凝治疗在危重型新型冠状病毒肺炎合并静脉血栓栓塞症中的应用

目的 探讨抗凝治疗在危重型新型冠状病毒肺炎(新冠肺炎)合并静脉血栓栓塞症(VTE)患者中的应用效果.方法 收集2020年1月30日至3月7日内蒙古科技大学包头医学院第一附属医院收治的3例危重型新冠肺炎患者的临床资料,记录患者的症状及辅助检查情况、治疗方法及预后,分析抗凝治疗对患者VTE的影响.结果 3例患者中,2例行无...     

老年肺癌患者静脉血栓栓塞症风险预测工具的比较研究

目的 比较4种静脉血栓栓塞症（venous thromboembolism,VTE）风险评估工具对老年肺癌患者发生VTE的预测效能。方法 连续选择2020年1月—2022年6月,北京市某三级甲等医院呼吸与危重症医学科住院的老年肺癌患者,采用Caprini评分、Padua评分、Khorana评分和COMPASS-CAT评分4种风险评估工具进行血栓风险评估,并随访至入组后第6个月。根据各评分对应截断值将患者分为低中危组和高危组,比较两组之间发生VTE的差异。利用受试者工作特征曲线下面积评价4种VTE预测工具对老年肺癌患者远期发生VTE的预测效能。结果 纳入111例老年肺癌患者,入组后6个月内,20例（18.0%）发生VTE。VTE组和未发生VTE组D-二聚体的比较,差异有统计学意义（P<0.05）。Caprini评分高危组VTE发生率显著高于中危组,差异有统计学意义（P=0.022）,Padua评分高危组VTE发生率显著高于低危组,差异有统计学意义（P<0.001）,而Khorana和COMPASS-CAT评分高危组VTE发生率均高于非高危组,但差异无统计学意义（均P>0...     

恶性肿瘤合并静脉血栓栓塞107例临床分析

目的 探讨恶性肿瘤合并静脉血栓栓塞(VTE)患者的临床特征,为恶性肿瘤合并VTE的早期预防及诊治提供临床依据.方法 对我院2009年6月至2011年6月收治的107例恶性肿瘤合并静脉血栓患者的临床资料进行回顾性研究.结果 107例恶性肿瘤合并VTE患者中,单纯深静脉血栓(DVT) 90例(84.1％);肺血栓栓塞症(PTE)17例(15.9％),其中合并DVT 7例(6.5％,7/107).平均年龄(59.6±10.5)岁,≥60岁63例(58.9％).Ⅲ～Ⅳ期恶性肿瘤61例(57.0％).69例(64.5％)VTE发生于恶性肿瘤诊断后3个月内,43例(40.2％)VTE发生于手术后1个月内,其中术后1～7天30例(28.0％).91例DVT患者中84例接受抗凝治疗,49例治疗后好转,有效率为58.3％(49/84).PTE患者溶栓联合抗凝治疗2例,1例治疗后明显好转,1例好转;单纯抗凝治疗12例,3例明显好转,6例好转,3例无效.本组PTE患者抗凝溶栓治疗的有效率78.6％(11/14),病死率29.4％ (5/17).结论 恶性肿瘤诊断后3个月内、手术后1个月尤其是1周内,Ⅲ～Ⅳ期、≥60岁的患者高发VTE.VTE(尤其是PTE)可以增加恶性肿瘤患者的病死率,影响其预后.对于恶性肿瘤合并VTE患者的早期诊断与治疗是降低病死率及改善预后的关键.     

基于Caprini模型评价胸腔镜下肺叶切除术后肺癌患者静脉血栓栓塞症发生风险

目的探讨基于Caprini模型评价胸腔镜下肺叶切除术后患者发生静脉血栓栓塞症(VTE)的风险,并分析VTE发生的相关危险因素。方法选取2016年1月—2018年1月在山东省胸科医院进行胸腔镜下肺叶切除术治疗的42例早期肺癌患者作为对照组,另选取同期在同家医院行手术且术后并发VTE的28例早期肺癌患者作为观察组。收集、对比两组患者的一般资料和Caprini风险评估得分,分析Caprini风险评估模型中的危险因素。结果观察组的年龄、术前纤维蛋白原、术前D-二聚体均高于对照组,观察组的恶性肿瘤史、BMI≥25 kg/m2、高血压、高血糖、方式为叶切、有吸烟史的比例均高于对照组,差异均有统计学意义(P<0.05)。观察组Caprini风险评估得分高于对照组,差异有统计学意义(P<0.01)。多因素分析结果显示,肺癌患者胸腔镜下肺叶切除术后VTE的危险因素为血浆D-二聚体高于临界值、有吸烟史、BMI≥25 kg/m2(P<0.05)。结论Caprini风险模型能有效预测胸腔镜肺叶切除术后患者发生VTE,可分类量化DVT发病风险。术前血浆D-二聚体升高、体重超重、重度吸烟史可能是胸腔镜肺叶术后患者发生VTE的高危因素。     

The incidence of venous thromboembolism among patients with primary lung cancer

Background:  The incidence of venous thromboembolism (VTE) by lung cancer histology and stage is unknown. Objectives:  To determine the incidence of VTE and the risk factors associated with development of VTE in a large population-based study of patients with non-small cell and small cell lung cancer. Methods:  The California Cancer Registry was merged with the Patient Discharge Data Set to determine the incidence of VTE among lung cancer cases diagnosed between 1993 and 1999. Results:  Among 91 933 patients with newly diagnosed lung cancer, the 1-year and 2-year cumulative VTE incidences were 3.0% and 3.4%, respectively, with a person-time rate of 7.2 events/100 patient-years during the first 6 months. The 1-year incidence of VTE was significantly increased in comparison to the general population [standardized incidence ratio = 21.2, 95% confidence interval (CI) = 20.4–22.0]. In a multivariate model, significant predictors of developing VTE within 1 year of non-small cell lung cancer (NSCLC) diagnosis were: younger age, the number of chronic medical comorbidities [hazard ratio (HR) = 2.8 if 3 vs. 0, 95% CI = 2.5–3.1], advancing cancer stage (HR = 4.0 for metastatic vs. local disease, 95% CI = 3.4–4.6) and adenocarcinoma histology (HR = 1.9 vs. squamous cell, 95% CI = 1.7–2.1). In multivariate models, VTE was a significant predictor of death within 2 years for both NSCLC and small cell lung cancer (SCLC), HR = 2.3, 95% CI = 2.2–2.4, and HR = 1.5, 95% CI = 1.3–1.7, respectively. Conclusions:  Approximately 3% of lung cancer patients developed VTE within 2 years. The diagnosis of VTE was associated with a higher risk of death within 2 years for NSCLC and SCLC.     

奥氮平使用合并静脉血栓栓塞症16例临床分析

目的 提高对精神疾病患者静脉血栓栓塞症(venous thromboembolism, VTE)的早期识别、早期诊断水平。方法 纳入2019年5月-2022年3月首诊于浙江大学医学院附属邵逸夫医院精神卫生科的精神疾病合并VTE的患者16例,收集这些患者的临床症状、实验室及影像学检查、抗精神疾病用药情况及治疗预后等。结果 16例患者中,男性6例,女性10例,平均年龄67岁,其中13例诊断为肺栓塞,4例为下肢静脉血栓,其中1例患者表现为肺栓塞合并下肢静脉血栓。肺栓塞和下肢静脉血栓的确诊遵循中国血栓性疾病防治指南2018版。12例肺栓塞为低危,1例为高危。有2例患者发病前有一过性的胸闷气急、呼吸费力,余14例患者无明显的胸闷气急、呼吸费力等症状。16例患者D-二聚体均异常,9例患者存在高脂血症,8例存在高同型半胱氨酸血症,5例存在高催乳素血症,2例存在凝血因子Ⅷ升高。10例患者的VTE发生在使用抗精神病药物的前6个月内,3例发生在1年内,3例发生在5年内。16例患者均使用了奥氮平。使用Caprini和Padua血栓风险评估量表评估,16例患者血栓风险均为低度。结论 精神疾病患者发生VTE事件...     

孕产妇静脉血栓栓塞症相关风险因素分析

目的：探讨孕产妇发生静脉血栓栓塞症（venous thromboembolism，VTE）的相关危险因素。方法：采用回顾性病例对照研究，选取我院2010-2020年收治的38例发生VTE的孕产妇作为观察组，同时随机选取同时段我院199例未发生VTE的孕产妇作为对照组。将两组患者的高危因素、Caprini评分及《产科静脉血栓栓塞症综合防治上海共识》中孕产妇静脉血栓栓塞风险因素评分（简称孕产妇VTE评分）、实验室指标等因素纳入统计学分析。结果：产褥期发生VTE的比例最高(65.79%,25/38)。发生类型最高的为下肢深静脉血栓形成，其次为颅内静脉血栓形成。其中2例死亡原因为广泛颅内静脉血栓形成伴脑梗死出血转化，1例为晚期乳腺癌并发肺栓塞形成。logistic回归单因素分析显示剖宫产、孕产妇VTE风险评分、血红蛋白、血小板计数、D-二聚体、凝血酶原时间、活化部分凝血酶原时间有统计学差异（P＜0.05）。多因素回归分析结果显示孕产妇VTE风险评分、D-二聚体、凝血酶原时间、活化部分凝血酶原时间为孕产妇发生VTE的独立危险因素（P＜0.05）。结论:上海共识孕产妇VTE风险评分、D-二聚体、凝血酶原时间、活化部分凝血酶原时间为孕产妇发生VTE的独立危险因素。VTE的发生重在预防，专科VTE评分对孕产妇预防静脉血栓形成有临床意义。一旦发生VTE，结合实验室指标及必要的影像学指标早期诊断和治疗。     

Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting

OBJECTIVE: The objectives of this study were to observe a commercially insured sample diagnosed with a venous thromboembolism (VTE) event and treated postevent with warfarin and to detail the thromboembolic and bleeding outcomes in the time periods during warfarin therapy and after discontinuation of such therapy. METHODS: This retrospective, observational cohort study used medical, pharmacy, and eligibility data from 2 US health plans. Study inclusion required an inpatient diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE) between January 1, 1998, and December 31, 2000; warfarin, heparin, or low-molecular-weight heparin within 30 days after diagnosis; no VTE diagnosis; and no anticoagulant use for 3 months preceding diagnosis. A random sample of medical charts was abstracted to validate VTE events and collect prothrombin time/international normalized ratio (INR) result data. Recurrent VTE events, bleeding events, and proportion of time within INR range were captured in the postindex VTE event time period. Univariate and multivariate statistical techniques were used to assess outcomes. RESULTS: A total of 2,090 patients were identified with a newly diagnosed VTE event (DVT only, 1450; PE with or without DVT, 640). Mean (SD) age was 61.7 (16) years; mean (SD) follow-up time after the index diagnosis was 21.3 (10) months. Overall mean (SD) length of warfarin therapy was 6.6 (6) months. During the follow-up period, 224 patients (10.7%) experienced a recurrent VTE event and 122 patients (5.8%) experienced a bleeding event requiring hospitalization. The cumulative incidence of recurrent VTE events over 3 and 6 months was 9.0% and 10.9%, respectively. Using the chart abstraction subset, patients were within the appropriate INR range 37.7% of the time while receiving warfarin. CONCLUSIONS: Negative outcomes associated with warfarin therapy-recurrent VTE events and bleeding requiring hospitalization-were experienced by 10.7% and 5.8% of patients, respectively. These data suggest that negative outcomes may be more prevalent in usual community medical practice compared with rates observed in the controlled environment of the clinical trial or specialized anticoagulation clinic.     

Accuracy of Very Low Pretest Probability Estimates for Pulmonary Embolism Using the Method of Attribute Matching Compared with the Wells Score

Objectives: Attribute matching matches an explicit clinical profile of a patient to a reference database to estimate the numeric value for the pretest probability of an acute disease. The authors tested the accuracy of this method for forecasting a very low probability of venous thromboembolism (VTE) in symptomatic emergency department (ED) patients. Methods: The authors performed a secondary analysis of five data sets from 15 hospitals in three countries. All patients had data collected at the time of clinical evaluation for suspected pulmonary embolism (PE). The criterion standard to exclude VTE required no evidence of PE or deep venous thrombosis (DVT) within 45 days of enrollment. To estimate pretest probabilities, a computer program selected, from a large reference database of patients previously evaluated for PE, patients who matched 10 predictor variables recorded for each current test patient. The authors compared the outcome frequency of having VTE [VTE(+)] in patients with a pretest probability estimate of <2.5% by attribute matching, compared with a value of 0 from the Wells score. Results: The five data sets included 10,734 patients, and 747 (7.0%, 95% confidence interval [CI] = 6.5% to 7.5%) were VTE(+) within 45 days. The pretest probability estimate for PE was <2.5% in 2,975 of 10,734 (27.7%) patients, and within this subset, the observed frequency of VTE(+) was 48 of 2,975 (1.6%, 95% CI = 1.2% to 2.1%). The lowest possible Wells score (0) was observed in 3,412 (31.7%) patients, and within this subset, the observed frequency of VTE(+) was 79 of 3,412 (2.3%, 95% CI = 1.8% to 2.9%) patients. Conclusions: Attribute matching categorizes over one‐quarter of patients tested for PE as having a pretest probability of <2.5%, and the observed rate of VTE within 45 days in this subset was <2.5%. ACADEMIC EMERGENCY MEDICINE 2010; 17:133–141 © 2010 by the Society for Academic Emergency Medicine     

Prevalence and risk factors of non-fatal venous thromboembolism in the active population of the VITA Project

Summary.  Cost-effective strategies for the identification of subjects at risk of venous thromboembolism (VTE) in the active population are still lacking. Our objectives were to identify risk factors for venous thromboembolism in active subjects. We analyzed data from a population-based sample of 15 055 Caucasians aged 18–65 years randomly selected from the census list of the township of Vicenza, Italy. A validated methodology was used to retrospectively identify subjects with previous VTE. Body mass index (BMI), smoking, oral contraceptive use, previous superficial vein thrombophlebitis (SVT) and familial history of VTE, all at the age of first thrombosis, were ascertained by direct interview and by review of available medical records. Ninety-two deep vein thromboses [prevalence: 61.1/10 000, 95% confidence interval (CI) 49.2–74.9], three upper deep vein thrombosis (prevalence: 1.9/10 000, 95% CI 0.4–5.8) and 21 pulmonary embolism (prevalence: 13.9/10 000, 95% CI 8.6–21.3) were identified. After age and sex adjustment, clinically identifiable risk factors were: history of SVT [odds ratio (OR) = 6.8], oral contraceptive use (OR = 4.7), family history of VTE (OR = 4.5), smoking (OR = 1.7) and BMI above the third tertile (OR vs. mid-tertile 2.9). While previous SVT and BMI were associated with VTE in all circumstantial situations (surgery/trauma, pregnancy or idiopathic VTE), for oral contraceptive use, positive family history and smoking the degree of association varied significantly depending on the situation. Non-fatal VTE affects 0.7% of the subjects belonging to an active population, 56% of cases being potentially preventable. In 30% of VTE cases, at least two easily recognizable risk factors are present. Clinical assessment of risk factors remains the mainstay of VTE prevention.     

Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: findings from the RIETE registry

OBJECTIVES: To examine the clinical characteristics and outcomes of cancer patients with venous thromboembolism (VTE) in order to identify factors that place these patients at an increased risk for fatal pulmonary embolism (PE) or fatal bleeding. PATIENTS AND METHODS: Registro Informatizado de la Enfermedad Trombo Embólica (RIETE) is a prospective registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. RESULTS: Up to January 2006, a total of 14 391 patients with symptomatic acute VTE were enrolled in RIETE, of whom 2945 (20%) had cancer. During the 3-month follow-up period the frequency of fatal PE in cancer patients was 2.6%, and that of fatal bleeding 1.0%. These frequencies were significantly higher than in VTE patients without cancer (1.4% and 0.3%, respectively). In patients with cancer, abnormal renal function, metastatic disease, recent major bleeding and recent immobility for >or= 4 days (42% of the 108 patients who died from PE or bleeding had recent immobility) were factors independently associated with an increased risk for both fatal PE and fatal bleeding. In addition, PE diagnosis on admission was an independent risk factor for fatal PE, while body weight < 60 kg was an independent risk factor for fatal bleeding. CONCLUSIONS: Both fatal PE and fatal bleeding are more common in cancer patients with VTE than in those patients without cancer. In cancer patients, abnormal renal function, metastatic disease, recent major bleeding and recent immobility for >or= 4 days are associated with an increased risk for both fatal PE and fatal bleeding.