Risk of venous thromboembolism in Chinese pregnant women: Hong Kong venous thromboembolism study

Duo Huang,Emmanuel Wong,Ming-Liang Zuo,Pak-Hei Chan,Wen-Sheng Yue,Hou-Xiang Hu,Ling Chen,Li-Xue Yin,Xin-Wu Cui,Ming-Xiang Wu,Xi Su,Chung-Wah Siu,Jo-Jo Hai 대한혈액학회 2019 Blood Research Vol.54 No.3

BackgroundPrevious Caucasian studies have described venous thromboembolism in pregnancy; however, little is known about its incidence during pregnancy and early postpartum peri-od in the Chinese population. We investigated the risk of venous thromboembolism in a “real-world” cohort of pregnant Chinese women with no prior history of venous thromboembolism.MethodsIn this observational study, 15,325 pregnancies were identified in 14,162 Chinese women at Queen Mary Hospital, Hong Kong between January 2004 and September 2016. Demographic data, obstetric information, and laboratory and imaging data were retrieved and reviewed.ResultsThe mean age at pregnancy was 32.4±5.3 years, and the median age was 33 years (interquartile range, 29‒36 yr). Pre-existing or newly diagnosed diabetes mellitus was present in 627 women (4.1%); 359 (0.7%) women had pre-existing or newly detected hypertension. There was a small number of women with pre-existing heart disease and/or rheumatic conditions. Most deliveries (86.0%) were normal vaginal; the remaining were Cesarean section 2,146 (14.0%). The incidence of venous thromboembolism was 0.4 per 1,000 pregnancies, of which 83.3% were deep vein thrombosis and 16.7% were pul-monary embolism. In contrast to previous studies, 66.7% of venous thrombosis occurred in the first trimester.ConclusionChinese women had a substantially lower risk of venous thromboembolism during preg-nancy and the postpartum period compared to that of Caucasians. The occurrence of pregnancy-related venous thromboembolism was largely confined to the early preg-nancy period, probably related to the adoption of thromboprophylaxis, a lower rate of Cesarean section, and early mobilization.

폐동맥혈전색전증과 사망에 대한 고찰

김유희 內務部 國立科學搜査硏究所 2001 國立 科學 搜査 硏究所 年報 Vol.33 No.-

폐동맥혈전색전증과 사망에 대한 고찰

김유희,강현욱 大韓法醫學會 2001 대한법의학회지 Vol.25 No.1

Despite advances in our understanding of venous thromboembolic disease, the prevention, diagnosis and treatment of pulmonary thromboembolism remain a clinical challenged. In western country, pulmonary thromboembolism is common : its antemortem diagnosis is not. Its frequency in routine hospital autopsies is 5% ∼ 10%. Especially, pregnancy and orthopedic surgery are widely recognized to be physiologic slates with markedly elevated risk for thromboembolic complication Deep venous thrombosis is very frequent after surgery, and its major complication, pulmonary thromboembolism, is the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. All of these 40 cases were autopsied between 1997 ∼ 1999 in National Institute of Scientific Investigation(NISI) and the causes of death were verified pulmonary throaboembolism. The aims of study were to investigate post-mortem verified causes of death, pulmonary thromboembolism, to cirrelate these with clinical practice, to identify the potential for prevention according to the literature and to contribute to decrease the mortality rate due to pulmonary thromboembolism.

Anticoagulation after pancreatic surgery with venous resection (TIGRESS): What should we do? Results from an international survey

Thomas B. Russell,Debora Ciprani,Somaiah Aroori 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.4

Backgrounds/Aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. This study aimed to establish current anticoagulation practices. Methods: A survey (https://form.jotform.com/220242489107048) was sent out to pancreatic surgeons. Questions covered center volume, venous resection/reconstruction techniques and anticoagulation policies. Results: Sixty-five centers from 17 countries responded. Following a “side-bite” venous resection with a patch repair, 40% used an autologous vein patch, 27% used peritoneum, and 27% used a bovine patch. After formally resecting a segment of vein, 17% of centers used an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (73%) grafts were the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a “side-bite” resection, 59%, 28%, and 19% of centers provided therapeutic anticoagulation, respectively (66% used low molecular-weight heparin). The duration of therapy provided varied from inpatient stay only (14%) to six months (32%). Conclusions: Our global survey indicates that anticoagulation practices are highly variable. Centers do not agree on when to anticoagulate, how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity.

Liver Infarction and Venous Thromboembolism after Tamoxifen Use in an ADPKD Patient with Encapsulating Peritoneal Sclerosis: A Case Report

( Kyoung Min Kwak ),( Gwang Ho Choi ),( Kwang Eon Shim ),( Ho Yong Jin ),( Seok Hyung Kim ),( Jong Woo Yoon ),( Hyunsuk Kim ) 대한전해질학회 2020 Electrolytes & Blood Pressure Vol.18 No.2

Encapsulating peritoneal sclerosis (EPS) is a potentially fatal complication after long-term peritoneal dialysis, and tamoxifen can be used for its prevention and treatment. However, tamoxifen is known to increase the risk of venous thromboembolism. A 49-year-old woman was admitted with sudden abdominal pain. The patient had received peritoneal dialysis for 20 years and switched to hemodialysis after the diagnosis of EPS. Tamoxifen (10mg) and prednisolone (20mg) had been administered for 8 months. On computed tomography, the left hepatic lobe was hardly illuminated, leading to a diagnosis of liver infarction. A month later, she was re-admitted due to abdominal pain and extensive deep vein thrombosis of the leg. The administration of tamoxifen was stopped and prednisolone was reduced to 10mg. As her malnutrition progressed, she succumbed to death of gram negative sepsis. The patient was concluded to have liver infarction and extensive venous thrombosis as a side effect of tamoxifen.

Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux in women at risk after cesarean section

( Ryuji Kawaguchi ),( Shoji Haruta ),( Hiroshi Kobayashi ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.6

Objective Cesarean section is associated with an increased risk for venous thromboembolism (VTE). The safety and efficacy of primary prophylaxis of fondaparinux, a synthetic sulfated pentasaccharide heparin analog, in women at risk after cesarean section is uncertain. Methods This was a retrospective study of 295 cases of pregnant women presenting to a tertiary referral center of Nara, Japan, to evaluate the usefulness of thromboprophylaxis with fondaparinux after cesarean delivery between 2011 and 2012. Patients were initially received unfractionated heparin (once 5,000 IU subcutaneously, twice a day), starting 6 hours after cesarean section for 24 hours, and then treated with fondaparinux (once 2.5 mg daily, subcutaneously) for 5 days. The primary efficacy end-point was an improvement in the incidence of symptomatic VTE or fatal post-cesarean pulmonary thromboembolism. The primary safety end-point was major bleeding during treatment. Results There were neither any episodes of symptomatic VTE cases nor maternal deaths. A total of 10 patients had a bleeding event. Major bleeding complication was observed in 2 (0.68%) of 295 patients receiving fondaparinux. Non-major bleeding into critical sites was observed in 8 patients, often at surgical sites, and recovery was not delayed. Conclusion This study demonstrates the safety and efficacy of fondaparinux in women at high risk of VTE after cesarean section. Large phase trials comparing clinical outcomes with fondaparinux across a wide spectrum of patients are needed to confirm these observations.

Efficacy of edoxaban for the treatment of gynecological cancer-associated venous thromboembolism: analysis of Japanese real-world data

Suguru Odajima,Toshiyuki Seki,Sayako Kato,Keisuke Tomita,Yuichi Shoburu,Eitaro Suzuki,Masataka Takenaka,Motoaki Saito,Hirokuni Takano,Kyosuke Yamada,Aikou Okamoto 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5

Objective: Direct oral anticoagulants (DOACs) are increasingly being used for the treatment of cancer-associated venous thromboembolism (CAT). However, there is limited evidence of the efficacy of DOACs for the treatment of gynecological CAT. Thus, this study aimed to investigate the efficacy and safety of edoxaban for the treatment of gynecological CAT using Japanese real-world data. Methods: We reviewed the medical records of patients with 371 gynecological cancer who received edoxaban or vitamin K antagonist (VKA) between January 2011 and December 2018. Results: Altogether, 211 and 160 patients were treated with edoxaban and VKA, respectively. Fourteen patients (6.8%) in the edoxaban group and 22 (13.8%) in the VKA group showed recurrence of venous thromboembolism (VTE). Cumulative VTE recurrence was not significantly different between the 2 groups (p=0.340). Adverse events occurred in 15 (7.1%) and 11 (6.9%) patients in the edoxaban and VKA groups, respectively (p=0.697). Subgroup analysis of the edoxaban and VKA groups according to different tumor types, including ovarian, endometrial, and cervical cancer, showed equivalent outcomes in terms of VTE recurrence and adverse events. Patients without pulmonary embolism (PE) were mostly omitted from initial unfractionated heparin (UFH) therapy prior to administration of edoxaban. However, this did not increase the recurrence of VTE. Conclusion: This study confirmed that edoxaban is effective and safe for the treatment of gynecological CAT. This finding was consistent for different types of gynecological cancer. Additionally, initial UFH therapy prior to the administration of edoxaban may be unnecessary for patients without PE.

슬관절 전치환술 후 정맥혈전색전증 예방을 위한 Rivaroxaban과 Aspirin 사용 후의 혈액학적 변화의 비교

송무호(Moo-Ho Song),김부환(Bu-Hwan Kim),안성준(Seong-Jun Ah),유성호(Seong-Ho Yoo),김영준(Yeong-Joon Kim) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.6

목적: 슬관절 전치환술 후 정맥혈전색전증 예방을 위해 사용하는 Rivaroxaban 또는 Aspirin 사용 후의 혈액학적 변화 및 문제점을 평가하였다. 대상 및 방법: 2010년 7월부터 2011년 3월까지 Rivaroxaban을 사용한 50명과 Aspirin을 사용한 50명의 두 군으로 나누어 혈색소 감소량 및 수혈 빈도의 차이를 비교하였다. 결과: Rivaroxaban군의 평균 혈색소 감소량은 4.7 (3.1-6.6)이었고, Aspirin군은 평균 3.6 (2.0-5.1) 감소되었다(p〈0.05). 혈색소가 8 g/dl 이하로 감소된 경우는 Rivaroxaban군 23명(46%), Aspirin군 9명(18%)이었고 수혈 받은 환자는 Rivaroxaban군 12명(24%), Aspirin군 2명(4%)으로 Rivaroxaban군에서 혈색소 감소량 및 수혈 빈도가 높았으며 통계학적으로 유의한 차이를 보였다(p〈0.05). 결론: Rivaroxaban군에서 Aspirin군보다 실혈량의 증가로 인한 수혈 대상군의 유의한 증가를 보여 표준 정맥혈전색전증 위험도 환자군에서의 Rivaroxaban 사용에 주의가 필요할 것으로 생각된다. Purpose: To compare the hematologic changes and the rates of transfusion of patients using rivaroxaban or aspirin for venous thromboembolism prophylaxis after a total knee arthroplasty. Materials and Methods: Among patients with total knee arthroplasty from July 2010 to March 2011, two groups of 100 consecutive cases were enrolled in this study, 50 patients with Rivaroxaban group and 50 patients with Aspirin group for venous thromboembolism prophylaxis after a total knee arthoplasty. Hematologic changes and transfusion rates were calculated in each group. Results: The mean of decreased hemoglobin was 4.7 (3.1-6.6) in the Rivaroxaban group and 3.6 (2.0-5.1) in the Aspirin group (p<0.05). The number of patients with decreased hemoglobin of less than 8 g/dl was observed in 23 cases (46%) in the Rivaroxaban group, and 9 cases (18%) in the Aspirin group. The numbers of patients who needed transfusion were 12 in the Rivaroxaban group, and 2 in the Aspirin group (p<0.05). Conclusion: Rivaroxaban group revealed more significant decrease of hemoglobin and needed more transfusion than the Aspirin group did. For the prevention of venous thromboembolism after total knee arthroplasty, we should be careful using Rivaroxaban for the standard risk patients of venous thromboembolism.

고관절 골절 수술에서 수술 전 Enoxaparin 혈전 예방 요법 대 수술 후 Enoxaparin 혈전 예방 요법

문남훈(Nam Hoon Moon),장재훈(Jae-Hoon Jang),박진섭(Jin Sup Park),박기영(Ki Young Park),박용건(Young Gun Park) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.5

목적: 고관절 골절 환자에서 정맥혈전색전증의 예방을 위해 수술 전 및 수술 후 시작한 enoxaparin 투여방법의 안전성과 유효성을 비교 분석하고자 한다. 대상 및 방법: 2009년 3월부터 2014년 3월까지 부산대학교병원에서 고관절 골절로 내원하였던 629명의 환자 중 연구 포함기준을 만족시키는 총 414명(65.8%)을 대상으로 하였다. 156명은 enoxaparin 40 ㎎을 수술 후 48시간부터 피하주사로 시작하였고(A군), 258명은 enoxaparin 40 ㎎을 수술 전부터 피하주사로 시작하였다(B군). 양 군에서 정맥혈전색전증의 발생 빈도와 입원 기간 중 출혈 위험성을 비교 분석하였다. 결과: 증상을 동반하는 정맥혈전색전증은 A군에서 7.1% (11명), B군에서 5.4% (14명)이었으며, 두 군 간의 유의한 차이는 없었다. 증상을 동반하는 심부정맥혈전증과 폐색전증의 발생 역시 두 군 간의 유의한 차이는 없었으나, A군 중 2예는 폐색전증으로 인하여 사망하였고, B군 중 1예는 폐출혈로 사망하였다. 주요 출혈 및 입원 기간 중 사망 빈도는 두 군 간에 유의한 차이가 없었다. 결론: 혈전색전증의 위험인자를 동반하는 고령의 고관절 골절 환자에서는 수술 전부터 시작하는 약물 예방 요법을 고려해 볼 수 있다. Purpose: The purpose of this study was to evaluate the safety and efficacy of pre- and postoperative initiation of enoxaparin in treatment of hip fracture. Materials and Methods: In this study, we enrolled 629 consecutive patients with hip fracture who Pusan National University Hospital between March 2009 and March 2014. Of these patients, 414 patients (65.8%) met the final inclusion criteria. Enoxaparin was administered subcutaneously at 40 mg once daily starting 48 hours after surgery in 156 patients (group A), and immediately after admission in 258 patients (group B). The incidence of symptomatic venous thromboembolism (VTE) and risk of bleeding during hospitalization period were compared between groups. Results: The incidence of symptomatic VTE during the hospitalization period was 7.1% (11 patients) in group A and 5.4% (14 patients) in group B. No significant difference in the rate of symptomatic VTE was found between the groups (unadjusted odds ratio [OR], 0.756; 95% confidence interval [CI], 0.334–1.710; adjusted OR, 0.554; 95% CI, 0.212–1.449). The incidence of symptomatic deep-vein thrombosis and pulmonary embolism (including fatal and non-fatal) did not significantly differ between groups. However, fatal pulmonary thromboembolism developed in two cases in group A and one patient expired postoperatively due to pulmonary hemorrhage in group B. Major bleeding and all-cause death did not differ between groups. Conclusion: Preoperative starting chemical thromboprophylaxis may be considered in the elderly patients with hip fracture who have risk factors for venous thromboembolism.

정맥혈전색전증의 예방과 치료

안형준 ( Hyung Joon Ahn ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.1

Deep vein thrombosis (DVT) is a common disease that can present with symptoms ranging from asymptomatic asymptomatic to fatal pulmonary embolism. And the pulmonary embolism (PE) is a major cause of morbidity and mortality in hospitalized patients. Thus, prevention and early diagnosis of DVT are very important. This review will be focus on the “prevention and treatment of venous thromboembolism”.