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Unprovoked VTE

Jean-Christophe Ianotto, Aurélie Chauveau, Dominique Mottier, Valérie Ugo, Christian Berthou, Eric Lippert, Aurélien Delluc
Cancer incidence in patients with recurrent unprovoked venous thromboembolism (VTE) is much higher than after a first event, but the incidence of myeloproliferative neoplasms (MPN) in this situation is still unknown. We tested for JAK2V617F and calreticulin mutants, 372 DNA samples of patients treated for (VTR). Among these patients, 10 (2.7%) were carrying JAK2V617F mutation and none of them any of the calreticulin (CALR) mutations. Among the 19 patients who had VTE recurrence under vitamin K antagonists, 4 patients (21...
October 20, 2016: Annals of Hematology
Pantep Angchaisuksiri
Thrombosis is a common complication in cancer patients. Although the major inherited risk factors for thrombophilia are different between Asians and Caucasians, the main acquired risk factors that are associated with the development of venous thromboembolism (VTE) in Asians appear to be similar to those for Caucasians. Malignancy is the most important acquired risk factor for VTE in Asians. Recent studies have shown that the incidence of VTE is significant in Asian patients with cancer, particularly those in an advanced stage...
2016: Thrombosis Journal
Bengt Zöller, Henrik Ohlsson, Jan Sundquist, Kristina Sundquist
BACKGROUND: Whether high cardiovascular fitness is associated with reduced risk of venous thromboembolism (VTE) is unknown. The present study aims to determine whether high cardiovascular fitness reduces the risk of VTE. METHODS: A Swedish cohort of male conscripts (n = 773925) born in 1954-1970 with no history of previous VTE were followed from enlistment (1972-1990) until 2010. Data on cardiovascular fitness using a cycle ergonometric test (maximal aerobic workload in Watt [Wmax]) at conscription were linked with national hospital register data and the Multi-Generation Register...
October 21, 2016: Annals of Medicine
Bengt Zöller, Xinjun Li, Henrik Ohlsson, Jianguang Ji, Ashfaque A Memon, Peter J Svensson, Karolina Palmér, Björn Dahlbäck, Jan Sundquist, Kristina Sundquist
Familial aggregation (clustering) of venous thromboembolism (VTE) is the clustering of VTE within a family. Though several genes, such as antithrombin, protein C, protein S, factor V, and prothrombin are associated with the familial clustering of VTE, these loci only partially explain the familial aggregation of VTE. The epidemiology of the familial aggregation of VTE exhibits typical characteristics of complex traits. The family history of VTE in first-degree relatives is associated with a two to three times increased familial relative risk (FRR)...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Paolo Prandoni, Enrico Bernardi, Fabio Dalla Valle, Adriana Visonà, Pietro F Tropeano, Carlo Bova, Eugenio Bucherini, Md Shahidul Islam, Andrea Piccioli
Patients with unprovoked venous thromboembolism (VTE) may harbor occult cancer. Whether an extensive diagnostic work-up for cancer has additional value over a more limited screening for detection of underlying malignancy in these patients is controversial. We performed a randomized multicenter trial to assess if in patients with unprovoked VTE, a computed tomography (CT)-based diagnostic strategy including thoracic, abdominal, and pelvic CT in combination with fecal occult blood test yields a higher cancer detection rate than a nonstandardized testing approach based on physicians' clinical judgment and patients' preferences...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Benilde Cosmi
Idiopathic or unprovoked venous thromboembolism is an event occurring in the absence of any apparent provoking or triggering environmental risk factors, such as surgery, trauma, and immobilization. Areas covered: Unprovoked VTE can be associated with occult cancer, but only limited, and not extensive cancer screening, may be warranted, as the rate of occult cancer is low in such patients. Routine thrombophilia testing is not currently recommended as it does not influence the management of the disease. The duration of anticoagulation for unprovoked VTE after the first three months is still debated as the disease tends to recur regardless of treatment duration...
October 14, 2016: Expert Review of Cardiovascular Therapy
Yasuhiko Kubota, Stephanie J London, Mary Cushman, Alanna M Chamberlain, Wayne D Rosamond, Susan R Heckbert, Neil Zakai, Aaron R Folsom
BACKGROUND: The evidence of the association between chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VTE) is limited. There is no study investigating the association of restrictive lung disease (RLD) and respiratory symptoms with VTE. OBJECTIVES: To investigate prospectively the association of lung function and respiratory symptoms with VTE. PATIENTS/METHODS: In 1987-1989, we assessed lung function using spirometry and obtained information on respiratory symptoms (cough, phlegm and dyspnea) in 14 654 participants aged 45-64, without a history of VTE or anticoagulant use, and followed them through 2,011...
October 1, 2016: Journal of Thrombosis and Haemostasis: JTH
P A Kyrle, M Kammer, L Eischer, A Weltermann, E Minar, M Hirschl, G Heinze, S Eichinger
BACKGROUND: The long-term recurrence risk (ltRR) of venous thromboembolism (VTE) is uncertain. Objective to assess the ltRR of patients with first unprovoked VTE. PATIENTS/METHODS: Patients were classified into 3 categories; distal deep-vein thrombosis (DVT), proximal DVT, or pulmonary embolism (PE), i.e. PE associated with DVT or isolated PE. Patients with major thrombophilia or antithrombotic therapy were excluded. End point was recurrent symptomatic VTE. RESULTS: 839 patients were followed for a median of 7...
October 2, 2016: Journal of Thrombosis and Haemostasis: JTH
Paolo Prandoni
Once anticoagulation is stopped, the risk of recurrent venous thromboembolism (VTE) over years after a first episode is consistently around 30 %. This risk is higher in patients with unprovoked than in those with (transient) provoked VTE, and among the latter in patients with medical than in those with surgical risk factors. Baseline parameters that have been found to be related to the risk of recurrent VTE are the proximal location of deep vein thrombosis, obesity, old age, male sex and non-0 blood group, whereas the role of inherited thrombophilia is controversial...
September 13, 2016: Advances in Experimental Medicine and Biology
Aisling Barrett, Barry Kevane, Patricia Hall, Fionnuala Ní Áinle, Tomás Breslin
In this prospective review of cancer screening in unselected patients with unprovoked venous thromboembolism (VTE) presenting to a large teaching hospital in the Republic of Ireland, we aimed to determine the effects of the implementation of the National Institute for Health and Care Excellence screening policy in a "real-world" population. Within our institution, 64 individuals presented with unprovoked VTE during the study period, of whom 47 underwent a screening computed tomography (CT) scan. Two cases of previously undiagnosed cancer were identified...
July 21, 2016: Clinical and Applied Thrombosis/hemostasis
Marja K Puurunen, Philimon N Gona, Martin G Larson, Joanne M Murabito, Jared W Magnani, Christopher J O'Donnell
BACKGROUND: Reports of the crude incidence of venous thromboembolism (VTE) in Western countries vary widely. Data regarding risk factors, incidence and recurrence of VTE from deeply-phenotyped community-based cohort studies are needed. OBJECTIVES: To study the incidence, associated mortality, and predisposing factors of VTE in the prospective, longitudinal community-based Framingham Heart Study. PATIENTS/METHODS: The study sample consisted of the Framingham Heart Study Original, Offspring, Third Generation, and Omni cohorts (N=9754)...
September 2016: Thrombosis Research
Dejun Xu, Rutao Xu, Liu He, Tao Xu, Zhenyu Zhang, Dongmei Han, Jianshi Du
PURPOSE: Unprovoked venous thromboembolism (VTE) generally divided into single and recurrent categories, is a common leading cause of morbidity and mortality in a real-world population. This study was aim to explore the similarities and differences in the mechanisms of single and recurrent VTE. MATERIAL AND METHODS: Gene expression data (GSE19151) generated from 63 healthy controls, 32 single and 38 recurrent VTE patients were analyzed. Differentially expressed genes (DEGs) were screened by Affy package and Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analysis were performed using database for annotation, visualization, and integrated discovery (DAVID)...
July 13, 2016: Annals of Vascular Surgery
Sigrid K Braekkan, Scott D Grosse, Ekwutosi M Okoroh, James Tsai, Suzanne C Cannegieter, Inger Anne Naess, Steinar Krokstad, John-Bjarne Hansen, Finn Egil Skjeldestad
BACKGROUND: The burden of venous thromboembolism (VTE) related to permanent work-related disability has never been assessed among a general population. Therefore, we aimed to estimate the risk of work-related disability in subjects with incident VTE compared with those without VTE in a population-based cohort. METHODS: From the Tromsø Study and the Nord-Trøndelag Health Study (HUNT), Norway, 66005 individuals aged 20-65 years were enrolled in 1994-1997 and followed to December 31, 2008...
July 13, 2016: Journal of Thrombosis and Haemostasis: JTH
F A Klok, M V Huisman
Recent American, European and Dutch guidelines recommend lifelong anticoagulation after a diagnosis of unprovoked venous thromboembolism (VTE) in the absence of high bleeding risk. Major bleeding events may, however, be devastating, and are reported to have a higher case fatality rate than recurrent venous thromboembolism itself. Unfortunately, there are no validated risk assessment tools for major bleeding that help physicians determine the optimal duration of anticoagulant therapy after VTE. Furthermore, the scarce studies on this subject have focused on vitamin K antagonist treatment regimens only, covering mainly the initial weeks and first month, during which period the level of anticoagulation is unstable...
2016: Nederlands Tijdschrift Voor Geneeskunde
C Kearon, S Parpia, F A Spencer, T Baglin, S M Stevens, K A Bauer, S R Lentz, C M Kessler, J D Douketis, S Moll, S Kaatz, S Schulman, J M Connors, J S Ginsberg, L Spadafora, P Liaw, J I Weitz, J A Julian
BACKGROUND: The rate of recurrent venous thromboembolism (VTE) in patients with a first unprovoked VTE who had a negative qualitative D-dimer test one month after stopping anticoagulant therapy was higher than expected in the D-dimer Optimal Duration Study (DODS). OBJECTIVES: To determine whether quantitative D-dimer levels using a low threshold, age- and sex-specific thresholds, or repeated measurements, would improve identification of patients at low risk of recurrent VTE...
June 23, 2016: Thrombosis Research
Michał Nowak, Katarzyna Królak-Nowak, Aleksandra Sobolewska-Włodarczyk, Jakub Fichna, Marcin Włodarczyk
Venous thromboembolism (VTE) is a multifactorial disease manifesting as either deep vein thrombosis or pulmonary embolism. Its prevalence makes VTE a significant issue for both the individual - as a negative factor influencing the quality of life and prognosis - and the society due to economic burden. VTE is the third most common vascular disorder in Western countries, after myocardial infarction and stroke, making it a major cause of in-hospital mortality, responsible for 5%-10% of hospital deaths. Despite many studies conducted, only 50%-60% provoking factors have been identified, while the remaining 40%-50% have been classified as idiopathic or unprovoked...
2016: Vascular Health and Risk Management
Elena Campello, Luca Spiezia, Claudia M Radu, Paolo Simioni
Microparticles (MPs) are small (0.1-1.0 μm) membrane vesicles constitutively released from the surface of cells after activation and apoptosis. The clinical research on MPs is hampered by the limitations of the currently available detection methods. A correlation between MPs and venous thromboembolism (VTE) has been observed. The effects of MPs on thrombogenesis involve the exposure of phosphatidylserine, the vehiculation of tissue factor, and MP-induced intercellular cross-talk between inflammation and coagulation...
July 2016: Biomarkers in Medicine
Yasuhiko Kubota, Mara McAdams-DeMarco, Aaron R Folsom
INTRODUCTION: Inflammatory diseases increase risk of venous thromboembolism (VTE). Whether gout, the most common rheumatologic inflammatory arthritis, or its cause, elevated serum uric acid (SUA), is associated with VTE incidence is unknown. MATERIALS AND METHODS: The Atherosclerosis Risk in Communities Study measured SUA in 14126 participants aged 45-64, without a history of VTE or gout and not using anticoagulants/gout medications, and obtained information on incident gout between 1987 and 1998 from 10247...
August 2016: Thrombosis Research
Prajwal Dhakal, Krishna Gundabolu, Vijaya R Bhatt
Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Factors such as the presence of transient risk factors for VTE, risk of bleeding, and location of deep vein thrombosis (DVT) determine the duration of anticoagulation. Extended anticoagulation is offered to patients with unprovoked pulmonary embolism (PE) or proximal DVT and a low risk of bleeding. Anticoagulation for 3 months is advised in patients with provoked DVT or PE, high risk of bleeding, and isolated distal or upper extremity DVT...
June 5, 2016: Clinical and Applied Thrombosis/hemostasis
Rupert Bauersachs
Venous thromboembolism (VTE) is associated with a risk of recurrence that depends on factors specific to index event and patient. A first unprovoked VTE increases the risk of a recurrent event, particularly during the first year after anticoagulation cessation. Determining a strategy for the long-term prevention of recurrent VTE poses challenges that stem from a lack of agreement on recommended therapy duration and varying treatment burden for the patient. Oral anticoagulants, including vitamin K antagonists and non-vitamin K antagonist oral anticoagulants (NOACs), are the main treatment options for the long-term prevention of recurrent VTE...
August 2016: Thrombosis Research
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