Incidence, Risk Factors, Risk Assessment Model and Compliance of Patients on Anticoagulants for Asymptomatic Venous Thromboembolism in Nononcological Urological Inpatients
Purpose: To study the incidence, risk factors for developing asymptomatic venous thromboembolism and the compliance of patients on anticoagulants for asymptomatic venous thromboembolism (VTE) in nononcological urological medium-high risk inpatients, and build a risk assessment model (RAM) for early screening for asymptomatic VTE.
Materials and Methods: We conducted a retrospective analysis of 573 inpatients admitted to a nononcological urological ward of a tertiary hospital in China from January 1, 2017, to June 30, 2019. Data were collected using the electronic medical record system, and patients underwent a follow-up by phone 6 months after discharge.
Results: Among the 573 medium-high risk inpatients, 73 (15.4%) were diagnosed with VTE, including 20 (4.2%) symptomatic and 53 (11.2%) asymptomatic. Prior history of VTE, a history of anticoagulants or antiplatelet agents before admission, and D-dimer ≥ 1 were the potential risk factors identified for asymptomatic VTE. Patients with poor awareness of VTE and its dangers, and patients who lived more than 1 hour away from the hospital had a high probability of poor compliance with anticoagulation therapy after discharge. Using D-dimer (1.785 μg/ml), we built a RAM for the early diagnosis of asymptomatic VTE.
Conclusion: We found that patients with urinary nontumor VTE had low compliance with anticoagulation therapy after discharge. The key factors for determining asymptomatic VTE in nononcological urological inpatients included prior history of VTE, a history of taking anticoagulants or anti-platelet agents before admission, and D-dimer ≥ 1. Furthermore, we found that the threshold of D-dimer should be elevated to 1.785 μg/ml to predict asymptomatic VTE.
- risk assessment model
- venous thromboembolism
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2. Chen E, Papa N, Lawrentschuk N, Bolton D, Sengupta SJBi. Incidence and risk factors of venous thromboembolism after pelvic uro-oncologic surgery--a single center experience. 201650-3.
3. Tyson M, Castle E, Humphreys M, Andrews PJTJou. Venous thromboembolism after urological surgery. 2014;192:793-7.
4. Kalayci A, Gibson C, Chi G, et al. Asymptomatic Deep Vein Thrombosis is Associated with an Increased Risk of Death: Insights from the APEX Trial. 2018;118:2046-52.
5. Violette P, Lavallée L, Kassouf W, Gross P, Shayegan BJCUAjJdlAdudC. Canadian Urological Association guideline: Perioperative thromboprophylaxis and management of anticoagulation. 2019;13:105-14.
6. K.A.O. Tikkinen (Chair) RC, M.K. Gould, R. Naspro, G. Novara, P.M. Sandset, P.D. Violette, G.H. Guyatt. EAU Guidelines on Thromboprophylaxis in Urological Surgery European Association of Urology. 2017.
7. Chan N, Stehouwer A, Hirsh J, et al. Lack of consistency in the relationship between asymptomatic DVT detected by venography and symptomatic VTE in thromboprophylaxis trials. 2015;114:1049-57.
8. Grant P, Greene M, Chopra V, Bernstein S, Hofer T, Flanders SJTAjom. Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients. 2016;129:528-35.
9. Singh D, Lawen J, Alkhudair WJTp. Does pretransplant obesity affect the outcome in kidney transplant recipients? 2005;37:717-20.
10. Meriwether K, Antosh D, Knoepp L, Chen C, Mete M, Gutman RJIuj. Increased morbidity in combined abdominal sacrocolpopexy and abdominoplasty procedures. 2013;24:385-91.
11. Wiznia D, Swami N, Nguyen J, et al. Patient compliance with deep vein thrombosis prophylaxis after total hip and total knee arthroplasty. 2019;11:7914.
12. Marchocki Z, Norris L, O'Toole S, Gleeson N, Saadeh FJIjogcojotIGCS. Patients' experience and compliance with extended low molecular weight heparin prophylaxis post-surgery for gynecological cancer: a prospective observational study. 2019.
13. Chan J, Roche S, Lenehan B, O'sullivan M, Kaar KJAoo, surgery t. Compliance and satisfaction with foot compression devices: an orthopaedic perspective. 2007;127:567-71.
14. Matsuoka Y, Morimatsu HJCjojotJCS. Incidence Rates of Postoperative Pulmonary Embolisms in Symptomatic and Asymptomatic Patients, Detected by Diagnostic Images - A Single-Center Retrospective Study. 2019;83:432-40.
15. Olson S, Shatzel J, DeLoughery TJR, thrombosis pi, haemostasis. Asymptomatic "breakthrough" thrombosis and anticoagulant "failure": Keep calm and carry on. 2019;3:498-502.
16. Gainsbury M, Erdrich J, Taubman D, et al. Prevalence and Predictors of Preoperative Venous Thromboembolism in Asymptomatic Patients Undergoing Major Oncologic Surgery. 2018;25:1640-5.
17. Pedersen M, Wahlsten L, Grønborg H, Gislason G, Petersen M, Bonde AJTAjosm. Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture. 2019;47:3229-37.
18. Yukizawa Y, Inaba Y, Kobayashi N, Kubota S, Saito TJMr. Current risk factors for asymptomatic venous thromboembolism in patients undergoing total hip arthroplasty. 2019;29:874-9.
19. Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. 2020;192:23-6.
20. Tasaka N, Minaguchi T, Hosokawa Y, et al. Prevalence of venous thromboembolism at pretreatment screening and associated risk factors in 2086 patients with gynecological cancer. 2020;46:765-73.
21. Janus N, Mahé I, Launay-Vacher V, Laroche J, Deray GJJdmv. Renal function and venous thromboembolic diseases. 2016;41:389-95.
22. Yamashita Y, Shiomi H, Morimoto T, et al. Asymptomatic Lower Extremity Deep Vein Thrombosis - Clinical Characteristics, Management Strategies, and Long-Term Outcomes. 2017;81:1936-44.
23. Gould M, Garcia D, Wren S, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2012;141:e227S-e77S.
24. Kesieme, Medicine KJJoB. Deep vein thrombosis: a clinical review. 2011;2.
25. Balogun I, Roberts L, Patel R, Pathansali R, Kalra L, Arya RJTr. Clinical and laboratory predictors of deep vein thrombosis after acute stroke. 2016;142:33-9.
26. Shi A, Huang J, Wang X, et al. Postoperative D-dimer predicts venous thromboembolism in patients undergoing urologic tumor surgery. 2018;36:307.e15-.e21.
27. Kassim NA, Farid TM, Pessar SA, Shawkat SAJCATH. Performance Evaluation of Different d-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients. 2016;23:1076029616665165.
28. Douma R, le Gal G, Söhne M, et al. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. 2010;340:c1475.
29. Hordern C, Bircher C, Prosser-Snelling E, et al. Patient compliance with postnatal thromboprophylaxis: An observational study. 2015;35:793-6.
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