====== Venous thromboembolism risk factors ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1FyuQ5jk6lAl7QJAKIiRMGqPHESBXPLviSY_I_uwRdhwGXoQru/?limit=15&utm_campaign=pubmed-2&fc=20230106034521}} ---- {{::venous_thromboembolism_risk_factors.jpg?400|}} ===== Deep-Vein Thrombosis ===== see [[Deep-Vein Thrombosis]]. ---- ---- A risk stratification algorithm has demonstrated its convenience and significant predictive value for determining the risk of [[venous thromboembolism]] among elective neurosurgical patients. In addition, the different incidence of venous [[thromboembolism]] was demonstrated in patients with various neurosurgical diseases ((Bervitskiy AV, Guzhin VE, Moisak GI, Borisov NN, Amelina EV, Rzaev DA. Novyi algoritm stratifikatsii riska venoznykh tromboembolicheskikh oslozhnenii v planovoi neirokhirurgii i ego prognosticheskaya znachimost' [The new algorithm for stratification of the risk of venous thromboembolic events in elective neurosurgery and its prognostic significance]. Zh Vopr Neirokhir Im N N Burdenko. 2022;86(6):7-15. Russian. doi: 10.17116/neiro2022860617. PMID: 36534619.)). ---- A [[meta-analysis]] revealed a high [[prevalence]] of [[venous thromboembolism]] in critically ill patients. The risk factors of VTE included [[thromboprophylaxis]] [[strategy]], SAPS II, age, malignancy, sex, [[spinal cord injury]], and ISS. Therefore, we need to pay more attention to high-risk populations of VTE in intensive care patients ((Gao X, Zeng L, Wang H, Zeng S, Tian J, Chen L, Peng T. Prevalence of Venous Thromboembolism in Intensive Care Units: A Meta-Analysis. J Clin Med. 2022 Nov 11;11(22):6691. doi: 10.3390/jcm11226691. PMID: 36431168.)). VTE risk is linked to decreased [[mobility]] and [[hypercoagulability]]. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients ((Shu L, Havenon A, Liberman AL, Henninger N, Goldstein E, Reznik ME, Mahta A, Al-Mufti F, Frontera J, Furie K, Yaghi S. Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage. J Stroke. 2023 Jan 3. doi: 10.5853/jos.2022.02215. Epub ahead of print. PMID: 36592970.)). ---- Larger RBC transfusion volumes and higher case mix index scores were associated with an increased risk of VTE events. Physicians should be aware of how these dose-response relationships can influence a patient's risk of developing thrombotic complications postoperatively ((Lo BD, Qayum O, Penberthy KK, Gyi R, Lester LC, Hensley NB, Sciubba DM, Frank SM, Cho BC. Dose-dependent effects of red blood cell transfusion and case mix index on venous thromboembolic events in spine surgery. Vox Sang. 2022 Dec 1. doi: 10.1111/vox.13383. Epub ahead of print. PMID: 36454545.)). ---- A [[meta-analysis]] revealed a high prevalence of VTE in critically ill patients. The risk factors of VTE included [[thromboprophylaxis]] [[strategy]], [[SAPS II]], age, malignancy, sex, spinal cord injury, and ISS. Therefore, we need to pay more attention to high-risk populations of VTE in intensive care patients ((Gao X, Zeng L, Wang H, Zeng S, Tian J, Chen L, Peng T. Prevalence of Venous Thromboembolism in Intensive Care Units: A Meta-Analysis. J Clin Med. 2022 Nov 11;11(22):6691. doi: 10.3390/jcm11226691. PMID: 36431168.)). ---- [[Cushing's disease]] (CD) is associated with an increased risk of [[venous thromboembolism]]. The purpose of Rabiei et al was to discuss preventive strategies for [[postoperative]] [[thrombosis]] in CD patients and their impact on patient outcomes. A [[systematic review]] under [[PRISMA]] guidelines was conducted within [[PubMed]], [[Embase]], [[Web of Science]], and [[Cochrane]] databases through July 2022. Of the 3207 [[paper]]s retrieved, seven [[article]]s were included in a [[systematic review]]. Four hundred forty-eight patients were presented in the reviewed studies and the overall reported [[mortality]] was 2.67% (12/448). Three studies utilized [[prophylaxis]] methods including graduated compression stockings (GCS) and early [[ambulation]] (EA) while the remaining four studies only used [[anticoagulation]] medicine. Only 20 patients received pre-operative prophylactic treatment, while 366 patients received post-operative prophylaxis which was delivered either immediately after surgery or at different time intervals within 2 days following the surgery. Thrombotic events mainly occurred within two to 3 months after surgery. Overall, a higher frequency of thromboembolic events and mortality was observed in the control groups in comparison to groups receiving prophylaxis. A combination of anticoagulation, EA, and GCS might reduce thrombotic events and mortality in CD patients after treatment. Although the early commencement of a prophylactic anticoagulation regimen on the same day of surgery and continuing up to 3 months seems beneficial, the application of a prophylactic regimen should be utilized with caution since the number of included studies was insufficient to draw a strong conclusion, as well as neither prospective study nor [[randomized controlled trial]]s existed ((Rabiei H, Shahbandi A, Sabahi M, Mandel M, Adada B, Borghei-Razavi H. Thrombosis in Cushing's disease; raising the flag of concern. Neurosurg Rev. 2023 Jan 6;46(1):32. doi: 10.1007/s10143-022-01941-x. PMID: 36604392.)). ---- The incidence of VTE in meningioma patients is not negligible. Identified risk factors should be taken into account in the decision-making process for chemoprophylaxis when the risk of bleeding decreases ((Lasica N, Djilvesi D, Papic V, Karan M, Jelaca B, Golubovic J, Pajicic F, Medic-Stojanoska M, Vulekovic P, Rasulic L. Venous thromboembolic and hemorrhagic events after meningioma surgery: A single-center retrospective cohort study of risk factors. PLoS One. 2022 Aug 16;17(8):e0273189. doi: 10.1371/journal.pone.0273189. PMID: 35972947; PMCID: PMC9380925.)). ---- Patients with [[osteoporosis]] have a significantly higher risk of intraoperative [[blood volume]] loss and postoperative [[thromboembolic event]]s ((Mugge L, DeBacker Dang D, Caras A, Dang JV, Diekemper N, Green BA, Gjolaj JP, Fanous AA. Osteoporosis as a Risk Factor for Intraoperative Complications and Long-term Instrumentation Failure in Patients With Scoliotic Spinal Deformity. Spine (Phila Pa 1976). 2022 Oct 15;47(20):1435-1442. doi: 10.1097/BRS.0000000000004418. Epub 2022 Jun 29. PMID: 36174132.)). ===== Retrospective cohort studies ===== This retrospective cohort study was conducted at a single [[center]], a university-based hospital in [[Thailand]]. [[Inclusion criteria]] comprised patients aged 15 years or older admitted for elective or [[emergency]] neurosurgery. Patients with preoperative VTE diagnosed within three months or a history of [[anticoagulant]] use were excluded. Outcomes measured included the 90-day incidences of VTE, any bleeding, major bleeding, and mortality. Between January 2021 and December 2022, 626 patients were included. The mean age was 50.21 ± 17.37 years, and 55.27% were males. [[Thromboprophylaxis]] was administered to 86 patients (13.74%, 95% CI 11.14-16.69). Fourteen patients were confirmed to have symptomatic VTE, resulting in an incidence of 2.24%, with a 95% confidence interval (CI) of 1.23-3.72. Patients aged ≥75 years (HR 4.53; 95% CI 1.25-16.38; p = 0.021), those with cancer (HR 8.51; 95% CI 2.95-24.60, p <0.001), and those experiencing postoperative paraparesis/paralysis (HR 3.26; 95% CI 1.12-9.45; p = 0.030) were associated with an increased risk of postoperative VTE. Fifty-three patients (8.47%, 95% CI 6.41-10.93) experienced any bleeding, with 23 patients (3.67%, 95% CI 2.34-5.46) having major bleeding. The incidence of postoperative mortality was 6.55%, with a 95% CI of 4.74-8.78. This study revealed that [[elderly]] patients, those with cancer, or those experiencing postoperative [[paraparesis]]/paralysis were at higher risk of VTE. These patients were likely to benefit from VTE prophylaxis ((Ponsumritchok P, Chaijaroen P, Ayurag T, Siritikul N, Niprapan P, Hantrakun N, Vongsfak J, Chai-Adisaksopha C. Three-Month [[Incidence]] of [[Venous Thromboembolism]] in Patients Who Underwent Neurological Surgeries. J Clin Med. 2025 Jan 16;14(2):552. doi: 10.3390/jcm14020552. PMID: 39860558.)).