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Thrombophilia Taskforce

Thrombophilia Taskforce. 7 9 19 VTE Prevention Update Sept 21st DOAC Clinic Peri operative guidelines Data review. VTE prevention. Thank you for the feedback. VTE Prevention. VTE Prevention. Present to PCC next Monday

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Thrombophilia Taskforce

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  1. Thrombophilia Taskforce 7 9 19 VTE Prevention Update Sept 21st DOAC Clinic Peri operative guidelines Data review

  2. VTE prevention • Thank you for the feedback.

  3. VTE Prevention

  4. VTE Prevention • Present to PCC next Monday • Implementation/ hit support/ ? Absorb –adapt code from U Michigan. • Measure-Vention • Aim to Launch Sept 21

  5. SEPT Lecture series Sept 20th. How to build a successful international Registry. Dr Manuel Monreal Sept 20th . NorthShore PERT program implementation and mortality results. Dr. A Tafur Submassive PE, catheter directed approaches Dr. Marc Alonzo Provoked vs Unprovoked. Is ti time to re think nomenclature? Dr. Manuel Monreal Sept 21st VTE Prevention Symposium Drs. Caprini, Monreal, Zorriasateyn, Tafur, Najman, Lovinger, Mahalakshmi Thrombosis Posters competition Northshore – Loyola Coagulation Pathology colloquium Prof Biller, Walenga, Wozniak, Gniadek, Ramasciotti, Rosenberg

  6. Thrombophilia Taskforce 7 9 19 VTE Prevention Update Sept 21st DOAC Clinic Peri operative guidelines Data review

  7. DOAC Clinic • Background • Clinic advertisement • Initial data • Service line improvement

  8. Isth Melbourne 2019 • High value on bleeding stratification • Keeps 3 tier thrombosis risk for research purposes • Cancer upgraded for VTE risk consideration in peri operative interruption • Adds Caprini risk for VTE prevention assessment to complement risk assessment in the interruption

  9. Thrombophilia Taskforce 7 9 19 VTE Prevention Update Sept 21st DOAC Clinic Peri operative guidelines Data review

  10. Data Review Low molecular weight heparin for prevention of venous thromboembolism in adults with lower-limb immobilization in an outpatient setting • Cochrane review update 2017 • M, Janssen L, Janzing HMJ

  11. Venographically-proven DVT in patients with lower- limb fractures range from 27% to 78% • The incidence of PE in trauma patients with DVT without pro-phylaxis is 4.3%, with a high mortality rate (20% to 23.3%). In patients with DVT receiving thromboprophylaxis this incidence can be lowered to 0.3% to 2.0% • National guidelines do not come to an evidence-based stand and there remains substantial practice variation amongst sur-geons regarding the use of anticoagulation measures

  12. Patients with cancer most commonly develop AF during active treatment with certain chemotherapeutic agents, radiation therapy, or surgery. • AF is also prevalent at the time of cancer diagnosis prior to treatment and in those with a history of cancer. • Malignancy is a well-established acquired thrombophilia that increases venous and, to a lesser degree, arterial thrombotic risk,

  13. The primary endpoint for this study were stroke and SE. • The primary endpoint for this study patients were considered to have a ‘history of cancer’ if two conditions were met. • First, the past medical history must have included any of the following terms: intracranial neoplasm; brain cancer; leukaemia; lymphoma; lung cancer; colorectal cancer; breast cancer; thyroid cancer; endometrial, ovarian, or cervical cancer; renal, bladder, or urinary tract cancers; or metastatic cancer. • Second, their history of cancer did not include the following terms: benign, pre-cancer, skin (except melanoma), basal, and squamous.

  14. The overall rate of stroke or SE was not significantly different between patients with and without a history of cancer (2.03 vs. 2.28 events/100 pt-yrs; HR 0.86, 95% CI 0.55–1.33; P = 0.50). • Trend toward higher rates of VTE was observed in patients with a history of cancer com pared with those without a history of cancer (0.64 vs. 0.30 events/100 pt-yrs; HR 1.76, 95% CI 0.84–3.70; P = 0.14), although this is based on only eight events in the cancer group. • Rates of MI and cardiovascular related deaths were similar between patients with and without a history of cancer.

  15. Asymptomatic DVT In the overall population, 309 asymptomatic DVTs were detected. Of these, 133 (4.27%) subjects were in the betrixaban arm and 176 (5.55%) subjects were in the enoxaparin arm (RR 0.77, 95% CI 0.62–0.97) Subjects with an asymptomatic DVT were more likely to have had thromboprophylaxis in the 96 hours prior to randomization, D-dimer levels 2 ULN, a history of VTE and hereditary or acquired thrombophilia In a time-to-event analysis up to 35 days following the CUS, 10 (3.62%) subjects in the asymptomatic DVT group and 69 (1.18%) subjects in the no DVT group died (p 0.001). There were 299 subjects in the asymptomatic DVT group and 5,898 subjects in the no DVT group.

  16. Thrombophilia Taskforce 7 9 19 VTE Prevention Update Sept 21st DOAC Clinic Peri operative guidelines Data review OOO next 2nd Tuesday

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