Age- and sex-specific incidence, risk, and latency period of a perioperative acute thromboembolism syndrome (PATS)

Abstract

We investigated age- and sex-specific incidence, risk factors, and latency period of a perioperative acute thromboembolism syndrome (PATS) in a large cohort study. We prospectively analyzed data on 21903 consecutive surgery patients to determine the incidence of myocardial infarction, pulmonary embolism, deep venous thrombosis, stroke, and cardiovascular death within 30 postoperative days. Among 255 (1.2 percent) patients with thromboembolism, 105 (0.48 percent) suffered myocardial infarction (mean latency: 5 days), 30 (0.14 percent) suffered pulmonary embolism (6 days), 23 (0.11 percent) suffered deep venous thrombosis (10 days), 97 (0.44 percent) suffered stroke (11 days), and 13 (0.06 percent) died (12 days). The critical period was postoperative week 1 for myocardial infarction and pulmonary embolism, and postoperative week 1 and 2 for deep venous thrombosis, stroke, and death. Risk of all events increased with age (P<0.0001), particularly for over 70 years (odds ratio: 12.5; 95 percent confidence interval, 7.8 to 19.9). Males had an increased risk (P<0.0001) of myocardial infarction (odds ratio; 1.5; 95 percent confidence interval, 1.0 to 2.3). Females had an increased risk (P<0.0001) of pulmonary embolism (odds ratio: 2.7; 95 percent confidence interval, 1.3 to 5.9) and deep venous thrombosis (odds ratio: 9.8; 95 percent confidence interval, 3.3 to 29.3). Risk of thromboembolic event was higher (P<0.0001) in patients with a history of arterial thrombotic events or cancer. Trend analysis indicates that thromboembolic events will increase 3-fold over the next decade. Our findings enable identification of higher risk patients for prophylactic anti-thromboembolic treatment and awareness of the critical postoperative period.

Hyperhomocysteinemia, a Risk Factor for Arteriovenous Fistula Thrombosis in Hemodialysis Patients

“…In Shemin study it was yielded that each 1 µmol/L increase in homocysteine level could increase the risk of VA thrombosis by 4% [21]. The Logistic Regression Model estimated that each 10 µmol/Lit increase in homocysteine level would increase the risk 2.3 times and after adjustment it would be 2.08 times [22]. In regard to high incidence of VA thrombosis and hyperhomocysteinemia in hemodialysis patients and strong association between thrombosis and hyperhomocysteinemia, interventional studies are needed to show the effect of lowering homocysteine level before insertion of fistula on thrombotic events in this population [23,24].…”