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Blood, 1 August 2008, Vol. 112, No. 3, pp. 504-510. Prepublished online as a Blood First Edition Paper on May 14, 2008; DOI 10.1182/blood-2007-10-117051. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2007-10-117051v1 112/3/504    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Gerber, D. E. Articles by Streiff, M. B. PubMed PubMed Citation Articles by Gerber, D. E. Articles by Streiff, M. B. Related Collections Hemostasis, Thrombosis, and Vascular Biology Free Research Articles Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention David E. Gerber1, Jodi B. Segal2, M. Yair Levy3, Joyce Kane4, Richard J. Jones3, and Michael B. Streiff5 1 Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas; 2 Division of General Internal Medicine, Department of Medicine; 3 Division of Hematologic Malignancies, and 4 Oncology Data Quality Assurance, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center; and 5 Division of Hematology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD Venous thromboembolism (VTE) is increasingly diagnosed among individuals with hematologic malignancies. However, the risk of VTE among patients undergoing hematopoietic stem cell transplantation (HSCT) is unclear. We examined the incidence and risk factors for VTE and bleeding among 1514 patients undergoing in-patient HSCT. No protocolized VTE prophylaxis was used. By HSCT day 180, 75 symptomatic VTE occurred in 70 patients (4.6%; 95% confidence interval [CI], 3.6%-5.8%). Fifty-five (3.6%) were catheter-associated, 11 (0.7%) were non–catheter-associated deep venous thromboses, and 9 (0.6%) were pulmonary emboli. Thirty-four percent of VTE occurred at a platelet count less than 50 x109/L; 13% occurred at a platelet count less than 20 x109/L. In multivariate analysis, VTE was associated with prior VTE (odds ratio [OR], 2.9; 95% CI, 1.3-6.6) and with graft-versus-host disease (GVHD; OR, 2.4; 95% CI, 1.4-4.0). Clinically significant bleeding occurred in 230 patients (15.2%; 95% CI, 13.4%-17.1%); 55 patients (3.6%; 95% CI, 2.7%-4.7%) had fatal bleeding. Bleeding was associated with anticoagulation (OR, 3.1; 95% CI, 1.8-5.5), GVHD (OR, 2.4; 95% CI, 1.8-3.3), and veno-occlusive disease (OR, 2.2; 95% CI, 1.4-3.6). In HSCT patients, VTE is primarily catheter-related and 3-fold less common than clinically significant bleeding. These findings warrant consideration when selecting VTE prophylaxis in HSCT patients. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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