Abstract：
OBJECTIVE: Ambulatory thromboprophylaxis (AT) in patients with pancreatic adenocarcinoma (PAC) reduces venous thromboembolism (VTE) risk and is recommended for patients receiving systemic chemotherapy. We evaluated VTE rates, severity, timing, and risk factors in PAC patients as well as AT rates and initiation times.
METHODS: Patients diagnosed with PAC were included. Data collected included patient demographics, medical history, PAC diagnosis, development of VTE, AT, and bleeding episodes. VTE was defined as a DVT or a PE. Patients were classified as receiving AT for VTE prevention if they received a prescription for outpatient anticoagulation.
RESULTS: The cohort included 243 PAC patients. VTE occurred in 24 %. Overall, 52 % developing VTE were hospitalized and 5 % died as a result of the VTE. Of those who developed VTE 50 % were diagnosed within the first 2 months of PAC diagnosis. Univariate predictors of elevated VTE risk included an elevated Onkotev score, metastasis at diagnosis, male gender and not receiving AT. Multivariate predictors of elevated VTE risk included male gender (P = 0.014) and not receiving AT (P = 0.001). Overall, 30 % of patients received AT. The median time from diagnosis to initiation of AT was 43 days. Major bleeding occurred in 5.8 %. Patients receiving AT were not at a significantly increased risk of major bleeding (p = 0.5). Patients with intestinal tumor invasion were at significantly increased risk of major bleeding (P = 0.021).
CONCLUSIONS: VTE risk is significant and morbid in PAC patients. AT rates are low, and initiation is often delayed. Therapeutic endoscopists diagnosing PAC may be helpful in AT initiation.
METHODS: Patients diagnosed with PAC were included. Data collected included patient demographics, medical history, PAC diagnosis, development of VTE, AT, and bleeding episodes. VTE was defined as a DVT or a PE. Patients were classified as receiving AT for VTE prevention if they received a prescription for outpatient anticoagulation.
RESULTS: The cohort included 243 PAC patients. VTE occurred in 24 %. Overall, 52 % developing VTE were hospitalized and 5 % died as a result of the VTE. Of those who developed VTE 50 % were diagnosed within the first 2 months of PAC diagnosis. Univariate predictors of elevated VTE risk included an elevated Onkotev score, metastasis at diagnosis, male gender and not receiving AT. Multivariate predictors of elevated VTE risk included male gender (P = 0.014) and not receiving AT (P = 0.001). Overall, 30 % of patients received AT. The median time from diagnosis to initiation of AT was 43 days. Major bleeding occurred in 5.8 %. Patients receiving AT were not at a significantly increased risk of major bleeding (p = 0.5). Patients with intestinal tumor invasion were at significantly increased risk of major bleeding (P = 0.021).
CONCLUSIONS: VTE risk is significant and morbid in PAC patients. AT rates are low, and initiation is often delayed. Therapeutic endoscopists diagnosing PAC may be helpful in AT initiation.
摘要：
目的：胰腺腺癌（PAC）患者的动态血栓预防（AT）可降低静脉血栓栓塞（VTE）的风险，推荐用于接受全身化疗的患者。我们评估了静脉血栓栓塞率，严重程度,定时,和PAC患者的危险因素以及AT率和开始时间。
方法：纳入诊断为PAC的患者。收集的数据包括患者人口统计学，病史,PAC诊断,VTE的发展,AT,和出血发作。VTE定义为DVT或PE。如果患者接受门诊抗凝处方，则将其归类为接受AT预防VTE。
结果：该队列包括243名PAC患者。VTE发生率为24%。总的来说,52％的发展中的VTE住院，5％的VTE死亡。在发生VTE的患者中，有50％在PAC诊断的前2个月内被诊断出。VTE风险升高的单变量预测因子包括Onkotev评分升高，诊断时转移，男性和不接受AT。VTE风险升高的多因素预测因素包括男性(P=0.014)和未接受AT(P=0.001)。总的来说,30%的患者接收AT。从诊断到开始AT的中位时间为43天。主要出血发生率为5.8%。接受AT治疗的患者大出血风险没有显著增加（p=0.5）。有肠肿瘤侵袭的患者发生大出血的风险显著增加(P=0.021)。
结论：PAC患者的VTE风险显著且病态。AT率很低，并且启动通常会延迟。治疗内镜医师诊断PAC可能有助于AT启动。
方法：纳入诊断为PAC的患者。收集的数据包括患者人口统计学，病史,PAC诊断,VTE的发展,AT,和出血发作。VTE定义为DVT或PE。如果患者接受门诊抗凝处方，则将其归类为接受AT预防VTE。
结果：该队列包括243名PAC患者。VTE发生率为24%。总的来说,52％的发展中的VTE住院，5％的VTE死亡。在发生VTE的患者中，有50％在PAC诊断的前2个月内被诊断出。VTE风险升高的单变量预测因子包括Onkotev评分升高，诊断时转移，男性和不接受AT。VTE风险升高的多因素预测因素包括男性(P=0.014)和未接受AT(P=0.001)。总的来说,30%的患者接收AT。从诊断到开始AT的中位时间为43天。主要出血发生率为5.8%。接受AT治疗的患者大出血风险没有显著增加（p=0.5）。有肠肿瘤侵袭的患者发生大出血的风险显著增加(P=0.021)。
结论：PAC患者的VTE风险显著且病态。AT率很低，并且启动通常会延迟。治疗内镜医师诊断PAC可能有助于AT启动。
