Adverse Outcomes Associated with Venous Thromboembolism Among Patients with Kidney Disease, Obesity, and Cancer: A Population-based Perspective

Parikh, Amisha Mayur

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Year:: 2012
Contributor:: Parikh, Amisha Mayur (creator); Goldberg, Robert (Director); Spencer, Frederick (Reader); Linkletter, Crystal (Reader); Baylin, Ana (Reader); Brown University. BIOMED: Epidemiology (sponsor)
Genre:: theses
Subject:: venous thromboembolism; complications; kidney disease; Cancer--Complications; Kidneys--Diseases; Obesity; Cancer
Extent:: x, 73 p.
DOI: https://doi.org/10.7301/Z0S46Q7P

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Abstract:: Venous thromboembolism (VTE) is the third most common cardiovascular disorder in the United States, and the most preventable cause of death in hospitals. Despite recent advances in our understanding of the natural history of VTE, considerable uncertainty remains on the prognosis following VTE for certain vulnerable patients with prevalent conditions that increase their risk of experiencing VTE-related complications, including patients with kidney disease, obesity, or cancer. This community-based investigation examined the differences in clinical characteristics, management practices, and the occurrence of VTE recurrences, major bleeding episodes, and all-cause mortality in patients with validated VTE in relation to their level of kidney dysfunction, weight status, or the presence of cancer. Data from the Worcester VTE Surveillance Study were used for this study, which included all metropolitan Worcester (MA) residents hospitalized with validated VTE during 1999, 2001, and 2003, with further follow-up for 3 years. All study data were extracted from hospital and outpatient medical records. Kidney dysfunction was categorized according to the estimated glomerular filtration rate (eGFR; ml/min/1.73m2): eGFR < 30, 30-59, 60-89, or 90+. Weight status was determined by body mass index (BMI; kg/m2): underweight (< 18.5), normal weight (18.5-24.9), overweight (25.0-29.9), mildly obese (30.0-34.9), or moderately/severely obese (35+). The presence of cancer was defined as any cancer that was active, treated, or palliated in the previous three months. Severe reductions in eGFR were associated with an increased risk of long-term recurrent VTE, bleeding, and mortality in patients with VTE. Underweight patients with VTE experienced a higher risk of bleeding and mortality. Paradoxically, overweight and obese patients had prolonged survival compared to normal weight patients. Cancer patients with VTE were at an increased risk for VTE recurrence and death. Given the substantial burden of VTE and its associated complications, the results from this investigation suggest an increased awareness for improving the monitoring and management of VTE among high-risk populations. Designing targeted interventions for these vulnerable groups is critical in improving their overall prognosis following VTE.
Notes:: Thesis (Ph.D. -- Brown University (2012)

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Parikh, Amisha Mayur, "Adverse Outcomes Associated with Venous Thromboembolism Among Patients with Kidney Disease, Obesity, and Cancer: A Population-based Perspective" (2012). Epidemiology Theses and Dissertations. Brown Digital Repository. Brown University Library. https://doi.org/10.7301/Z0S46Q7P

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Epidemiology Theses and Dissertations

Theses and Dissertations for the Epidemiology department.
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