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Blood First Edition Paper, prepublished online May 14, 2008; DOI 10.1182/blood-2007-10-117051. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted October 15, 2007 Accepted April 9, 2008 The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1,514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention David E Gerber, Jodi B Segal, M. Yair Levy, Joyce Kane, Richard J. Jones, and Michael B Streiff* Hematology-Oncology / Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States Hematologic Malignancies / Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, United States Oncology Data Quality Assurance / Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, United States Hematology / Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States * Corresponding author; email: mstreif{at}jhmi.edu. 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 1,514 patients undergoing inpatient HSCT. No protocolized VTE prophylaxis was used. By HSCT Day 180, 75 symptomatic VTE events occurred in 70 patients (4.6%; 95% 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 events occurred at a platelet count less than 50 K/mm3; 13% occurred at a platelet count less than 20 K/mm3. In multivariate analysis, VTE was associated with prior VTE (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 primarily 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 three-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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