Background Growth differentiation factor-15 (GDF-15) has been proposed as a bleeding biomarker. Objectives To evaluate the predictive value of GDF-15 for clinically relevant bleeding (CRB, major bleeding and clinically relevant non-major bleeding) during anticoagulation for venous thromboembolism (VTE). Methods This study was part of BACH-VTE, a cohort study including patients with acute, symptomatic pulmonary embolism or deep vein thrombosis with 2 years of follow-up. Patients with active cancer and pregnant/peripartum were excluded. GDF-15 was measured at baseline and 3 months. CRB cumulative incidences and regression models were adjusted for competing risks (death/anticoagulation stop). The performance of the VTE-PREDICT bleeding risk score with and without GDF-15 and the ABC-bleeding risk score, which includes GDF-15, was analyzed by assessing discrimination, calibration, and overall performance. Results Among 383 patients (39.2% female, median age 55 years, 48.0% with pulmonary embolism), 49 first CRB occurred (median follow-up: 178 days), corresponding to a 1-year cumulative incidence of 11.9% (95% confidence interval [95% CI]: 8.7-15.7). Median GDF-15 levels were 968 (interquartile range, 645-1554) pg/mL at baseline and 836 (597-1292) pg/mL at 3 months. Baseline GDF-15 was not associated with CRB in the univariable or multivariable model (subdistribution hazard ratio 1.05 [95% CI: 0.76-1.46] and 0.96 [95% CI: 0.70-1.30] per doubling, adjusted for bleeding history, age, and sex). Accordingly, GDF-15 did not meaningfully improve the predictive performance of VTE-PREDICT. ABC-bleeding showed modest discrimination for CRB in this cohort. Conclusion In patients receiving anticoagulation for acute VTE, GDF-15 was not associated with CRB and did not improve bleeding prediction.

Background Pulmonary embolism (PE) is a major cause of morbidity and mortality. In addition to traditional risk factors, environmental exposures such as air pollution and atmospheric conditions may influence PE risk, although existing evidence is inconsistent. Objectives We aimed to investigate the association between particulate matter (PM), air temperature, and barometric pressure with PE incidence and severity. Methods In this cohort study, we included all PE cases diagnosed at the Vienna General Hospital, Austria, during a 4-year period. Daily averages of PM2.5, PM10, barometric pressure, and air temperature were obtained from local monitoring stations. A 10-day moving average (lag, 0-9 days) was calculated for each environmental parameter prior to PE diagnosis. Poisson regression was used to analyze associations with weekly PE incidence, and ordinal logistic regression assessed associations with PE severity, classified according to European Society of Cardiology guidelines. Results Among 969 patients (median age, 64 years; 50.3% women), higher levels of PM2.5, PM10, and barometric pressure were significantly associated with increased PE incidence. Specifically, weekly PE incidence increased by 0.8% (95% CI, 0.0%-1.6%) per 1-μg/m3 PM2.5, 0.9% (95% CI, 0.1%-1.6%) per 1-μg/m3 PM10, and 1.8% (95% CI, 0.4%-3.1%) per 1-hPa increase. Associations were stronger in patients without known PE risk factors. Air temperature, modeled using a quadratic term, was not significantly associated with PE incidence (P = .052). None of the environmental parameters were linked to PE severity. Conclusion Our findings indicate that air pollution and atmospheric pressure are associated with increased PE incidence, emphasizing the potential contribution of environmental exposures to PE risk.

Background Adherence to anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE) might be influenced by disease perception. Objectives We aimed to understand disease perception, including subjective theory of illness, and attitude toward anticoagulation therapy in patients with unprovoked VTE. Methods We conducted a qualitative study encompassing semistructured interviews of patients with unprovoked VTE 3 to 12 months from diagnosis with a medical recommendation for long-term anticoagulation therapy. Patients were asked about diagnosis, self-perceived reasons for VTE, attitude toward anticoagulation therapy, and changes in daily life. Thematic analysis was performed to identify common themes. Additionally, patients were given 5 color pencils and were asked to express on paper what was important to them regarding diagnosis and management. Results From November 2024 to March 2025, we interviewed 22 patients with unprovoked VTE, including 10 (45.5%) women and 10 (45.5%) patients aged <50 years. Self-perceived reasons for unprovoked VTE included psychological stress; physical overload/overexertion; lifestyle; family history; and specific events prior to VTE. We identified the following themes: (1) VTE as a threatening and life-changing event; (2) feelings of uncertainty and lack of understanding; and (3) ambivalence with therapeutic options and follow-up. Common themes on paper included the human body, the sun, and written text. Conclusion Despite the lack of identifiable clinical reasons for a thrombotic event in patients with unprovoked VTE, patients themselves expressed various subjective theories of illness. These subjective theories of illness and patient-relevant themes might influence adherence to anticoagulation therapy and should therefore be openly discussed with patients to be incorporated into shared decision-making.

AIMS:Patients' rehabilitation after acute venous thromboembolism (VTE) may reduce the risk of persistent impairments in patients' functioning and quality of life. This systematic review addresses the safety and efficacy of early initiation of structured exercise training (ET) programmes in the rehabilitation of acute VTE. METHODS AND RESULTS:We systematically searched MEDLINE, EMBASE, and CENTRAL for randomized controlled trials (RCTs) evaluating structured ET initiated within 3 months after VTE, defined as deep vein thrombosis (DVT) and/or pulmonary embolism (PE). No restrictions were applied to comparator interventions or clinical indications. Two reviewers independently screened and extracted data, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. In total, 2160 records were identified, of which four RCTs (n = 250) met inclusion criteria. Two studies investigated ET after PE, one after DVT, and one after either condition. Interventions included supervised aerobic or high-intensity interval training, home-based ET programmes, and combined behavioural counselling. Three studies demonstrated improvements in exercise capacity, cardiopulmonary function, or quality of life within ET groups. However, differences between ET and control groups were nonsignificant and limited by small sample sizes and risk of bias. No trial reported safety concerns regarding ET initiated within 3 months after VTE. CONCLUSION:Early initiation of structured ET and rehabilitation programmes after VTE appears to be safe. Robust evidence on efficacy of ET and rehabilitation programmes in terms of functional and quality-of-life benefits is limited, and large scale RCTs addressing potential effects of ET to prevent post-thrombotic syndrome and post-PE syndromes are warranted. LAY SUMMARY:Thrombosis of the legs and pulmonary embolism are common conditions associated with long-term consequences for affected patients. These consequences include limitations in daily life, persistent symptoms, and reduced quality of life. Early exercise training and rehabilitation within 3 months of diagnosis might support affected patients in maintaining their physical functioning and preventing such long-term consequences. Therefore, we searched several databases for literature on medical studies evaluating exercise training and rehabilitation in this situation. We only considered medical studies that compared the exercise training and rehabilitation to standard treatment of thrombosis and pulmonary embolism (anticoagulation), with patients being randomly assigned to either treatment strategy. We identified four studies including 250 patients. Overall, patients tolerated the exercise training and rehabilitation very well, without adverse events or worsening of their thrombosis or pulmonary embolism. However, there was no clear benefit of exercise training or rehabilitation. This might be due to the small number of included patients. To summarize, exercise training and rehabilitation appear to be safe in patients with thrombosis of the legs and pulmonary embolism, but it remains to be clarified whether it can prevent long-term consequences.

Purpose: To characterize longitudinal patterns of intraretinal (IRF) and subretinal fluid (SRF) dynamics using AI-assisted optical coherence tomography (OCT) biomarker quantification and to evaluate their association with long-term visual outcomes in eyes with central retinal vein occlusion (CRVO). Methods: Patients with previously treatment-naïve CRVO and a documented 24-month follow-up were retrospectively included. All eyes received intravitreal aflibercept administered according to a treat-and-extend protocol. Spectral-domain OCT scans were analyzed at baseline, and after 3 and 24 months. IRF and SRF volumes were quantified using RetinAI Discovery OCT Biomarker Detector (Ikerian AG). Linear regression models were used to assess the association between fluid volumes and 24-month corrected distance visual acuity (CDVA). Patients were clustered according to their IRF trajectories over time to identify distinct fluid-response phenotypes. Results: Out of 173 patients, 64 eyes (64 patients) were included. Baseline IRF and SRF volumes showed no significant association with 24-month CDVA. Cluster analysis of longitudinal IRF trajectories identified four distinct fluid-response patterns. Eyes with low or rapidly resolving IRF achieved the best long-term visual outcomes (median CDVA 73 letters), whereas those with persistent or recurrent IRF showed poorer outcomes (median 53 letters; p=0.008). Early IRF resolution tended to predict superior visual recovery at 24 months. Conclusion: AI-based volumetric OCT analysis suggests that distinct retinal fluid trajectories in CRVO may have prognostic implications for long-term visual acuity, though these findings are preliminary and require validation. Dynamic IRF resolution patterns are more informative than static fluid volumes for predicting functional outcomes following anti-VEGF therapy.

Background Chemotherapy and immune checkpoint inhibitors (ICIs) are distinct anticancer treatments. We studied their impact on plasma protein profiles in cancer patients, potentially providing insight into treatment-specific prothrombotic mechanisms. Aims To compare baseline and longitudinal changes in protein profiles of patients with non-small cell lung cancer (NSCLC) or head and neck cancer receiving ICI or chemotherapy. Methods We analyzed a matched cohort of 30 treatment-naïve patients from the Vienna CAT-BLED study (10 NSCLC and five head and neck cancer pairs). Plasma was collected before treatment, after three weeks, and three months. We used quantitative protein mass spectrometry to measure 159 protein levels. Longitudinal changes were evaluated using linear mixed models with multiple testing correction. Results Baseline protein profiles clustered by treatment assignment. Patients starting ICIs showed higher immune-related proteins (e.g., CD5 antigen-like, immunoglobulin mu chain C) and lower coagulation proteins levels (factor[F]X, prothrombin) than those initiating chemotherapy. Two proteins changed during ICI, while 34(21%) proteins changed during chemotherapy, with none and 12(7%) remaining after multiple testing correction, respectively. At three months, chemotherapy was associated with increased levels of FXIIIA (mean difference: 0.30, 95%CI 0.06-0.54) and B (0.18, 95%CI 0.03-0.34), fibulin-1 (0.25, 95%CI 0.10-0.43), metalloproteinase inhibitor 2 (0.16, 95%CI 0.02-0.31), and sex hormone-binding globulin (0.71, 95%CI 0.23-1.14) and decreased serotransferrin (-0.10, 95%CI -0.18 to -0.01) and cartilage acid protein 1 (-0.21, 95%CI -0.33 to -0.09). Conclusion In this pilot, chemotherapy and ICI were associated with treatment-specific changes in protein profiles, suggesting distinct pathophysiological processes driving thrombosis and adverse outcomes during treatment.

Background: The blood coagulation system is dysregulated in patients with cancer. While the risk of thrombosis is well established, bleeding represents an important yet understudied complication. The specific risk factors contributing to the risk of bleeding in cancer remain poorly characterized, limiting individual risk stratification. Use of antidepressant agents is common in patients with cancer, and these agents have been associated with bleeding in non-cancer populations. However, data on bleeding risk associated with antidepressant use in patients with cancer are lacking. Therefore, we aimed to determine the risk of bleeding in patients with cancer using antidepressant agents. Methods: This analysis was performed within the framework of the Vienna Cancer, Thrombosis and Bleeding (CAT-BLED) study, a prospective, single-center, cohort study of patients with cancer undergoing systemic anti-cancer treatment at the Medical University of Vienna, Austria. At inclusion, electronic health records were reviewed for current medication use. For this analysis, patients were screened for antidepressant use, while those receiving anticoagulation were excluded. Patients were followed for the occurrence of bleeding events, defined as major bleeding (MB), clinically relevant bleeding (CRB), and CRB from the gastrointestinal tract (GI-CRB), which were independently adjudicated by an expert adjudication committee. Twelve-month cumulative incidences were calculated considering death as a competing event. Fine and Gray models adjusted for potential confounders were used to analyze the association of antidepressant use and bleeding events. Results: Overall, 1,161 patients were analyzed (median age 61 years [IQR: 53-69]; 612 females [52.7%]). The most common cancer sites were lung (243 patients, 20.9%), breast (175, 15.1%), and pancreas (119, 10.3%). At study inclusion, 651 patients (56.1%) had metastatic disease and 714 (61.5%) had newly diagnosed cancer. The most common cancer-specific therapies after inclusion were chemotherapy (570 patients, 49.1%), chemotherapy with immune-checkpoint inhibitors (206 patients, 17.7%), and chemotherapy with targeted agents (155 patients, 13.4%). Antidepressants were used in 218 patients (18.8%) at inclusion, with selective-serotonin re-uptake inhibitors (SSRIs) in 91 (7.8%), serotonin antagonist-re-uptake inhibitors (SARIs) in 75 (6.5%), other agents (mirtazapine, amitriptyline or bupropion) in 68 (5.9%), and serotonin-noradrenaline re-uptake inhibitors (SNRIs) in 13 (1.1%) patients. One-hundred-ninety-three (16.6%) patients were on antiplatelet therapy, of whom 41 were concurrently using antidepressants. The median follow-up duration was 258 days (IQR: 126-506). Over the duration of follow-up, 113 patients had a CRB, 60 a MB, and 50 a GI-CRB, with corresponding 12-month cumulative incidences of 10.4% (95% CI: 8.3-12.4), 6.5% (95% CI: 4.9-8.1) and 5.0% (95% CI: 3.6-6.5), respectively. The 12-month cumulative incidence of bleeding was higher in antidepressant users vs non-users (CRB: 12.3% [95% CI: 7.5-17.2] vs 9.8% [95% CI: 7.6-12.0]; MB: 11.7% [95% CI: 3.7-18.9] vs 6.0% [95% CI: 0.8-7.7]; GI-CRB 13.2% [95% CI: 5.5-21.0] vs 4.3% [95% CI: 2.8-5.7]). This was largely driven by SSRI users which had the highest incidence of bleeding when compared to non-antidepressant users (CRB: 18.6% [95% CI: 9.7-27.4] vs 9.8% [95% CI: 7.5-12.0]; MB: 11.7% [95% CI: 4.4-18.9] vs 5.9% [95% CI: 0.9-7.6]; GI-CRB 13.2% [95% CI: 5.5-21.0] vs 4.3% [95% CI: 0.8-5.9]). In multivariable regression (adjusted for age, sex, cancer type, stage, new or recurrent disease, and antiplatelet therapy), SSRI use was associated with CRB (SHR: 2.11 [95% CI: 1.15-3.85]), MB (SHR: 2.53 [95% CI: 1.24-5.54]), and GI-CRB (SHR: 3.81 [95% CI: 1.78-8.17]) when compared to non-antidepressant users. No significant associations were observed for other antidepressant classes. The concomitant use of antiplatelet agents and antidepressants was associated with an increased risk of CRB (SHR: 4.73 [95% CI: 1.72–12.97]), compared to non-antidepressant and non-antiplatelet users. Conclusions: Patients with cancer using antidepressant agents have a high risk of bleeding, particularly driven by GI-bleeding. Among different types of antidepressants, the highest bleeding-risk was observed among SSRI users. Concomitant use of antidepressants and antiplatelet agents was associated with a particularly high bleeding risk, warranting further investigations.

Background Data on the course of walking capacity after acute deep vein thrombosis (DVT) are scarce. Objectives The aim of this prospective observational study was to assess the course of walking impairment and venous claudication after DVT and the association with clinical characteristics and quality of life (QoL). Methods Walking capacity was assessed by standardized treadmill exercise tests (TETs) at DVT diagnosis and after 3 months. Pain-free walking distance (PWD) and maximum walking distance (MWD) were recorded. Venous claudication during TET was evaluated and documented by trained biomedical scientists according to a standardized protocol. QoL was evaluated with the EuroQoL Group 5-Dimension 5-Level and the VEnous INsufficiency Epidemiologic and Economic Study (VEINES-QoL/Sym) questionnaires. Results Seventy-three patients (30.1% women; median age, 53.8 years; IQR, 42.9-60.0 years) were included. PWD and MWD generally improved over time, with a median change of 305 m (IQR, 33-710 m) and 30 m (IQR, 0-258 m), respectively. However, 16 (28.1%) patients reported persistent venous claudication after 3 months. Patients with venous claudication after 3 months tended to have higher rates of suprainguinal DVT, higher body mass index, and higher rates of arterial hypertension and were admitted to the hospital at DVT diagnosis more often. Generic and disease-specific QoL improved overall, but patients with venous claudication had significantly lower QoL scores than those without. Conclusion Walking capacity generally improved after DVT, but about one-third of patients had persisting venous claudication after 3 months, which was associated with poorer QoL. Suprainguinal DVT, higher body mass index, arterial hypertension, and hospital admission at diagnosis were more common in patients with venous claudication 3 months after DVT.

Background Patients with venous thromboembolism (VTE) are at risk of bleeding during anticoagulation. Objectives This study aimed to assess bleeding risk and the performance of risk assessment models (RAMs) VTE-PREDICT, HAS-BLED, RIETE, and VTE-BLEED in patients with acute VTE initiating anticoagulation. Methods We used data from a prospective observational cohort study (BACH-VTE) including patients with acute VTE who initiated anticoagulation with a follow-up period of up to 2 years. Exclusion criteria were active cancer, pregnancy, and postpartum period. Major bleeding, clinically relevant nonmajor bleeding (CRNMB), and minor bleeding were recorded and their frequencies calculated. RAM performance was evaluated by discrimination and calibration. Predictors associated with clinically relevant bleeding (CRB; composite of major and CRNMB) were assessed. Results In total, 308 patients (median age, 55 years; 42% women, 47% pulmonary embolism, 62% unprovoked VTE) were included. During a median follow-up time of 12.6 months, we observed 2 major bleedings, 41 CRNMBs, and 66 minor bleedings, corresponding to 2-year cumulative incidences (95% CI) of 0.9% (0%-2.1%), 16.2% (10.7%-21.3%), and 20.6% (15.1%-25.8%), respectively, and of 33.4% (26.7-39.5) for any bleeding. RAM discrimination was poor to moderate with C-statistics (95% CI) for CRB of 0.71 (0.61-0.80) for VTE-PREDICT, 0.59 (0.49-0.68) for HAS-BLED, 0.52 (0.41-0.62) for RIETE, and 0.56 (0.45-0.68) for VTE-BLEED. Calibration analysis revealed underestimation of bleeding risk. Female sex, lower hemoglobin, and bleeding history were associated with CRB in a univariable but not in a multivariable model. Conclusion In patients treated with anticoagulants for VTE, we found high rates of CRB. Only the VTE-PREDICT model showed acceptable discrimination, but poor calibration.

BACKGROUND:The VTE-PREDICT score predicts venous thromboembolism (VTE) recurrence and clinically relevant bleeding (CRB; major and clinically relevant nonmajor bleeding) after acute VTE. OBJECTIVES:We aimed to externally validate the VTE-PREDICT score in the Registro Informatizado Enfermedad TromboEmbὀlica, a prospective registry of patients with VTE. METHODS:Exclusion criteria included enrollment before 2012, active cancer, and anticoagulation other than direct oral anticoagulants, vitamin K antagonists, or low-molecular-weight heparin. VTE recurrence and CRB risks were calculated using VTE-PREDICT for a prediction period of 3 months after the index VTE until the following 1 to 5 years. Predicted risks were then compared with observed risks. C-statistics and calibration plots were assessed. RESULTS:In total, 17 850 patients (50.3% women) were included in the final analysis, of whom 64.3% had pulmonary embolism. The median age was 67 years (IQR, 52-78). Regarding long-term anticoagulation, 21.8% of patients were treated with a direct oral anticoagulant, 39.9% with a vitamin K antagonist, and 4.8% with low-molecular-weight heparin, whereas 33.6% received no anticoagulant treatment. Cumulative incidences of VTE recurrence and CRB at 1 year were 3.7% (95% CI, 3.4%-4.0%) and 2.6% (95% CI, 2.4%-2.9%), respectively. The c-statistics of VTE-PREDICT for 1 to 5 years varied between 0.70 (95% CI, 0.67-0.72) and 0.73 (95% CI, 0.69-0.76) for VTE recurrence and between 0.65 (95% CI, 0.63-0.67) and 0.67 (95% CI, 0.64-0.70) for CRB. Calibration analysis revealed underestimation of VTE recurrence and overestimation of CRB risk. CONCLUSION:VTE-PREDICT showed good discrimination for VTE recurrence and moderate discrimination for CRB, but underestimated the risk of VTE recurrence in high-risk patients.

Functional limitations often persist in patients with venous thromboembolism (VTE). The relevance of biomarkers for these outcomes remains unexplored. Therefore, we aimed to investigate the association of hemostatic, inflammatory, and cardiovascular biomarkers with functional limitations 3 months after VTE. We conducted a prospective cohort study, including patients with acute VTE within 21 days of diagnosis. Biomarker levels (D-dimer, fibrinogen, factor VIII [FVIII], von Willebrand factor antigen [VWF], C-reactive protein [CRP], troponin T, N-terminal pro-B-type natriuretic peptide [proBNP]) were measured at inclusion and 3 months. Functional limitations at 3 months were evaluated with the post-VTE functional status (PVFS) scale (0-4, higher indicating more limitations). The association of biomarkers with functional limitations was assessed with proportional odds models adjusted for confounders. Furthermore, we evaluated the area under the receiver operating characteristic curve (AUC-ROC) for the presence of slight-to-severe functional limitations. Overall, we included 290 patients (41.4% of women) with a median age of 54.9 years (interquartile range [IQR]: 43.1-64.2). D-dimer, fibrinogen, FVIII, VWF, and CRP measured at inclusion were independently associated with functional limitations at 3 months. VWF showed the most favorable AUC-ROC (0.62, 95% CI, 0.55-0.69). In patients with pulmonary embolism, troponin T and proBNP were not associated with functional limitations. At the 3-month follow-up, D-dimer was the only biomarker independently associated with functional limitations, yielding an area under the curve (AUC) of 0.62 (95% CI, 0.55-0.69). In conclusion, we identified biomarkers independently associated with functional limitations 3 months after VTE. Our results indicate a role of these biomarkers in the early identification of patients at risk of persistent functional limitations and suggest their involvement in the underlying mechanisms.

Background:Venous thromboembolism (VTE) is associated with various long-term complications. Objectives:We aimed to investigate the association of clinical characteristics at VTE diagnosis with functional limitations 3 and 12 months afterward. Methods:We conducted a prospective cohort study of VTE patients, excluding patients with cancer, pregnancy, and postpartum period. Functional limitations were assessed with the post-VTE functional status (PVFS) scale (range, 0-4) within 21 days of diagnosis, after 3 and 12 months (prospectively), and 1 month before diagnosis (retrospectively). Twelve-month follow-up was only performed in patients on anticoagulation. We fitted 2 proportional odds logistic regression models for the 3- and 12-month follow-ups and computed odds ratios (ORs) with 95% bootstrap percentile confidence intervals (CIs). Results:We included 307 patients (42% female, median age 55.6 years) with a median (IQR) PVFS scale grade of 2 (2-3) at study inclusion and 0 (0-0) before diagnosis. After 3 months, PVFS scale grade in 269 patients was 1 (0-2). Female sex (OR, 2.15; 95% CI, 1.26-4.14), body mass index (OR per 1 kg/m2 increase, 1.05; 95% CI, 1.00-1.10), functional limitations at baseline, and older age were associated with functional limitations. After 12 months, PVFS scale grade in 124 patients was 1 (0-2). Female sex (OR, 4.47; 95% CI, 2.11-16.00), history of cardiovascular/pulmonary disease (OR, 2.36; 95% CI, 1.01-6.89), and functional limitations at baseline were associated with functional limitations. Conclusion:Functional limitations in VTE patients improved 3 and 12 months after diagnosis but did not return to pre-VTE values. We identified clinical characteristics that could help identify patients at risk of persisting functional limitations after VTE.

Introduction Hemostatic imbalances are frequent in patients with cancer. While thrombotic complications have been extensively studied, less is known about baseline bleeding risk and risk factors for bleeding. To allow for a personalized risk-assessment balancing the risk of thrombotic complications and bleeding in patients with cancer, more knowledge on bleeding risk is needed.

Introduction Cancer is associated with an increased risk of venous thromboembolism (VTE), which is in part attributable to systemic cancer therapies. Immune checkpoint inhibitors (ICIs) have changed the treatment landscape in oncology but their impact on VTE risk is still debated.

Background Venous thromboembolism (VTE) may complicate the clinical course of cancer patients and add to their psychological burden.Objectives We aimed to investigate the association between VTE and risk of subsequent depression in patients with hematological cancer.Patients and Methods We conducted a population-based cohort study using Danish national health registries. Between 1995 and 2020, we identified 1,190 patients with hematological cancer and incident VTE diagnosed within 6 months before to 1 year after cancer diagnosis. A comparison cohort of patients with hematological cancer without VTE (n 1/4 5,325) was matched by sex, year of birth, cancer type, and year of cancer diagnosis. Patients were followed until diagnosis of depression, emigration, death, study end (2021), or for a maximum of 3 years. Depression was defined as hospital discharge diagnosis of depression or >= 1 prescription for antidepressants. Absolute risks of depression were computed with cumulative incidence functions, treating death as competing event. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox proportional hazards regression models, adjusting for comorbidities.Results Depression was observed in 158 hematological cancer patients with and 585 without VTE. The 3-year absolute risks of depression were 13.3% (95% CI: 11.5-15.3%) in the VTE cancer cohort and 11.1% (95% CI: 10.3-12.0%) in the comparison cancer cohort, corresponding to a risk difference of 2.2% (95% CI:-1.8-6.5%). VTE was associated with an increased relative risk of depression (adjusted HR: 1.56, 95% CI: 1.28-1.90).Conclusion VTE was associated with an elevated risk of subsequent depression in patients with hematological cancer. cancer

Abstract High sugar consumption is associated with cardiovascular diseases and diabetes. Current sugar substitutes may cause taste sensations and gastrointestinal symptoms. ENSO 16 is a combination of 16 different sugar substitutes and plant fibers and has been designed as a sugar alternative. The impact on plasma glucose metabolism as well as on gastrointestinal tolerance has not been investigated yet. 17 healthy participants were enrolled in this randomized, double-blind trial. Participants received a single oral dose of 30 g glucose or 30 g ENSO 16 and crossed over to the alternate treatment after a 7 day wash out period. The study endpoint was the effect on plasma glucose, insulin, C-peptide concentrations and gastrointestinal disorders. A questionnaire regarding gastrointestinal symptoms was used for individual subjective scoring. The mean baseline adjusted plasma glucose AUC0–180 min was significantly greater after glucose administration compared to ENSO 16 (n = 15, p = 0.0128, paired t-test). Maximum plasma glucose elevation over baseline was 117 mg*dl−1 and 20 mg*dl−1 after oral glucose or ENSO 16, respectively. Insulin and C-peptide AUC0−180 min were significantly greater after glucose compared to ENSO 16 intake (p < 0.01, Wilcoxon rank sum test). The mean maximal concentrations of plasma glucose, insulin and C-peptide after glucose intake were 1.5, 4.6 and 2.7-fold greater after glucose intake compared to ENSO 16 intake, respectively. Adverse reactions were mostly mild and not different between treatments. Conclusion. ENSO 16 has only a small impact on plasma glucose metabolism. This may be of interest in a dietary context and may help to reduce calory intake. Trail registration NCT05457400. First registration: 14/07/2022. https://clinicaltrials.gov/study/NCT05457400 .

Abstract The risk of venous thromboembolism (VTE) increases with age. However, the risk of VTE in the setting of long-term care hospitals is understudied. Our objective was to provide data on the prevalence and incidence of VTE in older adults admitted to long-term care hospitals. In this retrospective cohort study, we collected data about chronically ill and multimorbid patients aged 65 years and older from two long-term care hospitals. The primary endpoint of this study was the lifetime prevalence of VTE, and the secondary endpoint was VTE incidence during residency in long-term care hospitals. We analysed data from 1148 patients with a mean age of 84.1 ± 7.9 years, of whom 74.2% were women. The lifetime prevalence of VTE at baseline was 9.6% (95% CI 7.9–11.4). Cumulative incidence of VTE at 1, 2, and 3 years from baseline was estimated at 3.5% (95% CI 2.5–4.7), 4.2% (95% CI 3.1–5.5), and 5.4% (95% CI 4.1–7.0), respectively. Overall, the incidence rate of VTE in our study was 2.82 (95% CI 2.18–3.66) per 100 person-years. The study indicated a considerably high lifetime prevalence and incidence of VTE during residence in long-term care hospital settings, requiring further evaluation in larger prospective studies.

Introduction In patients with cancer, dysregulation of hemostasis is present. While there is extensive knowledge on risk, risk factors, and predictive biomarkers for venous thromboembolism (VTE), there is limited understanding of bleeding risk and associated biomarkers. Prior research has indicated that growth differentiation factor-15 (GDF-15) holds promise as a predictive biomarker for bleeding risk in various patient populations, including a preliminary study focused on patients with cancer.