“Incidence of venous thromboembolism (VTE) in a designated adult cystic fibrosis service between 2010 and 2020.”

Title: “Incidence of venous thromboembolism (VTE) in a designated adult cystic fibrosis service between 2010 and 2020.”
Author(s): G Kavanagh, H Danish, D Morrissy, M McCarthy, C Fleming, J Dorgan, D Murphy, B.J. Plant
Institution: 1Cork Centre for Cystic Fibrosis (3CF), Dept. of Respiratory Medicine, Cork University Hospital 2HRB Clinical Research Facility Cork, University College Cork – Cork (Ireland).
Poster: Click to view poster
Category: CF and Pulmonary Infections
Abstract: Traditionally the use of VTE prophylaxis in CF is limited and controversial with many patients declining it.1 VTE prophylaxis is not routinely practiced in our service. Aim: To establish the incidence of VTE in a designated adult Cystic Fibrosis service over 10 years. Methods: A retrospective medical chart, electronic hospital information and radiology imaging system review was performed on all adult patients attending our service between 2010-2020. Results: 200 individual patients attended (n=22 post transplantation). The VTE cumulative incidence was 2% in total (Subgroup analysis: 1% pre-transplant and 9% post-transplant). 61 radiological investigations were performed to assess for VTE. Positive cases: CTPA 1 of 49 and US Doppler 4 of 12. The clinical characteristics of positive case are summarized in table 1.

Gender/ Age-years Genotype VTE prophylaxis Diagnosis / year ppFEV1 CFTR
F / 30* F508/F508 No Indwelling central venous catheter associated DVT / 2017 47 No
M / 21 ** F508/F508 No Pulmonary Embolism (PE) / 2020 30 Yes
M / 35* F508/F508 Yes Recurrent DVT + 35 No
F / 26 F508/F508 No Indwelling central venous catheter associated DVT / 2012 22 No
*Post transplant
+recurrent DVT (Right axillary thrombus post PICC, Right below knee dvt post angiogram)
** On Elexacaftor/Tezacaftor/Ivacaftor.

Discussion: The overall cumulative incidence of VTE and use of VTE prophylaxis is low in our population however higher in our post transplantation group suggesting definite need of use of VTE prophylaxis in this subgroup. The diagnostic positivity rate of PE with CTPA was low (2%). Interestingly the positive case was on a CFTR modulator. Large registry prospective analysis is needed in this area to determine a standardized approach .

1. Murray TS, Metzger NL, Chesson MM, Walker SD. Refusal of venous thromboembolism prophylaxis and incidence of thrombosis in patients with cystic fibrosis. Pulm Res Respir Med Open J. 2017; 4(2): 42-47. doi: 10.17140/PRRMOJ-4-138