scholarly journals Diagnosis and Management of Deep Vein Thrombosis

2009 ◽  
Vol 8 (2) ◽  
pp. 53-62
Author(s):  
CJ Mainwaring ◽  
◽  
S Bhandari ◽  
Keyword(s):  
Low Molecular Weight ◽  
Drug Induced ◽  
Radiological Investigation ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Calcium Heparin ◽  
Deep Vein ◽  
Hospital Inpatients ◽  
Test Probability

Awareness of deep venous thrombosis has increased considerably in the last decade including recognition of the importance of thromboprophylaxis for acutely ill hospital inpatients as preventative therapy. Combinations of a pre-test probability score plus a D-Dimer analysis can identify those patients where the chances of DVT are very low and radiological investigation can be obviated. The gold standard for diagnosis is still either ascending venography or venous Doppler ultrasound. Low molecular weight heparin has taken over from unfractionated calcium heparin as the initial treatment of choice. There are many challenges in management, especially deciding the optimum duration of anticoagulant treatment in order to balance the risks of drug induced bleeding against recurrent venous thromboembolic events.

scholarly journals Recurrence of Upper Extremity Deep Vein Thrombosis Secondary to COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 878
Author(s):  
Yesha H. Parekh ◽  
Nicole J. Altomare ◽  
Erin P. McDonnell ◽  
Martin J. Blaser ◽  
Payal D. Parikh
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.

scholarly journals Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Eleftheria Kampouri ◽  
Paraskevas Filippidis ◽  
Benjamin Viala ◽  
Marie Méan ◽  
Olivier Pantet ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Retrospective Study ◽  
University Hospital ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Wells Score ◽  
Deep Vein ◽  
D Dimer

Background. Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. Results. Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120   ng / ml ( P < 0.001 ; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation ( P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000   ng / l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611   ng / ml ( P < 0.001 ; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation ( P < 0.001 ; OR 5.9, 95% CI 2.3-15.1). Conclusions. VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D − dimer ≥ 3,000   ng / l is a good predictor of VTE at admission.

High incidence of in-hospital pulmonary embolism following joint arthroplasty with dalteparin prophylaxis

2010 ◽  
Vol 103 (01) ◽  
pp. 123-128 ◽  
Author(s):  
Jason Kerr ◽  
Lori-Ann Linkins
Keyword(s):  
Pulmonary Embolism ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Joint Arthroplasty ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

SummaryThe in-hospital incidence of pulmonary embolism (PE) in patients undergoing elective joint arthroplasty who receive a minimum of 10 days of dalteparin prophylaxis is reported to be less than 1%. Recent clinical experience raised suspicion that the incidence of PE was significantly higher at our tertiary care institution. It was the objective of this study to determine the incidence of in-hospital PE and symptomatic deep-vein thrombosis following elective joint arthroplasty in patients who received a minimum of 10 days of dalteparin prophylaxis. Consecutive charts of patients who underwent elective joint arthroplasty at our institution between January 2008 and June 2008 were reviewed. Data on risk factors for venous thromboembolism, objectively documented venous thromboembolic events, and signs and symptoms of PE were abstracted. Patients who received concomitant warfarin in the postoperative period were excluded. The study population consisted of 437 knee arthroplasty and 246 hip arthroplasty patients. The incidence of in-hospital PE following knee arthroplasty and hip arthroplasty was 4.6% and 0.4%, respectively. One out of every 10 knee patients, and one out of every 20 hip patients underwent testing for pulmonary embolism. Pulmonary embolism was diagnosed a median of 3.5 days after knee arthroplasty. The incidence of in-hospital PE in knee arthroplasty patients who received dalteparin prophylaxis was significantly higher than expected. Potential explanations for this finding include poor efficacy of dalteparin started 12–24 hours postoperatively and/or a low threshold for ordering diagnostic imaging for PE. Studies to clarify these issues are needed.

scholarly journals H1N1-Induced Venous Thromboembolic Events? Results of a Single-Institution Case Series

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Evangelos Dimakakos ◽  
Dimitra Grapsa ◽  
Ioannis Vathiotis ◽  
Aggeliki Papaspiliou ◽  
Meropi Panagiotarakou ◽  
...  
Keyword(s):  
Influenza A ◽  
Case Series ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Imaging Characteristics ◽  
Influenza A H1n1 ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein ◽  
Novel Influenza A

Abstract We describe the clinical and imaging characteristics of 7 cases with polymerase chain reaction-confirmed novel influenza A H1N1 virus (pH1N1) infection who developed venous thromboembolic events (VTEs) while being hospitalized for influenza pneumonia. Pulmonary embolism (PE) without deep vein thrombosis (DVT) was observed in 6 of 7 cases (85.7%); PE with underlying DVT was found in 1 patient (14.3%).

Rapid D-dimer test combined a clinical model for deep vein thrombosis

2004 ◽  
Vol 91 (06) ◽  
pp. 1237-1246 ◽  
Author(s):  
Alfonsa Friera ◽  
Pilar Artieda ◽  
Paloma Caballero ◽  
Pilar Moliní ◽  
Marta Morales ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Strategy ◽  
Thromboembolic Complications ◽  
Clinical Model ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Venous Thromboembolic ◽  
Deep Vein ◽  
Test Probability ◽  
D Dimer

SummaryAn optimal approach to the diagnosis of deep vein thrombosis (DVT) in lower limbs in the emergency department is still unknown. In this prospective cohort study, we aimed to evaluate the accuracy of the widely available plasma D-dimer test (VIDAS) and establish the usefulness of combining D-dimer testing with a clinical model to reduce the need for serial ultrasonographies and improve the diagnostic strategy of DVT. We performed a cohort study in 383 consecutive outpatients referred to the emergency department of Hospital La Princesa, with clinical suspicion of DVT. The patients were stratified into three pre-test probability categories using an explicit clinical model (Wells score), and underwent a quantitative automated ELISA D-dimer assay (VIDAS D-Dimer® bioMérieux). Patients were managed according to the diagnostic strategy based on clinical probability and compression ultrasonography (CU). Patients for whom DVT was considered a high pre-test probability with negative ultrasonographic findings in the initial CU, returned the following week for repeat ultrasonography. All patients with DVT excluded did not receive anticoagulant therapy, and were followed up for three months to monitor the development of venous thromboembolic complications. DVT was confirmed in 102 patients (26.6%): 95 in the initial test, four in the second test, and three who developed venous thromboembolic complications in the three-month follow-up period. The calculated D-dimer cut-off level was 1 µg/ml. One hundred patients (98%) with DVT had positive D-dimer. D-dimer had a sensitivity of 98% and a negative predictive value of 98.6%. Among the high-probability patients with positive D-dimer tests and initial negative CU, 9.75% had DVT on repeat CU at one week. The study results suggest that the addition of VIDAS D-dimer to this diagnostic algorithm could improve the management of patients with suspected DVT in daily practice. A diagnostic approach of DVT based on D-dimer (cut-off ≥1 μg/ml) as the first diagnostic tool for the exclusion of DVT, and the clinical probability model as the tool that identifies those patients requiring a second ultrasonography is useful and suitable for daily medical practice.

scholarly journals THROMBOPROPHYLAXIS;

2012 ◽  
Vol 19 (03) ◽  
pp. 332-335
Author(s):  
NAUSHEEN NABEEL ◽  
FAUZIA FAHIM ◽  
TALHA ABDUL HALIM
Keyword(s):  
Pregnant Women ◽  
Maternal Obesity ◽  
Objective Assessment ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Audit Cycle ◽  
Deep Vein ◽  
Global Health Problem

Maternal obesity (body mass index, BMI≥30kg/m²) is a global health problem. Significant evidence is available that it is directlyassociated with an increased risk of venous thromboembolic events in pregnancy and puerperium. Objective: This study aims to assess ourcurrent management protocols for thromboprophylaxis and to improve them according to guidelines recommended by The Royal College ofObstetricians and Gynecologists (RCOG). Design: Retrospective study. Period: September 2005 to December 2006. Method: In this study wedid a retrospective first audit cycle to evaluate the existing thromboprophylaxis management in women with high BMI (≥30) in our hospital.The aim was to check our compliance with RCOG recommendations and to introduce change in accordance with RCOG guidelines. Results:In first loop of audit cycle 120 pregnant women with BMI of more than 30 were evaluated.52 (43.3%) of them had no objective assessment doneduring antenatal period with no instructions regarding thromboprophylaxis. 3 of these patients developed Deep vein thrombosis (DVT).Change in practice was introduced based on findings of first loop of audit. In re-audit 120 pregnant women were reviewed with BMI of ≥30.Ninety eight(81.6%) women received Thromboprophylaxis, 22 (18.3%) did not receive thromboprophylaxis, none of them had any thromboticor embolic complications. Conclusions: Detailed objective assessment of obese pregnant women for thromboprophylaxis should beimplemented in our clinical practice according to the recommendations of NICE and RCOG guidelines.

scholarly journals Prevalence of Low Limb Venous Thromboembolic Events in Mild and Severe/Critically Ill Patients with COVID-19 Despite Pharmacological Thromboprophylaxis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 38-38
Author(s):  
Cong Zhang ◽  
Jialan Shi ◽  
Changjun WU ◽  
Chunxu Wang ◽  
Xinyi Zhao ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein ◽  
D Dimer

Background:The prevalence of deep vein thrombosis in hospitalized patients with COVID-19 is higher and is associated with adverse outcomes. However, the treatment options received by patients with different classifications are different, and previous studies have not discussed the differences in specific coagulation parameters between patients with mild, severe, and critically ill COVID-19. Aim:To investigate the change in coagulation function and the incidence of low limb venous thromboembolic events in mild/severe/critically ill patients with COVID-19. Methods:A retrospective analysis of coagulation parameters and lower extremity venous ultrasound examination results in 77 patients with laboratory-confirmed COVID-19 admitted to the first affiliated hospital of Harbin Medical University. We discussed the occurrence of vascular complications in patients with normal, severe and critically ill patients Rate and explore the nature of such vascular events. The anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis and patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Approval was obtained from the local institutional review board and all procedures were performed in accordance with the Declaration of Helsinki. Results:The incidence of low limb venous thromboembolic events in COVID-19 patients included in the study was 28.6% (22/77). A total of 22 cases with deep vein thrombosis, 13 of whom with multiple thrombosis events, and 9 cases with independent distal deep vein thrombosis. There were 0 cases, 8 cases (17.4%) and 14 cases (87.5%) of patients with deep vein thrombosis occurred in mild, severe and critically ill patients, respectively. There were 4 cases (50%) and 9 cases (64.29%) of severe and critically ill patients with multiple deep vein thrombosis events, respectively. There was no difference in age and gender between patients with lower extremity venous thrombosis and those without. The mortality rate of patients with thrombotic events has an upward trend; the mortality rate of patients with thrombosis is 18.18%, and the mortality rate of patients without thrombosis is 3.64%. Compared with mild patients, white blood cell counts, neutrophil percentage, fibrinogen, IL-6, IL-10 serum levels are higher in severe and critically ill patients. The patients whose ultrasonography reported thrombosis mostly showed a dynamic increase and/or a significant increase in D-dimer. The patients whose ultrasonography reported no thrombosis showed mildly elevated D-dimer or within the normal range. Conclusions:The development of massive venous thrombotic events, as observed in our study cohort, suggests the possibility of COVID-19 associated hypercoagulability and endothelial activation and/or dysfunction in affected individuals. Figure Disclosures No relevant conflicts of interest to declare.

Venous thromboembolism in ANCA-associated vasculitis: a population-based cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Matina Liapi ◽  
David Jayne ◽  
Peter A Merkel ◽  
Mårten Segelmark ◽  
Aladdin J Mohammad
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Incidence Rate ◽  
Cox Regression ◽  
Population Based ◽  
Vein Thrombosis ◽  
Anca Associated Vasculitis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

Abstract Objective To determine incidence rate and predictors of venous thromboembolic events (VTE) in a population-based cohort with ANCA-associated vasculitis (AAV). Methods The study comprised 325 patients diagnosed with AAV from 1997 to 2016. All cases of VTE from prior to vasculitis diagnosis to the end of the study period were identified. The BVAS was used to assess disease activity at diagnosis. Venous thromboembolisms occurring in a period beginning 3 months prior to AAV diagnosis were considered to be AAV-related. The standardized incidence ratio (SIR) and 95% CI of VTE were calculated using the incidence rate in the general population. Results Fifty-nine patients (18%) suffered 64 VTE events. Of these, 48 (81%) suffered AAV-related VTE [deep vein thrombosis (n = 23), pulmonary embolism (n = 18) and other (n = 9)]. The incidence rate of AAV-related VTE was 2.4 per 100 person-years (95% CI 1.7, 3.0) during 2039 person-years of follow-up. The incidence during the first 3 months post-AAV diagnosis was 20.4 per 100 person-years (95% CI 11.5, 29.4), decreasing to 8.9 (95% CI 0.2, 17.6) and 1.5 (95% CI 0.0, 3.5) in months 4–6 and months 7–12 post-AAV diagnosis, respectively. The SIR was 34.2 (95% CI 20.2, 48.1) for deep vein thrombosis and 10.4 (95% CI 5.6, 15.1) for pulmonary embolism. In multivariate Cox regression analyses, only age and BVAS were predictive of VTE. Conclusions The incidence rate and SIR of AAV-related VTE is high, and higher early in the course of the disease. Vasculitis activity and age are positively associated with VTE.

scholarly journals Patterns and predictors of thromboembolic events among patients with gastric cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Rawan Mustafa ◽  
Baha’ Sharaf ◽  
Abdallah Al-Tell ◽  
Dina Braik ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Risk Score ◽  
Metastatic Gastric Cancer ◽  
Assessment Model ◽  
Thromboembolic Events ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

Abstract Patients with gastric cancer are at higher risk for venous thromboembolic events (VTE). Majority of such patients are treated in ambulatory settings where thromboprophylaxis is not routinely offered. In this study, we report on VTE rates and search for predictors that may help identify patients at higher risk to justify VTE-prophylaxis in ambulatory settings. Patients with pathologically-confirmed gastric adenocarcinoma were retrospectively reviewed for VTE detected by imaging studies. Clinical and pathological features known to increase the risk of VTE were studied. Khorana risk assessment model was applied on patients receiving chemotherapy. A total of 671 patients; median age 55 years, were recruited. VTE were diagnosed in 150 (22.4%) patients, including 42 (28.0%) pulmonary embolism and 18 (12.0%) upper extremity deep vein thrombosis (DVT). Majority (> 80%) developed VTE while in ambulatory settings and none had been on thromboprophylaxis. Rate was higher (27.1%) among 365 patients with metastatic compared to 16.7% among 306 patients with nonmetastatic disease, p = 0.001. Patients with metastatic disease who received multiple lines of chemotherapy (n = 85) had significantly higher rate of VTE compared to those who received a single line; 48.2% versus 19.4%, p < 0.001. Among the whole group, Khorana risk score, age, gender, smoking and obesity had no impact on VTE rates. Patients with metastatic gastric cancer, especially when treated with multiple lines of chemotherapy, are at a significantly higher risk of VTE. Khorana risk score had no impact on VTE rates. Thromboprophylaxis in ambulatory patients with metastatic gastric cancer worth studying.

Long-term incidence of venous thromboembolic events following cystectomy: A population-based analysis.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 288-288 ◽  
Author(s):  
Christopher J.D. Wallis ◽  
Diana Magee ◽  
Raj Satkunasivam ◽  
Robert Nam
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cumulative Incidence ◽  
Population Based ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

288 Background: Cancer and immobility both contribute to the development of venous thromboembolic events (VTE), including pulmonary embolism and deep vein thrombosis. As such, patients undergoing radical cystectomy for bladder cancer are at elevated risk. We sought to assess the long-term incidence of VTE among all patients undergoing radical cystectomy in the province of Ontario. Methods: We conducted a population-based cohort study to examine the incidence of VTE, a composite of pulmonary embolism and deep vein thrombosis, among all patients treated with radical cystectomy for bladder cancer between 2002 and 2014 in Ontario, Canada. We estimated the cumulative incidence of VTE and used Fine and Grey competing risk survival analysis to assess risk factors for VTE while accounting for the risk of any cause mortality. Results: Among 3623 eligible patients, the 10 year cumulative incidence of VTE was 6.68% (Table 1). Among those who experienced VTE, the median time from surgery was 216 days (interquartile range 52-677 days; mean 527 days). However, VTE rates peaked much earlier with a mode of 20 days. Neither preoperative (HR 0.68, 95% CI 0.39-1.18) nor postoperative chemotherapy (HR 1.32, 95% CI 0.95-1.84) were significantly associated with VTE incidence. While patients with a prior history of VTE had increased risk of VTE after cystectomy (HR 5.1, 95% CI 2.2-12.0), age, gender, comorbidity score, rurality, diversion type (continent vs ileal conduit), treatment at an academic institution, or year of treatment were not significantly associated with the risk of VTE. Conclusions: Among patients undergoing cystectomy for bladder cancer, the cumulative incidence of VTE continues to rise long after the date of surgery indicating that previous studies may have underestimated these rates, but the highest rates occur at 20 days after surgery. Chemotherapy does not appear to increase the risk of VTE. [Table: see text]

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