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Annals of Internal Medicine Sep 2022Venous thromboembolism (VTE) is the third most common cardiovascular disorder, affecting up to 5% of the population. VTE commonly manifests as lower-extremity deep... (Review)
Review
Venous thromboembolism (VTE) is the third most common cardiovascular disorder, affecting up to 5% of the population. VTE commonly manifests as lower-extremity deep venous thrombosis (DVT) or pulmonary embolism. Half of these events are associated with a transient risk factor and may be preventable with prophylaxis. Direct oral anticoagulants are effective and safe and carry a lower risk for bleeding than vitamin K antagonists. Many patients with VTE will have a chronic disease requiring long-term anticoagulation. Postthrombotic syndrome affects 25% to 40% of patients with DVT and significantly impacts function and quality of life.
Topics: Anticoagulants; Humans; Quality of Life; Venous Thromboembolism; Venous Thrombosis; Vitamin K
PubMed: 36095313
DOI: 10.7326/AITC202209200 -
Clinical and Experimental Medicine Jul 2023Deep venous thrombosis is a frequent, multifactorial disease and a leading cause of morbidity and mortality. Most of the time deep venous thrombosis is triggered by the... (Review)
Review
Deep venous thrombosis is a frequent, multifactorial disease and a leading cause of morbidity and mortality. Most of the time deep venous thrombosis is triggered by the interaction between acquired risk factors, such as hip fracture, pregnancy, and immobility, and hereditary risk factors such as thrombophilias. The mechanisms underlying deep venous thrombosis are not fully elucidated; however, in recent years, important advances have shed light on the role of venous flow, endothelium, platelets, leukocytes, and the interaction between inflammation and hemostasis. It has been described that the alteration of venous blood flow produces endothelial activation, favoring the adhesion of platelets and leukocytes, which, through tissue factor expression and neutrophil extracellular traps formation, contribute to the activation of coagulation, trapping more cells, such as red blood cells. Thus, the concerted interaction of these phenomena allows the formation and growth of the thrombus. In this work, the main mechanisms involved in the pathophysiology of deep vein thrombosis will be described.
Topics: Humans; Venous Thrombosis; Blood Platelets; Blood Coagulation; Leukocytes; Inflammation
PubMed: 35471714
DOI: 10.1007/s10238-022-00829-w -
Emergency Medicine Clinics of North... Nov 2017Deep venous thrombosis (DVT) is a frequently encountered condition that is often diagnosed and treated in the outpatient setting. Risk stratification is helpful and... (Review)
Review
Deep venous thrombosis (DVT) is a frequently encountered condition that is often diagnosed and treated in the outpatient setting. Risk stratification is helpful and recommended in the evaluation of DVT. An evidence-based diagnostic approach is discussed here. Once diagnosed, the mainstay of DVT treatment is anticoagulation. The specific type and duration of anticoagulation depend upon the suspected etiology of the venous thromboembolism, as well as risks of bleeding and other patient comorbidities. Both specific details and a standardized approach to this vast treatment landscape are presented.
Topics: Diagnostic Imaging; Global Health; Humans; Incidence; Risk Factors; Thrombolytic Therapy; Venous Thrombosis
PubMed: 28987427
DOI: 10.1016/j.emc.2017.06.003 -
Minerva Medica Dec 2021Cerebral venous thrombosis (CVT) is a rare form of deep venous thrombosis (DVT), yet a leading cause of stroke in young adults, with an incidence that seems to be... (Review)
Review
Cerebral venous thrombosis (CVT) is a rare form of deep venous thrombosis (DVT), yet a leading cause of stroke in young adults, with an incidence that seems to be increasing in recent years. Risk factors for CVT overlap with those of DVT in other locations, with the addition of local risk factors, such as infections, head trauma and neurosurgery. The clinical presentation is highly variable, hence the diagnosis of CVT may be delayed or overlooked. Early recognition and timely initiation of anticoagulant treatment are of essence, while decompressive surgery can be lifesaving for patients with impending trans-tentorial herniation. Concomitant intracranial hemorrhage is not a contraindication to anticoagulant treatment. Endovascular treatment may be suggested for selected patients who deteriorate despite anticoagulant treatment. In this review we will provide an extensive and contemporary discussion of the incidence, pathophysiology, risk factors, clinical presentation, neuroimaging and management of CVT, in accordance with recent guidelines. Additionally, we will summarize the latest data with regards to direct oral anticoagulants (DOACs) treatment in CVT.
Topics: Anticoagulants; Humans; Intracranial Thrombosis; Venous Thrombosis
PubMed: 33555165
DOI: 10.23736/S0026-4806.21.07353-5 -
Journal of Thrombosis and Thrombolysis Jan 2015D-Dimer is a biomarker of fibrin formation and degradation. While a D-dimer within normal limits is used to rule out the diagnosis of deep venous thrombosis and... (Review)
Review
D-Dimer is a biomarker of fibrin formation and degradation. While a D-dimer within normal limits is used to rule out the diagnosis of deep venous thrombosis and pulmonary embolism among patients with a low clinical probability of venous thromboembolism (VTE), the prognostic association of an elevated D-dimer with adverse outcomes has received far less emphasis. An elevated D-dimer is independently associated with an increased risk for incident VTE, recurrent VTE, and mortality. An elevated D-dimer is an independent correlate of increased mortality and subsequent VTE across a broad variety of disease states. Therefore, medically ill subjects in whom the D-dimer is elevated constitute a high risk subgroup in which the prospective evaluation of the efficacy and safety of antithrombotic therapy is warranted.
Topics: Biomarkers; Female; Fibrin Fibrinogen Degradation Products; Fibrinolytic Agents; Humans; Male; Venous Thromboembolism; Venous Thrombosis
PubMed: 25006010
DOI: 10.1007/s11239-014-1101-6 -
Journal of Vascular Surgery. Venous and... May 2019Deep venous thrombosis (DVT) in the pediatric population is rare, occurring in about 10 to 14 out of 10,000 pediatric admissions annually, but with serious consequences... (Review)
Review
BACKGROUND
Deep venous thrombosis (DVT) in the pediatric population is rare, occurring in about 10 to 14 out of 10,000 pediatric admissions annually, but with serious consequences such as pulmonary embolism and/or post-thrombotic syndrome. There is a dearth of surgical literature regarding this entity, its pathophysiology, its treatment and its long-term sequelae.
METHODS
An extensive search of available surgical and medical literature in Medline, PubMed was obtained by searching terms synonymous with pediatric DVT. Case reports and opinion articles were excluded. Ongoing clinical trials were culled from clinicaltrial.gov by searching for pediatric DVT studies. Institutional guidelines, where available, were included in this summary.
RESULTS
We provide a clinically relevant summary with the aims of improving prevention, early identification and treatment of pediatric DVT.
CONCLUSIONS
Although rare and frequently with subtle presentations, pediatric DVT can be serious. Early identification and treatment can be instrumental in limiting sequelae and in improving outcomes for these patients.
Topics: Adolescent; Age of Onset; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Predictive Value of Tests; Risk Factors; Treatment Outcome; Venous Thrombosis
PubMed: 30853559
DOI: 10.1016/j.jvsv.2018.12.012 -
Advances in Experimental Medicine and... 2016Tendon metabolism after acute Achilles tendon rupture (ATR) is associated with major complications related to immobilization, which results in reduced circulation, high... (Review)
Review
Tendon metabolism after acute Achilles tendon rupture (ATR) is associated with major complications related to immobilization, which results in reduced circulation, high risk of deep venous thrombosis (DVT), impaired healing and functional deficits.DVT has been demonstrated to occur in up to 50 % of the patients with ATR. Suffering from a DVT during tendon healing has been demonstrated as an independent predictive factor for impaired patient outcome at 1 year after ATR, suggesting that specific interventions are warranted to prevent DVT. Since pharmacological DVT prophylaxis has low or no effect during lower leg immobilization it is speculated whether adjuvant treatment with intermittent pneumatic compression (IPC) applied during lower limb immobilization can reduce the incidence of DVT.IPC, which acts through mechanical, chemical and molecular mechanisms, has been demonstrated to enhance neuro-vascular ingrowth in a tendon repair model and stimulate collagen production leading to improved maximum force during healing.Recently, a prospective randomized trial compared adjuvant IPC applied under an orthosis versus plaster cast only in ATR patients. The study found at 2 weeks post-operatively 21 % DVTs in the IPC-group compared to 37 % in the control group. Patients that received no IPC treatment exhibited an almost threefold increased odds for DVT, independently of age. Furthermore, using microdialysis technique, adjuvant IPC treatment was shown to increase the metabolic healing activity at 2 weeks post-ATR.Tendon healing is impaired by reduced circulation and DVT. The demonstration that adjuvant IPC effectively reduced DVT incidence, and also is capable of enhancing the metabolic response suggests that IPC treatment may not only be a viable means of prophylaxis against DVT, but possibly also a method of promoting healing.
Topics: Animals; Humans; Immobilization; Intermittent Pneumatic Compression Devices; Postoperative Complications; Tendon Injuries; Tendons; Venous Thrombosis; Wound Healing
PubMed: 27535264
DOI: 10.1007/978-3-319-33943-6_21 -
The Surgical Clinics of North America Dec 2021There have been significant advances in vascular surgery in recent years. These advances include procedural techniques, choice of procedure, and application of... (Review)
Review
There have been significant advances in vascular surgery in recent years. These advances include procedural techniques, choice of procedure, and application of nonoperative management. Endovascular techniques have expanded greatly over the past decade. As a result, for many clinical scenarios there is more than 1 option for management, which has given rise to controversies in the choice of best management. This article reviews current controversies in the management of carotid artery disease, abdominal aortic aneurysms, acute deep venous thrombosis, and inferior vena cava filter placement.
Topics: Acute Disease; Anticoagulants; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Carotid Artery Diseases; Endovascular Procedures; Humans; Thrombolytic Therapy; Vascular Surgical Procedures; Vena Cava Filters; Venous Thrombosis
PubMed: 34774271
DOI: 10.1016/j.suc.2021.06.007 -
JACC. Cardiovascular Interventions Apr 2016Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of... (Review)
Review
Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of a congenital anomaly, the most common cause of IVC thrombosis is the presence of an unretrieved IVC filter. Due to the substantial increase in the number of IVC filters placed in the United States and the very low filter retrieval rates, clinicians are faced with a very large population of patients at risk for developing IVC thrombosis. Nevertheless, there is a paucity of data and societal guidelines with regards to the diagnosis and management of IVC thrombosis. This paper aims to enhance the awareness of this uncommon, but morbid, condition by providing a concise, yet comprehensive, review of the etiology, diagnostic approaches, and treatment strategies in patients with IVC thrombosis.
Topics: Angioplasty, Balloon; Anticoagulants; Combined Modality Therapy; Humans; Risk Factors; Stents; Stockings, Compression; Thrombectomy; Thrombolytic Therapy; Treatment Outcome; Vascular Malformations; Vena Cava Filters; Vena Cava, Inferior; Venous Thrombosis
PubMed: 26952909
DOI: 10.1016/j.jcin.2015.12.268 -
The Surgical Clinics of North America Apr 2015"Venous thromboembolism (VTE) remains a significant risk for all surgical patients, despite validated guidelines. Development of VTE remains a high risk in hospitalized... (Review)
Review
"Venous thromboembolism (VTE) remains a significant risk for all surgical patients, despite validated guidelines. Development of VTE remains a high risk in hospitalized surgical patients, leading to complications in up to 30%. The stratification of patient risk factors and subsequent utilization of a validated prophylaxis and treatment regimen is, therefore, of utmost importance. Familiarity with the current guidelines and recommendations ultimately results in decreased morbidity, mortality, and health care costs. This article discusses the risk factors for developing VTE and management strategies based on the currently available guidelines."
Topics: Anticoagulants; Clinical Protocols; Humans; Perioperative Care; Postoperative Complications; Pulmonary Embolism; Risk Factors; Venous Thromboembolism; Venous Thrombosis
PubMed: 25814107
DOI: 10.1016/j.suc.2014.11.005