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Frontiers in Immunology 2023Deep venous thrombosis (DVT) is a part of venous thromboembolism (VTE) that clinically manifests as swelling and pain in the lower limbs. The most serious clinical... (Review)
Review
Deep venous thrombosis (DVT) is a part of venous thromboembolism (VTE) that clinically manifests as swelling and pain in the lower limbs. The most serious clinical complication of DVT is pulmonary embolism (PE), which has a high mortality rate. To date, its underlying mechanisms are not fully understood, and patients usually present with clinical symptoms only after the formation of the thrombus. Thus, it is essential to understand the underlying mechanisms of deep vein thrombosis for an early diagnosis and treatment of DVT. In recent years, many studies have concluded that Neutrophil Extracellular Traps (NETs) are closely associated with DVT. These are released by neutrophils and, in addition to trapping pathogens, can mediate the formation of deep vein thrombi, thereby blocking blood vessels and leading to the development of disease. Therefore, this paper describes the occurrence and development of NETs and discusses the mechanism of action of NETs on deep vein thrombosis. It aims to provide a direction for improved diagnosis and treatment of deep vein thrombosis in the near future.
Topics: Humans; Extracellular Traps; Neutrophils; Lower Extremity; Pain; Venous Thrombosis
PubMed: 37680629
DOI: 10.3389/fimmu.2023.1198952 -
Expert Review of Cardiovascular Therapy 2016Pharmacomechanical Thrombectomy (PMT) is recognized as a recent advancement in the treatment of lower extremity deep venous thrombosis (DVT). Evidence for the use of... (Review)
Review
Pharmacomechanical Thrombectomy (PMT) is recognized as a recent advancement in the treatment of lower extremity deep venous thrombosis (DVT). Evidence for the use of this modality is growing rapidly, primarily based on anecdotal experience and large case series. Currently, the majority of patients with lower extremity DVT are treated with anticoagulation or compressive therapy without adjunctive surgical or interventional procedures. This article reviews the current evidence supporting the use of PMT over catheter directed thrombolysis or simple anticoagulation and the expected benefits that can be realized from each modality. In addition the relevant unique characteristics to each device currently available are described focusing on mechanism of action and potential side effects.
Topics: Combined Modality Therapy; Humans; Lower Extremity; Risk Assessment; Thrombectomy; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 26818769
DOI: 10.1586/14779072.2016.1140038 -
Arthroscopy : the Journal of... Dec 2022Knee arthroscopy has low complication rates overall, and most complications are not overly disabling. Yet one of the most concerning complications is venous...
Knee arthroscopy has low complication rates overall, and most complications are not overly disabling. Yet one of the most concerning complications is venous thromboembolism, and pulmonary embolism (PE), in particular. The combination of low rate of venous thromboembolism in knee arthroscopy but high potential cost in the event of PE makes for a challenging risk-benefit analysis in the decision for whether to use thromboprophylaxis. Research is inherently difficult due to the infrequency of deep venous thrombosis and PE, leaving orthopaedic surgeons to fill in the gaps with clinical judgement. Risk stratification based on patient risk factors (e.g., oral contraceptives, renal disease, cardiovascular disease) and specific surgical procedure (e.g., meniscectomy, anterior cruciate ligament reconstruction) are important to define the highest-risk patients that may warrant stronger anticoagulation. Yet even in low-risk patients, given the potential severity of a PE and safety of aspirin, surgeons should consider aspirin as thromboprophylaxis.
Topics: Humans; Arthroscopy; Venous Thromboembolism; Anticoagulants; Pulmonary Embolism; Aspirin; Venous Thrombosis
PubMed: 36462784
DOI: 10.1016/j.arthro.2022.08.011 -
Annals of Internal Medicine May 2015This issue provides a clinical overview of deep venous thrombosis, focusing on prevention, diagnosis, treatment, and patient information. The content of In the Clinic is... (Review)
Review
This issue provides a clinical overview of deep venous thrombosis, focusing on prevention, diagnosis, treatment, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.
Topics: Female; Humans; Patient Care; Patient Education as Topic; Pregnancy; Quality of Health Care; Risk Factors; Venous Thrombosis
PubMed: 25939012
DOI: 10.7326/AITC201505050 -
Clinics in Chest Medicine Sep 2018Overdiagnosis of venous thromboembolism is associated with increasing numbers of patient complications and health care burden. Multiple clinical tools exist to estimate... (Review)
Review
Overdiagnosis of venous thromboembolism is associated with increasing numbers of patient complications and health care burden. Multiple clinical tools exist to estimate the probability of pulmonary embolism and deep venous thrombosis. When used with d-dimer testing, these can further stratify venous thromboembolism risk to help inform the use of additional diagnostic testing. Although there are similar tools to estimate bleeding risk, these are not as well-validated and lack reliability.
Topics: Hemorrhage; Humans; Probability; Pulmonary Embolism; Venous Thromboembolism; Venous Thrombosis
PubMed: 30122172
DOI: 10.1016/j.ccm.2018.04.001 -
British Medical Bulletin Mar 2016This review aims to provide an update on the management of deep vein thrombosis (DVT). (Review)
Review
INTRODUCTION
This review aims to provide an update on the management of deep vein thrombosis (DVT).
SOURCES OF DATA
A systematic search of PubMed, Google Scholar and Cochrane databases was carried out.
AREAS OF AGREEMENT
Direct oral anticoagulants (DOACs) are as effective and easier to use than vitamin K antagonists for the treatment of DVT. Catheter-directed thrombolysis can reduce post thrombotic syndrome in patients with iliofemoral DVT. Compression bandaging can help heal a venous ulcer.
AREAS OF CONTROVERSY
Compression hosiery to prevent post thrombotic syndrome. Long-term evidence to show clinical benefit of using endovenous therapies to restore deep vein patency.
GROWING POINTS
Developing imaging methods to identify patients who would benefit from venous thrombolysis. The evolution of dedicated venous stents.
AREAS TIMELY FOR DEVELOPING RESEARCH
Understanding the mechanisms that lead to stent occlusion and investigation into the appropriate treatments that could prevent in-stent thrombosis is required.
Topics: Acute Disease; Anticoagulants; Chronic Disease; Humans; Patient Selection; Stents; Thrombectomy; Thrombolytic Therapy; Venous Thrombosis
PubMed: 26893407
DOI: 10.1093/bmb/ldw006 -
Critical Care Medicine Mar 2021
Topics: Central Venous Catheters; Humans; Venous Thrombosis
PubMed: 33616355
DOI: 10.1097/CCM.0000000000004833 -
Clinics in Chest Medicine Sep 2018The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and... (Review)
Review
The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and deep venous recanalization or bypass in the chronic phase. Along with the use of anticoagulation agents, endovascular techniques based on catheter-directed thrombolysis and pharmacomechanical thrombectomy have been increasingly used in patients with acute extensive DVT. Patient selection is crucial to provide optimal outcomes and minimize complications.
Topics: Endovascular Procedures; Humans; Treatment Outcome; Venous Thrombosis
PubMed: 30122186
DOI: 10.1016/j.ccm.2018.04.014 -
Seminars in Thrombosis and Hemostasis Feb 2018The presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At... (Review)
Review
The presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway.
Topics: Central Venous Catheters; Child; Critical Illness; Female; Humans; Male; Risk Factors; Venous Thrombosis
PubMed: 28778103
DOI: 10.1055/s-0037-1603938 -
Forensic Science, Medicine, and... Mar 2019Deep vein thrombosis resulting in lethal pulmonary thromboembolism is not-infrequently encountered in forensic cases. Predisposing factors include immobility, recent...
Deep vein thrombosis resulting in lethal pulmonary thromboembolism is not-infrequently encountered in forensic cases. Predisposing factors include immobility, recent surgery, previous deep venous thromboses/pulmonary thromboembolism, indwelling central venous lines, major trauma, the oral contraceptive pill, pregnancy, congenital cardiac disease, sepsis, malignancy, systemic lupus erythematosus, renal failure and certain inherited thrombophilias. Venous thrombosis associated with air travel was reported in the early 1950's and called the "economy class syndrome", although it is now recognized that reduced movement on long distance flights is more significant than seating class. Long-distance flights of eight hours or more are associated with a two to fourfold increase in the risk of deep venous thrombosis, but only in those individuals who have underlying risk factors. With increasing numbers of flights of more than 16 h duration forensic pathologists are well placed to monitor the potential impact of extended flying on the incidence of lethal pulmonary thromboembolism.
Topics: Air Travel; Forensic Medicine; Humans; Pulmonary Embolism; Risk Factors; Venous Thrombosis
PubMed: 29948593
DOI: 10.1007/s12024-018-9991-9