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Thrombosis Research Apr 2023Different patient characteristics influence the decision to order diagnostic imaging for deep venous thrombosis (DVT) and pulmonary embolism (PE) in different settings...
Characteristics associated with diagnostic yield of imaging for deep venous thrombosis and pulmonary embolism in the emergency department, hospital, and office settings: An Optum Clinformatics claims database study (2015-2019).
BACKGROUND
Different patient characteristics influence the decision to order diagnostic imaging for deep venous thrombosis (DVT) and pulmonary embolism (PE) in different settings (emergency department (ED), hospital, and office). Diagnostic yield is defined as the proportion of tests that report positive results. We hypothesize different patient characteristics are associated with higher or lower diagnostic yield of imaging for DVT and PE in different settings.
METHODS
We used Optum Clinformatics™ national claims database (2015-2019) to assess the diagnostic yield of imaging for DVT and PE in three settings: (a) ED discharge, (b) Hospitalized, and (c) Office. We studied the patient characteristics associated with diagnostic yield using logistic regression.
RESULTS
Diagnostic imaging for DVT and PE was performed in 1,502,417 and 710,263 visits, respectively. Diagnostic yield for DVT and PE was 9.8 ± 0.1 % and 12.7 ± 0.1 %, respectively in the overall cohort. In the ED discharge, hospitalized, and office settings, diagnostic yield for DVT was 10.4 ± 0.1 %, 16.9 ± 0.1 %, and 6.5 ± 0.1 %, respectively, and that for PE 6.4 ± 0.1 %, 18.7 ± 0.1 %, and 8.8 ± 0.2 %, respectively. Of the patients who underwent imaging for DVT, higher diagnostic yield was more likely with thrombophilia, central venous access, and cancer. Of the patients who underwent imaging for PE, higher diagnostic yield was most likely with thrombophilia, respiratory failure, and heart failure or acute myocardial infarction.
CONCLUSIONS
In each setting, different patient characteristics influence the diagnostic yield of imaging for DVT and PE and can inform clinical practice. Judicious use of imaging for DVT and PE could reduce costs and avoid exposure to radiation and contrast.
Topics: Humans; Venous Thrombosis; Pulmonary Embolism; Diagnostic Imaging; Hospitals; Thrombophilia; Risk Factors
PubMed: 36774701
DOI: 10.1016/j.thromres.2023.02.004 -
Postgraduate Medicine Aug 2021Deep venous thrombosis (DVT) is a major cause of acute and chronic morbidity, mortality, and increased healthcare costs. Endovascular methods for thrombus removal and... (Review)
Review
Deep venous thrombosis (DVT) is a major cause of acute and chronic morbidity, mortality, and increased healthcare costs. Endovascular methods for thrombus removal and reestablishing venous patency are increasing in both scope and usage. The most commonly used method for endovascular thrombectomy is catheter-directed thrombolysis (CDT). Several studies have shown promise for CDT in alleviating acute symptomatology in acute lower extremity DVT as well as mitigating potential long-term consequences of DVT, such as post-thrombotic syndrome (PTS). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial is the largest and most comprehensive randomized-controlled trial to date evaluating CDT compared to anticoagulation alone for the treatment of acute symptomatic proximal lower extremity DVT. This review discusses the current status of CDT and adjunctive endovascular interventions for DVT, particularly in the context of the ATTRACT trial.
Topics: Endovascular Procedures; Humans; Mechanical Thrombolysis; Patient Selection; Randomized Controlled Trials as Topic; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 33863270
DOI: 10.1080/00325481.2021.1919435 -
Thrombosis Research Oct 2019Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and... (Review)
Review
Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and important questions have been raised regarding their appropriateness. Although there have been instances where eponyms were abandoned, the remainder are largely embedded within the established literature making their disappearance unlikely. Physicians used a variety of techniques to describe signs of medical eponyms as a method for diagnosing deep venous thrombosis (DVT), pulmonary embolism (PE) or venothromboembolism (VTE). These methods (observation, palpation, pressure, or maneuvers), were detected during the physical examination and using bedside sphygmomanometer or radiographic imaging. Reviewed are both common and less frequently encountered VTE eponyms identified during the physical examination and radiologic imaging. Most of these signs have not been further studied and, therefore, there is a lack of information regarding their accuracy and reliability in clinical practice.
Topics: Eponyms; History, 20th Century; History, 21st Century; Humans; Palpation; Percussion; Pulmonary Embolism; Radiography; Radiology; Sphygmomanometers; Venous Thromboembolism; Venous Thrombosis
PubMed: 31285052
DOI: 10.1016/j.thromres.2019.06.011 -
Aesthetic Surgery Journal Sep 2021
Topics: Abdominoplasty; Humans; Risk Factors; Venous Thrombosis
PubMed: 33674868
DOI: 10.1093/asj/sjab037 -
World Neurosurgery Dec 2022To identify risk factors for development of deep venous thrombosis (DVT) in patients undergoing spinal irrigation and débridement for an infection with subsequent...
OBJECTIVE
To identify risk factors for development of deep venous thrombosis (DVT) in patients undergoing spinal irrigation and débridement for an infection with subsequent peripherally inserted central catheter placement and to determine if chemoprophylaxis mitigates the risk of developing DVT.
METHODS
Patients with spinal infection and peripherally inserted central catheter placement at an academic medical center between 2009 and 2020 were retrospectively identified. Patients were grouped based on whether they had postoperative DVT. Preoperative, intraoperative, and postoperative variables were compared to determine their association with postoperative DVT. A multivariate logistic regression model was developed to measure the effect of postoperative DVT chemoprophylaxis on the likelihood of DVT development.
RESULTS
Of 335 patients included in the analysis, 48 (14.3%) developed DVT, and 287 (85.7%) did not develop DVT. Patients who developed DVT had a greater number of irrigation and débridement procedures (1.90 ± 1.49 vs. 1.44 ± 0.86, P = 0.024). Multivariate logistic regression analysis identified a history of diabetes (odds ratio [OR] = 2.23; 95% confidence interval [CI], 1.01-4.92; P = 0.045), DVT/pulmonary embolism (OR = 4.49; 95% CI, 1.93-10.34; P < 0.001), and number of irrigation and débridement procedures (OR = 1.51; 95% CI, 1.13-2.06; P = 0.006) as significant positive predictors of postoperative DVT. Chemoprophylaxis (OR = 0.68; 95% CI, 0.32-1.45; P = 0.324) was not a significant negative predictor of postoperative DVT.
CONCLUSIONS
Patients undergoing spinal débridement with subsequent peripherally inserted central catheter placement are at high risk for postoperative DVT. Multiple spine débridement procedures, a history of diabetes, and previous DVT are risk factors for postoperative DVT. Chemoprophylaxis does not mitigate patients' risk for postoperative DVT.
Topics: Humans; Retrospective Studies; Debridement; Venous Thrombosis; Pulmonary Embolism; Risk Factors; Chemoprevention; Postoperative Complications
PubMed: 36191889
DOI: 10.1016/j.wneu.2022.09.111 -
Internal Medicine (Tokyo, Japan) May 2021
Topics: Humans; Leg; Thrombophlebitis
PubMed: 33229811
DOI: 10.2169/internalmedicine.6102-20 -
Techniques in Vascular and... Jun 2023Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard... (Review)
Review
Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits percutaneous intervention options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion. This article reviews specific factors to consider when planning percutaneous treatment of cancer patients with DVT/VTE, focusing on the iliocaval system.
Topics: Humans; Thrombolytic Therapy; Venous Thrombosis; Venous Thromboembolism; Anticoagulants; Thrombectomy; Catheters; Treatment Outcome; Neoplasms
PubMed: 37865450
DOI: 10.1016/j.tvir.2023.100900 -
Saudi Medical Journal Jan 2022To determine the prevalence of May-Thurner syndrome (MTS) in left lower limb deep venous thrombosis (DVT) cases and to analyze the outcome of endovascular intervention...
OBJECTIVES
To determine the prevalence of May-Thurner syndrome (MTS) in left lower limb deep venous thrombosis (DVT) cases and to analyze the outcome of endovascular intervention in these patients.
METHODS
A record-based descriptive study was carried out in Radiology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia, including patients who underwent lower limb duplex ultrasounds between January 2015-2021. Patients with bilateral DVTs, known pelvic masses, and pelvic surgeries were excluded. All patients positive for DVTs were identified and further imaging was reviewed. Left common iliac vein compression of 50% or more on computed tomography (CT) was considered positive for MTS. Endovascular interventions (venoplasty alone or with stenting) were evaluated and success recorded by observing patency of vein on follow-up imaging or improvement of symptoms on follow-up visits.
RESULTS
Of 182 patients with left lower limb duplex studies, 51 patients were positive for DVTs. A total of 37 patients had CTs and 21 patients had MTS (17 females, 3 males). A total of 15 patients underwent endovascular interventions, 2 patients had venoplasties alone (one successful) and 13 patients had venoplasties with stenting (10 successful).
CONCLUSION
Patients with MTS as cause of DVT may benefit from early endovascular intervention.
Topics: Endovascular Procedures; Female; Humans; Lower Extremity; Male; May-Thurner Syndrome; Stents; Treatment Outcome; Venous Thrombosis
PubMed: 35022292
DOI: 10.15537/smj.2022.43.1.20210473 -
Journal of the American Heart... Mar 2023Background Whether sex-specific differences exist for risk factors for pulmonary embolism (PE) and deep venous thrombosis (DVT), with the exception of pregnancy and...
Background Whether sex-specific differences exist for risk factors for pulmonary embolism (PE) and deep venous thrombosis (DVT), with the exception of pregnancy and estrogen therapy, has been sparsely studied. We aimed to study whether sex-specific differences of risk factors exist for noncancer-related DVT and PE in middle-aged and older individuals without cardiovascular history or previous diagnosis in a population-based historical (retrospective) cohort. Methods and Results Potential venous thromboembolism (VTE) risk factors were registered at baseline in 15 807 women and 9996 men aged 44 to 74 years, who participated in the Malmö Diet and Cancer study (1991-1996). We excluded subjects with a previous history of VTE, cancer, a diagnosis of cardiovascular disease, or a diagnosis of cancer-associated VTE during follow-up. Patients were followed up from baseline until the first event of PE or DVT, death, or December 31, 2018. During the follow-up period, 365 (2.3%) women and 168 (1.7%) men were affected by first DVT, and 309 (2.0%) women and 154 (1.5%) men were affected by first PE. In the multivariable Cox regression models, the anthropometric obesity markers of weight, body mass index, waist and hip circumference, fat percentage, and muscle weight were in a dose-dependent way associated with DVT and PE among women but not men. In an analysis that included patients with cardiovascular disease and cancer-related VTE, the results were similar for women. For men, several obesity measures became significantly associated with PE or DVT but were weaker than in women, especially for DVT. Conclusions Anthropometric obesity measures are more important risk factors for both DVT and PE among women than men, especially for individuals without cardiovascular history or previous diagnosis or cancer-related VTE.
Topics: Male; Middle Aged; Humans; Female; Aged; Venous Thromboembolism; Venous Thrombosis; Cohort Studies; Retrospective Studies; Pulmonary Embolism; Risk Factors; Obesity; Neoplasms
PubMed: 36847045
DOI: 10.1161/JAHA.122.027502 -
West African Journal of Medicine May 2023Deep venous thrombosis (DVT) is one of most common causes of morbidity and mortality among hospitalized patients. Many risk factors ranging from inherited to acquired...
BACKGROUND
Deep venous thrombosis (DVT) is one of most common causes of morbidity and mortality among hospitalized patients. Many risk factors ranging from inherited to acquired are associated with increased risk of DVT.
AIMS
The aim of the study was to review the pattern and risk factors of DVTs in Gombe.
METHODS
This study was a retrospective review of Doppler ultrasound confirmed lower limb DVT that were managed in the Department of Haematology, Federal Teaching Hospital Gombe, North-eastern Nigeria over a 4-year period (January 2018 to December 2021). Data obtained was analyzed using SPSS version 28.
RESULTS
Ninety (90) patients were seen and managed during the study period, most were females, (56.7%; n =51) with an age range of 18 to 92 years and mean of 47.3±17.8 years. Young adults (18-45 years) were in the majority (n=45; 50%), followed by the middle aged (46-60 years) (n=28; 31.1%) and then elderly (>60 years) (n=17; 18.9%). Twenty-five patients (27.8%) had proximal DVT, thirteen (14.4%) distal while 49 (57.8%) had extensive DVT. The most affected side is the left lower limb (64.4%; n=58). Most of the patients had provoked DVT (n=65; 72%) with immobilization, recent surgery, bone fracture and stroke as the leading provoking factors. Among those with provoked DVT, young adults were the majority (n=34; 38%), followed by those in the middle-aged group (n=21; 23%) and then the elderly (n=10; 8%).
CONCLUSION
Our study showed the preponderance of left sided DVT and the majority of the cases were provoked affecting young adults.
Topics: Aged; Female; Middle Aged; Young Adult; Humans; Adolescent; Adult; Aged, 80 and over; Male; Nigeria; Venous Thrombosis; Lower Extremity; Risk Factors; Fractures, Bone
PubMed: 37247260
DOI: No ID Found