-
International Journal of Hematology Nov 2023Post-thrombotic syndrome (PTS) is a common and potentially debilitating complication of deep vein thrombosis (DVT), affecting up to 50% of DVT patients. The consequence... (Review)
Review
Post-thrombotic syndrome (PTS) is a common and potentially debilitating complication of deep vein thrombosis (DVT), affecting up to 50% of DVT patients. The consequence of this chronic condition includes reduced quality of life, increased use of the healthcare system and decreased productivity. The societal impact of this condition is projected to increase, given our ageing population and increased burden of thrombotic diseases. Despite significant recent advances in our understanding of PTS, many unanswered questions remain. Currently, there are few effective and proven options for established PTS; hence, the emphasis should be on instituting effective prevention to reduce the progression to PTS. Effective anticoagulation lowers the risk of PTS, with direct oral anticoagulants appearing to outperform vitamin-K antagonists. However, the evidence for elastic compression stockings and endovascular thrombolysis or thrombectomy techniques remains unclear. Accurate identification of individuals at high risk of developing PTS may also improve the targeting of preventative interventions. This review will examine the current body of evidence regarding PTS, with a focus on preventative strategies as well as novel biomarkers.
Topics: Humans; Venous Thrombosis; Quality of Life; Postthrombotic Syndrome; Anticoagulants; Forecasting
PubMed: 37651058
DOI: 10.1007/s12185-023-03651-6 -
Croatian Medical Journal Oct 2022To assess the differences in clinical and laboratory parameters of non-hospitalized patients with deep venous thrombosis (DVT) according to the SARS-CoV-2 status.
AIM
To assess the differences in clinical and laboratory parameters of non-hospitalized patients with deep venous thrombosis (DVT) according to the SARS-CoV-2 status.
METHODS
We retrospectively reviewed demographic, clinical, laboratory, and ultrasound data of adult patients admitted to the Emergency Department of University Hospital Split between March 2020 and January 2021. Patients were classified into three groups: recent COVID-19 (<1 month), non-recent COVID-19 (1 to 12 months), and non-COVID-19.
RESULTS
Fifty (47.2%) of 106 patients had a history of SARS-CoV-2 infection (23 patients in the recent COVID-19 and 27 in non-recent COVID-19 group). The three groups did not significantly differ in demographic and clinical parameters, including the location of deep venous thrombosis. The recent COVID-19 group had significantly higher neutrophils and CRP levels, and significantly lower prothrombin than the other two groups.
CONCLUSION
Our results confirm the role of elevated inflammatory and coagulation response in DVT development in the first month after the infection, but not in non-recent COVID-19 or non-COVID-19 patients.
Topics: Adult; Humans; COVID-19; Retrospective Studies; SARS-CoV-2; Venous Thrombosis; Risk Factors
PubMed: 36325669
DOI: 10.3325/cmj.2022.63.448 -
Journal of Vascular Surgery. Venous and... May 2021Early reports suggest that patients with novel coronavirus disease-2019 (COVID-19) infection carry a significant risk of altered coagulation with an increased risk for...
OBJECTIVE
Early reports suggest that patients with novel coronavirus disease-2019 (COVID-19) infection carry a significant risk of altered coagulation with an increased risk for venous thromboembolic events. This report investigates the relationship of significant COVID-19 infection and deep venous thrombosis (DVT) as reflected in the patient clinical and laboratory characteristics.
METHODS
We reviewed the demographics, clinical presentation, laboratory and radiologic evaluations, results of venous duplex imaging and mortality of COVID-19-positive patients (18-89 years) admitted to the Indiana University Academic Health Center. Using oxygen saturation, radiologic findings, and need for advanced respiratory therapies, patients were classified into mild, moderate, or severe categories of COVID-19 infection. A descriptive analysis was performed using univariate and bivariate Fisher's exact and Wilcoxon rank-sum tests to examine the distribution of patient characteristics and compare the DVT outcomes. A multivariable logistic regression model was used to estimate the adjusted odds ratio of experiencing DVT and a receiver operating curve analysis to identify the optimal cutoff for d-dimer to predict DVT in this COVID-19 cohort. Time to the diagnosis of DVT from admission was analyzed using log-rank test and Kaplan-Meier plots.
RESULTS
Our study included 71 unique COVID-19-positive patients (mean age, 61 years) categorized as having 3% mild, 14% moderate, and 83% severe infection and evaluated with 107 venous duplex studies. DVT was identified in 47.8% of patients (37% of examinations) at an average of 5.9 days after admission. Patients with DVT were predominantly male (67%; P = .032) with proximal venous involvement (29% upper and 39% in the lower extremities with 55% of the latter demonstrating bilateral involvement). Patients with DVT had a significantly higher mean d-dimer of 5447 ± 7032 ng/mL (P = .0101), and alkaline phosphatase of 110 IU/L (P = .0095) than those without DVT. On multivariable analysis, elevated d-dimer (P = .038) and alkaline phosphatase (P = .021) were associated with risk for DVT, whereas age, sex, elevated C-reactive protein, and ferritin levels were not. A receiver operating curve analysis suggests an optimal d-dimer value of 2450 ng/mL cutoff with 70% sensitivity, 59.5% specificity, and 61% positive predictive value, and 68.8% negative predictive value.
CONCLUSIONS
This study suggests that males with severe COVID-19 infection requiring hospitalization are at highest risk for developing DVT. Elevated d-dimers and alkaline phosphatase along with our multivariable model can alert the clinician to the increased risk of DVT requiring early evaluation and aggressive treatment.
Topics: Alkaline Phosphatase; Anticoagulants; Biomarkers; Blood Coagulation; COVID-19; Early Diagnosis; Extremities; Female; Fibrin Fibrinogen Degradation Products; Humans; Indiana; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Risk Assessment; SARS-CoV-2; Time-to-Treatment; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 33190816
DOI: 10.1016/j.jvsv.2020.10.006 -
Journal of Thrombosis and Haemostasis :... Oct 2020The uterine venous plexus (UVP) is an unusual site for venous thrombosis (VT). Our aim was to determine the prevalence of UVP thrombosis (UVPT) and identify associated...
BACKGROUND
The uterine venous plexus (UVP) is an unusual site for venous thrombosis (VT). Our aim was to determine the prevalence of UVP thrombosis (UVPT) and identify associated risk factors.
METHODS
We conducted a cross-sectional study on consecutive nonpregnant women attending our general gynecology clinic with a wide variety of presenting symptoms over a 16-month period. All women underwent a transvaginal ultrasound scan which involved detailed examination of the uterine venous plexus. Women diagnosed with incidental UVPT had thrombophilia screening, lower limb venous duplex imaging, and specialist hematological review. Logistic regression was used to examine associations between various risk factors and UVPT.
RESULTS
We screened 1383 women, 39 of whom had an incidental UVPT, giving a prevalence of 3.0% (95% confidence interval [CI], 2.1%-4.1%). Multivariate analysis showed positive associations between multiparity (odds ratio [OR] 5.75 [95% CI 2.10, 15.7]), recent surgery (OR 3.10 [95% CI 1.19, 8.07]), presence of leg varicose veins (OR 3.15 [95% CI 1.32, 7.49]), and a family history of venous thromboembolism (OR 8.74 [1.65, 46.4]) and negative associations between postmenopausal status (OR 0.36 [95% CI 0.13, 0.95]) and the development of UVPT. Thrombophilia was detected in 12.8% women diagnosed with UVPT.
CONCLUSIONS
The prevalence of incidental UVPT in a general gynecology population was 3.0%. Several demographic and clinical factors were found to be associated with UVPT. This could help to identify women at risk of this condition, and facilitate its early detection and development of evidence-based management strategies.
Topics: Cross-Sectional Studies; Female; Humans; Odds Ratio; Prevalence; Risk Factors; Veins; Venous Thrombosis
PubMed: 32638480
DOI: 10.1111/jth.14989 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Apr 2020To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT.
OBJECTIVES
To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT.
METHODS
A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. -test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, -dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients.
RESULTS
There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all <0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy.
CONCLUSIONS
Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.
Topics: Craniotomy; Humans; Postoperative Complications; Postoperative Period; Risk Factors; Thrombophilia; Venous Thrombosis
PubMed: 32879063
DOI: 10.11817/j.issn.1672-7347.2020.190300 -
The Journal of International Medical... Apr 2022To develop and confirm an individualized predictive model to ascertain the probability of deep venous thrombosis in patients with acute poisoning after undergoing...
OBJECTIVE
To develop and confirm an individualized predictive model to ascertain the probability of deep venous thrombosis in patients with acute poisoning after undergoing hemoperfusion.
METHODS
Three hundred eleven patients with acute poisoning who were admitted to a hospital in China between October 2017 and February 2019 were included in the development group. Eighty patients with acute poisoning who were admitted between February and May 2019 were included in the validation group. The independent risk factors for deep venous thrombosis were examined. An individualized predictive model was developed using regression coefficients.
RESULTS
The number of catheter indwelling days, having a catheter while being transported, elevated serum homocysteine concentrations, and dyslipidemia were independent risk factors for deep venous thrombosis following hemoperfusion in patients with acute poisoning. The areas under the receiver operating characteristic curve of the development and validation groups were 0.713 and 0.702, respectively, which suggested that the prediction model had good discrimination capacity. The calibration belts of the two groups were ideal.
CONCLUSIONS
Our prediction model has a moderate predictive effect for the occurrence of deep venous thrombosis in patients with acute poisoning. In clinical practice, this model could be combined with a common thrombosis risk assessment model.
Topics: Hemoperfusion; Humans; ROC Curve; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 35437041
DOI: 10.1177/03000605221089779 -
Ugeskrift For Laeger Jul 2021Post-thrombotic syndrome (PTS) is a complication after deep venous thrombosis, causing considerable disability in affected patients. In this review, we present the... (Review)
Review
Post-thrombotic syndrome (PTS) is a complication after deep venous thrombosis, causing considerable disability in affected patients. In this review, we present the aetiology, pathophysiology, risk factors and diagnosis of PTS and discuss different treatments with a special focus on endovascular treatment for iliac vein obstruction, which is documented as a safe, effective and durable treatment for severe PTS. Although treatment of PTS in Denmark currently only is based on conservative strategy, we would like to encourage, that endovascular treatment should be considered as a treatment option in these patients.
Topics: Endovascular Procedures; Humans; Postthrombotic Syndrome; Risk Factors
PubMed: 34219646
DOI: No ID Found -
JPMA. the Journal of the Pakistan... Jun 2023To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no...
OBJECTIVE
To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis.
METHODS
The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22.
RESULTS
Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all.
CONCLUSIONS
There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.
Topics: Male; Female; Humans; Adult; Middle Aged; Venous Thrombosis; Pilot Projects; Orthopedics; Prospective Studies; Prevalence; Cross-Sectional Studies; Lower Extremity; Fractures, Bone
PubMed: 37427625
DOI: 10.47391/JPMA.6991 -
Current Treatment Options in Oncology Sep 2023Patients with primary brain tumors are at a substantially elevated risk of venous thromboembolism (VTE) compared to other disease states or other forms of malignancy.... (Review)
Review
Patients with primary brain tumors are at a substantially elevated risk of venous thromboembolism (VTE) compared to other disease states or other forms of malignancy. Deep venous thrombosis (DVT) and pulmonary embolism (PE), often complicate the care of patients with primary brain tumors, and treatment may pose specific unique risks and considerations for management. This paper critically reviews the relevant literature and the most common treatment options in addition to a discussion regarding the relative risk considerations for neurooncology patients facing thromboembolic disease.
Topics: Humans; Venous Thrombosis; Anticoagulants; Venous Thromboembolism; Pulmonary Embolism; Brain Neoplasms; Risk Factors
PubMed: 37407888
DOI: 10.1007/s11864-023-01116-w -
Journal of Vascular Surgery. Venous and... Sep 2019While determining the incidence of chronic deep vein thrombosis (DVT) and the hypercoagulation profiles of patients who underwent venous stenting for symptomatic venous...
OBJECTIVE
While determining the incidence of chronic deep vein thrombosis (DVT) and the hypercoagulation profiles of patients who underwent venous stenting for symptomatic venous insufficiency, we assessed the significance of Virchow's triad in the setting of proximal venous outflow obstruction and DVT.
METHODS
Within our registry of 500 patients who underwent venous stenting for proximal venous outflow obstruction between 2013 and 2016, we selected the first 152 consecutive patients who had routine hypercoagulation profile testing performed preoperatively. Statistical analysis was performed using independent t-tests, χ tests, and multiple logistic regressions.
RESULTS
By history or intraoperative chronic postphlebitic changes (CPPCs), 77 patients (50.7%) were positive for remote DVT; 51 (33.6%) had intraoperative findings of CPPCs without a history of DVT, 20 (13.2%) had intraoperative CPPCs with a history of DVT, and 6 (3.9%) had a history of DVT without intraoperative findings. The χ tests were significant for increased findings of CPPCs among patients with a history of DVT (81% vs 38%; P < .01). The χ tests were also significant for increased rates of intraoperative findings of CPPCs in patients with one or more positive hypercoagulation markers (67% vs 42%; P < .01). The most significant predictor for findings of CPPCs or DVT history was the presence of at least one hypercoagulation marker (n = 148; odds ratio, 2.41; P = .022).
CONCLUSIONS
Remote history of DVT and intraoperative findings of CPPCs were prevalent. CPPC findings were found in many patients with no history of DVT. Hypercoagulation markers conferred significant predictive value for DVT. This information may influence our understanding of Virchow's triad and DVT etiology.
Topics: Aged; Asymptomatic Diseases; Blood Coagulation; Chronic Disease; Cross-Sectional Studies; Endovascular Procedures; Female; Humans; Iliac Vein; Male; May-Thurner Syndrome; Middle Aged; Registries; Retrospective Studies; Risk Factors; Stents; Treatment Outcome; Venous Insufficiency; Venous Thrombosis
PubMed: 31078515
DOI: 10.1016/j.jvsv.2019.02.011