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Clinical Neurology and Neurosurgery Jun 2022To describe the clinical characteristics and outcomes of CVT in patients with history of recent COVID-19 infection or vaccination. (Review)
Review
OBJECTIVE
To describe the clinical characteristics and outcomes of CVT in patients with history of recent COVID-19 infection or vaccination.
METHODS
We reviewed demographic, clinical, and radiographic characteristics of non-pyrogenic, non-traumatic CVT cases at our multi-center institution between March 2020 and December 2021. Patients were grouped according to their history of recent COVID-19 infection or vaccination into group-I (+COVID-19 association) and group-II (-COVID-19 association).
RESULTS
Fifty-one patients with CVT were included, of which 14 (27.4%) had a positive COVID-19 association: 10 with infection and 4 with mRNA-COVID-vaccine. Nine patients in group-I had COVID-19 infection or vaccine within 30 days of CVT diagnosis, including 3 patients with active infection at the time of CVT diagnosis. Half of the patients in group-I (n = 7,50.0%) and 32.4% (n = 12) of group-II were male, and mean age was 52.6 years in group-I and 51.4 years in group-II. Fever at presentation was noted in one patient who had active COVID infection (I=1 (7.1%), II= 0 (0%)). Higher rates of comorbidities were observed in group-II: hypertension (I= 2 (14.3%), II= 13 (35.1%)), deep venous thrombosis(I=1(7.1%), II= 10 (27.0%)), pulmonary emboli (I=1(7.1%), II= 8(21.6%)), or stroke(I=0(0%), II= 6(16.4%)). Three patients had thrombocytopenia at the time of CVT diagnosis (5.4%) and most patients (n = 37, 72.5%) were treated medically with anticoagulation. Complication rate during hospitalization was 17.6% (n = 6), and no mortality was noted.
CONCLUSION
Twenty-seven percent of CVT patients were associated with COVID-19 infection or vaccination, and the majority presented within 30 days of infection/vaccination.
Topics: COVID-19; Female; Humans; Intracranial Thrombosis; Male; Middle Aged; Multicenter Studies as Topic; Pandemics; Vaccines; Venous Thrombosis
PubMed: 35462303
DOI: 10.1016/j.clineuro.2022.107256 -
Vascular Health and Risk Management 2022The prevalence of chronic venous disease (CVD), a common health care problem, is still underestimated. A few previous epidemiologic studies have report Asian patients... (Review)
Review
INTRODUCTION
The prevalence of chronic venous disease (CVD), a common health care problem, is still underestimated. A few previous epidemiologic studies have report Asian patients with this condition in western countries, but not in Asian countries. The aim of this study was to determine risk factors for CVD and its treatment in Thai individuals.
METHODS
In this cross-sectional study, we collected data of patients with CVD visiting Chulabhorn Hospital Vascular Clinic from 1 December 2018-1 October 2021. We reviewed medical records for patient characteristics, comorbidities, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) categories, Venous Clinical Severity Score (VCSS), ultrasound findings and treatment.
RESULTS
The study cohort comprised 260 CVD patients with CVD of mean age 61.92 ± 12.82 years. Almost 80% of participants were female. A history of deep vein thrombosis (DVT) was the strongest risk factor for severe CVD. Other identified risk factors comprised body-mass index (BMI) >30 kg/m, and older age. The most common CEAP categories were C2 (39%) and C1 (33.8%). Superficial venous reflux was the most common location of venous reflux in this study, 67.32% of participants having great saphenous vein reflux and 16.99% small saphenous vein reflux. Only 4.76% of our cohort had both reflux and obstruction. Most of the participants had undergone compression therapy, approximately half of them complying well with wearing of stockings. Nineteen percent of our cohort had undergone sclerotherapy and 14% surgery, which comprised radiofrequency ablation in 97% of them.
CONCLUSION
The major risk factors for severe CVD identified in this study were deep vein thrombosis, body mass index>30 kg/m and older age. The most common CEAP category was C2 (39%). GSV was the most commonly involved venous system. Involvement of numerous venous systems was a risk factor for severe CVD.
Topics: Aged; Chronic Disease; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Risk Factors; Saphenous Vein; Thailand; Vascular Diseases; Venous Insufficiency; Venous Thrombosis
PubMed: 36065282
DOI: 10.2147/VHRM.S382726 -
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 Formosan Medical... Aug 2022Postoperative venous thromboembolism is an important complication in Taiwan. We prospectively investigated the occurrence of deep vein thrombosis (DVT) after major... (Review)
Review
BACKGROUND/PURPOSE
Postoperative venous thromboembolism is an important complication in Taiwan. We prospectively investigated the occurrence of deep vein thrombosis (DVT) after major orthopedic surgery without pharmacologic thromboprophylaxis in a cohort of 120 patients (46 males, 74 females, median age 71 years) at our institute.
METHODS
Color duplex compression ultrasonography (CUS) was used to detect DVT before and after the operation, while contrast venography was performed postoperatively for comparison and validation.
RESULTS
Total knee arthroplasty (TKA, 57 cases) and total hip arthroplasty (23 cases) were the most commonly performed operations. The rate of postoperative DVT was 7.5% (9/120), including five with proximal DVT and four with distal DVT. All were detected in the limbs on the operated side. Four of them were symptomatic DVT cases. Venography was performed in 19 patients and confirmed most findings of CUS, indicating the effectiveness of CUS for detecting DVT. The type of surgery (TKA) was significantly correlated with postoperative DVT. No clinically symptomatic pulmonary embolism or sudden death events were noted.
CONCLUSION
Nine out of 120 (7.5%) orthopedic patients without pharmacologic thromboprophylaxis developed postoperative sonographic DVT in our study. The DVT rate is consistent with other reports from various Asian countries and evidence from meta-analyses.
Topics: Aged; Anticoagulants; Cross-Sectional Studies; Female; Humans; Male; Orthopedic Procedures; Postoperative Complications; Prospective Studies; Taiwan; Venous Thromboembolism; Venous Thrombosis
PubMed: 35033412
DOI: 10.1016/j.jfma.2021.12.027 -
Journal of Vascular Surgery. Venous and... Sep 2019Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on... (Review)
Review
BACKGROUND
Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on quality of life. Venous disorders can be attributed to a combination of vascular compression with a high burden of activity.
OBJECTIVE
This article promotes increased awareness of these uncommon conditions specific to the athlete by summarizing pathophysiology, clinical features, investigation, and treatment protocols for use in clinical practice. Prognostic outcomes of these management regimens are also discussed, allowing for clinicians to counsel these high-functioning individuals appropriately. With the aim of providing an overview of sport-related venous pathology, a literature review was undertaken identifying articles that were independently reviewed by the authors.
RESULTS
Lower limb venous thrombosis has been identified in young, high-functioning athletes attributed to both compression-related venous trauma, associated with repetitive movements resulting in intimal damage, and blunt trauma. The diagnosis and treatment follow the same protocols as for the general population. Of note, early ambulation is advocated, with an aim to return to premorbid (noncontact) function within 6 weeks. Athletes performing high-intensity repetitive upper limb movement, such as baseball players, are predisposed to upper limb deep venous thrombosis (DVT). Diagnosis follows the same protocols as for lower extremity DVT; however, the optimal treatment strategy remains debated. Current guidelines advocate the use of anticoagulation alone. A specific subset of primary upper limb DVT is effort thrombosis, where there is compression at the level of the thoracic outlet. Thrombolysis with first rib resection is indicated in the acute setting within 14 days. In cases of complete occlusion, surgical decompression with venous reconstruction may be required. Popliteal vein entrapment syndrome is also discussed. This entity has been identified as an overuse injury associated with popliteal vein compression. Duplex ultrasound examination is indicated as a first-line investigation, with conservative noninvasive options considered as an initial management strategy. Chronic venous insufficiency or persistent symptoms may require subsequent surgical decompression.
CONCLUSIONS
Key conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
Topics: Aneurysm; Athletic Injuries; Humans; Risk Factors; Thoracic Outlet Syndrome; Treatment Outcome; Vascular System Injuries; Veins; Venous Insufficiency; Venous Thrombosis; Wounds, Nonpenetrating
PubMed: 31231058
DOI: 10.1016/j.jvsv.2019.03.012 -
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 -
European Review For Medical and... Nov 2022Currently, there are still no convincing clinical models predicting closed lower extremity fracture-associated deep vein thrombosis in patients treated through...
OBJECTIVE
Currently, there are still no convincing clinical models predicting closed lower extremity fracture-associated deep vein thrombosis in patients treated through thromboprophylactic methods. We aimed at using two retrospective cohorts to develop and externally verify a clinical prediction model for deep vein thrombosis in patients treated with anticoagulants after suffering closed lower extremity fractures.
PATIENTS AND METHODS
We evaluated the patients' pre- and post-operatively, to accurately determine the predictive power of the biomarkers and clinical risk factors. Two retrospective cohorts were used for the development and external verification of a pre-operative clinical prediction model (development: n = 2,253; verification: n = 833) and post-operative clinical prediction model (development: n = 1,422; verification: n = 449), respectively.
RESULTS
The C-indices were used to show the predicted incidence of objective thrombosis at the pre- and post-operative stage, which were then compared with the observed incidence of thrombosis in both cohorts. Biomarkers and clinical indicators were included in pre- and post-operative nomograms, which were adequately calibrated in both cohorts. The cross-validated C-indices of the pre- and post-operative clinical prediction models in the verification cohort were 0.706 (95% Cl, 0.67-0.74) and 0.875 (95% Cl, 0.84-0.91), respectively.
CONCLUSIONS
We present our findings of novel pre- and post-operative nomograms for the prediction of deep venous thrombosis in patients who received thromboprophylaxis after suffering closed lower extremity fractures.
Topics: Humans; Anticoagulants; Models, Statistical; Retrospective Studies; Prognosis; Venous Thromboembolism; Fractures, Bone; Venous Thrombosis; Lower Extremity
PubMed: 36459032
DOI: 10.26355/eurrev_202211_30387 -
Circulation. Cardiovascular... Jul 2023Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous... (Review)
Review
Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics specific to evaluating percutaneous venous thrombectomy and stent placement. Using modified Delphi techniques for consensus achievement, a panel of physician experts in vascular disease voted on the statements and succeeded in reaching the predefined threshold of >80% consensus (agreement or strong agreement) on all 30 statements. It is hoped that the guidance from these statements will improve standardization, objectivity, and patient-centered relevance in the reporting of clinical outcomes of endovascular interventions for acute iliofemoral deep venous thrombosis and chronic iliofemoral venous obstruction in clinical studies and thereby enhance venous patient care.
Topics: Humans; Consensus; Delphi Technique; Femoral Vein; Treatment Outcome; Iliac Vein; Venous Thrombosis; Endovascular Procedures; Stents; Retrospective Studies; Vascular Patency
PubMed: 37340977
DOI: 10.1161/CIRCINTERVENTIONS.123.012894 -
Clinical and Applied... 2021Deep venous thrombosis (DVT) is associated with significant morbidity, mortality, and increased healthcare costs. Standard scoring systems for DVT risk stratification...
Deep venous thrombosis (DVT) is associated with significant morbidity, mortality, and increased healthcare costs. Standard scoring systems for DVT risk stratification often provide insufficient stratification of hospitalized patients and are unable to accurately predict which inpatients are most likely to present with DVT. There is a continued need for tools which can predict DVT in hospitalized patients. We performed a retrospective study on a database collected from a large academic hospital, comprised of 99,237 total general ward or ICU patients, 2,378 of whom experienced a DVT during their hospital stay. Gradient boosted machine learning algorithms were developed to predict a patient's risk of developing DVT at 12- and 24-hour windows prior to onset. The primary outcome of interest was diagnosis of in-hospital DVT. The machine learning predictors obtained AUROCs of 0.83 and 0.85 for DVT risk prediction on hospitalized patients at 12- and 24-hour windows, respectively. At both 12 and 24 hours before DVT onset, the most important features for prediction of DVT were cancer history, VTE history, and internal normalized ratio (INR). Improved risk stratification may prevent unnecessary invasive testing in patients for whom DVT cannot be ruled out using existing methods. Improved risk stratification may also allow for more targeted use of prophylactic anticoagulants, as well as earlier diagnosis and treatment, preventing the development of pulmonary emboli and other sequelae of DVT.
Topics: Adolescent; Adult; Aged; Hospitalization; Humans; Machine Learning; Male; Middle Aged; Risk Assessment; Risk Factors; Venous Thrombosis; Young Adult
PubMed: 33625875
DOI: 10.1177/1076029621991185 -
Vascular Pharmacology Aug 2021The outbreak of 2019 novel coronavirus disease (Covid-19) has deeply challenged the world population, but also our medical knowledge. Special attention has been paid... (Review)
Review
The outbreak of 2019 novel coronavirus disease (Covid-19) has deeply challenged the world population, but also our medical knowledge. Special attention has been paid early to an activation of coagulation, then to an elevated rate of venous thromboembolism (VTE) in patients hospitalized with severe COVID-19. These data suggested that anticoagulant drugs should be evaluated in the treatment of patients with COVID-19. The publication of unexpected high rates of VTE in patients hospitalized with COVID-19, despite receiving thromboprophylaxis, open the way to dedicated trials, evaluating modified regimens of thromboprophylaxis. Moreover, the further improvement in our comprehension of the disease, particularly the pulmonary endothelial dysfunction increased the hope that anticoagulant drugs may also protect patients from pulmonary thrombosis. In this comprehensive review, we cover the different situations where thromboprophylaxis standard may be modified (medically-ill inpatients, ICU inpatients, outpatients), and describe some of the current randomized controls trials evaluating new regimens of thromboprophylaxis in patients with COVID-19, including the preliminary available results. We also discuss the potential of anticoagulant drugs to target the thromboinflammation described in patients with severe COVID-19.
Topics: Anticoagulants; COVID-19; Humans; Pulmonary Embolism; Risk Assessment; Risk Factors; Treatment Outcome; Venous Thromboembolism; Venous Thrombosis; COVID-19 Drug Treatment
PubMed: 34091065
DOI: 10.1016/j.vph.2021.106883