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Journal of Vascular Surgery. Venous and... Nov 2022Hospital-acquired venous thromboembolism (VTE, including pulmonary embolism [PE] and deep vein thrombosis [DVT]) is a preventable cause of hospital death. The Caprini... (Review)
Review
OBJECTIVE
Hospital-acquired venous thromboembolism (VTE, including pulmonary embolism [PE] and deep vein thrombosis [DVT]) is a preventable cause of hospital death. The Caprini risk assessment model (RAM) is one of the most commonly used tools to assess VTE risk. The RAM is operationalized in clinical practice by grouping several risk scores into VTE risk categories that drive decisions on prophylaxis. A correlation between increasing Caprini scores and rising VTE risk is well-established. We assessed whether the increasing VTE risk categories assigned on the basis of recommended score ranges also correlate with increasing VTE risk.
METHODS
We conducted a systematic review of articles that used the Caprini RAM to assign VTE risk categories and that reported corresponding VTE rates. A Medline and EMBASE search retrieved 895 articles, of which 57 fulfilled inclusion criteria.
RESULTS
Forty-eight (84%) of the articles were cohort studies, 7 (12%) were case-control studies, and 2 (4%) were cross-sectional studies. The populations varied from postsurgical to medical patients. There was variability in the number of VTE risk categories assigned by individual studies (6 used 5 risk categories, 37 used 4, 11 used 3, and 3 used 2), and in the cutoff scores defining the risk categories (scores from 0 alone to 0-10 for the low-risk category; from ≥5 to ≥10 for high risk). The VTE rates reported for similar risk categories also varied across studies (0%-12.3% in the low-risk category; 0%-40% for high risk). The Caprini RAM is designed to assess composite VTE risk; however, two studies reported PE or DVT rates alone, and many of the other studies did not specify the types of DVTs analyzed. The Caprini RAM predicts VTE at 30 days after assessment; however, only 17 studies measured outcomes at 30 days; the remaining studies had either shorter or longer follow-ups (0-180 days).
CONCLUSIONS
The usefulness of the Caprini RAM is limited by heterogeneity in its implementation across centers. The score-derived VTE risk categorization has significant variability in the number of risk categories being used, the cutpoints used to define the risk categories, the outcome being measured, and the follow-up duration. This factor leads to similar risk categories being associated with different VTE rates, which impacts the clinical and research implications of the results. To enhance generalizability, there is a need for studies that validate the RAM in a broad population of medical and surgical patients, identify standardized risk categories, define risk of DVT and PE as distinct end points, and measure outcomes at standardized follow-up time points.
Topics: Humans; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Risk Factors; Venous Thromboembolism; Venous Thrombosis
PubMed: 35926802
DOI: 10.1016/j.jvsv.2022.05.003 -
Arteriosclerosis, Thrombosis, and... Nov 2014Thrombosis is the common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD... (Comparative Study)
Comparative Study Review
BACKGROUND
Thrombosis is the common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused 1 in 4 deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability.
OBJECTIVE
To review the literature on the global burden of disease caused by VTE.
APPROACH AND RESULTS
We performed a systematic review of the literature on the global disease burden because of VTE in low-, middle-, and high-income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1000 individuals in the population. The incidence increased to between 2 and 7 per 1000 among those aged ≥70 years. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalization was the leading cause of disability-adjusted life-years lost in low- and middle-income countries, and second in high-income countries, responsible for more disability-adjusted life-years lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events.
CONCLUSIONS
VTE causes a major burden of disease across low-, middle-, and high-income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems and to evaluate whether improved use of preventive measures will reduce the burden.
Topics: Age Factors; Cost of Illness; Global Health; Humans; Incidence; Racial Groups; Social Class; Venous Thrombosis
PubMed: 25304324
DOI: 10.1161/ATVBAHA.114.304488 -
Phlebology Oct 2023Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep venous thrombosis (DVT). Biomarkers are potentially valuable clinical tools for handling PTS....
Biomarkers and the post-thrombotic syndrome: A systematic review of biomarkers associated with the occurrence of the post-thrombotic syndrome after lower extremity deep venous thrombosis.
INTRODUCTION
Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep venous thrombosis (DVT). Biomarkers are potentially valuable clinical tools for handling PTS. The purpose of this review was to examine which biomarkers are associated with the development of PTS in adults with lower extremity DVT.
METHODS
We performed a systematic review of all English language prospective studies of biomarkers and PTS published in PubMed and EMBASE. Studies were included if diagnosing DVT by diagnostic imaging and assessing PTS by clinical scales, for example, the Villalta scale. Biomarkers of thrombophilia and pathological clot properties were not assessed. Data was reported qualitatively.
RESULTS
15 prospective studies were included. Studies varied widely in study design and methods of data analysis. Forty-six different biomarkers were examined, with seven being measured in two or more studies. The most frequently studied biomarkers were D-dimer, CRP, and IL-6. Associations between PTS and D-dimer were predominantly significant, while results on CRP and IL-6 were inconsistent. ICAM-1 was consistently associated with PTS in all studies and at all timepoints. IL-10 was significantly related to PTS development in the largest study and at all time points. Adiponectin, tPA, HRG and TAFI, MMP-1 and -8, and TIMP-1 and -2 were significantly associated with PTS in single studies.
CONCLUSION
(1) Further research on biomarkers and PTS is clearly warranted. (2) Significant differences in study designs made it difficult to draw reliable conclusions regarding individual biomarkers. We suggest the implementation of a standardized framework for the study of biomarkers and PTS, to make comparison of future studies more feasible. (3) D-dimer, ICAM-1, IL-10, MMP-1 and 8, TIMP-1, TIMP-2, and adiponectin are clinical biomarkers of particular interest to include in future studies of PTS. Large scale systemic quantitative proteomic analyses of DVT patients could help identify novel biomarkers of interest in PTS-patients.
Topics: Adult; Humans; Adiponectin; Biomarkers; Intercellular Adhesion Molecule-1; Interleukin-10; Interleukin-6; Lower Extremity; Matrix Metalloproteinase 1; Postthrombotic Syndrome; Prospective Studies; Proteomics; Risk Factors; Tissue Inhibitor of Metalloproteinase-1; Venous Thrombosis
PubMed: 37620994
DOI: 10.1177/02683555231186681 -
European Journal of Vascular and... Feb 2023To identify the rate of post-thrombotic syndrome (PTS) after isolated distal deep venous thrombosis (IDDVT) by performing a meta-analysis of the rate of PTS across... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To identify the rate of post-thrombotic syndrome (PTS) after isolated distal deep venous thrombosis (IDDVT) by performing a meta-analysis of the rate of PTS across randomised and observational studies.
DATA SOURCES
MEDLINE, Embase, the Cochrane Controlled Trials Register, Clinicaltrials.gov, European Union Clinical Trials, International Standard Randomised Controlled Trial Number, and the Australian and New-Zealand Trials Registries.
REVIEW METHODS
This review followed PRISMA guidelines using a registered protocol (CRD42021282136). Databases were searched up to December 2021 and prospective studies reporting the development of post-thrombotic syndrome were included; these were pooled with the meta-analysis.
RESULTS
The results showed a post-thrombotic rate of 17% (95% CI 11 - 26%) (seven studies, 217 cases, 1 105 participants). Heterogeneity was high (I = 89%). On meta-regression, the rate of post-thrombotic syndrome was not correlated with the length of follow up (p = .71). Three studies (302 participants) reported the severity of post-thrombotic syndrome: 78% were mild (Villalta score 5 - 9); 11% were moderate (Villalta score 10 - 14), and 11% were severe (Villalta score ≥ 15).
CONCLUSION
The risk of post-thrombotic syndrome after IDDVT was one in five and the risk of severe clinical manifestations, including ulceration, was one in 50. There was significant clinical, methodological, and statistical heterogeneity between studies and a substantial risk of bias from pooled studies. Randomised trials to support interventions for prevention of post-thrombotic syndrome are urgently needed.
Topics: Humans; Venous Thrombosis; Prospective Studies; Australia; Postthrombotic Syndrome; MEDLINE
PubMed: 36257568
DOI: 10.1016/j.ejvs.2022.10.018 -
Thrombosis and Haemostasis Feb 2024To summarize characteristics, complications, and success rates of different catheter-directed thrombolysis (CDT) protocols for the treatment of lower extremity deep... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize characteristics, complications, and success rates of different catheter-directed thrombolysis (CDT) protocols for the treatment of lower extremity deep venous thrombosis (LE-DVT).
METHODS
A systematic review using electronic databases (MEDLINE, Scopus, and Web of Science) was performed to identify randomized controlled trials and observational studies related to LE-DVT treated with CDT. A random-effects model meta-analysis was performed to obtain the pooled proportions of early complications, postthrombotic syndrome (PTS), and venous patency.
RESULTS
Forty-six studies met the inclusion criteria reporting 49 protocols ( = 3,028 participants). In studies that addressed the thrombus location ( = 37), LE-DVT had iliofemoral involvement in 90 ± 23% of the cases. Only four series described CDT as the sole intervention for LE-DVT, while 47% received additional thrombectomy (manual, surgical, aspiration, or pharmacomechanical), and 89% used stenting.Definition of venogram success was highly variable, being the Venous Registry Index the most used method ( = 19). Among those, the minimal thrombolysis rate (<50% lysed thrombus) was 0 to 53%, partial thrombolysis (50-90% lysis) was 10 to 71%, and complete thrombolysis (90-100%) was 0 to 88%. Pooled outcomes were 8.7% (95% confidence interval [CI]: 6.6-10.7) for minor bleeding, 1.2% (95% CI: 0.8-1.7%) for major bleeding, 1.1% (95% CI: 0.6-1.6) for pulmonary embolism, and 0.6% (95% CI: 0.3-0.9) for death. Pooled incidences of PTS and of venous patency at up to 1 year of follow-up were 17.6% (95% CI: 11.8-23.4) and 77.5% (95% CI: 68.1-86.9), respectively.
CONCLUSION
Assessment of the evidence is hampered by the heterogeneity of protocols, which may be reflected in the variation of PTS rates. Despite this, CDT is a low-risk treatment for LE-DVT.
Topics: Humans; Catheters; Femoral Vein; Fibrinolytic Agents; Iliac Vein; Lower Extremity; Postphlebitic Syndrome; Postthrombotic Syndrome; Retrospective Studies; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 37279794
DOI: 10.1055/a-2106-3754 -
European Journal of Neurology Jan 2007We performed a systematic review of the literature on venous thromboembolism (VTE) prophylaxis following cerebral infarct (CI) and haemorrhagic stroke. MEDLINE,... (Meta-Analysis)
Meta-Analysis Review
We performed a systematic review of the literature on venous thromboembolism (VTE) prophylaxis following cerebral infarct (CI) and haemorrhagic stroke. MEDLINE, Cochrane, LILACS and SciELO databases were scanned, and the Abstracts from Brazilian, American and European Neurology and Stroke Congresses were scrutinized for clinical trials. Moreover, the reference lists of articles and reviews were searched. A pooled analysis of two large studies with aspirin was made. Both unfractionated heparin and low molecular weight heparins/heparinoids (LMWH) are partially effective for VTE prophylaxis after CI, and should be routinely used in patients with motor deficit and reduced mobility and no contraindications. Reduction of deep venous thrombosis is better established than the effect over pulmonary embolism or mortality. Some evidence points to a greater efficacy of LMWH. The available evidence does not support the use of mechanical methods or dextran. Aspirin may have a mild protective effect. Low-dose Warfarin might be useful in the rehabilitation setting. Strict recommendations cannot be made in patients with haemorrhagic stroke but intermittent pneumatic compression merits further study. There are important limitations of current VTE preventive strategies following stroke. Additional studies on the combination of methods after CI and of low doses of anticoagulants following cerebral haemorrhage are urgently needed.
Topics: Humans; Pulmonary Embolism; Stroke; Venous Thrombosis
PubMed: 17222109
DOI: 10.1111/j.1468-1331.2006.01536.x -
Disaster Medicine and Public Health... Feb 2023Among natural disasters, earthquake is associated with heavy fatalities and financial damages, causing considerable mortality. The complications resulting from getting... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Among natural disasters, earthquake is associated with heavy fatalities and financial damages, causing considerable mortality. The complications resulting from getting trapped in rubble, secondary traumas, obligation to reside in temporary shelters, along with other factors such as limited mobility, stress, and dehydration, predispose earthquake survivors to Deep Vein Thrombosis (DVT). The aim of the present study is to investigate the rate of DVT after an earthquake using a systematic review and meta-analysis.
METHODS
To perform the present study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used. The protocol of this review study has been registered in the International Perspective Register of Systematic Review (PROSPERO) with the code of CRD42021290375. Credible data resources including PubMed, Scopus, Web of Science, Science Direct, Google Scholar, Magiran, SID, and Embase were used for extracting relevant studies. Random effect model was used to perform the meta-analysis. I was ritualized to investigate heterogeneity across the studies. Publication bias of studies was evaluated using the Begg test.
RESULTS
In this study, 267 primary studies were identified and extracted. After removing the duplicate ones and the screening, eventually 1 final studies were chosen for the meta-analysis. Based on the meta-analysis results, the total rate of DVT was 9.07% (95% confidence interval [CI]: 7.32-10.81; I = 97.9%; = 0<0.001). Analysis of DVT in the subgroups of the general population and patient survivors were 11.43% (95% CI: 9.06-13.79; I = 98%; = 0<0.001) and 2.51% (95% CI: 0.04-4.63; I = 77.7%; = 0.001). Also, based on the Begg test, the publication bias in the chosen studies was not considerable.
CONCLUSIONS
DVT rate in earthquake survivors is higher compared with other disasters, and over time it finds a growing trend. After earthquake, the focus of rescue and health-care teams is on individuals with observable injuries and damages. Because DVT is first asymptomatic but has fatal consequences, including pulmonary embolism and sudden death, it should be incorporated in health's status assessment of earthquake-stricken people as well as screening and diagnostic programs of health-care providers.
Topics: Humans; Venous Thrombosis; Earthquakes; Pulmonary Embolism; Disasters
PubMed: 36785532
DOI: 10.1017/dmp.2022.268 -
High Altitude Medicine & Biology Sep 2023Kharel, Sanjeev, Suraj Shrestha, Samriddha Raj Pant, Suman Acharya, Amit Sharma, Santosh Baniya, and Sanjeeb S. Bhandari. High-altitude exposure and cerebral venous... (Review)
Review
Kharel, Sanjeev, Suraj Shrestha, Samriddha Raj Pant, Suman Acharya, Amit Sharma, Santosh Baniya, and Sanjeeb S. Bhandari. High-altitude exposure and cerebral venous thrombosis: an updated systematic review. . 24:167-174, 2023. High altitude (HA) may increase the risk of cerebral venous thrombosis (CVT). Differentiating it from other HA illnesses is crucial for prompt treatment and better outcomes. We aimed to summarize the clinical data, etiology, and risk factors of this poorly understood entity at an HA. A systematic literature search of various databases, including PubMed, Embase, and Google Scholar, was done using relevant keywords; cerebral venous thrombosis; HA, up to May 1, 2022. A total of nine studies, including 75 cases of CVT at HA (3,000-8,848 m), with 66 males and 9 females, were included in this review. Headache and seizure were the most common clinical presentations. Smoking, drinking habits, and the use of oral contraceptive pills (OCP) were the most common risk factors for the development of CVT. Similarly, various underlying hypercoagulable states were also present among cases of CVT associated with HA exposure. Our review concludes that HA exposure can predispose individuals with risk factors such as preexisting hypercoagulable states, smoking, drinking habits, and use of OCP to an increased risk of CVT.
Topics: Female; Male; Humans; Altitude; Risk Factors; Smoking; Altitude Sickness; Venous Thrombosis
PubMed: 37615608
DOI: 10.1089/ham.2022.0106 -
Clinical and Applied... 2023The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are emerging tools that can be used in the diagnosis of deep venous thrombosis (DVT).... (Meta-Analysis)
Meta-Analysis
The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are emerging tools that can be used in the diagnosis of deep venous thrombosis (DVT). This study aims to evaluate the diagnostic value of NLR and PLR for patients with DVT. Our meta-analysis included 11 eligible studies and extracted relevant diagnostic indicators. Of these studies, 4 focused on the NLR, 1 on the PLR, while 6 evaluated both. For the 10 studies on NLR, the pooled sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio were 74%, 66%, 2.16, and 0.4, respectively. The estimated diagnostic odds ratio (DOR) was 5.3, and the area under the curve (AUC) of the summary receiver operating characteristic (SROC) curves was 0.74. For the 7 studies on the PLR, the pooled sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio were 0.65, 0.77, 2.89, and 0.45, respectively. The estimated DOR was 6.64, and the SROC-AUC was 0.79. Our findings showed that the NLR and PLR exhibit moderate diagnostic accuracy and may be helpful biomarkers for the diagnosis of DVT. Future prospective, well-designed studies with large sample sizes will be required to provide additional evidence to establish cutoff values and clinical value of these indicators.
Topics: Humans; Neutrophils; Lymphocytes; Blood Platelets; Biomarkers; ROC Curve; Venous Thrombosis; Retrospective Studies
PubMed: 37487186
DOI: 10.1177/10760296231187392 -
The European Journal of General Practice Mar 2015In patients with superficial venous thrombosis (SVT) co-existence of deep venous thrombosis (DVT) can be present. Varicosities are considered as a risk factor for both... (Review)
Review
BACKGROUND
In patients with superficial venous thrombosis (SVT) co-existence of deep venous thrombosis (DVT) can be present. Varicosities are considered as a risk factor for both SVT and DVT separately. However, current evidence is contradictory whether varicosities are associated with an increased or reduced prevalence of concomitant DVT in patients with SVT.
OBJECTIVES
To determine the diagnostic value of both presence and absence of varicosities in the detection of concomitant DVT in non-hospitalized patients with SVT.
METHODS
In MEDLINE and EMBASE, a systematic search was performed to collect all published studies on this topic. The selected papers were critically appraised. By diagnostic 2 × 2 tables prior probabilities and predictive values were computed.
RESULTS
Six relevant articles were identified. The prior probability of concomitant DVT in patients referred from primary care to the outpatient clinic varied between 13 and 34%. In five studies, absence of varicosities was related to a higher probability of concomitant DVT (33-44%) compared to a presence of varicosities (3-23%). The sixth study showed an inversed, non-significant association: DVT was present in 21% of patients with SVT on non-varicose veins versus in 35% of patients with SVT on varicose veins.
CONCLUSION
In five out of six studies on patients with SVT in outpatient settings, absence of varicosities was related to a higher probability of concomitant DVT. Further research is needed to determine whether an assessment of varicosities in general practice could result in an improved selection of patients who require additional imaging to detect or exclude DVT.
Topics: Ambulatory Care; Comorbidity; Humans; Prevalence; Primary Health Care; Risk; Risk Factors; Varicose Veins; Venous Thrombosis
PubMed: 24909345
DOI: 10.3109/13814788.2014.919629