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Journal of Vascular Surgery. Venous and... Sep 2020
Topics: Catheters; Humans; Popliteal Vein; Thrombolytic Therapy; Venous Thrombosis
PubMed: 32800263
DOI: 10.1016/j.jvsv.2019.10.027 -
The Surgical Clinics of North America Dec 1991All surgical patients are at risk for the development of deep venous thrombosis and subsequent pulmonary embolism or postphlebitic syndrome. The evolution of... (Review)
Review
All surgical patients are at risk for the development of deep venous thrombosis and subsequent pulmonary embolism or postphlebitic syndrome. The evolution of ultrasonographic imaging has increased the awareness of prevention, diagnosis, and treatment of deep venous thrombosis. Duplex imaging and Doppler color flow imaging have made the diagnosis of deep venous thrombosis relatively simple, painless, inexpensive, and definitive. These procedures have gained acceptance by both patients and physicians. Several risk factors have been identified that increase the chance of the development of deep venous thrombosis. These factors include a history of deep venous thrombosis, presence of a malignant process, increasing age, cigarette smoking, obesity, prolonged bed rest, and general anesthesia. The greater the number of risk factors, the more aggressive prophylaxis should be. Means of prophylaxis have improved, and surgeons now generally agree that some form of prophylaxis is required. Heparin and intermittent compression devices appear to be equally effective in preventing deep venous thrombosis. The addition of venous monitoring in high-risk patients permits immediate identification of the presence of deep venous thrombosis. During the last decade, the treatment of patients with deep venous thrombosis has changed little. Heparin followed by warfarin remains the treatment of choice. A small group of patients receive fibrinolytic therapy for deep venous thrombosis. Although the incidence of postoperative deep venous thrombosis has decreased during the last decade, it remains a significant complication.
Topics: Humans; Postoperative Complications; Pulmonary Embolism; Thrombophlebitis
PubMed: 1948569
DOI: 10.1016/s0039-6109(16)45585-4 -
Ultrasound Quarterly Dec 2005Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially... (Comparative Study)
Comparative Study Review
Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially fatal consequences. Ultrasound has become the "gold standard" in the diagnosis of deep venous thrombosis and with proper attention to technique sensitivity of this test is approximately 97%. An understanding of anatomy, pathophysiology, and risk factors is important. Thrombus formation usually begins beneath a valve leaflet below the knee. Approximately 40% will resolve spontaneously, 40% will become organized, and 20% will propagate. Whether or not a calf vein thrombus is identified, a repeat examination in 7 to 10 days is recommended in patients with risk factors or when deep venous thrombosis is suspected. The three main risk factors for thrombus formation are age greater than 75 years, previous history of deep venous thrombosis, and underlying malignancy. Other diagnostic studies include the contrast venogram, CT or MRI venogram, Tc99m Apcitide study, and the laboratory test D-Dimer. The D-Dimer study is being used more frequently as a screening test with 99% sensitivity in detecting thrombus, whether deep venous thrombosis or pulmonary embolism. However, specificity is only approximately 50% with many conditions leading to false-positive exams. Therefore, a negative examination is useful in avoiding other diagnostic studies, but a positive one may be misleading. Conditions that can lead to a false-positive examination include, but are not limited to diabetes, pregnancy, liver disease, heart conditions, recent surgery, and some gastrointestinal diseases. Like the sonogram, two negative D-Dimer studies a week apart exclude the diagnosis of deep venous thrombosis. Compression sonography with color Doppler remains the best overall test for deep venous thrombosis. It is easy to perform, less expensive than most "high tech" studies, can be performed as a portable examination, and is highly reliable when done properly.
Topics: Aged; Aged, 80 and over; Biomarkers; Education, Medical, Continuing; Female; Fibrin Fibrinogen Degradation Products; Forecasting; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Phlebography; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography, Doppler, Color; United States; Venous Thrombosis
PubMed: 16344726
DOI: 10.1097/01.ruq.0000187024.54319.19 -
Vascular Jun 2023
Topics: Humans; COVID-19; Pulmonary Embolism; Anticoagulants; Venous Thrombosis
PubMed: 35209749
DOI: 10.1177/17085381221076454 -
Journal of Pediatric Surgery Jun 2012Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and... (Review)
Review
PURPOSE
Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and risk-reduction strategies of CVC-associated DVT in infants.
METHODS
Infants younger than 1 year who had a CVC placed at our center from 2005 to 2009 were reviewed. Patients with ultrasonically diagnosed DVT were compared to those without radiographic evidence.
RESULTS
Of 333 patients, 47% (155/333) had femoral, 33% (111/333) had jugular, and 19% (64/333) had subclavian CVCs. Deep venous thromboses occurred in 18% (60/333) of patients. Sixty percent (36/60) of DVTs were in femoral veins. Femoral CVCs were associated with greater DVT rates (27%; 42/155) than jugular (11%; 12/111) or subclavian CVCs (9%; 6/64; P < .01). There was a 16% DVT rate in those with saphenofemoral Broviac CVCs vs 83% (20/24) in those with percutaneous femoral lines (P < .01). Multilumen CVCs had higher DVT rates than did single-lumen CVCs (54% vs 6%, P < .01), and mean catheter days before DVT diagnosis was shorter for percutaneous lines than Broviacs (13 ± 17 days vs 30 ± 37 days, P = .02). Patients with +DVT had longer length of stay (86 ± 88 days vs 48 ± 48 days, P < .01) and higher percentage of intensive care unit admission (82% vs 70%, P = .02).
CONCLUSIONS
Deep venous thrombosis reduction strategies in infants with CVCs include avoiding percutaneous femoral and multilumen CVCs, screening percutaneous lines, and early catheter removal.
Topics: Catheterization, Central Venous; Comorbidity; Female; Femoral Vein; Hospitals, Pediatric; Humans; Incidence; Infant; Intensive Care Units; Jugular Veins; Length of Stay; Male; Phlebography; Retrospective Studies; Risk Factors; Risk Reduction Behavior; Subclavian Vein; Ultrasonography; Upper Extremity Deep Vein Thrombosis; Venous Thrombosis
PubMed: 22703787
DOI: 10.1016/j.jpedsurg.2012.03.043 -
Seminars in Vascular Medicine 2001In the past 3 decades, numerous biological abnormalities linked with deep venous thrombosis have been described. Among the different possibilities, it is crucial to... (Review)
Review
In the past 3 decades, numerous biological abnormalities linked with deep venous thrombosis have been described. Among the different possibilities, it is crucial to order tests that can modify the therapeutic attitude towards the patient and/or his family. A combined clinical and laboratory approach taking into account the history of the patient and his family, the prevalence of the defects, and also the accuracy of the tests should allow tailoring a laboratory testing program to each patient. It is essential to keep in mind that the more difficult task is not to perform the tests but to consider who will benefit from testing both for prevention and therapy of venous thromboembolism. This article provides answers to some of these issues. These answers should, however, be considered as tentative and provisional because new findings and study results will certainly modify them in the near future.
Topics: Activated Protein C Resistance; Factor V; Female; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombophilia; Venous Thrombosis
PubMed: 15199518
DOI: 10.1055/s-2001-14545 -
La Revue de Medecine Interne Sep 2011Deep venous thrombosis of the upper limb has become recently more common because of the increasing use of central venous catheters. Diagnosis is sometimes difficult.... (Review)
Review
Deep venous thrombosis of the upper limb has become recently more common because of the increasing use of central venous catheters. Diagnosis is sometimes difficult. Main causes are pacemaker and central venous catheter related thrombosis. The thoracic outlet syndrome is a rare cause and requires a multidisciplinary diagnostic and therapeutic approach. A systematic research of a thrombophilic disorder is not recommended because of the weak therapeutic impact. Duration of anticoagulation is similar to lower limb deep venous thrombosis despite a lower rate of recurrence. Therapeutic alternatives recently developed include thrombolysis, angioplasty and vein stenting. To date, no randomized controlled studies have evaluated the efficacy and safety of the various treatments that have been proposed for upper limb deep venous thrombosis.
Topics: Humans; Upper Extremity; Venous Thrombosis
PubMed: 21269741
DOI: 10.1016/j.revmed.2010.08.007 -
Seminars in Vascular Surgery Dec 1998Despite improvements in trauma care and thromboembolism prophylaxis over the past 50 years, deep venous thrombosis (DVT) remains a source of morbidity and mortality in... (Review)
Review
Despite improvements in trauma care and thromboembolism prophylaxis over the past 50 years, deep venous thrombosis (DVT) remains a source of morbidity and mortality in the injured patient. Pulmonary embolism may complicate the course of up to 6% of such patients, although the morbidity associated with late development of the postthrombotic syndrome remains poorly defined and perhaps underemphasized. Prolonged immobilization and venous injury contribute to the risk of venous thrombosis, and accumulating evidence suggests underlying imbalances between activated coagulation and fibrinolysis. Much investigative work has focused on identifying subpopulations, including older patients (30 to 40 years) and those with prolonged immobilization, pelvic and lower extremity fractures, spinal cord injury, major venous injury, central venous lines, significant blood requirements, and admission coagulopathy, who are at particular risk of developing DVT. Given the diverse underlying pathophysiologic factors, it is perhaps not surprising that the benefits of prophylactic measures have been imperfect and remain controversial. Both intermittent pneumatic compression and low-dose unfractionated heparin have limitations, although the low-molecular-weight heparins have promise for prophylaxis in this population. It has also been suggested that other measures, such as serial duplex ultrasound screening and prophylactic vena cava filters, may have a role in very high-risk patients and those who are not candidates for other means of prophylaxis. However, the precise role of these measures remains poorly defined and awaits prospective validation. An improved understanding of the operative risk factors may permit prophylactic therapy to be better tailored to the individual patient.
Topics: Age Factors; Anticoagulants; Autopsy; Heparin; Humans; Prevalence; Risk Factors; Venous Thrombosis; Warfare; Wounds and Injuries
PubMed: 9876034
DOI: No ID Found -
Haematologica Jun 2010
Comparative Study Review
Topics: Animals; Anticoagulants; Blood Coagulation; Factor V; Fibrinolytic Agents; Humans; Point Mutation; Pulmonary Embolism; Venous Thrombosis
PubMed: 20513806
DOI: 10.3324/haematol.2010.023432 -
Annales de Cardiologie Et D'angeiologie Jun 2002Deep vein thrombosis is a frequent disease with an annual incidence reaching 5 per thousand among subjects over 75 years. Major acquired risk factors for venous... (Comparative Study)
Comparative Study Review
Deep vein thrombosis is a frequent disease with an annual incidence reaching 5 per thousand among subjects over 75 years. Major acquired risk factors for venous thrombosis include surgery, neoplasm, reduced mobility or paresis, and a previous episode of deep vein thrombosis. Among women, hormonal status (pregnancy, oral contraceptive, hormone replacement therapy) is responsible for the majority of all venous thrombotic events. The impact of other factors is controversial: obesity, tobacco use and varicose veins. Venous thrombosis is a multifactorial disease and analysis of the interactions between acquired and inherited risk factors is an extremely interesting field of investigation.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Case-Control Studies; Female; Hormone Replacement Therapy; Humans; Incidence; Male; Menopause; Middle Aged; Obesity; Phlebography; Pregnancy; Risk Factors; Sex Factors; Thrombophlebitis; Venous Thrombosis
PubMed: 12471641
DOI: 10.1016/s0003-3928(02)00083-5