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1
Allen, Lisa, and Andrew Wilkinson. "Deep vein thrombosis." InnovAiT: Education and inspiration for general practice 13, no. 6 (March 31, 2020): 344–51. http://dx.doi.org/10.1177/1755738020911990.
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Deep vein thrombosis (DVT) is a common and serious condition with a substantial risk of morbidity and mortality for patients. A diagnosis of DVT affects both the physical health and psychosocial functioning of patients. It represents a significant cost to the NHS in both expenditure and resource allocation. Management should focus on early recognition, prompt referral and prevention of its associated complications. This article aims to provide relevant background knowledge about DVT with advice on assessment using a clinical risk tool and appropriate referral to secondary care.
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Denny, Nicholas, Shreshta Musale, Helena Edlin, Ferdinando Serracino-Inglott, and Jecko Thachil. "Chronic deep vein thrombosis." Acute Medicine Journal 17, no. 3 (July 1, 2018): 144–47. http://dx.doi.org/10.52964/amja.0719.
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Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Although acute DVT is often well managed, there is uncertainty in the management of chronic DVT which is increasingly being noted among patients presenting with similar symptoms to their initial DVT. The presence of a residual venous clot can be a problem for both physicians and patients fearing the risk of emboli to the same extent as the acute DVT. There are also issues in the accurate diagnosis and appropriate management of chronic DVT, which is the focus of the second part of this review.
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HOLCOMB, SUSAN SIMMONS. "Deep vein thrombosis (DVT)." Nursing 36, no. 10 (October 2006): 43. http://dx.doi.org/10.1097/00152193-200610000-00036.
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Cheema, Ali Akhtar, Robert H. Mallinson, and Nicola Trepte. "Advances in Deep Vein Thrombosis Management with Thrombolysis." Acute Medicine Journal 8, no. 2 (April 1, 2009): 63–69. http://dx.doi.org/10.52964/amja.0234.
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Lower extremity deep vein thrombosis (DVT) is a common disease associated with serious short term and long term complications. Its conventional treatment has been anticoagulation. Thrombolytic treatment has been used for DVT for over 40 years. More recently catheter directed thrombolysis has taken over systemic thrombolysis. This technique is useful to prevent post thrombotic syndrome (PTS) after DVT. In this review article we present a case of DVT thrombolysis in our hospital, look at the pathophysiology of PTS, the mechanism of thrombolysis and the current status of thrombolysis in DVT.
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Aabideen, Kanakkande, Michael Ogendele, Ijaz Ahmad, and Laweh Amegavie. "Deep vein thrombosis in children." Pediatric Reports 5, no. 2 (June 19, 2013): 12. http://dx.doi.org/10.4081/pr.2013.e12.
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We describe a rare case of deep vein thrombosis (DVT) in children, highlight the importance of early diagnosis of rare disease with potential complications. In a 5 year old boy presented with persistent leg pain without any obvious cause. Detailed investigation led to diagnosis of DVT. As there are common differential diagnoses for leg pain in children, pediatricians usually have a low index of suspicious of DVT in children. This case highlight that paediatricians must consider DVT in their differential diagnosis when children present with leg pain.
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Hardman, Rulon. "Management of Chronic Deep Vein Thrombosis in Women." Seminars in Interventional Radiology 35, no. 01 (March 2018): 003–8. http://dx.doi.org/10.1055/s-0038-1636514.
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AbstractChronic deep vein thrombosis (DVT) affects hundreds of thousands of women in the United States. Chronic DVT can lead to pain, edema, venous ulcers, and varicosities. While there are limited data regarding the management of chronic DVT, several interventional radiology groups aggressively treat chronic DVT to aid patient symptom resolution. Recanalization of occluded veins and venous stenting re-establishes deep vein flow and decreases venous hypertension.
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Endig, Heike, Franziska Michalski, and Jan Beyer-Westendorf. "Deep Vein Thrombosis – Current Management Strategies." Clinical Medicine Insights: Therapeutics 8 (January 2016): CMT.S18890. http://dx.doi.org/10.4137/cmt.s18890.
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Deep vein thrombosis (DVT) is a frequent and potentially life-threatening condition, and acute and late complications are common. The diagnostic approach to DVT needs to be reliable, widely available, and cost-effective. Furthermore, several therapeutic options are available for DVT treatment and the choice of anticoagulant drug, dosage, and treatment duration has to reflect the specific situation of the individual DVT patient. This review was aimed to provide bedside guidance for clinicians faced with common (and less common) clinical scenarios in DVT treatment.
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Joffe, Hylton, Nils Kucher, Victor Tapson, and Samuel Goldhaber. "Few predictors of massive deep vein thrombosis." Thrombosis and Haemostasis 94, no. 11 (2005): 986–90. http://dx.doi.org/10.1160/th05-05-0314.
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SummaryFactors that predispose to thrombus propagation from the femoropopliteal veins to the pelvic veins are poorly understood. Our goal was to determine whether there are characteristics that identify patients with massive deep vein thrombosis (DVT). We compared the 122 (2.5%) patients presenting with massive DVT (pelvic plus lower-extremity DVT) to the 4,674 (97.5%) patients with isolated lower-extremity DVT from a prospective United States multicenter DVT registry. Patients with massive DVT were younger (59.4±18.9 years vs. 64.3±16.8 years; p<0.01), less likely to have hypertension (40% vs. 51%; p=0.02), and more likely to smoke (21% vs. 13%; p=0.02) and have on- going radiation therapy (7% vs. 3%; p=0.02). The massive DVT group more commonly presented with extremity edema (80% vs. 69%; p<0.01) and erythema (21% vs. 12%; p<0.01) than the isolated lower-extremity DVT group. However, after multivariable logistic regression analysis, extremity erythema (adjusted odds ratio 1.86; 95% CI 1.13–3.04) was the only independent sequela of massive DVT and younger age (adjusted odds ratio 1.17 per decreasing decade of age; 95% confidence interval: 1.02-1.34) was the only independent predictor of massive DVT. Thrombus propagation from the femoropopliteal system cannot be reliably predicted using demographic or clinical characteristics.
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Paris, Samuel, Grégoire Le Gal, Jean-Pierre Laroche, Arnaud Perrier, Henri Bounameaux, and Marc Righini. "Clinical relevance of distal deep vein thrombosis." Thrombosis and Haemostasis 95, no. 01 (2006): 56–64. http://dx.doi.org/10.1160/th05-08-0588.
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SummaryThe standard diagnostic approach of suspected deep vein thrombosis (DVT) is serial lower limb compression ultrasound (CUS) of proximal veins. Although it only assesses the proximal veins, withholding anticoagulant treatment in patients with a negative CUS on day one and after one week has been proven to be safe. However, in many centres, distal DVT is systematically screened for and treated by anticoagulants. The objectives of the review were 1) to evaluate the rate of extension of distal DVTs to proximal veins 2) to compare the safety of proximal limited CUS versus single complete CUS. We performed a MEDLINE search covering the period from January 1983 to January 2005 by using the key-words “calf vein thrombosis”, “distal thrombosis” and “compression ultrasonography”. English, German and French language original studies were retrieved. Moreover, references of retrieved articles were screened in order to detect missed pertinent articles. We pooled data of management studies where proximal or complete (i. e. proximal and distal) CUS were used, respectively. Studies evaluating CUS limited to the proximal veins showed a good safety profile with a pooled estimate of the 3-month thromboembolic rate of 0.6% (95% CI: 0.4–0.9%) in patients in whom anticoagulation was withheld. Studies using proximal and distal CUS showed a similar pooled estimate of the 3-month thromboembolic rate (0.4%, 95% CI: 0.1–0.6%) but distal DVT accounted for as many as 50% of all diagnosed DVTs in those series. Therefore, searching for distal DVT potentially doubles the number of patients given anticoagulant therapy and entails a risk of over-treatment. Data suggesting that anticoagulation is indicated for distal DVT are limited, and realizing distal CUS entails a risk of over-treatment. There is an urgent need for randomised trials assessing the usefulness of anticoagulant treatment in distal DVT.
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Kyrle, Paul A. "How I treat recurrent deep-vein thrombosis." Blood 127, no. 6 (February 11, 2016): 696–702. http://dx.doi.org/10.1182/blood-2015-09-671297.
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Abstract Deep-vein thrombosis (DVT) is regarded a chronic disease as it often recurs. DVT affects most frequently the lower limbs and hence DVT of the leg will be the focus of this article. Whereas algorithms were developed and validated for the diagnosis of a first DVT, no such well-defined strategies exist in the case of recurrence of DVT. Likewise, the scientific evidence regarding the treatment of recurrent DVT is sparse, in particular when it comes to deciding on the duration of anticoagulation. Two typical cases of recurrent DVT, one with an unprovoked DVT and one with DVT during anticoagulation, will be presented. Based on these two clinical scenarios, algorithms for the diagnosis and treatment of recurrent DVT will be put forward. The purpose of this article is to discuss strategies that can be applied in daily clinical practice by physicians who do not have access to means and measures available in specialized thrombosis centers.
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Rollins, David L., Carolyn Semrow, Keith Calligaro, Mark Friedell, and Dale Buchbinder. "Diagnosis of Recurrent Deep Venous Thrombosis Using B-Mode Ultrasonic Imaging." Phlebology: The Journal of Venous Disease 1, no. 3 (December 1986): 181–88. http://dx.doi.org/10.1177/026835558600100304.
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Accurate diagnosis of recurrent deep venous thrombosis (DVT) in patients with postphlebitic syndrome or a history of previous DVT can be extremely difficult. Real-time B-mode ultrasonic imaging (UI) was compared to ascending contrast venography (ACV) in a prospective study of 38 limbs with suspected recurrent DVT to determine if UI could reliably detect recurrent thrombosis. Six limbs had normal deep veins and 32 had evidence of previous DVT by both techniques. Acute thrombus was diagnosed by both UI and ACV in 9 limbs and by UI alone in an additional three limbs. New thrombus was found in 13 popliteal-proximal and 10 calf veins by UI; while ACV detected 12 popliteal-proximal and five new calf vein thromboses. UI is comparable to ACV in detecting recurrent thrombosis and may be particularly useful in assessing the calf veins.
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Mantoni, M. "Diagnosis of Deep Venous Thrombosis by Duplex Sonography." Acta Radiologica 30, no. 6 (November 1989): 575–79. http://dx.doi.org/10.1177/028418518903000602.
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In a prospective study 90 patients with clinically suggested lower limb deep venous thrombosis (DVT) were examined with duplex ultrasonography (US) prior to venography. No attempts were made to examine the calf veins. Five ultrasound examinations were inconclusive. Thirty-four patients had DVT diagnosed at US with a sensitivity of 97 per cent and a specificity of 96 per cent. Compressibility of the vein as assessed by the real-time image was in the acute phase an easy and fast test for DVT, whereas the Doppler data failed to add to the diagnostic accuracy. Twenty-seven patients with DVT were followed during anticoagulant treatment, but only 16 regained fully compressible veins within the observation period of 3 to 6 months. Duplex sonography was useful in monitoring the changes in vein patency during anticoagulant treatment.
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Ramadan, SM, EV Kasfiki, CWP Kelly, and I. Ali. "Primary upper extremity deep vein thrombosis (effort thrombosis)." Acute Medicine Journal 20, no. 2 (April 1, 2021): 151–54. http://dx.doi.org/10.52964/amja.0857.
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Primary spontaneous upper extremity deep vein thrombosis is characterised by thrombosis within deep veins draining the upper extremity due to anatomical abnormalities of the thoracic outlet causing axillosubclavian compression and subsequent thrombosis. It is an uncommon condition that typically presents with unilateral arm swelling in a young male following vigorous upper extremity activity. The diagnosis of this condition is usually made by Doppler ultrasound, but other investigations are mandatory to exclude the secondary causes of upper extremity DVT. Different treatment options are available including anticoagulation, thrombolysis, and surgery. We report the case of a young healthy male with athletic physique who presented with pain and swelling of his dominant arm after weightlifting in the gym.
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Denny, Nicholas, Shreshta Musale, Helena Edlin, Jecko Thachil, and Ferdinando Serracino-Inglott. "Iliofemoral deep vein thrombosis and the problem of post-thrombotic syndrome." Acute Medicine Journal 17, no. 2 (April 1, 2018): 99–103. http://dx.doi.org/10.52964/amja.0708.
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Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context. In this article, with the aid of a clinical case, we review the particular considerations to take into account when managing patients with an iliofemoral DVT.
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Zhang, Yan, Guoying Zhang, Cui Jian, Congqing Wu, Nigel Mackman, Susan Smyth, Yinan Wei, and Zhenyu Li. "Inflammasome Activation Promotes Deep Vein Thrombosis through Pyroptosis." Blood 134, Supplement_1 (November 13, 2019): 3644. http://dx.doi.org/10.1182/blood-2019-130439.
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Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is one of the most common causes of cardiovascular death worldwide. Monocytic cells (including monocytes/macrophages) and their derived tissue factor have been reported to play important roles in the development of DVT. However, the mechanism by which monocytes contribute to the development DVT is not well elucidated. In this study, we reported a critical role of inflammasome activation and pyroptosis in the development of DVT. Using a flow restriction-induced mouse DVT model in the inferior vena cava, we show that deficiency of caspase-1 protected against flow restriction-induced DVT. Inflammasome activation leads to interleukin (IL)-1b and IL-18 maturation/release and pyroptosis. Recent studies show that caspases-1 cleaves Gasdermin D (GSDMD) and triggers pyroptosis-a form of programmed cell death with similar morphology to necrosis. We tested the hypothesis that GSDMD-dependent pyroptosis drives inflammasome-induced coagulation and DVT using Gsdmd-/- mice. Indeed, flow restriction-induced DVT was inhibited by GSDMD deficiency. After induction of DVT, fibrin was deposited in the vein as detected by Western blot with a monoclonal antibody that specifically recognizes mouse fibrin, which were inhibited in the caspase-1 deficient mice and GSDMD deficient mice. IL-1b was also increased in tissue of vein following induction of DVT, which was inhibited by caspase-1 or GSDMD deficiency. Following inflammasome activation, pyroptotic macrophages release tissue factor (TF), an essential initiator of coagulation cascades. Consistently, flow restriction-induced DVT was flow restriction-induced DVT inhibited in inducible TF deficient mice. Our data reveal a critical role of inflammasome activation and pyroptosis in the development of DVT. Disclosures No relevant conflicts of interest to declare.
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Hamandi, Mohanad, Allison T. Lanfear, Seth Woolbert, Madison L. Bolin, Joy Fan, Michael William, Zoheb Khan, J. Michael DiMaio, and Chadi Dib. "Challenging Management of a Patient With Severe Bilateral Deep Vein Thrombosis." Journal of Investigative Medicine High Impact Case Reports 8 (January 2020): 232470962091028. http://dx.doi.org/10.1177/2324709620910288.
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Among patients with proximal iliofemoral deep vein thrombosis (DVT) and an elevated Villalta score, anticoagulation therapy alone may not be a sufficient management strategy in select cases. In this article, we report a case of severe bilateral iliofemoral DVT that resisted the standard treatment for DVT, requiring catheter-directed thrombolysis and subsequent mechanical thrombectomy.
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Hunt, N., R. K. Strachan, A. N. Nicolaides, and K. T. Delis. "Incidence, Natural History and Risk Factors of Deep Vein Thrombosis in Elective Knee Arthroscopy." Thrombosis and Haemostasis 86, no. 09 (2001): 817–21. http://dx.doi.org/10.1055/s-0037-1616137.
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Summary Aims: to determine the incidence, anatomical distribution and extent of deep vein thrombosis (DVT) in limbs undergoing elective unilateral knee arthroscopy without active prophylaxis, to evaluate its effect on venous function following early diagnosis, and to quantify the impact of risk factors on its incidence. Methods: 102 consecutive patients undergoing unilateral knee arthroscopy without prophylaxis were studied. A history was obtained with emphasis on the risk factors for thromboembolism, and physical examination and colour duplex were performed prior to and within a week after surgery. Patients who developed calf DVT were given aspirin (150 mg) and compression stockings; those with proximal DVT were admitted for anticoagulation (heparin followed by warfarin). Follow-up (mean 118 [range 84-168] days) entailed weekly physical and duplex examinations during the first month and monthly thereafter. Results: 8 patients developed calf DVT in the operated leg (incidence 7.84% [95% Cl: 2.7%-13.2%]); thrombosis was asymptomatic in 4 of those (50%), caused calf tenderness in 4 (50%) and a positive Homan’s sign in one (12.5%). DVT occurred in the following veins: peroneal 4 subjects (50%), soleal 4 (50%), gastrocnemial 2 (25%) and tibial 2 (25%). Propagation of a calf DVT to the popliteal vein was identified in 1 patient (12.5%). After a median period of 118 days, total clot lysis was found in 50% of DVTs, with partial thrombus resorption in the rest; reflux in the thrombosed veins was present in 75% of limbs with DVT. 43% of patients had 1 risk factor for DVT and 20% had ≥2. The incidence of DVT was higher amongst those with two or more risk factors for thromboembolism (p <.05) or those with previous thrombosis alone (p <.005). Symptoms or signs of pulmonary embolism were not documented. Conclusions: Elective unilateral knee arthroscopy performed without prophylaxis is complicated by ipsilateral calf DVT in 7.8% (95% CI: 2.7%-13.2%) of cases. The risk is higher in the presence of previous thrombosis (relative risk: 8.2) and two or more risk factors for DVT (relative risk: 2.94). Thrombosis may propagate to the proximal veins, despite early diagnosis. 50% of calf clots totally lyse in 4 months, yet reflux develops in at least 75% of limbs with DVT. Further studies to determine optimal prophylaxis are warranted.
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Zambrano, Maria, Yoon Ko, and Vikram S. Dogra. "Glomus Jugulare Tumor Presenting as Deep Vein Thrombosis." American Journal of Sonography 1 (July 7, 2018): 11. http://dx.doi.org/10.25259/ajs-24-2018.
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Intraluminal filling defect and non-compressibility of the vein are diagnostic of a deep vein thrombosis (DVT). However, other etiologies can present with features similar to DVTs; these include tumors extending into the vein and primary tumors arising from the vein such as leiomyosarcoma and hemangioendothelioma. Here, we present a case of an 80-year-old female with a right glomus jugulare tumor (GJT) with extension into the right internal jugular vein mimicking a DVT. This case report presents the sonographic features of GJT presenting as DVT and review of the literature of other tumors that can present in a similar fashion.
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Nyamekye, I., and L. Merker. "Management of proximal deep vein thrombosis." Phlebology: The Journal of Venous Disease 27, no. 2_suppl (April 2012): 61–72. http://dx.doi.org/10.1258/phleb.2012.012s37.
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Iliofemoral DVT constitutes approximately 20–25% of lower limb DVT and represents a specific subgroup of patients at highest risk for post-thrombotic syndrome (PTS). Anticoagulation alone has no significant thrombolytic activity and has not impact on PTS prevention. Early thrombus removal has reduced PTS in uncontrolled reports and reviews but major trials are awaited. The optimal timing for treatment appear to be thrombus <2 weeks old and, methods for thrombus removal include direct open or suction thrombectomy, catheter directed thrombolysis (CDT), with or without percutaneous mechanical thrombectomy (PMT) devices. Three principle types of PMT device are in use (rotational, rheolytic and ultrasound enhanced devices) and are combined with CDT in pharmocomechanical thrombolysis (PhMT) to enhance early thrombus removal. These devices have individual device specific attributes and side effects that are additional to the bleeding complications of thrombolysis. A number of additional interventions may be utilised to the improve results of CDT and PhMT. IVC filter deployment to reduce periprocedural PE, is supported by little evidence unless an indication for its use already exists. However, balloon venoplasty and vein stents undoubtedly vein patency after treatment. Early thrombus removal comes with additional upfront costs derived from devices, imaging and critical care bed usage. However, significant potential savings from reduction in PTS and rethrombosis rates may reduce overall societal costs. This review focuses on iliofemoral thrombosis, however, the less commonly encountered but clinically important subclavian vein thrombosis is also discussed.
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Galli, Matteo, Alessandro Squizzato, Francesco Dentali, Elisa Manfredi, Luigi Steidl, Achille Venco, and Walter Ageno. "Residual venous obstruction in patients with a single episode of deep vein thrombosis and in patients with recurrent deep vein thrombosis." Thrombosis and Haemostasis 94, no. 07 (2005): 93–95. http://dx.doi.org/10.1160/th04-12-0817.
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SummaryResidual venous obstruction (RVO) in patients with previous deep vein thrombosis (DVT) of the lower limbs has been suggested as an independent risk factor for recurrent venous thromboembolism (VTE).RVO could be a marker of a persistent prothrombotic state. We have compared the rate of RVO in patients with DVT and a personal history of at least one previous episode of VTE to the rate of RVO among patients with a first episode of DVT. All patients underwent compression ultrasonography (CUS) of the lower limbs 1 year after index DVT. RVO was arbitrarily defined as a thrombus occupying, at maximal compressibility, more than 20% of the vein area in the absence of compression. 50 consecutive patients with recurrent DVT and 50 age and sex-matched patients with a single episode of DVT were enrolled. The index event was idiopathic in 62% of patients with recurrent DVT and in 60% of patients with a single episode. In 74% of patients with recurrent DVT the index event occurred in either the contralateral leg or in a different segment of the ipsilateral leg. RVO was detected in 50% of patients with a single episode of DVT and in 88% of patients with recurrent DVT (p<0.00001). The prevalence of RVO is significantly higher in patients with recurrent DVT than in patients with a single episode. This finding supports the importance of RVO as a potential marker of a persistent prothrombotic state.
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Hanindito, Elizeus, Prananda Surya Airlangga, Soni Sunarso Sulistiawan, Bambang Pujo Semedi, Lucky Andriyanto, Arie Utariani, and Nancy Margarita Rehatta. "Comparison of Length of Stay and Deep Vein Thrombosis (DVT) Incidents in Dr. Soetomo Hospital." Folia Medica Indonesiana 54, no. 4 (December 11, 2018): 278. http://dx.doi.org/10.20473/fmi.v54i4.10713.
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Vein thrombosis may occur both in deep and superficial vein of all extremities. Ninety percent of vein thrombosis may progress into pulmonary embolism which is lethal. Deep vein thrombosis (DVT) is frequently found in critically ill patients in ICU, especially patients who are treated for a long time. This study aims to analyse the comparison between length of stay and DVT incidents in critically ill patients. A cross-sectional study was employed. We include all patients who were 18 years or older and were treated in ICU of Dr Soetomo public hospital for at least 7 days. The patients were examined with Sonosite USG to look for any thrombosis in iliac, femoral, popliteal, and tibial veins and Well’s criteria were also taken. This study showed that length of stay is not the only risk factor for DVT in patients treated in ICU. In our data, we found out that the length of treatment did not significantly cause DVT. Other risk factors such as age and comorbidities in patients who are risk factors may support the incidence of DVT events. The diagnosis of DVT is enforced using an ultrasound performed by an expert in the use of ultrasound to locate thrombus in a vein. Length of treatment is not a significant risk factor for DVT. Several other factors still need to be investigated in order for DVT events to be detected early and prevented.
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Karahan, Oguz, H. Barıs Kutas, Orcun Gurbuz, Orhan Tezcan, Ahmet Caliskan, Celal Yavuz, Sinan Demirtas, and Binali Mavitas. "Pharmacomechanical thrombolysis with a rotator thrombolysis device in iliofemoral deep venous thrombosis." Vascular 24, no. 5 (July 10, 2016): 481–86. http://dx.doi.org/10.1177/1708538115612637.
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Objective Deep venous thrombosis (DVT) is a life-threatening and morbid pathology. This study aimed to investigate the efficacy of an early thrombolysis procedure using a rotator thrombolysis device. Methods Sixty-seven patients with acute proximal DVT were enrolled in the study. Patients’ data were recorded retrospectively. Initially, an infrarenal retrievable vena cava filter was placed through the femoral vein. Then, a rotator thrombolysis device and a thrombolytic agent injection were applied to the occluded segments of the deep veins by puncturing the popliteal vein. Results The identified reasons were trauma (43.3%), pregnancy (20.9%), undiagnosed (11.9%), major surgical operation (10.5%), immobilization (7.5%), and malignancy (5.9%). Immediate total recanalization was conducted in all patients, and the leg diameters returned to normal ranges in the early postoperative period. Hospital mortality or severe complications were not detected. Conclusion New thrombolytic devices seem to reduce in-hospital mortality risks and may potentially decrease post-thrombotic morbidity.
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Schellong, S. M. "Diagnosis of recurrent deep vein thrombosis." Hämostaseologie 33, no. 03 (2013): 195–200. http://dx.doi.org/10.5482/hamo-13-06-0029.
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SummaryDeep vein thrombosis is a chronic disease with a continuing risk of recurrence. In a patient with recurrence long term prognosis and treatment are significantly altered both carrying their own risks not only in the acute phase but mainly in the long term perspective. Thus, accurate diagnosis of recurrence is of utmost importance for the fate of the patient. Diagnosis of a first DVT episode is well established and follows an algorithm including clinical prediction rules, D-Dimer testing and compression ultrasound. Due to the previous episode the efficiency of all three elements is impaired in a patient with suspected recurrence. This opens up areas of uncertainty which have to be filled by individual clinical judgement. Guidelines reflect this difficulty by providing mainly weak recommendations based on sparse data. The present review summarizes what is known about the performance of tools for DVT diagnosis, discusses recent guidelines, and finally gives personally weighed recommendations how to deal with this peculiar diagnostic situation. In conclusion, it will turn out that the well accepted diagnostic algorithm for a first DVT may be applied as well if the lower efficiency is regarded. Compression ultrasound largely benefits from a baseline assessment at the end of the previous episode. The order of tests may be discussed according to local and regional attitudes.
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Sharma, Vishal, Mahendra Bendre, Shahaji Chavan, and Sree Ganesh B. "Comparative study to establish significance of D-dimer, lipid profile and homocysteine level in cases of deep vein thrombosis." International Surgery Journal 6, no. 5 (April 29, 2019): 1733. http://dx.doi.org/10.18203/2349-2902.isj20191899.
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Background: The purpose of the study was to establish the relationship of D-dimer, lipid profile and homocysteine level in deep-vein thrombosis (DVT). The purpose of this study was to assess the value of D-dimer in the detection of early DVT.Methods: A hospital based comparative study was conducted at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune with 100 patients to compare the level of D-dimer and lipid profile in cases of Deep Vein Thrombosis (DVT) with healthy controls. The study was carried out with following two groups of 50 patients each: study group : 50 cases with DVT; control group: 50 healthy controls.Results: The D-Dimer levels was significantly higher in study group as compared to control group (748.44±93.17 vs. 426.06±78.11 ng/ml) and statistically significant as per student t-test (p<0.05). It was observed that total cholesterol (r=0.714; p<0.05), triglyceride (r=0.534; p<0.05), LDL (r=0.662; p<0.05), HDL (r=0.655; p<0.05), homocysteine (r=0.285; p<0.05) and D-dimer (r=0.368; p<0.05) were strongly and directly correlated with DVT.Conclusions: In our study most sensitive test for early diagnosis of DVT is D-dimer as it is considered to be useful as a screening test for DVT in hospitalized patients with acute medical diseases/episodes. D-dimer assay is an important preliminary test to detect deep vein thrombosis in post-operative cases. Its extreme sensitivity and high negative predictive value make it an ideal single test to screen patients suspected of having deep vein thrombosis. A negative test rules out deep vein thrombois and a positive test report needs further investigation for its confirmation. In case of increased lipid profile levels, patients are more prone to develop DVT hence there should be regular screening for DVT.
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Daneschvar, H., Ali Seddighzadeh, Gregory Piazza, and Samuel Goldhaber. "Deep vein thrombosis in patients with chronic kidney disease." Thrombosis and Haemostasis 99, no. 06 (2008): 1035–39. http://dx.doi.org/10.1160/th08-02-0107.
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SummaryDeep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome.We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p<0.0001), more often African- American (p<0.0001), and more often Hispanic (p=0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p=0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p=0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p<0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p=0.003) and difficulty ambulating (5.4% vs. 10.1%, p=0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p=0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population.
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Stake, Seth, Anne L. du Breuil, and Jeremy Close. "Upper Extremity Deep Vein Thromboses: The Bowler and the Barista." Case Reports in Vascular Medicine 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/9631432.
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Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses.
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Martaria, Nency, Iwan Fuadi, and Sudadi Sudadi. "Deep Vein Thrombosis (DVT) Pasca Cedera Otak Traumatik Berat." Jurnal Neuroanestesi Indonesia 8, no. 3 (October 29, 2019): 217–25. http://dx.doi.org/10.24244/jni.v8i3.236.
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Cedera otak traumatik(COT) adalah penyebab utama kematian dan disabilitas. Deep vein thrombosis (DVT) adalah salah satu risiko tinggi dari COT. Faktor risiko DVT lain yang umum ditemukan pada pasien COTadalah paralisis, imobilisasi, dan cedera ortopedi. Deep vein thrombosis diduga terkait gangguan koagulasi yang sering ditemukan pada COT, terutama pada COT berat. Deep vein thrombosis dapat menyebabkan pulmonary embolism (PE) yang merupakan salah satu penyebab kematian lambat terbanyak pada pasien trauma. Diagnosis DVT didapatkan melalui stratifikasi risiko, pemeriksaan fisik, dan pemeriksaan penunjang yang mencakup pemeriksaan d-dimer, ultrasonografi, dan penunjang lain seperti spiral computed tomography venography. Tata laksana DVT pada pasien COT mencakup pemberian antikoagulan intravena yang dilanjutkan oral jangka panjang,stoking kompresi, dan pemasangan vena cava filter (VCF). Pada pasien COT, adanya risiko perdarahan intrakranial umumnya menimbulkan keraguan pada klinisi terkait inisiasi profilaksis farmakologis dengan antikoagulan. Profilaksis nonfarmakologis mencakup penggunaan graduated compression stocking (GCS), alat kompresi pneumatik (pneumatic compression devices/PCD), A-V foot pump, dan vena cava filter (VCF). Beberapa studi terkini menyarankan pemasangan PCD pada semua pasien COT pada awal perawatan selama tidak ditemukan kontraindikasi. Pemeriksaan CT selanjutnya dilakukan setelah 24 jam. Penemuan hasil yang stabil pada CT, profilaksis farmakologis dapat dimulai dalam 24-48 jam setelah CT. Selama pemberian antikoagulan, CT serial dapat dilakukan untuk memantau progresi perdarahan.Deep Vein Thrombosis (DVT) after Severe Traumatic Brain InjuryAbstractTraumatic brain injury (TBI) is a risk factor for deep vein thrombosis (DVT). Beside the common risk factors of DVT among TBI patients, this is associated with coagulopathycommonly foundin TBI, especially in severe TBI.Diagnosis and treatment of DVT are also crucial to prevent mortality. Deep vein thrombosis could be diagnosed through risk stratification, physical examination, and d-dimer as well as ultrasonography examination. Treatment includes intravena anticoagulant continue with longterm oral, stocking compression and the use of vein cava filter (VCF). Deep vein thrombosis could cause pulmonary embolism (PE), a common cause of late mortality in trauma patients. Deep vein thrombosis could be prevented pharmacologically (with anticoagulant) and nonpharmacologically. However, in TBI patients, the risk of intracranial hemorrhage usually considered an initiation of pharmacological prophylaxis. Nonpharmacological prophylaxisincludes graduated compression stocking (GCS), pneumatic compression devices (PCD), A-V foot pump, and vena cava filter (VCF). Latest studes suggest the use of PCD for all TBI patients without contraindication since administration. Computed tomography should be performed within 24 hours and if the resultis stable, pharmacological prophylaxis should be initiated within 24-48 hours.
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Nielsen, J. D. "The incidence of pulmonary embolism during deep vein thrombosis." Phlebology: The Journal of Venous Disease 28, no. 1_suppl (March 2013): 29–33. http://dx.doi.org/10.1177/0268355513477009.
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Among life-threatening cardiovascular diseases, pulmonary embolism (PE) is the third most common after myocardial infarction and stroke. PE is a manifestation of venous thromboembolism (VTE). PE shares risk factors with deep vein thrombosis (DVT) and is regarded as a consequence of DVT rather than a separate clinical entity. Risk factors for VTE include major surgery, major trauma, high age, myocardial infarction, chronic heart failure, prolonged immobility, malignancy, thrombophilia and prior VTE. It is, however, important to recognize that these factors are not equally important and not equally common in patients with PE and DVT, respectively. Compared with DVT, PE is more often associated with major surgery, major trauma, high age, myocardial infarction and chronic heart failure, whereas malignancy and thrombophilia primarily are clinical predictors of DVT. In patients with prior VTE the initial clinical manifestation strongly predicts the manifestation of recurrent episodes, i.e. patients with previous PE are more likely to develop recurrent PE than DVT while patients with DVT predominantly are at risk of recurrent DVT.
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Male, Christoph, Peter Chait, Jeffrey Ginsberg, Kim Hanna, Maureen Andrew, Jacqueline Halton, Ron Anderson, et al. "Comparison of Venography and Ultrasound for the Diagnosis of Asymptomatic Deep Vein Thrombosis in the Upper Body in Children." Thrombosis and Haemostasis 87, no. 04 (2002): 593–98. http://dx.doi.org/10.1055/s-0037-1613054.
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SummaryDeep vein thrombosis (DVT) in children occurs primarily in the upper body venous system. This prospective diagnostic study compared bilateral venography and ultrasound for detection of DVT in the upper venous system in 66 children with acute lymphoblastic leukemia. Results were interpreted by central blinded adjudication.Deep venous thrombosis occurred in 29% (19/66) patients. While 15/19 DVT were detected by venography (sensitivity 79%), only 7/19 were detected by ultrasound (sensitivity 37%). The 12 DVT detected by venography but not by ultrasound were located in the subclavian vein or more central veins. Three of 4 DVT detected by ultrasound but not by venography were in the jugular vein. We conclude that ultrasound is insensitive for DVT in the central upper venous system but may be more sensitive than venography in the jugular veins. A combination of both venography and ultrasound is required for screening for DVT in the upper venous system.
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Ezelsoy, Mehmet, Gorkem Turunc, and Muhammed Bayram. "Early Outcomes of Pharmacomechanical Thrombectomy in Acute Deep Vein Thrombosis Patients." Heart Surgery Forum 18, no. 6 (November 5, 2015): 222. http://dx.doi.org/10.1532/hsf.1307.
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<strong>Background:</strong> Acute lower extremity deep vein thrombosis (DVT) occurs due to obstruction of large veins by thrombus and its clinical findings are pain and swelling. If not treated, it can cause morbidity and mortality. Oral warfarin or low molecular weight heparin are applied in traditional treatment. However, recently, endovascular procedures have gained increasing popularity in deep vein thrombosis. In this study we aimed to compare our early results of pharmacomechanical thrombectomy (PMT) versus oral anticoagulation for acute deep vein thrombosis. <br /><strong>Methods:</strong> We comprised 50 patients presented with acute DVT between January 2013 and June 2014, who received either adjusted subcutaneous low molecular weight heparin (LMWH) or PMT followed by intravenous unfractionated heparin (UFH) for 5 days. Warfarin was administered to PMT patients for 3 months and at least 6 months for the control group. <br /><strong>Results:</strong> Median follow-up was 14 months (6-18 months). Recanalization within 6 months was found in 84.0%, femoral venous insufficiency was found in 36.0%, and postthrombotic syndrome (PTS) was found in 28.0% of the patients who received PMT treatment. The mean duration of symptoms was 11.0 days (range, 3-20 days). The mean duration of the procedure was 78.1 minutes (range, 55-100 min).<br /><strong>Conclusion:</strong> In contrast to medical therapy in the treatment of deep vein thrombosis, usage of catheter-directed thrombolysis experienced early recanalization with higher thrombus resolution. PMT with adjunctive thrombolytic therapy is an effective treatment modality in patients with significant DVT. Also, early thrombus removal in patients with acute DVT prevents development of postthrombotic morbidity. We believe that the efficacy and usage will increase with the experience of surgeons in the future.
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Bækgaard, N., R. Broholm, and S. Just. "Indications for stenting during thrombolysis." Phlebology: The Journal of Venous Disease 28, no. 1_suppl (March 2013): 112–16. http://dx.doi.org/10.1177/0268355513476818.
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The most important vein segment to thrombolyse after deep venous thrombosis (DVT) is the outflow tract meaning the iliofemoral vein. Iliofemoral DVT is defined as DVT in the iliac vein and the common femoral vein. Spontaneous recanalization is less than 50%, particularly on the left side. The compression from adjacent structures, predominantly on the left side is known as the iliac vein compression syndrome. Therefore, it is essential that supplementary endovenous procedures have to be performed in case of persistent obstructive lesions following catheter-directed thrombolysis. Insertion of a stent in this position is the treatment of choice facilitating the venous flow into an unobstructed outflow tract either from the femoral vein or the deep femoral vein or both. The stent, made of stainless steel or nitinol, has to be self-expandable and flexible with radial force to overcome the challenges in this low-pressure system. The characteristics of the anatomy with external compression and often a curved vein segment with diameter difference make stent placement necessary. Ballooning alone has no place in this area. The proportion of inserted stents varies in the published materials with catheter-directed thrombolysis of iliofemoral deep venous thrombosis.
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Lin, Te-Yu, Yu-Guang Chen, Wen-Yen Huang, Cheng-Li Lin, Chiao-Ling Peng, Fung-Chang Sung, and Chia-Hung Kao. "Association between chronic osteomyelitis and deep-vein thrombosis." Thrombosis and Haemostasis 112, no. 09 (2014): 573–79. http://dx.doi.org/10.1160/th14-01-0012.
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SummaryStudies on the association between chronic osteomyelitis and deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) are scarce. The aim of this study was to analyse a nationwide population-based database for association between DVT or PE after a diagnosis of chronic osteomyelitis. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with chronic osteomyelitis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The patients with chronic osteomyelitis and comparison controls were selected by 1:1 matching on a propensity score. The propensity score was calculated by a logistic regression to estimate the probability of the treatment assignment given the baseline variables including age, sex, and Charlson comorbidity index score. We analysed the risks of DVT and PE by using Cox proportional hazards regression models, including sex, age, and comorbidities. In total, 24,335 chronic osteomyelitis patients and 24,335 controls were enrolled in the study. The risk of developing DVT was 2.49-fold in patients with chronic osteomyelitis compared with the comparison cohort, after adjusting for age, sex, and comorbidities. The multiplicative increased risks of DVT were also significant in patients with chronic osteomyelitis with any comorbidity. In conclusion, physicians should consider chronic osteomyelitis in their evaluation of risk factors for DVT.
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Ishida, Takuto, Takeshi Katagiri, Hiroyuki Uchida, Takefumi Suzuki, Koichiro Watanabe, and Masaru Mimura. "Asymptomatic Deep Vein Thrombosis in a Patient with Major Depressive Disorder." Case Reports in Psychiatry 2012 (2012): 1–2. http://dx.doi.org/10.1155/2012/261251.
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Pulmonary embolism is a serious, life-threatening condition and most commonly derives from deep vein thrombosis of the lower extremities. Once deep vein thrombosis (DVT) reaches a proximal vein (i.e., popliteal vein or higher), pulmonary embolism reportedly occurs in up to 50% of patients.Case Presentation. We report on an inpatient with major depressive disorder in a catatonic state in whom an asymptomatic proximal deep vein thrombosis of 11 × 70 mm was detected through routine screening, using doppler ultrasound scanning. Anticoagulant therapy was immediately started and continued for three months, which resulted in resolution of the deep vein thrombosis.Discussion. To our knowledge, this is the first description of asymptomatic proximal DVT that was detected in a psychiatric inpatient setting. In light of the reported causal relationship between DVT and pulmonary embolism, screening for DVT can be of high clinical value in patients with psychiatric disorders, especially when their physical activity is highly compromised.
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Forster, Alan, and Philip Wells. "Thrombolysis in Deep Vein Thrombosis: Is there still an Indication?" Thrombosis and Haemostasis 86, no. 07 (2001): 499–508. http://dx.doi.org/10.1055/s-0037-1616247.
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SummaryThe most accepted therapy for DVT consists of anticoagulation with unfractionated heparin or low molecular weight heparin, followed by variable duration oral anticoagulation but thrombolytic therapy has been proposed in addition to standard anticoagulation. This paper reviews the literature on post thrombotic syndrome, the natural history of vein patency after therapy, and we perform a systematic review, using accepted standards for meta-analysis, to determine the outcomes when thrombolytic therapy is used to treat DVT. We demonstrate that thrombolytic therapy for DVT results in a significant increase in the risk of major hemorrhage and a significant increase in the rate of vein patency. However, although thrombolytic therapy is advantageous over anticoagulation as measured by early vein patency, a benefit in terms of a reduction in PTS risk, is unproven. Our review also shows that there is no evidence that there is a difference in efficacy between thrombolytic agents or that local therapy differs from systemic therapy. Finally, the potential role of catheter directed therapy is unknown since appropriate trials have not been performed but it is reasonable to use catheter directed therapy in patients with phlegmasia cerulea dolens. We conclude that more work is needed to define the role of thrombolytic therapy but it is too early to abandon this therapeutic modality.
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Petrov, V. I., O. V. Shatalova, O. N. Smuseva, and V. S. Gorbatenko. "PHARMACOECONOMIC ANALYSIS OF THE CONVENTIONAL PHARMACOTHERAPYOF dEEP VEIN THROMBOSIS." HERALD of North-Western State Medical University named after I.I. Mechnikov 7, no. 1 (March 15, 2015): 128–33. http://dx.doi.org/10.17816/mechnikov201571128-133.
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The cost analysis of treatment of deep vein thrombosis was performed in conventional therapy. The estimation of the cost of treatment of DVT in conventional treatment was done, using clinical-economic analysis - the «cost of illness» (COI). The study took into account only the direct costs of state and patients during 6 month treatment course. The cost analysis of DVT in conventional treatment was held, the economic burden of DVT is 1,8 billion rubles, in structure of cost it is occupying 98%. The cost of purchase of warfarin is occupying only 2%. At the present stage DVT and its complications are the serious problem, spending resources. In the cost`s structure of DVT outgoings of hospital treatment are 83%, if we reduce hospitalization costs, we can reduce state costs of DVT treatment.
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Ziatdinov, B. G., and I. F. Akhtyamov. "Risk Factors of Venous Thrombosis Development at Primary Hip Arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 23, no. 4 (December 15, 2016): 22–27. http://dx.doi.org/10.17816/vto201623422-27.
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The purpose of the work was to determine the factors responsible for the development of lower extremity deep vein thrombosis (DVT) after total hip arthroplasty in patients with aseptic femoral head necrosis and coxarthrosis. Complex clinical laboratory examination was performed in 56 patients aged 26 - 85 years (mean 59.11±2.42). At hospitalization stage 11 (19.64%) cases of DVT development were recorded. It was stated that more often thrombosis developed on the background of the lower limb veins pathology (varicose great saphenous vein, changes in deep veins after great saphenous vein thrombophlebitis). In group of patients with DVT statistically significantly more often the inflammatory reaction markers (leukocytosis and ESR), thrombocytosis as well as shortened APTT and increased fibrinogen levels. Besides, for DVT patients the more prolonged surgery, more marked blood loss and more often use of cement were typical. Such peculiarities may play a certain role in the development of thrombohemorragic complications after total hip arthroplasty and should be taken into consideration as a risk factor of venous thrombosis development at this type of surgical intervention.
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Ziatdinov, B. G., and I. F. Akhtyamov. "Risk Factors of Venous Thrombosis Development at Primary Hip Arthroplasty." Vestnik travmatologii i ortopedii imeni N.N. Priorova, no. 4 (December 30, 2016): 22–27. http://dx.doi.org/10.32414/0869-8678-2016-4-22-27.
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The purpose of the work was to determine the factors responsible for the development of lower extremity deep vein thrombosis (DVT) after total hip arthroplasty in patients with aseptic femoral head necrosis and coxarthrosis. Complex clinical laboratory examination was performed in 56 patients aged 26 - 85 years (mean 59.11±2.42). At hospitalization stage 11 (19.64%) cases of DVT development were recorded. It was stated that more often thrombosis developed on the background of the lower limb veins pathology (varicose great saphenous vein, changes in deep veins after great saphenous vein thrombophlebitis). In group of patients with DVT statistically significantly more often the inflammatory reaction markers (leukocytosis and ESR), thrombocytosis as well as shortened APTT and increased fibrinogen levels. Besides, for DVT patients the more prolonged surgery, more marked blood loss and more often use of cement were typical. Such peculiarities may play a certain role in the development of thrombohemorragic complications after total hip arthroplasty and should be taken into consideration as a risk factor of venous thrombosis development at this type of surgical intervention.
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Arnoldussen, C. W. K. P., and C. H. A. Wittens. "An Imaging Approach to Deep Vein Thrombosis and the Lower Extremity Thrombosis Classification." Phlebology: The Journal of Venous Disease 27, no. 1_suppl (March 2012): 143–48. http://dx.doi.org/10.1258/phleb.2012.012s25.
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In this article we want to discuss the potential of lower extremity deep vein thrombosis (DVT) imaging and propose a systematic approach to DVT management based on a DVT classification of the lower extremity; the LET classification. Identifying and reporting DVT more systematically allows for accurate stratification for initial patient care, future clinical trials and appropriate descriptions for natural history studies.
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Jeraj, Luka, Ana Spirkoska, Mateja Kaja Ježovnik, and Pavel Poredoš. "Deep vein thrombosis and properties of the arterial wall." Vasa 47, no. 3 (April 1, 2018): 197–202. http://dx.doi.org/10.1024/0301-1526/a000695.
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Abstract. Background: Deep vein thrombosis (DVT) affects more than one out of 1,000 people every year, of which 50 % develop post-thrombotic syndrome (PTS). Studies indicated that patients with DVT have deteriorated arterial wall function, while less is known about the association with PTS. We therefore investigated this relationship further. Patients and methods: A total of 120 patients treated for DVT of the lower extremity and a control group of 40 subjects without DVT were included. We assessed the presence of PTS using the Villalta scale. Flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) were calculated and reactive hyperaemia index (RHI) and augmentation index (AI) were obtained. Results: Patients with a history of DVT had lower FMD (4.0 % vs. 8.0 %, p < 0.001), lower NMD (12 % vs. 19 %, p = 0.001), and increased diameter of brachial artery (4.8 mm vs. 4.4 mm, p = 0.017). Peripheral arterial tonometry showed higher AI in patients with DVT (22.0 vs. 6.0, p = 0.004), while there was no difference in RHI. No differences in values between PTS-positive and PTS-negative patients were found. Conclusions: We confirmed the association between DVT and deteriorated functional properties of the arterial wall. Endothelial dysfunction of the large arteries, increased arterial stiffness, and increased diameter of the brachial artery were found in patients with DVT. However, there was no association between functional capability of the arterial wall and the incidence of PTS in DVT patients.
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Hirsh, Jack, and Agnes Y. Y. Lee. "How we diagnose and treat deep vein thrombosis." Blood 99, no. 9 (May 1, 2002): 3102–10. http://dx.doi.org/10.1182/blood.v99.9.3102.
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Abstract Making a diagnosis of deep vein thrombosis (DVT) requires both clinical assessment and objective testing because the clinical features are nonspecific and investigations can be either falsely positive or negative. The initial step in the diagnostic process is to stratify patients into high-, intermediate-, or low-risk categories using a validated clinical model. When the clinical probability is intermediate or high and the venous ultrasound result is positive, acute symptomatic DVT is confirmed. Similarly, when the probability is low and the ultrasound result is normal, DVT is ruled out. A low clinical probability combined with a negative D-dimer result can also be used to rule out DVT, thereby obviating the need for ultrasonography. In contrast, when the clinical assessment is discordant with the results of objective testing, serial venous ultrasonography or venography is required to confirm or refute a diagnosis of DVT. Once a patient is diagnosed with an acute DVT, low-molecular-weight heparin (LMWH) is the agent of choice for initial therapy and oral anticoagulant therapy is the standard for long-term secondary prophylaxis. Therapy should continue for at least 3 months; the decision to continue treatment beyond 3 months is made by weighing the risks of recurrent thrombosis and anticoagulant-related bleeding, and is influenced by patient preference. Screening for associated thrombophilia is not indicated routinely, but should be performed in selected patients whose clinical features suggest an underlying hypercoagulable state. Several new anticoagulants with theoretical advantages over existing agents are undergoing evaluation in phase 3 studies in patients with venous thromboembolism.
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Lowe, G. D. O. "Management of deep vein thrombosis to reduce the incidence of post-thrombotic syndrome." Phlebology: The Journal of Venous Disease 25, no. 1_suppl (September 24, 2010): 9–13. http://dx.doi.org/10.1258/phleb.2010.010s02.
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The post-thrombotic syndrome (PTS) is the major chronic sequel of deep vein thrombosis (DVT) of the leg, and is a major socioeconomic challenge. In addition to systematic prophylaxis of DVT in hospitalized patients, effective management of DVT is important to reduce the incidence of PTS. Thrombolysis and thrombectomy are not indicated routinely. Optimal anticoagulation, usually with heparins initially and then with oral warfarin, is important to prevent recurrent DVT, which is a major risk factor for PTS. Following a routine three-month period of anticoagulation, patients with proximal idiopathic DVT should be individually assessed for the benefits and risks of continued oral anticoagulation, including patient preferences. Risk factors for recurrent DVT include active cancer, pregnancy, continued use of oral oestrogens, male sex, obesity, recurrent thrombosis, established PTS, permanent inferior vena caval filters, residual DVT, high fibrin D-dimer and other thrombophilias. Early walking, continued high levels of physical activity and wearing compression stockings for up to two years may also reduce the risk of PTS.
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Simioni, Paolo, Paolo Prandoni, Alberto Burlina, Daniela Tormene, Corrado Sardella, Vanni Ferrari, Lino Benedetti, and Antonio Girolami. "Hyperhomocysteinemia and Deep-Vein Thrombosis A Case-Control Study." Thrombosis and Haemostasis 76, no. 06 (1996): 0883–86. http://dx.doi.org/10.1055/s-0038-1650680.
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SummaryIn a case-control study, fasting total homocysteinemia was determined in 208 consecutive outpatients who underwent phlebography because of the first episode of clinically suspected deep-vein thrombosis (DVT) of lower limbs. Contrast venography confirmed the clinical suspicion in 60 patients (28.8%). Hyperhomocysteinemia was detected in 15 of the 60 patients with DVT (25.0%), and in 17 of the 148 subjects without thrombosis (11.5%; p = 0.025). The OR for having an acute DVT in patients with hyperhomocysteinemia was 2.6 (95% Cl: 1.1-5.9). It is concluded that high plasma homocysteine levels are significantly associated with DVT in symptomatic patients. Further studies are needed to clarify the clinical implications of this association.
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Wormald, JR, TRA Lane, PE Herbert, M. Ellis, NJ Burfitt, and IJ Franklin. "Total preservation of patency and valve function after percutaneous pharmacomechanical thrombolysis using the Trellis®-8 system for an acute, extensive deep venous thrombosis." Annals of The Royal College of Surgeons of England 94, no. 2 (March 2012): e103-e105. http://dx.doi.org/10.1308/003588412x13171221589496.
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Pharmacomechanical thrombolysis is being used increasingly for the treatment of deep vein thrombosis (DVT) and aims to reduce the severity of post-thrombotic syndrome. We report the case of a 60-year-old woman with extensive lower limb DVT that was treated using pharmacomechanical thrombolysis leading to complete recovery of her deep venous system. The prompt use of pharmacomechanical thrombolysis for the acute management of extensive DVT should be considered when treating patients with extensive DVT in order to facilitate return of normal function.
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M., Basavarajappa, Anantharaju G. S., and Deepak G. "Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities." International Surgery Journal 6, no. 10 (September 26, 2019): 3548. http://dx.doi.org/10.18203/2349-2902.isj20194218.
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Background: The main aim is to study the association between asymptomatic deep vein thrombosis (DVT) in patients with varicose veins in different gender and age groups. Secondly, to study the risk of developing DVT in patients having superficial venous thrombophlebitis (SVT) with varicose veins and finally to study the clinical correlation of clinical, etiological, anatomical and pathological (CEAP) classification with DVT in patients with varicose veins.Methods: Patients presenting to department of General surgery at SS Institute of Medical Science and Research Centre during the period from June 2017 to June 2019 with varicose veins of lower limbs and without clinical signs of DVT were included in this study. Patients were categorised according to CEAP classification. All patients were subjected to duplex scanning of lower limbs to look for presence of SVT and DVT.Results: In our study, 73% patients were males and 27% patients were females. Maximum patients were in age group of 40-60 years.16 patients had DVT, 38 patients had SVT, 166 patients belonged to C2 and 56 patients belonged to CEAP class C3 and beyond.Conclusions: There is a strong association between varicose veins and asymptomatic DVT .The presence of SVT is not a risk factor for concomitant DVT in varicose vein patients. Clinical presentation with C3 or more CEAP grade is one of the potential risk factors for concomitant DVT in varicose vein patients.
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Hutagalung, Ebenezer Verian, Teddy Arnold Sihite, and Dimmy Prasetya. "Karakteristik Pasien Trombosis Vena Dalam: Tinjauan Sistematik." Journal Of The Indonesian Medical Association 71, no. 4 (September 21, 2021): 161–69. http://dx.doi.org/10.47830/jinma-vol.71.4-2021-479.
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Introduction: Deep vein thrombosis (DVT) is one of the biggest causes of death in the world. DVT has various risk factors so that DVT patient presentation can be different in each age, sex, and race group. This review aimed to obtain information regarding characteristics of deep vein thrombosis patients.Method: This study used qualitative approach that is library research using books and other literatures as the main object. This study was conducted using search engine, such as Pubmed, Google Scholar, and Clinical Key to obtain journals related with characteristics of deep vein thrombosis patients. Result: From 17 literatures, we found that characteristics of deep thrombosis patients are different in each age, sex, and race group. The severity of DVT increased with increasing age because of other conditions usually found in older age. Men are more susceptible to have DVT than women without reproductive risk factors such as pregnancy and menopause. African has more severe DVT presentation than other races. Lowest risk is found in Asian, although there is no significant difference in mortality between races.Conclusions: Characteristics of DVT patients (incidence rate, risk factors, location, and severity) vary in each age, sex, and race group.
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Grommes, J., KT von Trotha, MA de Wolf, H. Jalaie, and CHA Wittens. "Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?" Phlebology: The Journal of Venous Disease 29, no. 1_suppl (May 2014): 135–39. http://dx.doi.org/10.1177/0268355514529394.
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The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.
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Gromadziński, Leszek, Łukasz Paukszto, Agnieszka Skowrońska, Piotr Holak, Michał Smoliński, Elżbieta Łopieńska-Biernat, Ewa Lepiarczyk, Aleksandra Lipka, Jan Paweł Jastrzębski, and Marta Majewska. "Transcriptomic Profiling of Femoral Veins in Deep Vein Thrombosis in a Porcine Model." Cells 10, no. 7 (June 22, 2021): 1576. http://dx.doi.org/10.3390/cells10071576.
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Deep vein thrombosis (DVT) is a severe disease affecting the human venous system, accompanied by high morbidity and mortality rates caused by early and late complications. The study aimed at analyzing the changes in the transcriptome of the femoral vein caused by DVT in the porcine model based on the formation of the thrombus in vivo. The study was performed on 11 castrated male pigs: A thrombus was formed in each left femoral vein in six animals; the remaining five served as a control group. Total RNA was isolated from the left femoral veins of the experimental and control animals. High-throughput RNA sequencing was used to analyze the global changes in the transcriptome of veins with induced DVT. Applied multistep bioinformatics revealed 1474 differentially expressed genes (DEGs): 1019 upregulated and 455 downregulated. Functional Gene Ontology annotated 1220 of DEGs into 225 biological processes, 30 molecular functions and 40 cellular components categories. KEGG analysis disclosed TNF, NF-κB and apoptosis pathways’ overexpression in DVT samples. A thorough analysis of the detected DEGs indicated that a dysregulated inflammatory response and disturbed balance between clotting and anti-clotting factors play a crucial role in the process of DVT.
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Tian En Jason, Tay, Tay Jia Sheng, Tieng Chek Edward Choke, and Pooja Sachdeva. "May–Thurner Syndrome: A Consideration for Deep Vein Thrombosis in Males." Case Reports in Medicine 2020 (May 25, 2020): 1–5. http://dx.doi.org/10.1155/2020/2324637.
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May–Thurner syndrome (MTS) is an underdiagnosed cause of lower limb deep vein thrombosis (DVT). The clinical prevalence of MTS-related DVT is likely underestimated, particularly in patients with other more recognisable risk factors. MTS is classically described in females between the age group of 20–50 years. In patients with acute iliofemoral thrombosis, medical treatment with anticoagulation alone has been associated with higher risk of postthrombotic syndrome (PTS) and lower iliofemoral patency rates, as compared to endovascular correction. We describe a case of MTS-related extensive iliofemoral DVT occurring in a middle age male who presented with acute onset of left lower limb swelling and pain, complicated by pulmonary embolism. Doppler compression ultrasonography of the left lower limb showed partial DVT extending from the left external iliac to the popliteal veins, and contrasted computed tomography (CT) of the thorax abdomen and pelvis established features of MTS, together with right pulmonary embolism. He was started on low molecular weight heparin (LMWH) and then underwent left lower limb AngioJet pharmacomechanical thrombolysis/thrombectomy, iliac vein stenting, and temporary inferior vena cava (IVC) filter insertion. After the procedure, the patient recovered and improved symptomatically with rapid resolution of this left lower limb swelling and pain. He was switched to an oral Factor Xa inhibitor and was subsequently discharged. After 1-month follow-up, he remained well with stent patency visualised on repeat ultrasound and underwent an uneventful elective IVC filter retrieval with subsequent plans for a 1-year follow-up.
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Yaguchi, Arino, Ryuichi Moroi, Tomoyuki Harada, Munekazu Takeda, Masaru Abe, Mizuho Namiki, Keiko Natori, et al. "Diagnosis of Deep Vein Thrombosis (DVT) In Critically Ill Patients." Blood 116, no. 21 (November 19, 2010): 5123. http://dx.doi.org/10.1182/blood.v116.21.5123.5123.
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Abstract Abstract 5123 Introduction: The assessment of existences of DVT is important to prevent pulmonary embolism for hospitalized patients. Especially, there is a high incidence of DVT in critically ill patients in the intensive care unit (ICU). Because almost all the patients in the ICU have limitations of their activities of daily living due to unstable vital status, controlled under the analgesia, or multiple injuries. The aim of the present study is to evaluate D-dimer levels as a diagnostic marker of DVT in critically ill patients. Methods: One-hundred ten adult patients (66 men, 44 women; age range 20–94 [median 64.5]) who admitted in our medico-surgical ICU in a university hospital were enrolled in this study. Serum D-dimer test and ultrasonic duplex scanning (ALOKA, Co., Ltd, Tokyo) were performed within one week after admission to the ICU. Serum D-dimer levels (μ g/mL) were measured by latex agglutination test (Sekisui Medical®, Tokyo) (normal <1.0μ g/mL). PT-INR (Quick one method) and APTT ratio (Langdell method) were also measured (Sysmex®, Kobe, Japan). DVT was diagnosed by ultrasonic duplex scanning. Value was expressed by median. Data were analyzed by Fisher's exact probability test and Mann-Whitney U test. A p < .05 was considered as statistically significant. Results: There were 32 patients (29.0 %) with DVT and 78 without DVT (71%) in the ICU. Primary diagnoses on admission were 31 cerebrovascular disease, 30 trauma patients, 16 sepsis, 9 acute respiratory failure, 8 hemorrhagic shock, 8 cardiogenic failure and 8 others. Between patients with DVT and without DVT, there were no significant differences in age (67.5 vs. 64.0, p=0.71), sex (19 men and 13 women vs. 47 men and 31 women, p=0.93), primary diagnosis (p=0.13), PT-INR (1.06 vs. 1.07, p=0.97) or APTT ratio (1.02 vs. 1.04, p=0.81), respectively. D-dimer level was also no statistically significant difference (10.4 vs. 7.3μ g/mL, p=0.21) between patients with DVT and without DVT. D-dimer level was higher in all DVT patients with DVT and in 95 per cent of non-DVT patients than normal range. Moreover, thromobosis tended to exist in soleal vein and femoral vein (Table) Conclusion: The present study suggests that D-dimer level could not be a useful marker for assessment of existence of DVT in critically ill patients. And DVT almost existed in soleal and femoral veins. D-dimer level elevates because of the primary disease and/or complications of patients in the ICU. The ultrasonic duplex scanning is an easy and non-invasive examination at the bed side, while there is a limitation to perform it for ICU patients due to their unstable vital status, difficulty of appropriate posture, such as prone positioning, or injured lower limbs. But at least the examination by duplex scan of soleal and femoral veins, which have more possibility to develop to pulmonary embolism, could be significance in the ICU patients. Disclosures: No relevant conflicts of interest to declare.
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Dhanesha, Nirav, Manish Jain, Prakash Doddapattar, Anetta Undas, and Anil K. Chauhan. "Cellular Fibronectin Promotes Deep Vein Thrombosis in Obese Mice." Blood 136, Supplement 1 (November 5, 2020): 19–20. http://dx.doi.org/10.1182/blood-2020-141441.
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Objective: Obesity is a significant risk factor for deep vein thrombosis (DVT). The mechanisms of increased DVT in preexisting comorbid condition of obesity remain poorly understood. Cellular fibronectin containing extra domain A (Fn-EDA), an endogenous ligand for toll-like-receptor 4 (TLR4), is known to contribute to thrombo-inflammation in the experimental models. However, the role of Fn-EDA in modulation of venous thrombosis in context of obesity is not elucidated yet. Approach and Results: We found that cellular Fn-EDA levels were significantly elevated in plasma of venous thromboembolism (VTE) patients that positively correlated with body mass index (BMI). To investigate whether Fn-EDA promotes venous thrombosis in obese condition, WT and Fn-EDA-/- mice were either fed a control or high-fat diet (HF-diet) for 12-weeks. DVT was induced by inferior vena cava stenosis and evaluated after 48 hours. We found that HF diet-fed WT mice exhibited increased DVT susceptibility compared with control diet-fed WT mice. In contrast, HF-fed Fn-EDA-/- mice exhibited significantly reduced thrombus weight and decreased incidence (%) of DVT compared with HF-fed WT mice that was concomitant with improved blood flow, reduced neutrophil content and citrullinated histone H3-positive cells (a marker of NETosis) in IVC thrombus. Exogenous Fn-EDA potentiated NETosis in neutrophils stimulated with thrombin-activated platelets via TLR4. Genetic deletion of TLR4 in Fn-EDAfl/fl mice, which constitutively express Fn-EDA, reduced DVT compared with Fn-EDAfl/fl mice. Conclusion: These results demonstrate a previously unknown role of Fn-EDA in the modulation of DVT, which may be an important mechanism promoting DVT in the setting of obesity. Figure Disclosures No relevant conflicts of interest to declare.