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1
Behme, Anita Diana. "Distributional properties of solutions of dVt = Vt-dUt + dLt with Lévy noise." Advances in Applied Probability 43, no. 3 (September 2011): 688–711. http://dx.doi.org/10.1239/aap/1316792666.
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For a given bivariate Lévy process (Ut, Lt)t≥0, distributional properties of the stationary solutions of the stochastic differential equation dVt = Vt-dUt + dLt are analysed. In particular, the expectation and autocorrelation function are obtained in terms of the process (U, L) and in several cases of interest the tail behavior is described. In the case where U has jumps of size −1, necessary and sufficient conditions for the law of the solutions to be (absolutely) continuous are given.
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HICKEY, AMY. "DVT." Nursing 25, no. 1 (January 1995): 4–5. http://dx.doi.org/10.1097/00152193-199501000-00002.
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Chen, Xiao, Weiran Zhang, and Jingmin Huang. "Homocysteine is potential serological marker for predicting the risk of deep venous thrombosis of the lower extremities in patients received operation of lower limb fracture." Pteridines 32, no. 1 (January 1, 2021): 33–38. http://dx.doi.org/10.1515/pteridines-2020-0027.
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Abstract Objective The aim of the study is to investigate the correlations among serum homocysteine (Hcy), D-dimer, and the risk of developing deep venous thrombosis (DVT) of the lower extremities in patients who underwent operation for lower limb fracture. Methods Seventy-five cases who underwent operation for lower limb fracture were included and further divided into DVT group (n = 26) and control group (n = 49) based on post-DVT diagnostic criteria. The serum Hcy and D-dimer were examined 48 h after operation. The serum Hcy and D-dimer levels were compared between the two groups. The correlation between serum Hcy and D-dimer was investigated by the Pearson correlation test. The receiver-operating characteristic (ROC) curve was applied to evaluate the diagnostic performance of serum Hcy and D-dimer as serological markers for DVT. Results The serum Hcy concentrations were 11.96 ± 3.98 μmol/L and 7.92 ± 3.27 μmol/L for DVT and control groups, respectively, with statistical difference (t = 4.72, P < 0.01). The serum D-dimer in the DVT group was significantly higher than that of the control group (8.99 ± 4.50 vs 1.70 ± 2.11) μg/mL with statistical difference (t = 9.56, P < 0.01). Line regression analysis indicated that serum Hcy was positively correlated with serum D-dimer concentration and can be demonstrated by the equation of Y = 0.6651*X + 1.036 for the DVT group. Using serum Hcy as the biomarker for predicting DVT, the prediction sensitivity and specificity were 76.92 and 71.44%, respectively, with the AUC of 0.7804 under the cut-point of 9.54 μmol/L. For serum D-dimer, the prediction sensitivity and specificity were 96.15 and 73.47%, respectively, with the area under the ROC (AUC) of 0.9455 under the cut-point of 1.66 μg/mL. Conclusion Serum Hcy was significantly elevated in DTV patients, and hence, it can be applied as a serological marker for DVT prediction in patients who underwent operation for lower limb fracture. However, the DVT prediction performance of serum Hcy was inferior to D-dimer especially for diagnostic sensitivity.
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Liang, Xiao, Wenhui Gao, Jiali Xu, Sara Saymuah, Xiaojie Wang, Jing Wang, Wenbo Zhao, et al. "Triage Nurse-Activated Emergency Evaluation Reduced Door-to-Needle Time in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis." Evidence-Based Complementary and Alternative Medicine 2022 (March 3, 2022): 1–7. http://dx.doi.org/10.1155/2022/9199856.
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Background and Purpose. Shorter door-to-needle time (DNT) is associated with a better outcome in acute ischemic stroke (AIS) patients who accept intravenous thrombolysis. We aimed to explore whether triage nurse-activated emergency evaluation would reduce DNT compared with doctor-activated emergency evaluation in AIS patients treated with intravenous thrombolysis who failed to use emergency medical services (EMSs). Methods. This was a retrospective analysis in a general hospital emergency department in Beijing, China. 212 adult AIS patients treated with thrombolysis who failed to use EMSs were included. In addition to DNT, door-to-vein open time (DVT), door-to-blood sample deliver time (DBT), and 7-day NIHSS scores were evaluated. Results. 137 (64.6%) patients were in the triage nurse-activated group and 75 (35.4%) patients were in the doctor-activated group. The DNT of the triage nurse-activated group was significantly reduced compared with the doctor-activated group (28 (26, 32.5) min vs. 30 (28, 40) min, p = 0.001 ). DNT less than 45 min was seen in 95.6% of patients in the triage nurse-activated group and 84% of patients in the doctor-activated group ( p = 0.011 , OR 3.972, 95% CI 1.375–11.477). In addition, DVT (7 (4, 10) min vs. 8 (5, 12) min, P = 0.025 ) and DBT (15 (13, 21) min vs. 19 (15, 26) min, p = 0.001 ) of the triage nurse-activated group were also shorter than those of the doctor-activated group ( p < 0.05 ). The 7-day NIHSS scores were not statistically different between the two groups. Conclusions. Triage nurse-activated urgent emergency evaluation could reduce the door-to-needle time, which provides a feasible opportunity to optimize the emergency department service for AIS patients who failed to use emergency medical services.
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Hirmerova, Jana, Jitka Seidlerova, and Zdenek Chudacek. "The Prevalence of Concomitant Deep Vein Thrombosis, Symptomatic or Asymptomatic, Proximal or Distal, in Patients With Symptomatic Pulmonary Embolism." Clinical and Applied Thrombosis/Hemostasis 24, no. 8 (May 30, 2018): 1352–57. http://dx.doi.org/10.1177/1076029618779143.
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Patients with pulmonary embolism (PE) may have symptomatic or asymptomatic concomitant deep vein thrombosis (DVT). The reported prevalence of PE-associated DVT is variable, and thus, the utility of routine testing is controversial. The aim of our study was to analyze the prevalence of DVT and the factors associated with proximal DVT/whole-leg DVT in patients with symptomatic PE. In 428 consecutive patients (mean age: 59 ± 16.4 years; 52.3% men), we performed clinical examination and complete bilateral compression ultrasound and ascertained medical history and risk factors for DVT/PE. χ2 and t tests were used. Deep vein thrombosis was found in 70.6%; proximal DVT in 49.5%. Sensitivity/specificity of DVT symptoms was 42.7%/93.7% for whole-leg DVT and 47.6%/83.3% for proximal DVT. Male gender significantly prevailed among those with whole-leg DVT and with proximal DVT (58.9% and 61.8%). Active malignancy was significantly more frequent in the patients with proximal DVT than without proximal DVT (10.4% vs 3.7%). In conclusion, the prevalence of PE-associated DVT is quite high but clinical diagnosis is unreliable. In our group, male gender and active malignancy were significantly associated with the presence of concomitant proximal DVT.
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Sevestre-Pietri, Marie-Antoinette, Jean-Luc Bosson, Jean-Pieere Laroche, Marc Righini, Dominique Brisot, Gudrun Boge, Aaurelie van Kien, et al. "Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: Results from the OPTIMEV study." Thrombosis and Haemostasis 102, no. 09 (2009): 493–500. http://dx.doi.org/10.1160/th09-01-0053.
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SummaryThere is a lack of consensus on the value of detecting and treating symptomatic isolated distal deep-vein thrombosis (DVT) of the lower limbs. In our study, we compared the risk factors and outcomes in patients with isolated symptomatic distal DVT with those with proximal symptomatic DVT. We analysed the data of patients with objectively confirmed symptomatic isolated DVT enrolled in the national (France), multicenter, prospective OPTIMEV study.This sub-study outcomes were recurrent venous thromboembolism, major bleeding and death at three months. Among the 6141 patients with suspicion of isolated DVT included between November 2004 and January 2006, DVT was confirmed in 1643 patients (26.8%). Isolated distal DVT was more frequent than proximal DVT (56.8% vs. 43.2%, respectively; p=0.01). Isolated distal DVT was significantly more often associated with transient risk factors (recent surgery, recent plaster immobilisation, recent travel), whereas proximal DVT was significantly more associated with more chronic states (active cancer, congestive heart failure or respiratory insufficiency, age >75 years). Most patients (96.8%) with isolated distal DVT received anticoagulant therapies.There was no difference in the percentage of recurrent venous thromboembolism and major bleeding in patients with proximal DVT and isolated distal DVT. However, the mortality rate was significantly higher (p<0.01) in patients with proximal DVT (8.0%) than in those with isolated distal DVT (4.4%). Symptomatic isolated distal DVT differs from symptomatic proximal DVT both in terms of risk factors and clinical outcome. Whether these differences should influence the clinical management of these two events remains to be determined.
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SHEIKH, MUHAMMAD SAJID, and MUHAMMAD FASIH UR REHMAN. "DVT PROPHYLAXIS." Professional Medical Journal 18, no. 02 (June 10, 2011): 275–79. http://dx.doi.org/10.29309/tpmj/2011.18.02.2080.
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Objectives: To evaluate the effectiveness of LMWH prophylaxis for DVT in high risk patients after general surgery. Study design: Randomized controlled study. Setting: Surgical Unit-IV, District Head Quarters Hospital, Faisalabad. Period: From March 2009 to August 2009. Patients and Methods: Sixty patients in the LMWH group were given perioperative enoxaparin (Clexane) as prophylaxis while compression stockings were used in another control group comprised of 60 patients. At 5th postoperative day, Doppler study was performed to detect DVT in both groups. Categorical data were analyzed for significance using Chi square test through SPSS. Results: There were significant difference in age factor, history of DVT, Medical factor, surgical trauma factor and interpretation on the basis of points. However, there is non significant difference between LMWH group and control group for chemoprophylasis. Conclusions: LMWH administration is effective for the prevention of venous thromboembolism in high risk patients and its practice should be the standard of care in the practice of surgery.
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Preis, Markus. "Perspektive DVT." Orthopädie und Unfallchirurgie 10, no. 2 (April 2020): 21–22. http://dx.doi.org/10.1007/s41785-020-1518-4.
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Schaufler, Michael. "Perspektive DVT." Orthopädie und Unfallchirurgie 10, no. 3 (June 2020): 30. http://dx.doi.org/10.1007/s41785-020-1557-x.
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Benton, Linda. "DVT Prevention." American Journal of Nursing 100, no. 2 (February 2000): 85. http://dx.doi.org/10.1097/00000446-200002000-00055.
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Fligelstone, L., and R. Salaman. "DVT diagnosis." European Journal of Vascular and Endovascular Surgery 9, no. 3 (April 1995): 361–62. http://dx.doi.org/10.1016/s1078-5884(05)80153-4.
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Oh-Park, Mooyeon. "Proximal DVT." Archives of Physical Medicine and Rehabilitation 77, no. 6 (June 1996): 630. http://dx.doi.org/10.1016/s0003-9993(96)90309-3.
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Fu, Ya-Hui, Ping Liu, Xin Xu, Peng-Fei Wang, Kun Shang, Chao Ke, Chen Fei, et al. "Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949901990117. http://dx.doi.org/10.1177/2309499019901172.
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Purpose: The actual incidence of deep vein thrombosis (DVT) in femoral neck fractures is underestimated. This study aimed to investigate the incidence of DVT in the lower extremities after femoral neck fracture before and after operation. Methods: The clinical data of patients with femoral neck fractures treated at Xi’an Honghui Hospital between July 1, 2016, and December 31, 2018, were collected. The patients were examined with ultrasonography before and after operation and divided into thrombosis and non-thrombosis groups according to their ultrasonographic results. The incidence of DVT was reported as a percentage. Results: The incidence rates of preoperative and postoperative DVT were 32% and 56%, respectively. DVT on the uninjured side constituted 45% of all preoperative DVT and 43% of all postoperative DVT. Peripheral DVT constituted 90% and 84% of all preoperative and postoperative DVT, respectively. Diabetes was an independent risk factor of preoperative DVT. Blood loss was an independent risk factor of postoperative DVT, and open reduction and internal fixation surgical procedure was independent protective factor of postoperative DVT as compared with hemiarthroplasty and total hip replacement. Conclusions: The incidence rates of preoperative and postoperative DVT in the patients with femoral neck fracture were high, and orthopedists should pay more attention to DVT as a complication.
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Dahm, Anders E. A., Trine O. Andersen, Frits Rosendaal, and Per Morten Sandset. "Biological Relevance of a New TFPI Anticoagulant Activity Assay of Full-Length TFPI." Blood 104, no. 11 (November 16, 2004): 2982. http://dx.doi.org/10.1182/blood.v104.11.2982.2982.
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Abstract Introduction: We have recently shown that low TFPI is a weak risk factor for deep vein thrombosis (DVT)(Dahm et al Blood2003;101;4387–92). Plasma contains free, full-length TFPI (FL-TFPI) and truncated and lipoprotein associated TFPI. Since free, FL-TFPI has a much stronger ability to prolong clotting time in diluted prothrombin time (dPT) assay than other types of TFPI, it has been suggested that FL-TFPI biologically plays a more important role than other forms of TFPI. Aims: To determine the fraction of free, FL-TFPI in plasma and to determine the role of TFPI anticoagulant activity in the prevention of DVT. Materials and Methods: Normalized TFPI Anticoagulant Activity (n-TFPIac) Ratio was assayed using a dPT assay after incubation of plasma in the absence and the presence of neutralizing anti-TFPI antibodies. Results were expressed as a ratio with dPT in the presence of anti-TFPI as the denominator. The ratio was normalized against a ratio obtained with a reference plasma within each run. TFPI chromogenic substrate (TFPIcs) activity assay was determined by the quantification of residual TF/FVIIa catalytic activity after the incubation of diluted plasma (containing TFPI) with TF, FVIIa, and FXa. TFPI antigen assays: TFPI free antigen (full-length TFPI) and TFPI total antigen (full-length + truncated TFPI) were assayed with commercial kits from Stago, France. Bound TFPI was calculated as the difference between TFPI total antigen and TFPI free antigen. Study population: Individuals included in The Leiden Thrombophila Study (LETS), which is a case-control study of 474 patients with DVT and 474 controls. 363 controls and 362 cases were available for the OR calculations and 473 controls for the estimation of the fraction of free, FL-TFPI. Statistics: The fraction of free, FL-TFPI was calculated by dividing TFPI free antigen by TFPI total antigen. Odds ratios (OR) for DVT were calculated for individuals with TFPI values below the 10th percentile as compared with those above. Results: The fraction of free, FL-TFPI in plasma was 19%, but with large variations due to hormonal state (table 1). Normalized TFPIac ratio below the 10th percentile gave an OR of 1.5 (95% CI 0.97-2.4) for DVT, which was comparable to the ORs obtained with other TFPI assays. Individuals with low TFPI in both activity assays had an OR of 5.9 (95% CI 1.7–20) for DVT (table 2). Conclusion: Approximately 20% of TFPI in plasma was free, FL-TFPI. Low n-TFPIac ratio was a weak risk factor for DVT, but was not a stronger risk factor than low TFPI in the other assays. However, combined low n-TFPIac ratio and low TFPIcs activity seemed to be a strong risk factor for DVT. Table 1. Mean (95% CI) plasma fraction of TFPI free antigen in controls OC users (n=54) OC nonusers (n=99) Postmenopausal women (n=89) Men (n=201) All (n=473) TFPI Free Antigen/TFPI total TFPI antigen 0.125 (0.115–0.135) 0.175 (0.165–0.184) 0.197 (0.186–0.208) 0.206 (0.199–0.209) 0.187 (0.182–0.192) Table 2. OR (95% CI) for DVT for different TFPI parameters below the 10th percentile nTFPIac ratio TFPI free antigen TFPI total antigen TFPIcs activity Bound TFPI n-TFPIac ratio + TFPIcs activity 1.5 (0.97–2.4) 1.3 (0.83–2.1) 1.3 (0.85–2.1) 1.2 (0.75–1.9) 1.4 (0.90–2.2) 5.9 (1.7–20)
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Vesa, Ştefan Cristian, Romeo Chira, Sonia Irina Vlaicu, Sergiu Pașca, Sorin Crișan, Adrian Trifa, and Anca Dana Buzoianu. "Systemic and Local Factors’ Influence on the Topological Differences in Deep Vein Thrombosis." Medicina 55, no. 10 (October 16, 2019): 691. http://dx.doi.org/10.3390/medicina55100691.
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Background and Objectives: Deep vein thrombosis (DVT) is a common cause of intra-hospital morbidity and mortality, and its most severe complication is pulmonary thromboembolism. The risk factors that influence the apparition of DVT are generally derived from Virchow’s triad. Since the most severe complications of DVT occur in proximal rather than distal deep vein thrombosis, the aim of this study was to identify the factors influencing the apparition of proximal DVT. Materials and Methods: This was a transversal, cohort study. The study included 167 consecutive patients with lower limb DVT over a two-year period. The following data were recorded or determined: general data, conditions that are known to influence DVT, medical history and coagulation or thrombophilia-related genetic variations. Results: In the univariate analysis, male gender, neoplasia, previous DVT and mutated factor V Leiden were all associated with proximal DVT, while bed rest was associated with distal DVT. In the multivariate analysis, male gender, previous DVT and factor V Leiden mutation were independently correlated with proximal DVT, while bed rest was independently associated with distal deep vein thrombosis. Conclusion: Our observations point out that the factors indicating a systemic involvement of coagulation were correlated with proximal DVT, while local factors were associated with distal DVT.
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Kucher, Nils, Victor Tapson, Rene Quiroz, Samy Mir, Ruth Morrison, David McKenzie, and Samuel Goldhaber. "Gender differences in the administration of prophylaxis to prevent deep venous thrombosis." Thrombosis and Haemostasis 93, no. 02 (2005): 284–88. http://dx.doi.org/10.1160/th04-08-0513.
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SummaryWe investigated gender differences in the prescription of prophylaxis against deep vein thrombosis (DVT) in 2,619 patients who developed acute DVT while being hospitalized for reasons other than DVT or were diagnosed with acute DVT as outpatients but who had been hospitalized within 30 days prior to DVT diagnosis. Men were 21% more likely than women to receive prophylaxis (OR 1.21, 95% CI 1.03–1.43; p = 0.021) after adjusting for DVT risk factors, including surgery, trauma, prior DVT, age, and cancer.
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El-Menyar, Ayman, Mohammad Asim, Gaby Jabbour, and Hassan Al-Thani. "Clinical implications of the anatomical variation of deep venous thrombosis." Phlebology: The Journal of Venous Disease 33, no. 2 (January 10, 2017): 97–106. http://dx.doi.org/10.1177/0268355516687863.
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Introduction Little is known about the anatomic variation and its implication in patients with lower limb deep venous thrombosis (DVT). We studied the clinical presentation, site of thrombosis and risk factors based on the anatomic distribution of lower limb DVT. Methods A retrospective analysis of clinically suspected DVT cases was conducted between 2008 and 2012. DVT was categorized by the location of the thrombosed segment and limb involved. The DVT anatomic segments were assessed according to left-to-right ratio, predisposing factors and clinical presentations. Results A total of 637 patients with DVT were included with a mean age of 50 ± 17 years (51%; females). The most frequently thrombosed segments were popliteal, posterior tibial and profunda femoris veins. DVT was more common at the left side, with a left-to-right ratio of 1.5:1. Bilateral DVT cases (38.5%) had more prior history of DVT as compared to left- (20.3%) and right-sided DVTs (22.6%); p = 0.01. Bilateral DVT was complicated more with post-thrombotic syndrome (leg ulcer) ( p = 0.02). The rates of pulmonary embolism (25%) and mortality (23.1%) were significantly higher for bilateral DVT in comparison to left- and right-sided DVT. Abnormal coagulation profile was significantly associated with posterior tibial DVT (81% vs. 71.4%; p = 0.01) as compared to patients with normal coagulation profile. Conclusion Lower limb DVTs are more common at the left side; however, patients with bilateral DVT have higher frequency of recurrence, post-thrombotic syndrome, pulmonary embolism and mortality. The anatomic segments of DVT show specific distribution depending on the predisposing factors. These findings could improve our understanding of the pathophysiology and management of DVT patients.
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Brown, Helen K., John A. Simpson, and John T. Murchison. "The influence of meteorological variables on the development of deep venous thrombosis." Thrombosis and Haemostasis 102, no. 10 (2009): 676–82. http://dx.doi.org/10.1160/th09-04-0214.
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SummaryThe influence of weather on deep venous thrombosis (DVT) incidence remains controversial. We aimed to characterize the temporal association between DVT and meteorological variables including atmospheric pressure. Data relating to hospital admissions with DVT in Scotland were collected retrospectively for a 20 year period for which corresponding meteorological recordings were available. Weather variables were calculated as weighted daily averages to adjust for variations in population density. Seasonal variation in DVT and short-term effects of weather variables on the relative risk of developing DVT were assess using Poisson regression modelling. The models allowed for the identification of lag periods between variation in the weather and DVT presentation. A total of 37,336 cases of DVT were recorded. There was significant seasonal variation in DVT with a winter peak. Seasonal variation in wind speed and temperature were significantly associated with seasonal variation in DVT. When studying more immediate meteorological influences, low atmospheric pressure, high wind speed and high rainfall were significantly associated with an increased risk of DVT approximately 9–10 days later. The effect was most strikingly demonstrated for atmospheric pressure, every 10 millibar decrease in pressure being associated with a 2.1% increase in relative risk of DVT. Alterations in weather have a small but significant impact upon the incidence of DVT. DVT is particularly associated with reduction in atmospheric pressure giving weight to the hypothesis that reduced cabin pressure in long haul flights contributes to DVT. These findings have implications for our understanding of the pathogenesis of DVT.
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Cheng, Gregory, Crystal Chan, Ying Ting Liu, Yee Fun Choy, Mei Mei Wong, Pui Kwan Ernest Yeung, Ka Ling Ng, Lai Shan Tsang, and Raymond S. M. Wong. "Incidence of Deep Vein Thrombosis in Hospitalized Chinese Medical Patients and the Impact of DVT Prophylaxis." Thrombosis 2011 (February 15, 2011): 1–4. http://dx.doi.org/10.1155/2011/629383.
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Objective. To evaluate the incidence of deep vein thrombosis in hospitalized Chinese medical patients and the impact of DVT prophylaxis. Methods. All cases of confirmed proximal DVT from 1 January 2005 to 31 December 2008 were reviewed retrospectively to determine the presence of risk factors and whether DVT developed: during hospitalization in medical wards or in case of readmission with a diagnosis of DVT within 14 days of discharge from a recent admission to medical wards. The impact of prophylaxis will be estimated by comparing the annual incidence of proximal DVT among medical patients hospitalized from 2005 to 2007 with that of 2008 (DVT prophylaxis commonly used). Results. From 1 January 2005 to 31 December 2008, 3938 Doppler ultrasound studies were performed for suspected DVT. Proximal DVT was diagnosed in 687 patients. The calculated incidence of proximal DVT among medical patients hospitalized for at least two days was , , and for the year 2005, 2006, and 2007, respectively. The incidence was for 2008 (). Conclusion. Proximal DVT was substantial in Chinese medical patients, and DVT prophylaxis might reduce such risk.
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Lv, Bing, Haiying Wang, Weifeng Li, Gefeng Han, Xiangdong Liu, Cheng Zhang, and Zipeng Zhang. "Admission Prevalence and Risk Factors of Deep Vein Thrombosis in Patients with Spinal Cord Injury Complicated with Cervical Fractures." Clinical and Applied Thrombosis/Hemostasis 28 (January 2022): 107602962211089. http://dx.doi.org/10.1177/10760296221108969.
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The purpose of this study was to investigate the prevalence of deep vein thrombosis (DVT) and to clarify the risk factors of DVT in patients with acute spinal cord injury (SCI) complicated with cervical fractures at admission. From January 2018 to December 2021, a total of 175 patients with acute SCI complicated with cervical fractures in our hospital were retrospectively analyzed. Duplex ultrasound was used to diagnose the DVT. All patients' medical record data, including demographic variables, medical history, and laboratory results, were collected. The patients were divided into DVT group and non-DVT group according to ultrasound results. The prevalence of DVT was determined and risk factors of DVT were identified. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of different factors. The prevalence of DVT at admission was 21.71%(38/175), including one (2.63%) with central DVT, thirty-two (84.21%) with peripheral DVT and five (13.16%) with mixed DVT. The multivariate analysis revealed that decreased lower extremity muscle strength, time from injury to admission, and D-dimer were risk factors for DVT at admission. The diagnostic value of D-dimer was the highest among these risk factors. In conclusion, in patients with acute SCI complicated with cervical fractures, the risk of DVT at admission is very high. Decreased lower extremity muscle strength, time from injury to admission, and D-dimer are risk factors for DVT. Moreover, D-dimer has the highest diagnostic value among these risk factors.
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Wang, Yi, Yu Shi, Yi Dong, Qiang Dong, Ting Ye, and Kun Fang. "Clinical Risk Factors of Asymptomatic Deep Venous Thrombosis in Patients With Acute Stroke." Clinical and Applied Thrombosis/Hemostasis 25 (January 1, 2019): 107602961986853. http://dx.doi.org/10.1177/1076029619868534.
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Background: Deep venous thrombosis (DVT) is a common complication after stroke. It is easy to identify the patients with symptomatic DVT; however, the tool for asymptomatic high-risk population needs to be further explored. Our aim was to explore the risk factors of acute stroke patients with asymptomatic DVT. Methods: We performed a prospective observation study among 452 patients with acute stroke who had a stroke within 14 days. Ultrasound examination of deep veins was repeatedly performed in each patient for DVT every 7 days during his admission. The dynamic rate of DVT in acute stroke was analyzed. Then risk factors were compared between DVT patients and non-DVT patients. The predictive model was explored based on thr cox proportion model. Results: Asymptomatic DVT was detected in 52 (11.5%) patients with stroke and 85.9% of thrombi were identified in their distal veins. Patients with longer length of stay ( P = .004), more severe stroke ( P = 0.001), higher level of D-dimer ( P = .003), and higher blood glucose level were associated with higher risk of DVT, while patients with higher triglyceride level ( P = .003) were less likely to have DVT, after adjusting age and sex. With the median of D-dimer (0.38 FEU mg/L) as cutoff value. Patients with higher level of D-dimer might have a higher risk of DVT with a significant statistical difference. Also, the severity of stroke differed DVT risk in Kaplan-Meier model. Using cox-proportion hazard regression model, asymptomatic DVT could be predicted (area under the curve 0.852). Conclusion: Our data showed that asymptomatic DVT was common in patients with acute stroke and most of thrombosis occurred in distal veins. Combination of clinical manifestation and laboratory results might be helpful predict DVT. DVT prophylaxis should be condisdered in high risk.
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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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Wang, Xindan, Jing Huang, Zhao Bingbing, Shape Li, and Li Li. "Risk factors, risk assessment, and prognosis in patients with gynecological cancer and thromboembolism." Journal of International Medical Research 48, no. 4 (December 29, 2019): 030006051989317. http://dx.doi.org/10.1177/0300060519893173.
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Objective This study aimed to investigate a suitable risk assessment model to predict deep vein thrombosis (DVT) in patients with gynecological cancer. Methods Data from 212 patients with gynecological cancer in the Affiliated Tumor Hospital of Guangxi Medical University were retrospectively analyzed. Patients were risk-stratified with three different risk assessment models individually, including the Caprini model, Wells DVT model, and Khorana model. Results The difference in risk level evaluated by the Caprini model was not different between the DVT and control groups. However, the DVT group had a significantly higher risk level than the control group with the Wells DVT or Khorana model. The Wells DVT model was more effective for stratifying patients in the DVT group into the higher risk level and for stratifying those in the control group into the lower risk level. Receiver operating curve analysis showed that the area under the curve of the Wells DVT, Khorana, and Caprini models was 0.995 ± 0.002, 0.642 ± 0.038, and 0.567 ± 0.039, respectively. Conclusion The Wells DVT model is the most suitable risk assessment model for predicting DVT. Clinicians could also combine the Caprini and Wells DVT models to effectively identify high-risk patients and eliminate patients without DVT.
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White, Richard H., Ann M. Brunson, Anjlee Mahajan, Theresa H. M. Keegan, and Ted Wun. "Incidence and Outcomes Associated with Distal Deep Vein Thrombosis in 760,344 Patients with 13 Common Malignancies." Blood 132, Supplement 1 (November 29, 2018): 2526. http://dx.doi.org/10.1182/blood-2018-99-110872.
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Abstract Introduction: The epidemiology of isolated distal deep-vein-thrombosis (d-DVT) in the calf among cancer patients is not well defined, particularly the incidence and effect on development of recurrent VTE (rVTE) and overall survival. Methods: We used the California Cancer Registry (CCR), linked with the California Patient Discharge Database (PDD) and the Emergency Department Database (ED), which were linked to the CCR vital statistics file. Excluding patients with a prior diagnosis of VTE, we identified 760,344 first primary cancer patients diagnosed in 2005-2014 with one of the 13 most common, invasive cancers (breast, prostate, lung and bronchus, colorectal, lymphoma, urinary bladder, uterus, kidney, pancreas, stomach, ovary, myeloma, and brain). Patients with an incident cancer-associated thrombosis (CAT) diagnosis were identified if in the PDD or ED databases there was a specific ICD-9-CM code for: pulmonary embolism (PE, 415.11, 415.13. 415.19, 673.20, 673.21, 673.23, 673.24), proximal DVT (p-DVT, 451.11, 451.19, 451.81, 453.2, 453.41), distal DVT (d-DVT, 453.42), or unspecified leg DVT (nos-DVT, 453.40, 453.8 (principal diagnosis only)) or pregnancy related leg VTE (671.31, 671.33, 671.42, 671.44). The VTE location was assigned in a hierarchical fashion: PE (+/- DVT) then p-DVT, then d-DVT alone. Recurrent VTE was defined as a subsequent PDD admission with a specific ICD-9-CM VTE code in: 1) a principal diagnosis of VTE, 2) principal diagnosis of cancer and second position VTE code, or 3) secondary position of a hospital acquired VTE code. Incidence and outcomes associated with d-DVT were analyzed by cancer type. The 24-month cumulative incidence function (CIF) of first-time CAT adjusts for the competing risk of death. Multivariable Cox proportional hazards regression models were used to identify factors associated with rVTE, adjusting for the competing risk of death. The association of incident CAT location with overall survival was analyzed using multivariable Cox regression models, using CAT as a time-dependent covariate. Model covariates included sex, race/ethnicity, age at diagnosis, incident CAT location, neighborhood socioeconomic status, type of health insurance at cancer diagnosis or initial treatment, cancer stage, and initial cancer treatment (chemotherapy, radiation, and surgery); we report adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: Incident CAT occurred in 39,044 patients in our study (5.1%); 59.1% had PE (+/- DVT), 21.9% p-DVT, 12.1% d-DVT and 7.0% nos-DVT. Among incident CAT patients, 9.2% (n=3,587) had a rVTE, with 64.7% as PE (+/-DVT), 21.8% as p-DVT, 7.0% as d-DVT and 6.5% as nos-DVT. Among patients with incident d-DVT, 46.8% of rVTE events presented as PE, 26.1% as p-DVT and 17.8% as d-DVT. The 2-year CIF of incident d-DVT by cancer type and stage is shown in the Figure. The CIF of myeloma and brain cancers were 1.10% and 1.50%, respectively. In multivariable models assessing the impact of incident CAT location on risk of rVTE, the risk for recurrence was similar for an incident d-DVT and p-DVT for all cancers types. The risk for rVTE was similar between those with d-DVT and PE for all cancers except prostate, stomach, and ovarian, where incident d-DVT had a 50% reduced risk of rVTE compared to PE. In multivariable models considering the impact of incident CAT location on survival (Table), d-DVT was associated with worse survival among all cancer types compared to those with no CAT, with a HR that ranged from 1.55 (CI: 1.26-1.89) for myeloma to HR=4.86 (CI: 4.28-5.53) for prostate cancer. When we compared survival of incident d-DVT to p-DVT for each type of cancer, survival was similar, except for patients with colorectal [HR=0.80 (CI: 0.71-0.90)], bladder [HR=0.76, (CI: 0.63-0.91)], uterus [HR=0.75, (CI: 0.63-0.91)], kidney [HR= 0.74 (CI: 0.59-0.92)], and myeloma [HR=0.64,( CI: 0.50-0.81)] where d-DVT was associated with improved survival. Conclusions: Isolated distal DVT cases made up only a small percentage of all diagnosed incident CAT events for all cancer types analyzed, with the 2-year cumulative incidence ranging from 0.5% - 2.0% for stage 4 patients. Subsequent rVTE events in these patients were principally PE or p-DVT (73%). D-DVT was not a significant predictor of rVTE. A diagnosis of incident d-DVT was strongly associated with worse survival, and for most cancers, survival was similar among patients with an incident p-DVT or PE. Disclosures No relevant conflicts of interest to declare.
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Chen, Feng, Ji Xin Xiong, and Wei Min Zhou. "Differences in limb, age and sex of Chinese deep vein thrombosis patients." Phlebology: The Journal of Venous Disease 30, no. 4 (February 14, 2014): 242–48. http://dx.doi.org/10.1177/0268355514524192.
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Objective Recently, the differences in age or sex of deep vein thrombosis (DVT) patients have been widely debated. However, close analyses of the differences in limb, age and sex of Chinese DVT patients have been scarcely reported. The purpose of this research is to study the differences in limb, age and sex of DVT patients. Methods A total of 783 consecutive DVT patients were retrospectively reviewed. Patients with an acute presentation of DVT were diagnosed by means of compression ultrasonography or venography. Clinical characteristics and provoked risk factors were analyzed. Results There were three frequency peaks including two smaller peaks at age 20–24 and 70–74 years, and the largest peak at age 45–59 years. The most significant risk factors affecting different age groups were as follows: pregnancy/puerperium for age ≤39; fracture and hysterectomy for age 40–64; fracture and malignancy for age ≥65. DVT frequency rate provoked by malignancy was higher in right DVT than left DVT (15.8% vs. 4.6%; p < 0.001). Left DVT was more common than right DVT (582 vs. 158). Left DVT tended to occur in females (male:female, 40.5%:59.5%), and right DVT in males (male:female, 74.7%:25.3%). DVT provoked by pregnancy/puerperium (56/63, 88.9%) or hysterectomy (27/30, 90.0%) was mostly located in left limb. Conclusion It is necessary to pay more attention to thromboprophylaxis for patients with the risk factors of pregnancy/puerperium, hysterectomy, fracture and malignancy, especially those over the age of 65. And further research into the cause of limb, age and sex differences in DVT occurrence is needed.
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Peng, Huan, Liqing Yue, Hongmei Gao, Ruolan Zheng, Penghui Liang, Ang Wang, and Ailan He. "Risk Assessment of Deep Venous Thrombosis and Its Influencing Factors in Burn Patients." Journal of Burn Care & Research 41, no. 1 (October 11, 2019): 113–20. http://dx.doi.org/10.1093/jbcr/irz121.
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Abstract The objective of this study is to explore the relevant risk factors of deep venous thrombosis (DVT) in burn patients. A retrospective analysis was conducted for the medical records of 845 hospitalized burn patients from September 2012 to August 2017. Caprini thrombosis risk assessment scale (CTRAS) was employed for evaluating the risks of DVT. Based upon whether or not DVT occurred, they were divided into non-DVT group (n = 830) and DVT group (n = 15). Among 360 (42.7%) patients with high-risk Caprini scores, only 30 patients received color Doppler examination of lower limb veins, and 15 patients were diagnosed as DVT with a diagnostic rate of 1.8%. Caprini scores of non-DVT and DVT groups were 4.30 ± 2.71 and 9.87 ± 1.46 points, respectively. There was statistically significant difference (P < .05). As revealed by stepwise Logistic regression analysis, age, lower limb burn, wound infection, femoral vein catheterization, and long bedriddening time (>40 days) were independent risk factors for DVT. Burn patients are particularly prone to develop DVT. Age, wound infection, femoral vein catheterization, and long bedriddening time (>40 days) are risk factors. Aggressive preventive measures of DVT should be implemented.
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Bikdeli, Behnood, Babak Sharif-Kashani, Bavand Bikdeli, Reina Valle, Conxita Falga, Antoni Riera-Mestre, Lucia Mazzolai, et al. "Impact of Thrombus Sidedness on Presentation and Outcomes of Patients with Proximal Lower Extremity Deep Vein Thrombosis." Seminars in Thrombosis and Hemostasis 44, no. 04 (January 12, 2018): 341–47. http://dx.doi.org/10.1055/s-0037-1621716.
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AbstractSmall studies have suggested differences in demographics and outcomes between left- and right-sided deep vein thrombosis (DVT), and also unilateral versus bilateral DVT. We investigated the clinical presentation and outcomes of patients with DVT based on thrombus sidedness. The authors used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) database (2001–2016) to identify patients with symptomatic proximal lower-extremity DVT. Main outcomes included cumulative 90-day symptomatic pulmonary embolism (PE) and 1-year mortality. Overall, 30,445 patients were included. The majority of DVTs occurred in the left leg (16,421 left-sided, 12,643 right-sided, and 1,390 bilateral; p < 0.001 for chi-squared test comparing all three groups). Comorbidities were relatively similar in those with left-sided and right-sided DVT. Compared with those with left-sided DVT, patients with right-sided DVT had higher relative frequency of PE (26% versus 23%, p < 0.001) and 1-year mortality (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00–1.18). This difference in mortality did not persist after multivariable adjustment (OR: 1.01; 95% CI: 0.93–1.1). Patients with bilateral DVT had a greater burden of comorbidities such as heart failure, and recent surgery compared with those with unilateral DVT (p < 0.001), and higher relative frequency of PE (48%), and 1-year mortality (24.1%). Worse outcomes in patients with bilateral DVT were attenuated but persisted after multivariable adjustment for demographics and risk factors (OR: 1.64; 95% CI: 1.43–1.87). Patients with bilateral DVT had worse outcomes during and after discontinuation of anticoagulation. There is a left-sided preponderance for proximal lower-extremity DVT. Compared with those with left-sided DVT, patients with right-sided DVT have slightly higher rates of PE. Bilateral DVT is associated with markedly worse short-term and 1-year outcomes.
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Stoeva, Natalia, Milena Staneva, Galina Kirova, and Rumiana Bakalova. "Deep venous thrombosis in the clinical course of pulmonary embolism." Phlebology: The Journal of Venous Disease 34, no. 7 (December 24, 2018): 453–58. http://dx.doi.org/10.1177/0268355518819510.
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Objectives The aim of the study is to find how concomitant deep venous thrombosis (DVT) changes the clinical course of pulmonary embolism. Methods Three hundred and five patients with pulmonary embolism were examined and grouped into DVT and non-DVT groups. Both groups were compared with regard to demography, predisposing factors, clinical signs, thrombotic burden, and one-month mortality rate. Results The patients with DVT had a more severe clinical presentation: higher heart rate (94.80 ± 18.66 beats per minute versus 87.9 ± 13.90 in the non-DVT group, p = 0.00033), more hemodynamic instability (11.35% versus 3.05% in the non-DVT group, p = 0.005), and less pCO2 in arterial blood gases (30.81 ± 7.94 mmHg versus 32.59 ± 7.35 mmHg in the non-DVT group, p = 0.049). The DVT group had heavier thrombotic burden in pulmonary artery, measured by Mastora score. The one-month mortality rate did not differ statistically between groups. Conclusions Patients with symptomatic pulmonary embolism and concomitant DVT have heavier thrombotic burden in the pulmonary artery and more severe clinical presentation compared to those without DVT, but a similar one-month mortality rate.
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Ryan, Logan, Samson Mataraso, Anna Siefkas, Emily Pellegrini, Gina Barnes, Abigail Green-Saxena, Jana Hoffman, Jacob Calvert, and Ritankar Das. "A Machine Learning Approach to Predict Deep Venous Thrombosis Among Hospitalized Patients." Clinical and Applied Thrombosis/Hemostasis 27 (January 1, 2021): 107602962199118. http://dx.doi.org/10.1177/1076029621991185.
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Deep venous thrombosis (DVT) is associated with significant morbidity, mortality, and increased healthcare costs. Standard scoring systems for DVT risk stratification often provide insufficient stratification of hospitalized patients and are unable to accurately predict which inpatients are most likely to present with DVT. There is a continued need for tools which can predict DVT in hospitalized patients. We performed a retrospective study on a database collected from a large academic hospital, comprised of 99,237 total general ward or ICU patients, 2,378 of whom experienced a DVT during their hospital stay. Gradient boosted machine learning algorithms were developed to predict a patient’s risk of developing DVT at 12- and 24-hour windows prior to onset. The primary outcome of interest was diagnosis of in-hospital DVT. The machine learning predictors obtained AUROCs of 0.83 and 0.85 for DVT risk prediction on hospitalized patients at 12- and 24-hour windows, respectively. At both 12 and 24 hours before DVT onset, the most important features for prediction of DVT were cancer history, VTE history, and internal normalized ratio (INR). Improved risk stratification may prevent unnecessary invasive testing in patients for whom DVT cannot be ruled out using existing methods. Improved risk stratification may also allow for more targeted use of prophylactic anticoagulants, as well as earlier diagnosis and treatment, preventing the development of pulmonary emboli and other sequelae of DVT.
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Kahn, Susan R. "The Post-Thrombotic Syndrome." Hematology 2010, no. 1 (December 4, 2010): 216–20. http://dx.doi.org/10.1182/asheducation-2010.1.216.
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AbstractThe post-thrombotic syndrome (PTS) is an important chronic complication of deep vein thrombosis (DVT). The present review focuses on risk determinants of PTS after DVT and available means to prevent and treat PTS. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients develop severe PTS, which can manifest as venous ulcers. PTS has an adverse impact on quality of life as well as significant socioeconomic consequences. The main risk factors for PTS are persistent leg symptoms 1 month after acute DVT, anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Subtherapeutic dosing of initial oral anticoagulation therapy for DVT treatment may also be linked to subsequent PTS. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will prevent cases of PTS. Daily use of elastic compression stockings for 2 years after proximal DVT appears to reduce the risk of PTS; however, uncertainty remains regarding optimal duration of use, optimal compression strength, and usefulness after distal DVT. The cornerstone of managing PTS is compression therapy, primarily using elastic compression stockings. Venoactive medications such as aescin and rutosides may provide short-term relief of PTS symptoms. Further studies to elucidate the pathophysiology of PTS, to identify clinical and biological risk factors, and to test new preventive and therapeutic approaches to PTS are needed.
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Meister, Florian, Jan Schwonberg, Marc Schindewolf, Dimitrios Zgouras, Edelgard Lindhoff-Last, and Birgit Linnemann. "Hereditary and acquired thrombophilia in patients with upper extremity deep-vein thrombosis." Thrombosis and Haemostasis 100, no. 09 (2008): 440–46. http://dx.doi.org/10.1160/th08-03-0196.
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SummaryThe prevalence of coagulation disorders in patients with upper extremity deep-vein thrombosis (UE-DVT) is unknown due to only a few observational studies of limited size reporting varying results. Therefore, we aimed to evaluate the prevalence of thrombophilia in patients with UE-DVT compared to patients with lower extremity deep vein thrombosis (LE-DVT). One hundred fifty consecutive patients (15 to 91 years of age) with UE-DVT were recruited from the MAISTHRO (MAin-ISar-THROmbosis) registry. Three hundred LE-DVT patients matched for gender and age served as controls. Thrombophilia screening included tests for the factor V Leiden mutation, the prothrombin G20210A mutation, antiphospholipid antibodies and factor VIII (FVIII), protein C, protein S and antithrombin activities. At least one thrombophilia was present in 34.2% of UE-DVT and 39.2% in UE-DVT that was unrelated to venous catheters relative to 55.3% in LE-DVT patients (p<0.001). In particular, a persistently elevated FVIII is less likely to be found in UE-DVT patients than in those with LE-DVT and is the only thrombophilia that is differentially expressed after controlling for established VTE risk factors [OR 0.46, (95% CI 0.25–0.83)]. Although less prevalent than in LE-DVT patients, thrombophilia is a common finding in patients with UE-DVT, especially in those with thrombosis that is unrelated to venous catheters.
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Bosson, Jean Luc, Marie Antoinete Sevestre, Jose Labarere, Joel Constans, Isabelle Quere, and Gilles Pernod. "Recurrence and Mortality of DVT-Associated PE Is Greater Than Isolated PE Alone: Results of the 7532-Patients Prospective OPTIMEV Cohort Study." Blood 110, no. 11 (November 16, 2007): 700. http://dx.doi.org/10.1182/blood.v110.11.700.700.
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Abstract Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is associated with a significant mortality and life-long morbidity. A large number of studies have focused on VTE, contributing to better improving its management. Especially studies have provided accurate estimates of 3-month mortality rates for PE and have identified prognostic factors that may guide the physician’s initial treatment decision for these patients. However, improvements in the prevention of venous thromboembolism (VTE) and diagnosis have changed the epidemiology of VTE over the last twenty years. Advances in imaging technology have resulted in more frequent diagnosis and treatment of early presentation of VTE, including isolated distal DVT or isolated PE. However, the clinical signification and the prognosis of these forms of VTE are unknown. Therefore we prospectively investigated the 3-month overall for isolated distal DVT, proximal DVT, PE with DVT and PE without DVT, among a large in and out population study. Between November 2004 and January 2006, all patients over 18 years old who were referred to 359 french board-certified vascular physicians for a clinical suspicion of VTE were included. VTE presentations were categorized using validated clinical decision rules and objective tests including ultrasonography, lung scan and helical CT scan. Subjects without an objectively confirmed diagnosis of VTE were used as controls. All patients with confirmed VTE and a random sample of controls were followed-up at 3 months. We estimated 3 months survival for each type of VTE 8256 patients entered the study, among which 7532 were analysed. The median age for all patients was 65 years (49–77 years), 2923 (39%) were men, 2925 were inpatients (39%), and 1884 (25%) had a previous history of VTE. 933 had isolated distal DVT (12%), 710 proximal DVT (9.4%), 426 PE with DVT (5.7%), 148 PE without DVT (2.0%) and 5315 had no VTE (70.6%). Overall, 4290 patients were followed up at 3 months. At 3 months, VTE recurrence was not significantly different between the 5 groups of patients. By contrast, 95/2407 control patients (4%), 35/787 (4.4%) distal DVT, 48/598 (8%) proximal DVT, 48/371 (12.9%) PE with DVT, and 6/130 (4.6%) died. In multivariate analysis, the 3-months mortality adjusted hazard ratio [95% CI] was 1.1 [0.7–1.7] for distal DVT (P 0.59), 1.6 [1.1–2.3] for proximal DVT (P 0.013), 2.1 [1.4–3.0] for DVT-associated PE (p<0.01), and 0.5 [0.2–1.1] for isolated PE (P 0.084). Kaplan-Meier survival estimates were 96% [95% CI 95–97] for controls as compared with 95% [94–97], 92% [90–94], 87% [83–90] and 95% [90–98] for isolated distal DVT, proximal DVT, PE with DVT, and PE without DVT cases, respectively (Figure 1). Therefore, compared to controls, only patients with proximal DVT or PE with DVT were at increased risk of death, while patients with isolated PE without DVT were not. Figure Figure
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Cai, Chuanqi, Yi Guo, Yun You, Ke Hu, Fei Cai, Mingxing Xie, Lu Yang, et al. "Deep Venous Thrombosis in COVID-19 Patients: A Cohort Analysis." Clinical and Applied Thrombosis/Hemostasis 26 (January 1, 2020): 107602962098266. http://dx.doi.org/10.1177/1076029620982669.
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Deep venous thrombosis (DVT) is a severe complication of coronavirus disease 2019 (COVID-19). The purpose of this study was to study the prevalence, risk factors, anticoagulant therapy and sex differences of DVT in patients with COVID-19. The enrolled 121 hospitalized non-ventilator patients were confirmed positive for COVID-19. All suspected patients received color Doppler ultrasound (US) to screen for DVT in both lower extremities. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. DVT was found in 48% of the asymptomatic COVID-19 patients with an increased PADUA or Caprini index using US scanning. The multivariate logistic regression determined that age (OR, 1.05; p = .0306), C-reactive protein (CRP) (OR, 1.02; p = .0040), and baseline D-dimer (OR, 1.42; p = .0010) were risk factors among COVID-19 patients. Although the most common DVT location was infrapopliteal (classes I and II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in CRP, neutrophil count, and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia in DVT patients, men DVT-COVID-19 patients with anticoagulant therapy showed significant higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio, but showed lower lymphocyte counts compared to women DVT-COVID-19 patients. DVT is common in COVID-19 patients with high-risk factors, especially for older age and higher CRP and baseline D-dimer populations. It is important to consider sex differences in anticoagulant therapy among DVT-COVID-19 patients.
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Ahmad, Maria, Christine M. Knoll, Sanjay J. Shah, and Lucia Mirea. "Risk Factors and Outcomes of Deep Vein Thrombosis in Pediatric Osteomyelitis." Blood 132, Supplement 1 (November 29, 2018): 5054. http://dx.doi.org/10.1182/blood-2018-99-111411.
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Abstract Background: Estimates of the incidence of DVT in patients with osteomyelitis range widely from 5%-30%, however risk factors and outcomes of DVT in this cohort have not been thoroughly established. Objective: This study aims to estimate the incidence of DVT in patients with osteomyelitis, and to assess risk factors and outcomes of DVT. Design/Method: After IRB approval, a retrospective chart review was conducted for patients aged 0-18 years seen at Phoenix Children's Hospital between 2012-2016 with ICD 9/10 codes for osteomyelitis. Exclusion criteria included chronic recurrent multifocal osteomyelitis, and chronic DVT. Demographics, clinical factors and outcomes were compared between osteomyelitis patients with and without DVT using the Fisher-exact and Wilcoxon-rank sum tests, as appropriate for the data distribution. Results: A total of 179 study subjects with osteomyelitis had a mean (standard deviation) age of 8.4 (5.7) years. DVT was present in 14 (8% of 179) patients, and 4 (28%), 5 (36%) and 5 (36%) patients received anticoagulation for < 6, 6-12 and ≥12 weeks, respectively. Patients with vs without DVT were more likely to be male (86% vs 59%; p-value=0.05), and had significantly higher rates of bacteremia (64% vs 24%; p-value=0.003). Rates of central lines were comparable between DVT and non-DVT patients (71% vs 68%; p-value=1.00); however patients with DVT vs without DVT had significantly longer mean length of stay (18 vs 9 days; p-value <0.0001) and higher rates of ICU admission (71% vs 16%; p-value <0.0001). Conclusion: The incidence of DVT among osteomyelitis pediatric patients was estimated at 8%, with risk increased by male sex and bacteremia. Patients with DVT had significantly higher rates of ICU admission and longer length of hospital stay. Many of these patients had standard practice management of their DVT with 6-12 weeks of anticoagulation underscoring the need for future efforts targeting DVT prophylaxis. Disclosures No relevant conflicts of interest to declare.
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Jovanovic, Milan, Dragan Milic, Boris Djindjic, Jovica Jovanovic, Goran Stanojevic, and Miroslav Stojanovic. "Importance of D-dimmer testing in ambulatory detection of atypical and 'silent' phlebothrombosis." Vojnosanitetski pregled 67, no. 7 (2010): 543–47. http://dx.doi.org/10.2298/vsp1007543j.
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Background/Aim. Deep venous thrombosis (DVT) is a lifethreatening condition, which could be manifested with discrete symptoms (silent DVT). High mortality and disability of patients with DVT indicate the importance of early diagnosis, especially of 'silent' DVT. The aim of this paper was to evaluate of reliability of early detection model for diagnosing DVT in ambulatory patients by using clinical probability of DVT presence, D-dimmer test (DD) and ultrasound evaluation (US). Methods. Ambulatory patients with suspected DVT were classified as 'unlikely' and 'likely' DVT by the Wells clinical model. The patients were randomly divided into the control and DD group. In the control group (629 patients) only US examination of lower limbs deep vein was done. All patients in the DD group (643 patients), with 'unlikely' TDV, had DD, and in the positive patients US examination was done. In the 'likely' patients US examination was done and negative US finding indicated DD test. Positive DD test was an indication for US examination after 7 days. The patients with initially excluded DVT were evaluated during 3 months. Results. A total number of 1 272 patients were examined; 117 (9.19%) patients were with DVT - 62 (9.64%) in the DD and 55 (8.74%) in the control group. During the follow-up periods in the DD group (with 582 initially excluded DVT) we registered DVT in only one patient (0.17%). It was significantly lower (p < 0.05) compared to the control group where we registered 7 (1.1%) DVT (a group with 581 initially excluded DVT). The applied DD diagnostic strategy for 70.7% (p < 0.001) reduced the need for US examination. Conclusion. The applied DD strategy in the diagnostic of DVT reduces the need for US examinations and reduces frequency of false negative results, with direct impact on cost and efficacy of procedures. DD diagnostic model should replace serial US examination in patients with suspect DVT.
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Attia, F. M., D. P. Mikhailidis, and S. A. Reffat. "Prothrombin Gene G20210A Mutation in Acute Deep Venous Thrombosis Patients with Poor Response to Warfarin Therapy." Open Cardiovascular Medicine Journal 3, no. 1 (October 21, 2009): 147–51. http://dx.doi.org/10.2174/1874192400903010147.
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Aim: The pathogenesis of deep venous thrombosis (DVT) involves an interaction between hereditary and acquired factors. Prothrombin gene mutation is one of the hereditary risk factors. We evaluated the frequency of the prothrombin gene mutation in patients with DVT and its relation to oral warfarin anticoagulant therapy response.Methods: Prothrombin gene mutation was looked for in 40 DVT patients with poor response to warfarin. The results were compared with 40 DVT patients with a normal response to warfarin and 30 healthy blood donors. Blood samples were also assessed for protein C, protein S, anti-thrombin III and anticardiolipin antibodies (ACA) levels.Results: Prothrombin gene mutation was found in normal and poor DVT responders (6/40 and 13/40, respectively; p = NS) as well as in healthy controls (1/30). Patients with recurrent DVT or a family history of DVT were significantly (p<0.0001) more likely to have the prothrombin mutation than other DVT patients. Non prothrombin abnormalities (protein C, anti-thrombin III and ACA) were more common in poor responders than controls (p<0.0037) as were ACA (p<0.034).Conclusions: Prothrombin gene mutation is present in several DVT patients, especially those with recurrent DVT or a family history of DVT. This mutation may contribute to a poor response to warfarin.
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Sarker, Mohammad Abu Kawsar, Md Abdullah Al Amin, AKM Nuruzzaman, and Avisak Bhattacharjee. "Post Operative Deep Vein Thrombosis: A Study of 150 Cases." Journal of Chittagong Medical College Teachers' Association 26, no. 2 (February 18, 2016): 29–33. http://dx.doi.org/10.3329/jcmcta.v26i2.62247.
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Thromboembolism is a wide spectrum entity of which post operative Deep Vein Thrombosis (DVT) is a part. At present there is inadequate information available regarding the incidence of DVT in Bangladesh. The aim of this cross-sectional study was to see the incidence of postoperative DVT at BIRDEM Hospital from March to December 2008. It was performed on 150 patients who had any operation of more than one hour of duration. Among 150 patients, 102 were male and 48 were female. The incidence of DVT in male was 36.3% and in female it was 27.5%. One-fifth of the DVT patients were smokers. Thirty two patients underwent amputation of which 14 (43.7%) developed DVT. Among the DVT cases, only 3 were clinical DVT and the rest were sub-clinical. In half of the Laparotomy patients (10/20) DVT developed. About one-fourth (34/8) of the hernioplasty patients and half of the APR patients (4/8) developed DVT. The occurrence of the condition in diabetes mellitus (36.7%) and cancer (33.3%) was high. Forty percent of the obese patients developed the condition. DVT in Bangladesh is not that much rare event. Further in-depth studies are necessary to extract other relevant information in this regard. JCMCTA 2015 ; 26 (2) : 29 - 33
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Levi, D., V. Tagalakis, V. Cohen, J. Agulnik, G. Kasymjanova, and D. Small. "Determining incidence and predictors of deep vein thrombosis in patients with non-small cell lung cancer." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 7159. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.7159.
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7159 Background: The risk of deep vein thrombosis (DVT) among patients with non-small cell lung cancer (NSCLC) has not been well studied. We conducted a retrospective cohort study of patients with NSCLC to determine the incidence of DVT and characterize predictors of DVT in NSCLC patients. Methods: The pulmonary oncology database of the SMBD-Jewish General Hospital contains prospectively collected clinical data on all lung cancer patients followed in the pulmonary oncology clinic since January 1, 1997. We identified all consecutive patients with a histologically confirmed new diagnosis of NSCLC between January 1, 1997 and December 31, 2004 and determined the occurrence of an objectively defined DVT. Data on age, gender, NSCLC type and stage, Eastern Cooperative Oncology Group (ECOG) performance status, exposure to surgery and chemotherapy, and death was collected and compared among patients with DVT and patients without DVT. Results: Of the 493 NSCLC patients included in the cohort for a total of 634 person-years, 67 (13.6%) patients developed an objectively confirmed DVT. We calculated an incidence rate of 110 cases (95% confidence interval (CI) 80, 130) per 1000 person-years. Risk factors associated with occurrence of DVT were advanced stage (p = 0.0006) and male sex (p = 0.04). A multivariable regression analysis adjusted for recent surgery and performance status showed that advanced stage (Rate ratio 2.55, 95% CI 1.33–4.89) and male sex (Rate ratio 1.75, 95% CI 1.03–2.94) were independent predictors of DVT. Age, type of NSCLC, and chemotherapy did not predict DVT. The risk of dying was 1.7-fold increased (Hazard Ratio 1.73, 95% CI 1.29–2.32, adjusted for age, sex, stage, surgery, performance status, and date of lung cancer diagnosis) among patients with DVT compared to patients without DVT. Conclusions: Our results show a high incidence of DVT in NSCLC patients and that advanced stage and male sex are important predictors of DVT. Moreover, NSCLC patients with DVT have a 1.7 fold increased risk of dying than patients without DVT. Confirmation of our results by prospective studies may provide the necessary evidence for targeted use of prophylactic anticoagulants in NSCLC patients to prevent development of DVT and improve related survival. No significant financial relationships to disclose.
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Saarinen, J., M. Anturaniemi, M. Heikkinen, V. Suominen, and J.-P. Salenius. "Clinical and anatomical findings of acute iliofemoral deep venous thrombosis." Phlebology: The Journal of Venous Disease 19, no. 1 (March 1, 2004): 42–46. http://dx.doi.org/10.1258/026835504773042266.
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Objective: To observe the clinical and anatomical features of acute iliofemoral deep venous thrombosis (DVT). Methods: A consecutive sample of phlebographically confirmed DVT cases during a 25-month period were retrospectively assessed. There were 390 DVT cases, including 73 patients with iliofemoral DVT. The phlebograms of iliofemoral DVTs were reviewed and the location of the thrombus mapped. The patients' files were completely reviewed in all patients with DVT, including concomitant diseases and mortality after the diagnosis of DVT. Results: The average age of the patients with iliofemoral DVT was 63 years compared with 57 years in the cases of infrainguinal DVT ( P<0.005). Left : right-ratio was 2.43 in iliofemoral DVTs, and 1.42 in infrainguinal cases ( P<0.005). Iliofemoral DVT cases were multisegmental (from calf into iliac veins) in 92% of the legs. The aetiology of iliofemoral DVT was idiopathic in 55%, surgery in 14%, malignancy in 14%, immobilization in 10%, trauma in 5%, coagulation disorder in 1% and pregnancy in 1% of the cases. No concomitant diseases were noted in 32% of the patients with iliofemoral DVT, and the corresponding finding in the subgroup of infrainguinal DVTs was 57%. The incidence of death within one-year was 18% and 8% in the subgroups of iliofemoral and infrainguinal DVT. In patients with a combination of iliofemoral DVT and malignancy,the incidence of death within one-year was 80%. Conclusions: According to anatomical findings iliofemoral DVT is typically left-sided and multisegmental. However, clinical findings show that patients with this condition are relatively aged, and the frequency of concomitant diseases is high. The prognosis among the patients with pre-existing malignant disease was very poor. Prevention of post-thrombotic syndrome by using invasive treatment should be considered only in selected cases.
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Gibson, Charlisa D., Mai O. Colvin, Michael J. Park, Qingying Lai, Juan Lin, Abdissa Negassa, Chirag D. Shah, and Matthew D. Langston. "Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography." Journal of Intensive Care Medicine 35, no. 10 (November 19, 2018): 1062–66. http://dx.doi.org/10.1177/0885066618813300.
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Introduction: Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes. Methods: This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence. Results: Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence ( P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis ( P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay ( P = .35) or mortality ( P = .34). Conclusions: Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.
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Poh, Christina, Ann Brunson, Anjlee Mahajan, Theresa Keegan, and Ted Wun. "Upper extremity deep venous thrombosis in 10 common malignancies: Analysis of incidence, risk factors, and effect on mortality from the California Cancer Registry." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18190-e18190. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18190.
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e18190 Background: Upper extremity deep venous thrombosis (UE DVT) is a known complication in patients with cancer. However, the cumulative incidence by cancer type, risk factors associated with UE DVT and impact on survival is not well-described. Methods: Using the California Cancer Registry , we identified patients with 10 common malignancies (2005-2014) and linked this to the California hospitalization and emergency department databases to find patients with an incident UE DVT event using specific ICD-9-CM codes. We determined cumulative incidence of UE DVT adjusted for the competing risk of death. Using Cox proportional hazards regression, stratified by tumor type and adjusted for other prognostic covariates including central venous catheters (CVC), we identified risk factors for developing UE DVT and the impact of UE DVT on overall survival. Patients with venous thromboembolism prior to malignancy diagnosis were excluded. Results: Among 785,444 patients with malignancy, 6,099 (0.8%) had an incident UE DVT. The 24-month cumulative incidence of UE DVT varied by cancer type (Table). Most UE DVT (62.2%) occurred in patients with CVC. VTE after cancer diagnosis and CVC substantially increased the risk for UE DVT across all cancers. UE DVT was also associated with worse overall survival for all malignancies with hazard ratios ranging from 1.52 to 3.72. Conclusions: UE DVT is a rare but important complication among patients with malignancy, with incidence highest in leukemia and lowest in prostate cancer. Although uncommon, UE DVT may affect prognosis in patients with malignancy as it is associated with an increased hazard of death. Table: 24-month cumulative incidence of UE DVT, adjusted for the competing risk of death, in 10 common malignancies among California cancer patients, 2005-2014. [Table: see text]
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Díaz, Gema, Elena Marín, Rafael Vidal, Antonio Sueiro, Roger Yusen, and David Jiménez. "The risk of recurrent venous thromboembolism in patients with unprovoked symptomatic deep vein thrombosis and asymptomatic pulmonary embolism." Thrombosis and Haemostasis 95, no. 03 (2006): 562–66. http://dx.doi.org/10.1160/th05-10-0677.
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SummaryPatients with a first episode of symptomatic pulmonary embolism (PE) havea higher risk of recurrent venous thromboembolism (VTE) than patients with a first episode of proximal lower extremity deep vein thrombosis (DVT). Patients with symptomatic DVT and silent PE may havea different risk of VTE recurrence than patients that have symptomatic DVT without PE. Therefore, it was the aim of this prospective cohort study to compare the risk of recurrent symptomaticVTE in patients with proximal lower extremity DVT and silent PE to the risk in patients that only have proximal lower extremity DVT. Ninty-one consecutive outpatients presenting to the emergency department of a university hospital subsequently hospitalised with a first episode of unprovoked symptomatic proximal lower extremity DVT, and without new pulmonary symptoms were included. Standard initial treatment consisted of intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin for 5–7 days, overlapped with oral vitamin-K antagonist therapy, with long-term oral vitamin-K antagonist therapy (goal INR 2.5 [2.0–3.0]). Study endpoints were: symptomatic recurrent DVT, new PE, and recurrent PE, evaluated by standard objective testing. At enrolment, 28 of 91 (31%) patients with DVT had silent PE. In the patients with DVT and silent PE, there were 3 VTE recurrences during 20 person-years of follow-up, while there were no VTE recurrences during 61 person-years of follow-up in the patients with isolated DVT. The Kaplan-Meier estimated VTE recurrence rate at 1 year after the diagnosis of DVT was 11% (95% CI: 2–28%) for patients with symptomatic DVT and silent PE, compared to 0% in patients with isolated symptomatic DVT (p = 0.0045). In patients with a first episode of unprovoked symptomatic acute proximal lower extremity DVT, the risk of recurrent VTE was significantly higher in those with silent PE compared to those without PE.
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Sullivan, Martin, Ilian Dominiq Eusebio, Kristin Haigh, Juan Paulo Panti, Abdullah Omari, and Jacqueline R. Hang. "Prevalence of Deep Vein Thrombosis in Low-Risk Patients After Elective Foot and Ankle Surgery." Foot & Ankle International 40, no. 3 (December 21, 2018): 330–35. http://dx.doi.org/10.1177/1071100718807889.
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Background: The evidence regarding the prevalence of deep vein thrombosis (DVT) after foot and ankle surgery in elective patients that need to be 6 weeks non–weight bearing postoperatively is incomplete and has limitations. Methods: The prevalence of DVT in 114 procedures involving the hindfoot and midfoot was determined using ultrasonographic surveillance at 2 and 6 weeks after surgery. Results: The prevalence of DVT was observed to be 25.4%. The majority (68.9%) of DVTs were diagnosed at the ultrasonographic scan performed 2 weeks postoperatively. The remainder (31.1%) of DVTs were diagnosed at the 6-week postoperative ultrasonographic scan. At least 75% of the patients who had early and late DVT had no clinical symptoms or signs of DVT. The prevalence of DVT in clinically detectable patients was 6%. The average age of patients with early DVT was 62.2 years, significantly higher compared to those who had no DVT. The mean tourniquet time for patients with early DVT was 68.1 minutes, significantly higher compared to those without DVT. All DVTs detected were distal to the popliteal vein. Conclusions: The prevalence of clinically silent DVT was significantly higher than was previously thought. We believe this increased rate is directly attributable to the use of ultrasonographic surveillance postsurgery both at 2 and 6 weeks. The risk of DVT continued after the 2-week visit, and 30% of the DVTs were detected at the ultrasonographic scan at 6 weeks. Level of Evidence: Level II, prospective cohort.
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Journeycake, Janna M., Charles T. Quinn, Kim L. Miller, Joy L. Zajac, and George R. Buchanan. "Catheter-related deep venous thrombosis in children with hemophilia." Blood 98, no. 6 (September 15, 2001): 1727–31. http://dx.doi.org/10.1182/blood.v98.6.1727.
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Abstract Central venous catheters (CVCs) are a common adjunct to hemophilia therapy, but the risk of CVC-related deep venous thrombosis (DVT) in hemophiliacs is not well defined. In a previous study, 13 patients with CVCs had no radiographic evidence of DVT. However, recent abstracts and case studies demonstrate that DVT does occur. Therefore, this study sought to determine the frequency of DVT in children with hemophilia and long-term CVCs and to correlate venographic findings with clinical features. All hemophilia patients with tunneled subclavian CVCs in place for 12 months or more were candidates for evaluation. Patients were examined for physical signs of DVT and questioned about catheter dysfunction. Contrast venograms were obtained to identify DVT. Fifteen boys with severe hemophilia were evaluated, including 9 from the initially studied group of 13. Eight patients had evidence of DVT, 5 of whom previously had normal venograms. Five of 15 patients had clinical problems related to the CVC, all of whom had DVT. Four of 15 patients had suggestive physical signs; 3 had DVT. The mean duration of catheter placement for all patients was 57.5 months (range, 12-102 months). For patients with DVT, the mean duration was 66.6 ± 7.5 months, compared to 49.5 ± 7.2 months for patients without DVT (P = .06). No patient whose CVC was in place fewer than 48 months had an abnormal venogram. Many hemophilia patients with CVCs develop DVT of the upper venous system, and the risk increases with duration of catheter placement.
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Poh, Christina, Ann M. Brunson, Theresa H. M. Keegan, Ted Wun, and Anjlee Mahajan. "Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Non-Hodgkin's Lymphoma: Analysis of the California Cancer Registry." Blood 134, Supplement_1 (November 13, 2019): 932. http://dx.doi.org/10.1182/blood-2019-124249.
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Background Venous thromboembolism (VTE) is a known complication in patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and non-Hodgkin's lymphoma (NHL). However, the cumulative incidence, risk factors, rate of subsequent VTE and impact on mortality of upper extremity deep vein thrombosis (UE DVT) in these diseases is not well-described. Methods Using the California Cancer Registry, we identified patients with a first primary diagnosis of AML, ALL and NHL from 2005-2014 and linked these patients with the statewide hospitalization and emergency department databases to identify an incident UE DVT event using specific ICD-9-CM codes. Patients with VTE prior to or at the time of malignancy diagnosis or who were not treated with chemotherapy were excluded. We determined the cumulative incidence of first UE DVT, adjusted for the competing risk of death. We also examined the cumulative incidence of subsequent VTE (UE DVT, lower extremity deep vein thrombosis (LE DVT) and pulmonary embolism (PE)) and major bleeding after incident UE DVT. Using Cox proportional hazards regression models, stratified by tumor type and adjusted for other prognostic covariates including sex, race/ethnicity, age at diagnosis, neighborhood, sociodemographic status and central venous catheter (CVC) placement, we identified risk factors for development of incident UE DVT, the effect of incident UE DVT on PE and/or LE DVT development, and impact of incident UE DVT on cancer specific survival. The association of CVC placement with incident UE DVT was not assessed in acute leukemia patients, as all who undergo treatment were assumed to have a CVC. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results Among 37,282 patients included in this analysis, 6,213 had AML, 3,730 had ALL and 27,339 had NHL. The 3- and 12-month cumulative incidence of UE DVT was 2.6% and 3.6% for AML, 2.1% and 3% for ALL and 1.0% and 1.6% for NHL respectively (Figure 1A). Most (56-64%) incident UE DVT events occurred within the first 3 months of malignancy diagnosis. African Americans (HR 1.66; CI 1.22-2.28) and Hispanics (HR 1.35; CI 1.10-1.66) with NHL had an increased risk of incident UE DVT compared to non-Hispanics Whites. NHL patients with a CVC had over a 2-fold increased risk of incident UE DVT (HR 2.05; CI 1.68-2.51) compared to those without a CVC. UE DVT was a risk factor for development of PE or LE DVT in ALL (HR 2.53; CI 1.29-4.95) and NHL (HR 1.63; CI 1.11-2.39) but not in AML. The 12-month cumulative incidence of subsequent VTE after an incident UE DVT diagnosis was 6.4% for AML, 12.0% for ALL and 7.6% for NHL. 46-58% of subsequent VTEs occurred within the first 3 months of incident UE DVT diagnosis. The majority of subsequent VTEs were UE DVT which had a 12-month cumulative incidence of 4.6% for AML, 6.6% for ALL and 4.0% for NHL (Figure 1B). The 12-month cumulative incidence of subsequent LE DVT was 1.3% for AML, 1.6% for ALL and 1.9% for NHL (Figure 1C). The 12-month cumulative incidence of subsequent PE was 0.4% for AML, 4.1% for ALL and 1.8% for NHL (Figure 1D). The 12-month cumulative incidence of major bleeding after an UE DVT diagnosis was 29% for AML, 29% for ALL and 20% for NHL. Common major bleeding events included gastrointestinal (GI) bleeds, epistaxis and intracranial hemorrhage. GI bleeding was the most common major bleeding event among all three malignancies (14.2% in AML, 9.6% in ALL and 12.4% in NHL). The rate of intracranial hemorrhage was 6% in AML, 3.5% in ALL and 1.7% in NHL. A diagnosis of incident UE DVT was associated with an increased risk of cancer-specific mortality in all three malignancies (HR 1.38; CI 1.16-1.65 in AML, HR 2.16; CI 1.66-2.82 in ALL, HR 2.38; CI 2.06-2.75 in NHL). Conclusions UE DVT is an important complication among patients with AML, ALL and NHL, with the majority of UE DVT events occurring within the first 3 months of diagnosis. The most common VTE event after an index UE DVT was another UE DVT, although patients also had subsequent PE and LE DVT. UE DVT was a risk factor for development of PE or LE DVT in ALL and NHL, but not in AML. Major bleeding after an UE DVT was high in all three malignancies (>20%), with GI bleeds being the most common. UE DVT in patients with AML, ALL and NHL is associated with increased risk of mortality. Disclosures Wun: Janssen: Other: Steering committee; Pfizer: Other: Steering committee.
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Behme, Anita, Alexander Lindner, and Ross Maller. "Stationary solutions of the stochastic differential equation dVt=Vt−dUt+dLt with Lévy noise." Stochastic Processes and their Applications 121, no. 1 (January 2011): 91–108. http://dx.doi.org/10.1016/j.spa.2010.09.003.
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Park, Hyung Jun, Seung-Baik Kang, Jisu Park, Moon Jong Chang, Tae Woo Kim, Chong Bum Chang, and Byung Sun Choi. "Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy." Orthopaedic Journal of Sports Medicine 9, no. 10 (October 1, 2021): 232596712110308. http://dx.doi.org/10.1177/23259671211030883.
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Background: Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome. Purpose: To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model. Results: Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 ( P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 ( P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 ( P = .786) at 2 years after surgery in patients without and those with DVT, respectively. Conclusion: The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.
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Avila, Maria Laura, Eleanor Pullenayegum, Suzan Williams, Natasha Yue, Peter Krol, and Leonardo R. Brandão. "Postthrombotic syndrome and other outcomes of lower extremity deep vein thrombosis in children." Blood 128, no. 14 (October 6, 2016): 1862–69. http://dx.doi.org/10.1182/blood-2016-03-704585.
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Key Points The frequency of PTS, PE, and DVT recurrence was higher in children with Non-LR DVT than in children with LR DVT. Thrombus resolution, DVT triggering event, and sex were predictors of LE PTS in children.
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Stawicki, Stanislaw P., Michael D. Grossman, James Cipolla, William S. Hoff, Brian A. Hoey, Gail Wainwright, and James F. Reed. "Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients: An Overstatement of the Problem?" American Surgeon 71, no. 5 (May 2005): 387–91. http://dx.doi.org/10.1177/000313480507100504.
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Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study. High-risk factors (HRF) included pelvic fracture (PFx), lower extremity fracture (LEFx), severe head injury (CHI) (AIS – head ≥3), and spinal cord injury. HRF alone or in combination, age, Injury Severity Score (ISS), and Glasgow Coma Score (GCS) were examined for association with DVT/PE. A total of 73,419 HRTP were included: 1377 (1.9%) had DVT, 365 (0.5%) had PE. The incidence of DVT in level I trauma centers was 2.2 per cent and was 1.5 per cent in level II centers. The lowest incidence of DVT was 1.3 per cent for isolated LEFx; highest was 5.4% for combined PFx, LEFx, and CHI. Variables associated with DVT included age, ISS, and GCS (all P < 0.001). In logistic regression analysis, only ISS was consistently predictive for DVT and PE. Though increased during the past decade, the overall incidence of DVT in HRTP remains below 3 per cent. Only the combination of multiple injuries or an ISS >30 result in DVT incidence of ≥5 per cent. We believe that current guidelines for screening for DVT may need to be reevaluated.
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Kucher, Nils, Victor Tapson, and Samuel Goldhaber. "Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients." Thrombosis and Haemostasis 93, no. 03 (2005): 494–98. http://dx.doi.org/10.1160/th04-09-0587.
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SummaryIn patients with deep vein thrombosis (DVT), the factors which predispose to concomitant symptomatic pulmonary embolism (PE) have remained uncertain. From a prospective cohort of 5,451 consecutive patients with ultrasound-confirmed DVT, we analyzed 4,211 patients with a known status for presence (n =639) or absence (n = 3572) of symptomatic PE. Age and gender were similar in DVT plus PE (63.7±15.6 years; 49% men) and DVT patients (63.4±17.3 years; 46% men). Body mass index (BMI) was higher in patients with DVT plus PE (median 29.0, range 15.4–67.0 kg/m2) than in patients with DVT (median 26.8, range 9.7–64.4 kg/m2; p < 0.001). Chronic lung disease (17% vs. 12%; p < 0.001), a personal history of PE (11% vs. 6%; p < 0.001), and a family history of DVT or PE (8% vs. 4%; p < 0.001) were more frequent in DVT plus PE patients. Twenty-seven percent of DVT plus PE patients received prophylaxis prior to the thromboembolic event compared with 32% of DVT patients (p=0.002). Proximal DVT (OR 1.84, 95% CI 1.39–2.43), prior PE (OR 1.68, 95% CI 1.20–2.35), obesity (BMI > 30 kg/m2) (OR 1.65, 95% CI 1.33–2.04), chronic lung disease (OR 1.51, 95%CI 1.13–2.01), as well as omission of prophylaxis (OR 1.30, 95%CI 1.04–1.64) emerged as independent predictors of concomitant symptomatic PE.