Possibilities of using active surgical tactics in the treatment of patients with cvd of the lower extremities complicated by superficial vein thrombosis

Simple SummaryThe natural history of isolated lower-limb superficial vein thrombosis (SVT) in cancer patients is not well understood. To address this gap, we analyzed data from the RIETE registry, which included 110 cancer patients with isolated SVT, 1695 cancer patients with isolated deep vein thrombosis (DVT), and 1030 non-cancer patients with SVT. Compared to cancer patients with DVT, cancer patients with lower-limb SVT received lower doses of anticoagulants, had similar rates of subsequent pulmonary embolism (PE), DVT or SVT, were less likely to have metastases and had a lower mortality rate. However, cancer patients with lower-limb SVT had a higher rate of subsequent PE, DVT or SVT than non-cancer patients with SVT. Additionally, in cancer patients with lower-limb SVT, almost all recurrences and bleeding occurred within the first three months.Background: The clinical characteristics and outcomes of cancer patients with lower-limb isolated superficial vein thrombosis (SVT) have not been consistently evaluated. Methods: We used data in the RIETE registry to compare the clinical characteristics and 90-day outcomes for patients with: (1) active cancer and lower-limb SVT; (2) active cancer and lower-limb deep vein thrombosis (DVT); (3) lower-limb SVT without cancer. The primary outcomes included subsequent symptomatic SVT, DVT or pulmonary embolism (PE). Secondary outcomes were major bleeding and death. Results: From March 2015 to April 2021, there were 110 patients with cancer and SVT, 1695 with cancer and DVT, and 1030 with SVT but no cancer. Most patients in all subgroups (93%, 99% and 96%, respectively) received anticoagulants, while those with SVT received lower daily doses of low-molecular-weight heparin (114 ± 58, 163 ± 44, and 106 ± 50 IU/kg, respectively). During the first 90 days, 101 patients (3.6%) developed subsequent VTE (PE 47, DVT 41, SVT 13), whereas 72 (2.5%) had major bleeding and 282 (9.9%) died. Among the three groups, 90-day events were, respectively: VTE at rates of 7.3%, 4.0% and 2.4%; major bleeding at rates of 2.7%, 3.9% and 0.3%; mortality at rates of 8.2%, 16% and 0.3%. Between D90 and D180, only one SVT recurrence and one death occurred in SVT cancer patients. In multivariable analysis, cancer was associated with subsequent VTE (HR = 2.04; 1.15–3.62), while initial presentation as SVT or DVT were not associated with a different risk. Conclusions: The risk for subsequent VTE (including symptomatic SVT, DVT or PE) was similar in cancer patients with isolated SVT than in those with isolated DVT.

Aim: To evaluate the results of surgical prophylaxis of venous thromboembolic complications in superficial vein thrombosis in the basin of the small saphenous vein. Materials and Methods: The study evaluated the results of treatment of 134 patients with superficial vein thrombosis in the basin of the small saphenous vein, who were divided into two groups: Group I - 86 (64.2%) patients who were operated on for thrombosis in the basin of the small saphenous vein and Group II - 48 (35.8%) patients who received only conservative treatment. Results: In the postoperative period, no recurrence of superficial or deep vein thrombosis and pulmonary embolism was detected in patients of group I within 12 months. The regression of symptoms of chronic venous insufficiency was noted in 66.7% of patients, and no patient was diagnosed with a decompensated form of chronic venous insufficiency. Over the course of the year, 12.2% of patients in group II showed an increase in the manifestations of chronic venous insufficiency. Recurrence of superficial or deep vein thrombosis in group II was detected in 14.6% and 4.9% of patients, respectively. Conclusions: Surgical treatment of superficial vein thrombosis in the basin of the small saphenous vein prevented pulmonary embolism and recurrence of venous thrombosis in all patients, and in 66.7% of patients contributed to the regression of decompensated forms of chronic venous insufficiency. Recurrence of superficial and deep vein thrombosis during conservative treatment was observed in 14.6% and 4.9% of cases, respectively, which led to pulmonary embolism in 4.9% of patients.

D-dimer is not useful for the diagnosis of isolated superficial venous thrombosis

Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children

Background: Thrombosis is a common complication of cancer with a negative impact on quality of life and overall prognosis. Guidelines recommend low-molecular-weight heparin (LMWH) as initial and prolonged anticoagulation treatment. Little is known about current treatment patterns of these patients in ambulatory care. Patients and methods: The current retrospective observational study interrogates a large German statutory health insurance claims database in order to understand which kind of data can be extracted and analysed. An age- and sex-adjusted sample of about 4.1million insured people from 2011 to 2016 could be used. Cancer patients with incident deep and superficial leg vein thrombosis were identified. Patients with preexisting cancer were allocated to a normal risk group; those who suffered from simultaneously diagnosed cancer and thrombosis were classified as high-risk group. Results: We identified 322,600patients with inpatient or outpatient documented cancer diagnosis in at least two different quarters within one year. 87,755patients were identified with an incident deep or superficial vein thrombosis. 8,201patients suffered from both cancer and incident thrombosis. 56.9% of the patients received an anticoagulation regimen with predominant LMWH prescription, 24.2% vitaminK antagonists, 17.2% direct oral anticoagulants; in 1.7% of patients, no predominant anticoagulant drug/regime could be identified. On average, patients were prescribed anticoagulants for 4.5months. An estimate of clinically relevant gastrointestinal bleeding could be derived (1.8% of patients). Conclusions: The dataset allows assigning detailed information of anticoagulant prescriptions in ambulatory care to well-defined groups of cancer patients. A first analysis suggests that in Germany current medical care of patients with cancer-related deep or superficial vein thrombosis does not entirely comply with guideline recommendations regarding type and duration of anticoagulation.

PurposeTo identify risk factors for recurrent thromboembolic events (RTEs) and define the optimum duration of treatment with tinzaparin in patients with superficial vein thrombosis (SVT) of the lower limbs.Materials and MethodsA total of 147 consecutive patients with significant SVT were treated with subcutaneously administered tinzaparin. The composite primary endpoint of the study was RTE, deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) at 120 days. Patients were stratified into group A, where patients received a variable dose of tinzaparin for up to 60 days (n=98), and a subsequent group B-ext, where patients received a standardized intermediate dose of tinzaparin (n=49) for 90 days.ResultsRTEs occurred in 15/147 patients (10.2%), including recurrent SVT (n=10), DVT (n=4) and fatal PE (n=1). RTEs were less frequent in group B-ext (0% vs. 15.3% for group A, P=0.004), a difference that remained significant at the one-year follow-up. Clinically extensive SVT was an independent predictor for RTEs (hazard ratio, 5.94; 95% confidence interval, 2.05–17.23; P=0.001, Cox regression). Predictors or DVT or PE in group A included clinically extensive SVT (P=0.004), absence of local pain (P=0.023) and the ultrasound findings of superficial axial vein thrombosis (any, P=0.006 or isolated, P=0.036) and multiple thrombosed superficial venous sites (P<0.001).ConclusionAn extended three-month regimen of tinzaparin in patients with SVT of the lower limbs is more effective than a shorter course and may be desirable in patients with risk factors.

Superficial Venous Thrombosis: Prevalence of Common Genetic Risk Factors and Their Role on Spreading to Deep Veins

Background Venous thromboembolism (VTE) is quite common among post-operative neurosurgical patients. This study aims to identify the incidence of deep vein thrombosis (DVT) and superficial vein thrombosis (SVT) among post-craniotomy/craniectomy patients and further evaluate established hypercoagulability risk factors such as trauma, tumors, and surgery. Methodology This single-center retrospective study investigated 197 patients who underwent a craniotomy/craniectomy. The incidences of DVT and SVT were compared, along with laterality and peripherally inserted central catheter (PICC) line involvement. A multivariate logistic regression analysis was conducted to identify risk factors for post-craniotomy/craniectomy VTE. This model included variables such as age, post-operative days before anticoagulant administration, female sex, indications for surgery such as tumor and trauma, presence of a PICC line, and anticoagulant administration. Results Among the 197 post-craniotomy/craniectomy patients (39.6% female; mean age 53.8±15.7 years), the incidences of DVT, SVT, and VTE were 4.6%, 9.6%, and 12.2%, respectively. The multivariate logistic regression analysis found that increasing the number of days between surgery and administration of anticoagulants significantly increased the risk of VTE incidence (odds ratio 1.183, 95% CI 1.068-1.311, p = 0.001). Conclusions Contrary to existing evidence, this study did not find trauma or the presence of tumors to be risk factors for VTE. Future prospective studies should assess VTE risk assessment models such as "3 Bucket" or "Caprini" to develop universal guidelines for administering anticoagulant therapy to post-craniotomy/craniectomy patients that consider the timing of post-operative therapy initiation.

Prevalence of cancer in patients with superficial vein thrombosis and its clinical importance

Derivation and Validation of Natural Language Processing Algorithms to Identify and Classify Venous Thrombotic Events from Lower Extremity Duplex Ultrasound Reports

Retrospective Assessment of Outcomes Following Superficial Vein Thrombosis in Cancer Patients

Fondaparinux for Isolated Superficial Vein Thrombosis of the Legs: A Cost-Effectiveness Analysis

Temporal and anatomic relationship between superficial and deep vein thromboses in hospitalized children

The interrelation of cancer with venous thromboembolism is established, yet the specific impact on the incidence and progression of superficial vein thrombosis (SVT) remains unclear. To investigate the association between SVT and malignancies, focusing on risk factors, presentation, course and complications. A single-center prospective observational study of patients diagnosed with DVT or SVT referred to a venous thromboembolism clinic between January 2013 and April 2018. Of the 632 patients, 205 presented with SVT at referral, 16.6% having active cancer. Significant associations were found between active cancer and the risk of developing proximal SVT (RR 1.54 [1.18-2.03] p < 0.01), SVT within 3cm from junction (RR 2.01 [1.13-3.72] p = 0.019), bilateral SVT (RR 8.38 [2.10-33.43] p < 0.01) and SVT affecting multiple veins (RR 2.42 [1.40-4.20] p < 0.01), with a higher risk of persistence (RR 1.51 [1.18-1.95] p < 0.01) and progression (RR 5.75 [2.23-14.79] p < 0.01) at initial assessment. Patients with SVT and no malignancy history demonstrated an elevated risk for new-onset cancer during follow-up (RR 1.43 [1.13-1.18] p = 0.022), especially in cases of proximal or bilateral SVT, initial progression or subsequent DVT or PE. No significant differences were observed in persistence, recurrence or complications during initial evaluation or follow-up across different pharmacological treatments. Research suggests a probable link between cancer history and the development of SVT. SVT presented more severely in cancer patients. SVT, especially in its more complex forms, could serve as a predictive marker for the future development of cancer. Treatment approaches varied, no significant differences in outcomes were noted.

Thrombophlebitis is an inflammatory process in the superficial veins with coexistent vein thrombosis, usually occurring in patients with specific preconditions (trauma, surgery or inactivity, signs of venous insufficiency, malignancies). The concept of thrombophlebitis has evolved over time, and also its definition has changed from thrombophlebitis to superficial vein thrombosis (SVT). SVT course is usually benign, if appropriate and prompt treatment is undertaken. Pharmacologic treatment includes anticoagulation with low‑molecular‑weight heparin, fondaparinux and, more recently, rivaroxaban. In selected cases, the course of thrombophlebitis is not self‑limited, and its management is challenging for clinicians and varies in different centers. SVT complications include deep vein thrombosis, pulmonary embolism, and thrombosis recurrence. In this review, we define nonstandard SVT as the cases presenting with 1 or more of the following features: SVT involving healthy veins; recurrent, migrant, or significantly extended SVT; SVT involving deep vein confluence; or SVT not associated with recognized risk factors, especially if occurring in young individuals. In such nonstandard cases, SVT may also represent the epiphenomenon of a more complex systemic condition. Therefore, investigation may require more attention and resources. This series of clinical cases focuses on uncertainties in the management of nonstandard SVT, from diagnosis to treatment, and it underlines, on the one side, the need of a multidisciplinary approach to investigation and care, and on the other side, the opportunity of a systematic data collection and analysis to provide more reliable recommendations in this setting.