Cases Of Deep Venous Thrombosis Research Articles

Venous anomalies: an underrecognized but important cause of venous thromboembolism

AbstractAnatomical variants, such as May-Thurner syndrome (MTS) and inferior vena cava (IVC) variants, are underrecognized causes of deep venous thrombosis (DVT), despite affecting management. We aimed to identify the proportion of anatomical variants in proximal lower limb DVT. A retrospective cohort study was performed with cases of acute proximal DVT from 2014 to 2021 identified from ICD-10 codes. We identified 4731 DVTs and included 1268 proximal DVTs. Thirty-six (2.84%) had an anatomical variant (25 MTS and 11 IVC variants), with a rate of 14.39% in females <50 years old. Compared with nonvariant DVTs, they were more likely to be unprovoked (81% vs 23%), younger (median age, 37 vs 63 years), female (67% vs 37%), and have postthrombotic syndrome (22% vs 9%). Variants frequently received thrombolysis (58% vs 1%) or angioplasty (47% vs 0%) and indefinite anticoagulation (83% vs 40%). Further investigation for variants should be considered for high-risk patients, as variants affect management.

The Hidden Impact of COVID-19 Lockdowns: A Study in NonCOVID Venous Thromboembolism Cases-our Experience

Background: In March 2020, the World Health Organization declared COVID-19 a pandemic, disrupting healthcare systems globally. While COVID-19-related venous thromboembolism (VTE) has been widely studied, the impact of the pandemic on non-COVID-19 VTE cases remains unclear. VTE includes pulmonary embolism (PE) and deep venous thrombosis (DVT), both of which are linked to lifestyle factors, such as physical inactivity. Aim: This study aimed to investigate the effect of pandemic-related restrictions on the prevalence of non-COVID-19 VTE hospitalizations. Methods: We performed a single-center retrospective analysis of consecutive non-COVID-19 patients admitted for VTE at University Hospital Centre Zagreb. Patients hospitalized between March 1 and October 31, 2019, were compared to those hospitalized during the same period in 2020. Data on demographic characteristics, diagnostics, and outcomes were collected. Results: In 2019, 70 non-COVID-19 patients (48% female; mean age 60.8 ± 17.2 years) were admitted, compared to 86 patients (50% female; mean age 68.5 ± 16.8 years) in 2020. A significant increase in combined DVT and PE cases was observed in 2020 (p = 0.03). While the overall prevalence of VTE hospitalizations was not statistically different (4.1% in 2019 vs 5.4% in 2020, p = 0.106), patients in 2020 were significantly older (p = 0.002). Conclusion: The COVID-19 pandemic has indirectly led to an increase in non-COVID-19 VTE cases, especially combined DVT and PE. This is likely due to the sedentary lifestyle imposed by pandemic restrictions, delayed medical treatment, and avoidance of healthcare facilities.

The paradigm shift in treatment of severe venous thromboembolism.

Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).

Biomarkers Profile in Provoked Versus Unprovoked Deep Venous Thrombosis.

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a substantial healthcare challenge. Provoked and unprovoked DVT cases carry distinct risks and treatment considerations. Recognizing the limitations of this classification, molecular markers may enhance diagnostic precision and guide anticoagulation therapy duration relying on patient history and risk factors. This preliminary, open-label, prospective cohort study was conducted including 15 patients (10 provoked DVT and 5 unprovoked DVT) and a control group of healthy plasmatic subjects. Plasma levels of 9 biomarkers were measured at diagnosis (baseline, day 0, and D0) and after 30 days (day 30-D30). Patient demographics, clinical data, and biomarker concentrations were analyzed. Serum concentrations of D-dimer, von Willebrand factor, C-reactive protein, and Anti-Xa were elevated in DVT groups at D0 compared to controls. No significant differences were observed between the provoked and unprovoked groups on the day of diagnosis and 30 days later. Over 30 days, the provoked group exhibited significant biomarker changes related to temporal assessment. No significant differences were noted in the biomarker profile between provoked and unprovoked DVT groups. This study is indicative of the concept of individualized thrombosis assessment and subsequent treatment for VTE. Larger cohorts are warranted to validate these findings and further define the most appropriate use of the molecular markers.

Incidence, timing, location, risk factors, and nomogram of lower extremity deep venous thrombosis after acutecarbon monoxide poisoning.

Data on lower extremity deep venous thrombosis (DVT) following acute carbon monoxide (CO) poisoning are lacking. This study aimed to identify the incidence rate, timing, locations, risk factors, and nomogram of lower extremity DVT after acute CO poisoning. A total of 203 patients with acute CO poisoning from October 2019 to April 2021 were included in this retrospective study. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with lower extremity DVT. Nomogram was drawn and area under the curve (AUC) was calculated to predict lower extremity DVT. Overall, 14.3% (29/203) had lower extremity DVT, with incidence rates of 2.5% (5/203) for proximal DVT and 11.8% (24/203) for distal DVT. The lower extremity DVTs involved intermuscular vein in 28 patients, popliteal vein in 5 patients, and posterior tibial vein in 3 patients. The mean time from end of exposure to diagnosis of lower extremity DVT was 1.24days. Among 29 lower extremity DVT cases, 6 (23.1%) DVT cases had thrombolysis. Multivariate logistic regression analysis revealed that long coma duration (P < 0.001) and high D-dimer levels (P < 0.001) were significantly associated with lower extremity DVT. The discrimination of nomogram was good with AUC of 0.93 (95% CI, 0.89-0.98). Clinicians should be aware of and concerned with lower extremity DVT after acute CO poisoning, especially in patientswith long coma duration and high D-dimer levels.

Incidence of Deep Vein Thrombosis in Spine Surgery Patients at a Tertiary Care Hospital

Introduction: The prevalence of deep venous thrombosis (DVT) and pulmonary embolisms (PE) has not been established accurately. Reported literature suggests an incidence rate of either DVT or PE ranging from 0.27% to as high as 60% in special cases. We aimed to discern the incidence rate in our local population post spinal surgery.&#x0D; Methodology: A retrospective chart review was conducted on 892 adult patients who were admitted to our center either electively or in an emergent manner between January 1, 2016 and January 1, 2019 at KAMC, Riyadh. The collected data included information on: demographics, diagnosis, complaint-to-surgery time, type of surgery, location, approach, functional status, days till max function for each patient, blood loss, smoking history, and type of trauma if it was a traumatic case. In addition, DVT/PE status of each patient with their previous or existing health conditions was also included.&#x0D; Result: Eight hundred patients met our inclusion criteria. Our sample was predominantly male at 422 patients (52.8%) with a mean age of 49.8 ± 18.83 years for both genders. The mean BMI was 28.9 ± 7.03 kg with the average weight being 75.9 ± 18.81 kg. Additionally, 422 (52.8%) participants were cardiac patients and 295 (36.9%) were diabetics. We had 30 (3.8%) instances of either DVT or PE out of the 800 patients, isolated cases of DVT being 18 cases (2.3%). The cervical region was found to be protective against DVT/PE (P = 0.0227). The length of stay was also significant for the development of DVT/PE (P &lt; 0.0001).&#x0D; Conclusion: Our study is one of the largest conducted in our region, especially in spinal surgical patients. We found that the incidence for DVT/PE (3.8%) was consistent with the lower end of reported literature. We found significance especially in cervical operations being protective against the development of DVT/PE in comparison to other sites. Length of stay was also significant for the development of DVT/PE unlike the length of the operation itself. While we did not observe a significant difference between the prophylactic protocols for the development of DVT/PE in our patients, we had an overall low number of venous thromboembolic events, especially when comparing it to the reported literature.

Isolated calf deep venous thrombosis: frequency on venous ultrasound and clinical characteristics

BackgroundIt remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the frequency and clinical characteristics of isolated calf DVT.Materials and methodsIn this retrospective analysis, we investigated a cohort of 596 patients (median age 69 years, 52.3% women) who had been imaged with complete lower extremity venous duplex ultrasound for suspected acute DVT. Radiology reports were analyzed for the presence and localization of DVT. Clinical information was collected from patients’ electronic charts.ResultsDVT was found in 157 patients (26.3%), of which 74 patients (47.1%) had isolated calf DVT. Isolated calf DVTs were located in the posterior tibial veins (22 patients, 29.7%), peroneal veins (41 patients, 55.4%) and muscle veins (19 patients, 25.7%). There were no differences in age or sex between patients with isolated calf DVT and patients with proximal DVT. Isolated calf DVT was more commonly associated with leg pain (52.7% vs. 33.7%, p = 0.0234) and less commonly associated with subjective leg swelling (35.1% vs. 55.4%, p = 0.0158) and objectively measured difference in leg circumference (23% vs. 39.8%, p = 0.0268). D-Dimers were significantly lower in patients with isolated lower leg DVT (median 2.3 vs. 6.8 mg/L, p < 0.0001) compared to patients with proximal DVT.ConclusionsIsolated calf DVT represents approximately half of DVT cases and has different clinical characteristics than proximal DVT.

The Natural History of Uterine Venous Plexus Thrombosis.

The management of incidental or unusual site venous thrombosis (VT) is challenging and is often extrapolated from studies on symptomatic deep venous thrombosis (DVT). There is a tendency to treat with anticoagulation, due to the theoretical risk of propagation and embolism; however, this is not without risk. Furthermore, there is little guidance on how to monitor incidental VT. The aim of this study was to describe the natural history of incidental uterine venous plexus thrombosis (UVPT) and provide a structured approach to its overall management. A prospective study was conducted in a university teaching hospital over a 16-month period. Women diagnosed with UVPT on transvaginal ultrasound (TVS) were followed up over a six-month period and managed based on an individualised risk assessments, in conjunction with haematologists. Fifty women were diagnosed with UVPT during the study period, of which 38 were managed expectantly. The resolution was documented in 70% of women. There were no cases of symptomatic DVT or pulmonary embolisms in either the expectant or treatment groups. Our study has shown that in a high proportion of women, incidental UVPT could be managed successfully without the need for anticoagulation. The overall management of UVPT should be based on individualised clinical risk assessments.

Histopathologic analysis of extracted thrombi from deep venous thrombosis and pulmonary embolism: Mechanisms and timing.

Mechanical thrombectomy is increasingly being used as an alternative to pharmacologic therapies for the treatment of patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE) and allows direct histopathologic comparison of thrombi extracted from living patients. We performed histopathologic analysis to thrombi extracted from cases of DVT and PE to gain insights into their relative cellular compositions. Thrombus retrieved using a catheter-based thrombectomy system (ClotTriever for lower extremity DVT and FlowTriever for PE) from the 17 patients (7 DVT cases and 10 PE cases) were histologically evaluated. Histological features were used to estimate their age and pathological characteristics. The thrombus in all cases were composed of fibrin, platelets, red blood cells, and acute inflammatory cells. The weights of thrombus obtained from DVT versus PE cases were heavier (DVT 7.2g (g) (5.6-10.2) vs. PE 4.8g (3.6-6.8), p=.01). Overall thrombus healing (i.e., thrombus composed of smooth muscle cells, endothelial cells, and proteoglycans) was different between DVT and PE cases. 6/7 (86%) with features of late stage healing were from DVT cases while only three of ten (30%) were from PE cases while PE contained more acute thrombi with 7/10 (70%) stage 2 as compared 1/7 (14%) for DVT (p=.0498). This study is the first to directly compare the histology of extracted thrombus in DVT versus PE cases from patients with clinical events. Overall PE cases demonstrated significantly earlier stage thrombus with a larger component of red blood cells.

Low rate of subclinical venous thrombosis in patients with haemophilia undergoing major orthopaedic surgery in the absence of pharmacological thromboprophylaxis.

Deep venous thrombosis (DVT) is a common postoperative complication in patients undergoing major orthopaedic surgery of the lower limbs, such as total hip or knee replacement (THR, TKR). Routine pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) or a direct oral anticoagulant agent is strongly recommended in this setting. THR and TKR as well as ankle arthrodesis are frequently performed in people with haemophilia (PWH) and chronic haemophilic arthropathy. Pharmacological thromboprophylaxis in this population remains controversial. We report the results of a single-centre prospective study initiated in 2002 evaluating by systematic Doppler ultrasound the incidence of subclinical DVT in consecutive PWH referred for major orthopaedic surgery and not receiving pharmacological thromboprophylaxis. We included 46 different PWH (39 Haemophilia A, 7 Haemophilia B, 27 severe, 15 moderate and 4 mild forms) undergoing 67 orthopaedic procedures. Most (89.5%) were performed with continuous infusion of clotting factor concentrates. Rehabilitation was usually started on day 1 post-op. No clinical DVT or pulmonary embolism was suspected. In total, there were 5 cases (3 severe, 1 moderate HA and 1 moderate HB) of subclinical DVT which were all distal. Two patients were treated with a short course (10-14days) of LMWH. The overall incidence of DVT was 7.5%. These data provide imaging-based evidence that the risk of DVT following major orthopaedic surgery among PWH is low. Identified DVTs were distal and resolved spontaneously in most cases. Systematic pharmacological thromboprophylaxis in this specific population is probably for most patients not required.

Perioperative prevalence of deep vein thrombosis in patients with percutaneous kyphoplasty: A retrospective study with routine ultrasonography.

In recent years, deep venous thrombosis (DVT) after spine surgery has received extensive attention, but perioperative prevalence of DVT in patients undergoing percutaneous kyphoplasty (PKP) is lacking.To assess the perioperative prevalence of deep vein thrombosis (DVT) in patients undergoing PKP with routinely applied ultrasonography.We reviewed 1113 consecutive patients undergoing PKP from January 2014 to August 2017. The surgical procedure was bilateral PKP. All patients were routinely examined with ultrasonography when admitted to the hospital and on the first post-operative day. Clinical signs of DVT were checked and recorded before examination.Forty (3.6%) out of 1113 patients were diagnosed with DVT by ultrasonography. Of the 40 detected cases of DVT, only six (0.54%) patients presented with clinical signs of DVT, demonstrating that there were 34 (3.05%) asymptomatic cases. No patient presenting with clinically suspected pulmonary embolism (PE) was observed. Gender, body mass index (BMI), operative time, hypertension, diabetes, heart disease, and lower limb fracture were not significant risk factors for DVT (P > .05). In contrast, patient age, oncologic conditions, DVT history, and paraplegia appeared to be significant risk factors for DVT (P < .01). There was no significant difference in the incidence of DVT found between the three PKP surgical levels (P > .05).The total incidence of perioperative DVT diagnosed with ultrasonography in patients undergoing PKP was 3.6%, of which only 0.54% was symptomatic cases. It is necessary to assess DVT using ultrasonography during the perioperative procedure of PKP, especially for high-risk patients.Level of evidence: Level IV.

Hyperhomocysteinemia is associated with deep vein thrombosis in Nigerian patients

Background Hyperhomocysteinemia is a modifiable risk factor associated with deep venous thrombosis (DVT). Low serum concentrations of vitamin B12 and folate are modifiable causes of hyperhomocysteinemia. This study was carried out to determine the prevalence of hyperhomocysteinemia in Nigerian patients with DVT and also to assess the association of homocysteine with vitamin B12 and folate. Patients and methods A case–control study was carried out in which serum homocysteine, vitamin B12, and folate levels were measured in 45 Doppler ultrasound confirmed cases of DVT and 43 controls. Hyperhomocysteinemia was defined by serum levels more than 15.0 μmol/l, low serum folate less than 3 μg/l, and low serum vitamin B12 less than 160 ng/l. Results The prevalence of hyperhomocysteinemia in DVT patients was 20 (44.4%) compared with four (9.35%) in the control (P Conclusion Hyperhomocysteinemia may be a risk factor for DVT in the Nigerian population but may not be responsible for thrombosis in all cases. There was however no significant correlation between serum level of homocysteine and serum levels of vitamin B12 and folate in DVT patients. Therefore, larger sized sample studies should be carried out to investigate the relationship between hyperhomocysteinemia and related vitamins as well as genetic causes of hyperhomocysteinemia in DVT patients in our environment.

Incidence of silent venous thromboembolism after total hip arthroplasty: A comparison of rivaroxaban and enoxaparin.

Total hip arthroplasty (THA) is associated with a significant risk of venous thromboembolism (VTE). Different thromboprophylaxis strategies have been used to prevent VTE. The primary aim of this study was to report the incidence of VTE and compare the efficacy and safety of rivaroxaban to enoxaparin. The secondary outcome was to report the incidence of silent deep venous thrombosis (DVT) using computed tomography venography. One hundred sixty patients who underwent THA were enrolled in a prospective study. Patients were randomized into two groups as follows: those who received rivaroxaban 10 mg oral daily (group RXE) and those who received enoxaparin 40 IU/day subcutaneously for 14 days (group ENO). Both groups were matched for age, sex, comorbidities, special habits and preoperative laboratory investigations. The overall incidence of DVT was 5% (n = 8), which included four patients clinically diagnosed as having DVT and four with silent DVT. All the DVT cases occurred in veins below the knee and in the group RXE; none of the cases occurred in group ENO (p = 0.04). The incidence of DVT was significantly higher in patients with high body mass indexes (p < 0.001), older age (p = 0.024) and medical comorbidities (p = 0.14). No mortality, pulmonary embolism, stroke, wound infection or major bleeding occurred in either group. Among the patients who underwent hip arthroplasty, rivaroxaban prophylaxis was found to be associated with lower efficacy and similar safety outcomes as compared with enoxaparin anticoagulants.

Construction of deep venous thrombosis nursing intervention model for gastrointestinal cancer patients based on the theory of planned behavior

Objective To construct a nursing intervention model based on the theory of planned behavior (TPB) , to prevent deep venous thrombosis (DVT) of lower extremities, and to explore its application in patients with gastrointestinal cancer after operation. Methods By convenience sampling, a total of 163 patients admitted in the Department of Gastrointestinal Surgery, Ningbo First Hospital, Zhejiang Province who underwent gastrointestinal surgeries from January to December in 2018 were selected as the research objects in this study. The 79 patients admitted from January to June in 2018 were taken as the control group and the conventional perioperative DVT prevention nursing care was given. The other 84 patients admitted from July to December in 2018 were taken as the observation group and the TPB based DVT nursing intervention model was adopted. The two groups were compared in terms of the patient's scores in cognition about DVT, postoperative ankle pump movement, quadriceps femoris movement, first out-of-bed activity within 24 hours and compliance with walking target volume within 3 days after surgery, as well as the number of cases of DVT during hospitalization after surgery. Results The score of DVT knowledge in the observation group was higher than that in the control group; the compliance of ankle pump movement, quadriceps femoris movement and the proportion of patients getting out of bed for the first time within 24 hours after operation in the observation group were higher than those in the control group; the differences between the two groups were statistically significant (P 0.05) . There were 7 cases of DVT in control group and 1 case in observation group after operation, and there was statistically significant difference between the two groups (P<0.05) . Conclusions The DVT nursing intervention model based on TPB is helpful to improve the cognitive level of DVT in patients undergoing gastrointestinal cancer surgery, improve the compliance of lower limb activities and early ambulation, and reduce the incidence of DVT after surgery, establish good healthy behavior for patients undergoing gastrointestinal cancer surgery and effectively prevent DVT. Key words: Deep venous thrombosis; Perioperative nursing; Gastrointestinal neoplasm; Prevention; Theory of planned behavior

Study of risk factors for lower extremity deep venous thrombosis in elderly patients with degenerative diseases of the spine

Objective To explore the risk factors of lower extremity deep venous thrombosis (DVT) after orthopedic surgery in orthopedic patients. Methods We retrospectively analyzed 500 patients who underwent surgery in orthopedics due to degenerative diseases of the spine from September 2016 to May 2019. All patients underwent ultrasound examination of the lower extremities before surgery to confirm the absence of thrombosis Double lower extremity ultrasound on the 3th, 6th, 9th and 12th postoperative day. According to the results of ultrasound, the patients were divided into DVT group and non-DVT group. A total of 65 cases of DVT were diagnosed and the DVT formation rate was 13%. The age, D-dimer, body mass index (BMI), comorbidity, preoperative and postoperative coagulation, operation time, Logistic multivariate regression analysis of hospitalization time, intraoperative blood loss, etc. to explore risk factors associated with DVT. Results A total of 500 patients were included for analysis, According to the final results, 65 patients were included in the DVT group, and 435 were included in the non-DVT group. The incidence of DVT was 13%. Univariate analysis showed statistically significant differences in age, BMI, and hypertension between the two groups (P<0.05). Logistic regression analysis showed D-dimer [odds ratio (OR)=7.059, 95% confidence interval (CI)=2.864-17.401], OR=1.836, 95%CI=1.022-3.301) and operative time (OR=1.513, 95%CI= 1.039-2.203) is a risk factor for postoperative lower extremity DVT. Conclusion Obesity, D-dimer and long operation time are independent risk factors for lower extremity DVT. Key words: Spinal degenerative disease; Lower extremity deep venous thrombosis; Risk factor

Therapeutic aspects, determining the outcome of deep veins thrombosis (dvt) in children with hematological diseases

Deep venous thrombosis (DVT) is a frequent complication in hospitalized children with hematological cancer. Antithrombotic therapy is a main treatment option in these cases, but there is still a lack of data on its influence on DVT outcomes in children. Objective: to compare the frequency of favorable and unfavorable outcomes of DVT in children with hematological and hemato-oncological diseases, depending on the antithrombotic therapy performed. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. 429 medical charts of patients, who received inpatient treatment in the Dmitry Rogachev National Research Center from 01/01/2013 - 12/31/17 were analyzed. There were used hemodynamic characteristics of DVT, also criteria for the correctness of management approach, therapy approach and criteria for DVT outcomes were developed. There were 122 symptomatic DVT (sDVT) and 408 asymptomatic DVT (aDVT). The treatment outcomes were analyzed in 424 (80%) cases of DVT, depending on the correctness of the therapy. In the group of sDVT, the number of favorable outcomes increases with correct therapy (66.7% for sDVT without treatment, 77.9% for treated sDVT, and 84.0% for sDVT, treated correctly, p < 0.05). In the group of aDVT there were no clear dependence between correctness of the treatment and thrombosis outcomes (45.2%, 57.9%, 57.2%, respectively, p = 0.09). Correctly performed antithrombotic treatment rises the favorable outcome rates by more than 20%. In contrast to sDVT, in cases of aDVT outcomes don't depend on therapy or its correctness. This fact could potentially rise the question of aDVT's nature and clinical significance. To determine the best therapy strategy, further research is needed.

Deep Venous Thrombosis: Commonly Affected Veins in the Lower Limbs

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p < 0.001). The common femoral vein (CFV) was affected in 71.7% of cases. The superficial femoral vein (SFV) was affected in 71.7% of cases. The popliteal vein was affected in 67.4%. The deep femoral vein was affected only in 17.4%. Both CFV and SFV were affected together in 47.8% of cases. Both SFV and popliteal vein were affected together in 50% of cases. The majority of DVT cases (71.1%) were in the acute stage. This study revealed an essential relationship between the acute stage of DVT and distension of the affected veins (p < 0.001) (OR 20.667, 95% CI 3.826 - 111.633). It also detected a significant relationship between the acute stage and absence of venous blood flow (p < 0.001) (OR 90.667, 95% CI 8.303 - 990.114). Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

Once-daily versus twice-daily enoxaparin for the initial treatment of acute deep venous thrombosis: a case–control study

Background In the initial treatment of deep venous thrombosis (DVT), enoxaparin is administered twice daily. A once-daily treatment regimen is more convenient for the patients and may optimize home treatment. However, it is not clear whether a once-daily treatment regimen is as safe and effective as a twice-daily treatment regimen. Purpose Our objective is to assess and compare the efficacy (in terms of recurrent venous thromboembolism) and safety (i.e. major hemorrhagic events) of once-daily versus twice-daily administration of enoxaparin for the initial treatment of DVT. Patients and methods A case–control study was conducted. We studied the efficacy and safety of an enoxaparin regimen, 1.5 mg/kg once daily, as a bridge to warfarin for the treatment of acute DVT. We undertook a case–control design. We enrolled 40 acute DVT cases prospectively and matched them by age, sex, and location of venous thromboembolism to 40 previously treated controls. Only hospitalized patients were enrolled; no outpatients were studied. All controls had received enoxaparin 1 mg/kg twice daily. We followed the cases for 30 days. We discontinued enoxaparin after we achieved the target international normalized ratio between 2.0 and 3.0. Results One (2.5%) case and two (5%) controls had recurrent venous thromboembolic events. There were no major bleeding complications in the case group, compared with one (2.5%) in the control group. Conclusion Once-daily enoxaparin, 1.5 mg/kg, as a bridge to warfarin is as effective with a similar safety profile as twice-daily enoxaparin, 1 mg/kg, for initial treatment of acute DVT. Results showed no statistically significant differences between the two treatment regimens.

Genetic effects of BDKRB2 and KNG1 on deep venous thrombosis after orthopedic surgery and the potential mediator

Deep venous thrombosis (DVT) is a common complication of orthopedic surgery. Genetic risk factors and high heritability carried a substantial risk of DVT. In this study, we aimed to investigate the potential association in the Han Chinese population between the polymorphisms of BDKRB2 and KNG1 and DVT after orthopedic surgery (DVTAOS). A total of 3,010 study subjects comprising 892 DVT cases and 2,118 controls were included in the study, and 39 single nucleotide polymorphisms (SNPs) in total (30 for BDKRB2 and 9 for KNG1) were chosen for genotyping. Two SNPs, rs710446 (OR = 1.27, P = 0.00016) and rs2069588 (OR = 1.29, P = 0.00056), were identified as significantly associated with DVTAOS. After adjusting for BMI, the significance of rs2069588 decreased (P = 0.0013). Haplotype analyses showed that an LD block containing rs2069588 significantly correlated with the DVTAOS risk. Moreover, bioinformatics analysis indicated that hsa-miR-758-5p and BDKRB2 formed miRNA/SNP target duplexes if the rs2069588 allele was in the T form, suggesting that rs2069588 may alter BDKRB2 expression by affecting hsa-miR-758-5p/single-nucleotide polymorphism target duplexes. Our results demonstrate additional evidence supporting that there is an important role for the KNG1 and BDKRB2 genes in the increased susceptibility of DVTAOS.

Formulation and application of prevention and control guideline for deep venous thrombosis in lower extremities bedridden elderly patients

Objective To formulate a prevention and control guideline for deep venous thrombosis (DVT) in lower extremities in bedridden elderly patients and to explore its effects. Methods The problems existing in prevention and control of DVT in bedridden elderly patients were analyzed by search for literature, interviewing medical and nursing staff in the ward and reviewing DVT cases in bedridden elderly patients. The prevention and control guideline was formulated based on the evidence-based practice guideline. Relevant health videos were made and quality control measures were formulated by building DVT prevention and control teams and processes for bedridden elderly patients and adopting Caprini's and Padua's risk assessment tools. The prevention and control guideline was put into clinical use since February 2017. The incidence of DVT and blood stasis in bedridden elderly patients before (from May 2016 to January 2017, n=112) and after (between February and November 2017, n=99) the implementation of the guideline. Results After the prevention and control guideline was implemented, the positive rate of blood stasis in the bedridden elderly patients rose from 6.3% (7/112) to 15.2% (15/99) , while the incidence rate of DVT dropped from 8.9% (10/112) to 2.0% (2/99) (χ2=4.458, 4.676; P<0.05) . Conclusions The prevention and control guideline based on the DVT prevention and management guideline can reduce the risks of DVT in bedridden elderly inpatients. Key words: Aged; Deep venous thrombosis; Bedridden patients; Prevention