Clinical Presentation Of Venous Thromboembolism Research Articles

The History of Diagnosing Venous Thromboembolism.

An accurate and prompt diagnosis of deep vein thrombosis and/or pulmonary embolism is important to prevent serious complications and mortality. Because the clinical presentation of venous thromboembolism (VTE) is often nonspecific, objective testing by means of radiological imaging is required to confirm the diagnosis. Historically, a diagnosis of VTE involved invasive imaging techniques like contrast venography or conventional pulmonary angiography. Technological developments toward more accurate and less invasive diagnostics have driven the implementation of a variety of newer technologies over the past decades, as well as the derivation and validation of clinical decision rules (CDRs) that can be used to rule out VTE in combination with D-dimer blood tests. In this narrative review, we provide a historical overview of the most notable developments in the imaging techniques and CDRs for VTE diagnosis.

Pulmonary embolism presenting as delirium: an acute confusional state in an elderly patient—a case report

BackgroundLarge numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium.Case presentationA 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month’s follow-up visit.ConclusionPE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.

In-hospital diagnostic strategies for acute pulmonary embolism — results of a single-center study based on the experience of a multi-profile clinical hospital

Introduction: Acute pulmonary embolism (APE) is the most severe clinical presentation of venous thromboembolism (VTE) and inappropriate diagnostic strategies of APE lead to death or chronic thromboembolic pulmonary hypertension. Material and methods: In prospective manner we followed patients admitted to a tertiary clinical center with APE proven with CT scan within the period of 24 months. We assessed diagnostic strategies of APE in different clinical departments of Polish multi-profile hospital and their association with prognosis. Results: A total number of 178 patients with APE were enrolled in the study, of which 56 patients were diagnosed with APE in the emergency department (ED), 42 in cardiology departments, and 80 in other departments. No significant differences in diagnostic strategies between departments were found. Adherence to ESC guidelines was 56.1% and it was similar in compared departments (p = 0.648). The in-hospital mortality rate was 6.7%. In the 6 month follow-up period 18.1% of the studied died. Coronary artery disease (p = 0.002), cancer (p = 0.032), serious medical condition (p = 0.047), altered mental status (p = 0.032), CRP (p = 0.006), and hemoglobin (p = 0.023) were identified as predictors of clinical deterioration. Risk factors for in-hospital and 6-month mortality were congestive heart failure, serious medical condition, and systolic blood pressure (p < 0.05). Immobility over 3 days and cancer were also identified as predictors of death within 6 months (p < 0.001). There was no association between the type of the department, clinical deterioration, in-hospital, and 6-month mortality. Conclusion: There is no difference in APE management and prognosis in different profile departments.

Association between obstructive sleep apnea and venous thromboembolism recurrence: results from a French cohort

BackgroundGrowing evidence suggests the relationship between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Few studies focused on VTE recurrence risk associated with OSA after anticoagulation cessation.MethodsIn a prospective cohort study, patients with documented VTE, were followed for an indefinite length of time and VTE recurrence were documented and adjudicated. The primary outcome was recurrent VTE after anticoagulation discontinuation. Secondary outcomes included all-cause mortality and the clinical presentation of VTE. Univariable and multivariable analyses were performed to identify risk factors for recurrence and mortality.ResultsAmong the 2109 patients with documented VTE included, 74 patients had moderate to severe OSA diagnosis confirmed by home sleep test or polysomnography. During a median follow-up of 4.8 (interquartile range 2.5–8.0) years recurrent VTE occurred in 252 patients (9 with OSA and 243 without OSA). The recurrence risk in the univariable and multivariable analysis was not increased in patients with OSA, regardless of the time of diagnosis (before or after index VTE or pooled). VTE phenotype was significantly more often PE with or without associated deep vein thrombosis in the first event and recurrence for OSA patients compared to non-OSA patients. The risk of death was not increased in the OSA population compared to non-OSA patients in multivariable analysis.ConclusionsIn patients with OSA and VTE, the risk of all-cause mortality and VTE recurrence after anticoagulation discontinuation was not increased compared to non-OSA patients.

AngioVac Aspiration Thrombectomy of Right Atrial Thrombus is Safe and Effective in Cancer Patients

The aim of this study was to test the hypothesis that endovascular aspiration thrombectomy of right atrial thrombus (RAT) using the AngioVac device is as safe and effective in patients with cancer as those without cancer. RAT is a uniquely challenging clinical presentation of venous thromboembolism due to its low incidence and historically high-risk of mortality due to thrombus propagation into the pulmonary arteries. There is a lack of consensus regarding management, particularly in high-risk cancer patients. Endovascular aspiration thrombectomy utilizing the AngioVac device is effective in removal of right atrial thrombus and may be a safer option for patients with cancer in whom avoidance of higher-risk intervention is preferred. This was an institutional review board-approved retrospective single-center case control study of patients with RAT who underwent AngioVac aspiration thrombectomy between August 2013 and July 2020. Analysis of patient demographics and clinical characteristics, thrombus-related factors, and operative details was performed. Primary endpoints included survival, safety, and technical success. A total of 44 patients met inclusion criteria, 20 of whom with active malignancy. The oncology group had a significantly higher Charlson comorbidity index (P=0.01). Comparative outcomes between the oncology and non-oncology group showed no difference in survival (P=0.8) or technical success (OR 3, 95% CI 0.83-10.9). There were 9 complications, including 6 minor, 1 moderate, 1 severe, and 1 death. AngioVac aspiration thrombectomy of RAT is as safe and effective in patients with cancer as those without cancer.

Case of recurrent pulmonary thromboembolism due to therapeutic non-compliance

Pulmonary embolism occurs when thrombi enter the pulmonary arterial circulation. Most pulmonary embolisms are the result of deep venous thrombosis of the pelvic limbs, chest or pelvis, and, less commonly, the jugular veins or inferior vena cava. Venous thromboembolism includes deep vein thrombosis and pulmonary embolism. It is the third most common cardiovascular disease, with a total annual incidence of 100-200 per 100 000 population. INTRODUCTION: Acute pulmonary embolism is the most serious clinical presentation of venous thromboembolism. Overall, pulmonary embolism is a major cause of mortality, morbidity and hospitalization. Mortality in pulmonary embolism depends on haemodynamic impairment, age and co morbidities. The prognosis of patients with pulmonary embolism depends on two factors : underlying disease state plus diagnosis, and appropriate treatment. Approximately 10% of patients who develop pulmonary embolism die within the first hour, and 30% subsequently die of recurrent embolism. CASE PRESENTATION: In this presentation we present the case of a 49-year-old male patient without co morbidities, presented repeatedly to the Emergency Room for symptoms suggestive of pulmonary thromboembolism, who benefited from life-saving therapies due to timely diagnosis and appropriate treatment, with subsequent favorable outcome. CONCLUSIONS: The particularity of the case is that, on the one hand, the thromboembolic event recurred in a short time, on the other hand, the evolution was favorable in both cases, with complete recovery of right ventricular function and disappearance of pulmonary hypertension, despite the fact that the patient was non-compliant with initial anticoagulation therapy. This was due to both early diagnosis and timely administration of appropriate treatment.

Effect of Statins on Recurrent Venous Thromboembolism (from the COMMAND VTE Registry)

Statins, which are considered as essential for primary and secondary prevention of atherosclerotic diseases, were also reported to reduce first venous thromboembolism (VTE). However, the effect of statins on VTE recurrence remains conflicting. We aimed to examine the association between statin use and VTE recurrence in a large observational study in Japan. The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE in 29 centers in Japan between January 2010 and August 2014. In the current study, the entire cohort was divided into statin group (N = 437) and no-statin group (N = 2590) according to the status of statin use at baseline. The statin group as compared with the no-statin group was older (statin group 71.2 vs no-statin group 66.5 years, p <0.001), included more women (67% vs 60%, p = 0.008), and less frequently had active cancer (12% vs 25%, p <0.001). There was no significant difference in the clinical presentation of VTE (pulmonary embolism, 58% vs 56%, p = 0.44). The cumulative 3-year incidence of recurrent VTE was significantly lower in the statin group than the no-statin group (3.8% vs 8.8%, p <0.001). After adjusting for confounders including active cancer, statin use was associated with significantly lower risk for recurrent VTE (Hazard ratio 0.49, 95% confidence interval 0.29 to 0.78, p = 0.002). The results were consistent in a sensitivity sub-group analysis with and without active cancer. In conclusion, statin use was associated with significantly lower risk for the recurrent VTE in patients with VTE.

Abstract P309: The High Risk of Venous Thromboembolism in Black Americans

Background: Reports suggest a higher risk of venous thromboembolism (VTE) in Black persons compared to Whites. The major clinical presentations of VTE, pulmonary embolism (PE) and deep venous thrombosis (DVT) are considered parts of the same pathological process and generally share the same risk factors. Sparse data raise the possibility of additional Black/White disparity in clinical VTE presentation; specifically, larger proportions of presentation with PE in Blacks than Whites and vice versa with DVT in Whites compared to Blacks. We present here relevant data from a new study with 4,674 VTE subjects. Hypothesis: The Black/White disparity in VTE may be concentrated in greater risk of Blacks for PE. Methods: We studied composite VTE risk in 61,459 members of a comprehensive health plan, who had supplied self-classified ethnicity data on prior health examinations between 1978 and 1985 and remained plan members in 1996, when out-patient diagnoses were added to electronic health records. Subjects were 28% Black, (n = 17,442), and 53% White (n = 32,557). From 1996 through 2015, at least one diagnosis of VTE was made during an outpatient visit or hospitalization for 4,675 persons (1,554 Black and 2,576 White). With Whites as referent we performed logistic regressions with 5 covariates. Models stratified by race were performed to explore traits of specific VTE codes and circumstances of diagnosis (hospitalization, out-patient, etc.). Results: The table shows HRs (95% CI) of Blacks vs Whites. Increased VTE risk of Blacks in each sex was entirely concentrated in subjects with PE and with hospitalization diagnoses. Among covariates sex, education, and smoking were unrelated to VTE risk while BMI was directly associated; results were similar in Whites, Blacks and race-stratified models within the diagnosis code and location of diagnosis groups. Conclusion: Compared to Whites, Black persons have an unexplained increased risk of PE but not of DVT.

Direct Oral Anticoagulant Vs Vitamin K Antagonist As Anticoagulant Therapy in Patients with Inherited and Acquired Thrombophilia

BACKGROUNDThe patients with venous thromboembolism (VTE) and thrombophilia have historically been treated with vitamin K antagonist (VKA) therapy. Nowadays, direct oral anticoagulants (DOAC) are broadly used in the treatment and prevention of VTE. However, the use of DOAC in the treatment of inherited and acquired thrombophilia remains unclear.AIMSTo assess the safety and effectiveness in both cohorts according to DOAC or VKA treatment in a cohort of patients with VTE and thrombophilia.METHODSWe included adult patients with VTE and thrombophilia treated with DOAC or VKA (2016-2018) from the beginning of treatment. Patients in the VKA group received acenocoumarol. Demographic, laboratory, thrombophilia diagnosis data and clinical presentation of VTE were collected. All patients with history of at least one VTE episode were included. The diagnosis of VTE was established by a positive finding of duplex sonography. Pulmonary embolism was diagnosed based on positive results of high resolution computed tomography. Inherited trombophilia included homozygous and heterozygous Factor V Leiden and prothrombin G20210A, natural anticoagulant deficiencies (protein C, protein S, or antithrombin) or combined defects. Patients with antiphospholipid syndrome (APS) were considered to have acquired thrombophilia. Bleeding events were classified according to ISTH criteria.RESULTSAmong 181 patients, 96 (45.5%) were treated with DOAC (6 Dabigatran, 45 Rivaroxaban, 12 Apixaban and 33 Edoxaban) and 85 were treated with VKA. Among patients receiving VKA, the time in therapeutic range was 58.5%. Mean Follow - Up (FU) were 8.1 and 6.8 months (DOAC vs VKA, p:0.77). Demographic characteristics, thrombophilia subtypes and clinical features of VTE are summarised in table 1. The most frequent previous anticoagulant treatment was low molecular weight heparin (DOAC 71.6% vs VKA 98%, p:0.15). During FU, 9 recurrent VTE episodes were reported: 2 (2.1%) vs 5 (5.9%) [DOAC vs VKA, p: 0.57] and 5 (5.2%) vs 17 (20%) major and clinically relevant non-major bleeding events [DOAC vs VKA, p: 0.001] occurred. There were 2 arterial thromboembolic events in the VKA group (APS and antithrombin deficiency patient's in the periprocedural setting).CONCLUSIONSIn our study, the effectiveness of DOAC treatment for VTE in patients with thrombophilia had a similar profile to VKA and caused significantly less major and clinically relevant non-major bleeding. This suggests that DOAC could be a good treatment option in this clinical setting. However, additional evaluation of DOAC use in patients with thrombophilia is necessary in order to provide more evidence. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Triple POCUS: A New Approach to an Old Problem.

Pulmonary embolism (PE) is the most serious and life-threatening clinical presentation of venous thromboembolism, and difficult to diagnose. Triple point-of-care-ultrasonography (POCUS) of the lung, heart and leg veins is a multiorgan approach that may help to evaluate patients suspected of having PE, in combination with existing protocols and computed tomographic pulmonary angiography (CTPA). We present the case of a 26-year-old man with sudden onset of dyspnoea and swelling of the leg with a Well’s score of 9. With CTPA unavailable at the time of presentation, triple POCUS showed subpleural consolidations and a venous thrombus in a popliteal vein. A diagnosis of deep vein thrombosis with PE was made and the appropriate treatment was started immediately. Although triple POCUS has less sensitivity and specificity than CTPA, it could be very useful in some clinical settings.LEARNING POINTSIn a patient with suspected pulmonary embolism, the best diagnostic strategy is to combine clinical assessment, plasma D-dimer measurement and computed tomographic pulmonary angiography (CTPA).Triple point-of-care ultrasonography of the lung, heart and leg veins may improve clinical assessment of pulmonary embolism if CTPA is unavailable or contraindicated.Point-of-care ultrasonography should be incorporated as the fifth pillar of the physical examination.

Diagnostic Considerations of Venous Thromboembolic Disease.

Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). The clinical presentation of VTE is nonspecific and requires confirmatory testing. The most common diagnostic tool for DVT is duplex ultrasonography since it is a noninvasive test with high accuracy. Contrast venography is considered the gold standard modality to diagnose DVT, but it is an invasive test. Magnetic resonance venography and computed tomography venography are alternative diagnostic methods for DVT, which can be helpful in certain circumstances. Pulmonary embolism is commonly diagnosed by computed tomography pulmonary angiography. Ventilation perfusion scanning is an alternative imaging to diagnose PE in patients who cannot receive intravenous contrast. Pulmonary angiography is still the gold standard in the diagnosis of PE and is usually needed in specific conditions. D-dimer assay can be utilized in ruling VTE out in low-risk patients. Estimating the pretest clinical probability for having VTE is the key step in guiding the clinicians and nurses to the appropriate diagnostic method for patients with suspected DVT or PE.

Venous Thromboembolism

Deep vein thrombosis (DVT) and pulmonary embolism (PE) comprise venous thromboembolism (VTE). Together, they comprise a serious health problem as there are over 275,000 new VTE cases per year in the United States, resulting in a prevalence of one to two per 1,000 individuals, with some studies suggesting that the incidence may even be double that. This review covers assessment of a VTE event, initial evaluation of a patient suspected of having VTE, medical history, clinical presentation of VTE, physical examination, laboratory evaluation, imaging, prophylaxis against perioperative VTE, indications for immediate intervention (threat to life or limb), indications for urgent intervention, and management of nonemergent VTE. Figures show a modified Caprini score questionnaire used at the University of Michigan to determine individual risk of VTE and the indicated prophylaxis regimen; Wells criteria for DVT and PE; phlegmasia cerulea dolens secondary to acute left iliofemoral DVT after thigh trauma; compression duplex ultrasonography of lower extremity veins; computed tomographic angiogram of the chest demonstrating a thrombus in the pulmonary artery, with extension into the right main pulmonary; management of PE according to Wells criteria findings; management of PE with right heart strain in cases of massive or submassive PE; treatment of DVT according to clinical scenario; a lower extremity venogram of a patient with May-Thurner syndrome and its subsequent endovascular treatment; and various examples of retrievable vena cava filters (not drawn to scale). Tables list initial clinical assessment for VTE, clinical scenarios possibly benefiting from prolonged anticoagulation after VTE, indications for laboratory investigation of secondary thrombophilia, venous thromboembolic risk accorded to hypercoagulable states, and Pulmonary Embolism Rule-out Criteria Score to avoid the need for D-dimer in patients suspected of having PE.   This review contains 11 highly rendered figures, 5 tables, and 167 references. Key words: anticoagulation; deep vein thrombosis; postthrombotic syndrome; pulmonary embolism; recurrent venous thromboembolism; thrombophilia; venous thromboembolism; PE; VTE; DVT 

Venous Thromboembolism

Deep vein thrombosis (DVT) and pulmonary embolism (PE) comprise venous thromboembolism (VTE). Together, they comprise a serious health problem as there are over 275,000 new VTE cases per year in the United States, resulting in a prevalence of one to two per 1,000 individuals, with some studies suggesting that the incidence may even be double that. This review covers assessment of a VTE event, initial evaluation of a patient suspected of having VTE, medical history, clinical presentation of VTE, physical examination, laboratory evaluation, imaging, prophylaxis against perioperative VTE, indications for immediate intervention (threat to life or limb), indications for urgent intervention, and management of nonemergent VTE. Figures show a modified Caprini score questionnaire used at the University of Michigan to determine individual risk of VTE and the indicated prophylaxis regimen; Wells criteria for DVT and PE; phlegmasia cerulea dolens secondary to acute left iliofemoral DVT after thigh trauma; compression duplex ultrasonography of lower extremity veins; computed tomographic angiogram of the chest demonstrating a thrombus in the pulmonary artery, with extension into the right main pulmonary; management of PE according to Wells criteria findings; management of PE with right heart strain in cases of massive or submassive PE; treatment of DVT according to clinical scenario; a lower extremity venogram of a patient with May-Thurner syndrome and its subsequent endovascular treatment; and various examples of retrievable vena cava filters (not drawn to scale). Tables list initial clinical assessment for VTE, clinical scenarios possibly benefiting from prolonged anticoagulation after VTE, indications for laboratory investigation of secondary thrombophilia, venous thromboembolic risk accorded to hypercoagulable states, and Pulmonary Embolism Rule-out Criteria Score to avoid the need for D-dimer in patients suspected of having PE.   This review contains 11 highly rendered figures, 5 tables, and 167 references. Key words: anticoagulation; deep vein thrombosis; postthrombotic syndrome; pulmonary embolism; recurrent venous thromboembolism; thrombophilia; venous thromboembolism; PE; VTE; DVT 

Venous Thromboembolism in the Elderly

Aging is a major risk factor for venous thromboembolism. Compared to the general population, the elderly have a much higher 1-year mortality from venous thromboembolism (VTE). Clinical presentation of VTE in the elderly tends to be different, with atypical symptoms being more common than in the general population. Diagnostic work-up starts with establishing a VTE pretest probability followed by D-dimer testing for patients with low pretest probability and confirmatory testing for patients with high pretest probability of VTE. The age-adjusted D-dimer cutoffs are associated with a higher specificity without compromising the test’s sensitivity. Anticoagulation is the cornerstone of VTE therapy. The use of novel oral anticoagulants is safe in elderly patients and is associated with a decreased risk of bleeding.

Venous thromboembolism: An overview

Venous thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a common, lethal disorder that affects both hospitalized and nonhospitalized patients. PE and DVT are 2 clinical presentations of VTE and share the same predisposing factors. In most cases, PE is a consequence of DVT. This article discusses the predisposing factors, prevalence, and individuals who are at risk of developing this often life-threatening disease.

Acute pulmonary embolism (PE) as the most serious clinical presentation of venous thromboembolism (VTE)

Acute pulmonary embolism (PE) as the most serious clinical presentation of venous thromboembolism (VTE)

Whole blood gene expression profiles distinguish clinical phenotypes of venous thromboembolism

IntroductionRecurrent venous thromboembolism (VTE) occurs infrequently following a provoked event but occurs in up to 30% of individuals following an initial unprovoked event. There is limited understanding of the biological mechanisms that predispose patients to recurrent VTE. ObjectivesTo identify whole blood gene expression profiles that distinguished patients with clinically distinct patterns of VTE. Patients/MethodsWe studied 107 patients with VTE separated into 3 groups: (1) ‘low-risk’ patients had one or more provoked VTE; (2) ‘moderate-risk’ patients had a single unprovoked VTE; (3) ‘high-risk’ patients had ≥2 unprovoked VTE. Each patient group was also compared to twenty-five individuals with no personal history of VTE. Total RNA from whole blood was isolated and hybridized to Illumina HT-12V4 Beadchips to assay whole genome expression. ResultsUsing class prediction analysis, we distinguished high-risk patients from low-risk patients and healthy controls with good receiver operating curve characteristics (AUC=0.81 and 0.84, respectively). We also distinguished moderate-risk individuals and low-risk individuals from healthy controls with AUC’s of 0.69 and 0.80, respectively. Using differential expression analysis, we identified several genes previously implicated in thrombotic disorders by genetic analyses, including SELP, KLKB1, ANXA5, and CD46. Protein levels for several of the identified genes were not significantly different between the different groups. ConclusionGene expression profiles are capable of distinguishing patients with different clinical presentations of VTE, and genes relevant to VTE risk are frequently differentially expressed in these comparisons.

Evaluation of the usefulness of a D dimer test in combination with clinical pretest probability score in the prediction and exclusion of Venous Thromboembolism by medical residents.

IntroductionVenous thromboembolism (VTE) requires urgent diagnosis and treatment to avoid related complications. Clinical presentations of VTE are nonspecific and require definitive confirmation by imaging techniques. A clinical pretest probability (PTP) score system helps predict VTE and reduces the need for costly imaging studies. d-dimer (DD) assay has been used to screen patients for VTE and has shown to be specific for VTE. The combined use of PTP and DD assay may improve exclusion of VTE and safely avoid imaging studies.Materials and methodsWe prospectively used the Wells PTP score and a DD test to evaluate 230 consecutive patients who presented with VTE symptoms. The receiver operating characteristic curve was used to identify a new DD cutoff value, which was applied to VTE diagnosis and compared with the upper limit of locally established reference range for prediction of thrombosis alone and in combination with the clinical PTP score.ResultsWe evaluated 118 patients with VTE symptoms fulfilling the inclusion criteria, 64 (54.2%) with clinically suspected deep vein thrombosis (DVT) and 54 (45.8%) with symptoms of pulmonary embolism (PE). The PTP was low in 28 (43.8%) and moderate/high in 36 (56.25%) of the suspected DVT patients, and low in 29 (53.7%) and moderate/high in 25 (46.3%) of the suspected PE patients. Eighteen cases were confirmed by imaging studies: 9 DVT and 9 PE. The agreement between confirmed cases and PTP was significant with PE but not DVT. The negative predictive value for both DVT and PE with current DD cutoff value of <250 μg/L DDU was 100%, whereas with the calculated cutoff the NPV was 88%.ConclusionsWe confirm that PTP score is valuable tool for medical residents to improve the detection accuracy of VTE, especially for PE. The DD cutoff value of 250 μg/L FEU is ideal for excluding most cases of low PTP; however, the calculated cutoff was less specific for the exclusion of VTE.

The association of factor V Leiden with various clinical patterns of venous thromboembolism--the factor V Leiden paradox

Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombosis (DVT), compared to the risk of pulmonary embolism (PE). To prove this paradox in a group of patients with various clinical presentation of venous thromboembolism (VTE). We retrospectively evaluated clinical pattern of VTE in patients who had been referred to vascular clinic shortly after an acute VTE event. In FVL positive and FVL negative groups we compared the prevalence of isolated symptomatic DVT (proximal or distal) and symptomatic PE with/without DVT, and, moreover, asymptomatic DVT or PE. Of 575 patients (mean age 57 years, 50.1% women), 120 were FVL positive and those had significantly higher prevalence of isolated symptomatic DVT, compared to symptomatic PE with/without DVT. Proximal DVT location was significantly more frequent in FVL carriers. The prevalence of asymptomatic PE did not differ between the two groups. The rate of asymptomatic DVT tended to be higher in FVL negative group. In a multivariate analysis, we confirmed FVL to be positively associated with isolated DVT presentation (odds ratio OR 1.757; 95% confidence interval (CI) 1.148-2.690). On the contrary, increasing age and unprovoked nature of VTE event carried a higher risk of symptomatic PE. We confirmed FVL to be significantly associated with isolated symptomatic DVT despite higher prevalence of proximal DVT in FVL carriers. The fact of relatively lower risk of PE in FVL positive patients might have clinical implication. However, mechanisms of FVL paradox remain to be elucidated.

Chemotherapy-induced venous thromboembolism in patients with breast cancer

Background: This study aims to investigate the clinical presentation of venous thromboembolism (VTE) in patients with breast cancer undergoing chemotherapy. Methods: Between January 2008 and December 2012, 500 women who were diagnosed with grade 1, 2 or 3 breast cancer and underwent postoperative chemotherapy to prevent recurrences at Ondokuz Mayıs University, Faculty of Medicine, Department of Oncology were included. All data were reviewed by the experts at Ondokuz Mayıs University, Faculty of Medicine, Department of Cardiovascular Surgery. Results: The median age was 70 years (range, 32 to 76 years) in patients with VTE and 48 years (range, 23 to 76 years) in patients without VTE. Eleven patients (2.2%) had VTE. The median age was higher in patients with thromboembolism (p