Prevalence Of Deep Venous Thrombosis Research Articles

The impact of stent protrusion into the inferior vena cava or jailing of the contralateral iliac vein on the incidence of contralateral deep vein thrombosis following venous stenting.

Iliac vein stenting is the standard of care for patients with pelvic venous disorders secondary to symptomatic iliac vein outflow obstruction. Venous stents are often extended proximally into the inferior vena cava (IVC) which may result in partial or complete coverage of the contralateral iliac vein. The purpose of this investigation is to determine if extension of iliac vein stents into the IVC results in increased risk of contralateral deep venous thrombosis (DVT). We retrospectively reviewed prospectively collected data from 409 patients who underwent iliac vein stenting at the Center for Vascular Medicine (CVM) from 2019 to 2020. Stent type, covered territories, initial and follow-up consults, ultrasound and operative reports were reviewed to assess for incidence of post-implantation DVT. Patients were stratified into three groups: Iliac vein stents which protruded into the IVC, stents that completely covered the orifice of the contralateral iliac vein and those with no stent protrusion into the IVC. Out of 409 patients, the average age was 53.96 ± 13.40 years with 94 males and 315 females. All stents placed were Venovo stents and all iliac vein lesions were non-thrombotic stenoses. The average follow-up period was 14.35 ± 10.09 months. The most common territories stented were the IVC-LCIV-LEIV (n = , 74%) and the IVC-RCIV-REIV (n = , 26%). Stent protrusion and distance into the IVC in millimeters (mm) was the following: Partial protrusion (n = 314, 77%, 27.6 ± 19.1), jailing of the contralateral iliac vein (n = 78, 19%, 45.9 ± 18.6), no protrusion (n = 16, 4%). The overall DVT rate post-implantation was 0.49% (n = 2). No DVTs ipsilateral to the index stent were identified and both DVTs were contralateral DVTs. A hypercoaguable disorder was reported in 6 patients (1.5%). There were no significant differences in prevalence of contralateral DVT between the three groups. (p = .35). The rate of contralateral DVTs post iliac vein stenting with Nitonol based stents is extremely low. Partial or complete coverage of the contralateral iliac vein via stenting does not result in an increased incidence of contralateral DVT in the short-term. Longer follow up is needed to determine if contralateral DVTs occur after long-term implantation.

Risk of deep venous thrombosis associated with peripherally inserted central catheter: A retrospective cohort study of 11.588 catheters in Brazil.

Deep Venous Thrombosis (DVT) due to Peripherally Inserted Central Catheter (PICC) is one of the most threatening complications after device insertion. To assess the rate of PICC-associated DVT and analyze the risk factors associated with this event in cancer and critically ill patients. We conducted a descriptive, retrospective cohort study with 11,588 PICCs from December 2014 to December 2019. Patients ≥ 18 years receiving a PICC were included. Pre-and post-puncture variables were collected and a logistic regression was used to identify the independent factors associated with the risk of DVT. The DVT prevalence was 1.8% (n = 213). The median length of PICC use was 15.3 days. The median age was 75 years (18; 107) and 52% were men, 53.5% were critically ill and 29.1% oncological patients. The most common indications for PICC's were intravenous antibiotics (79.1%). Notably, 91.5% of PICC showed a catheter-to-vein ratio of no more than 33%. The tip location method with intracavitary electrocardiogram was used in 43%. Most catheters (67.9%) were electively removed at the end of intravenous therapy. After adjusting for cancer profile ou chemotherapy, regression anaysis revealed that age (OR 1.011; 95% CI 1.002-1.020), previous DVT (OR 1.96; 95% CI 1.12-3.44) and obstruction of the device (OR 1.60; 95% CI 1.05-2.42) were independent factors associated with PICC-associated DVT, whereas the use of an anticoagulant regimen was a protective variable (OR 0.73; 95% CI 0.54-0.99). PICC is a safe and suitable intravenous device for medium and long-term therapy, with low rates of DVT even in a cohort of critically ill and cancer patients.

Incidence of venous thromboembolism after cardiovascular surgery.

Among venous thromboembolism, pulmonary thromboembolism (PTE) is one of the most serious postoperative complications. Deep venous thrombosis (DVT) is the main cause. Considering the unknown prevalence of DVT and PTE in the postoperative period of cardiovascular surgery in Japan, we investigated the incidence in consecutive patients who underwent cardiovascular surgery. A total of 225 patients who underwent cardiovascular surgery at four hospitals consented to participate in the study. We assessed DVT using lower extremity venous ultrasound preoperatively and postoperatively. Seven patients with preexisting DVT were excluded. Postoperative antithrombotic therapy was administered at the discretion of the attending physician at each institution. The postoperative intermittent pneumatic compression therapy followed the standard prophylaxis protocol at each institution. Patients were grouped into DVT and non-DVT cohorts for comparison. Continuous variables were expressed as means ± standard deviations and compared by the t-test. The analysis of lower extremity venous ultrasound images indicated that DVT developed in 16 of the 218 study patients (DVT, 7.3%). No patient had PTE. Procedure-related data revealed significantly higher total blood transfusion (DVT group: 61.2 ± 49.9 IU vs. non-DVT group: 27.7 ± 30.2 IU: p = 0.018, effect size = 1.048) in the DVT group. The multivariate logistic regression predictor of DVT based on preoperative, intraoperative, and postoperative factors was blood transfusion (p = 0.005, 95% confidence interval 1.010-1.059, odds ratio 1.034). The incidence of postoperatively developed DVT was 7.3% in this study.

The impact of deep venous thrombosis on 90 day mortality in chronic obstructive pulmonary disease patients presenting with pulmonary embolism

BackgroundThere are a limited number of studies investigating the effect of deep venous thrombosis (DVT) in patients presenting with both pulmonary embolism and chronic obstructive pulmonary disease. The aim of this study is to investigate the prevalence and prognostic significance of DVT in patients with PE-COPD. MethodsCOPD patients admitted with a diagnosis of PE to our tertiary hospital between January 2016 and January 2021 were retrospectively evaluated with an electronic hospital database. Univariate and multivariate Cox regression analyses were performed to reveal independent prognostic factors. ResultsTwo hundred thirty-three patients (mean age 65.1 ± 12.2, 158 men (67.5 %)) were included. DVT was present at the time of diagnosis in 45 (19.31 %) of the patients. Patients with DVT tend to have more comorbidities, central pulmonary embolism, higher CRP and d-dimer levels, and SPESI score (p<0.05). After performing multivariate analyses, the presence of DVT (HR=3.48, CI: 1.02- 11.88, p = 0.046), ischemic heart disease (HR=3.82, CI: 1.38- 10.80, p = 0.01), and malignancy (HR=4.85, CI: 1.53- 15.41, p = 0.007) were found to be independent factors in predicting 90-day mortality. ConclusionsIn PE-COPD patients, co-existing DVT may predict a worse outcome.

Is it safe for the spinal metastasis patients with preoperative deep vein thrombosis to use low-molecular-weight heparin before surgery? A prospective study

Spine surgeons should weigh the risks of anticoagulants against their benefits in preventing deep venous thrombosis (DVT), as they may increase the risk of bleeding. Spinal metastasis patients undergoing decompression with fixation are at a high risk for DVT, which may occur preoperatively. Therefore, anticoagulants should be administered preoperatively. This study aimed to evaluate the safety of the administration of anticoagulants in treating spinal metastasis patients with preoperative DVT. Therefore, we prospectively investigated the prevalence of DVT in these patients. Patients who were diagnosed with preoperative DVT were included in an anticoagulant group. Subcutaneous low-molecular-weight heparin (LMWH) was administered. Patients without DVT were included in a non-anticoagulant group. Data on patient information, clinical parameters, blood test results, and bleeding complications were also collected. Moreover, the safety of anticoagulants was analyzed. The prevalence of preoperative DVT was 8.0%. None of the patients developed pulmonary thromboembolism. Furthermore, no significant differences in blood loss, drainage volume, hemoglobin levels, number of transfusions, or preoperative trans-catheter arterial embolization were observed between the two groups. None of the patients developed major bleeding. However, two patients experienced wound hematoma and one experienced incisional bleeding in the non-anticoagulant group. Therefore, LMWH is safe for spinal metastasis patients. Future randomized controlled trials should be conducted to evaluate the validity of perioperative prophylactic anticoagulation therapy in these patients.

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

AbstractAimPatients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.Patients and MethodsThis study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur‐hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (n = 66, enoxaparin initiation 24 h after operation) and control (n = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; P value &lt;.05 was defined significant.ResultsA total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow‐up duration was 19.139 ± 2.2 months. Long‐term recurrence rate was 2.4% (n = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (P = .031).ConclusionIn terms of VTE chemoprophylaxis, following bur‐hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.

The prevalence of deep Venous thrombosis of the lower extremity in hospitalised bedridden orthopaedic patients: a pilot study.

To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis. The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22. Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all. There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.

Prognostic value of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure

The role of echocardiographic right ventricular (RV) dysfunction in predicting clinical outcome in clinically stable patients with pulmonary embolism (PE) is undefined. In this study, we assessed the prevalence and clinical outcome of normotensive patients with RV dysfunction among a broad spectrum of PE patients. This retrospective clinical outcome study included cohort of 186 consecutive patients (age: 62 ± 15 years) with documented PE. Acute RV dysfunction was diagnosed in the presence of one or more of the following criteria: a quotient of RV septal-lateral diameter/LV septal-lateral diameter > 0.9 in the 4 chamber view in TTE or CT, RV hypokinesis (TAPSE < 15 mm), Doppler evidence of pulmonary hypertension (PASP > 40 mmHg) and/or paradox septal systolic motion. Eighty-eight patients were judged to have RV dysfunction (47.3%). There was no difference in age, gender, prevalence of deep venous thrombosis (DVT), cancer or other risk factors in these two groups. In hospital mortality (21.6% vs. 5.4%; P = 0.001), cardiogenic shock (P = 0.001), and thrombolytic therapy use (P = 0.004) were significantly higher for RV dysfunction patients than for the other group. The multivariate logistic regression models revealed significant associations between RV dysfunction and in-hospital mortality (OR: 3.815, 95% CI: 1.012–10.47, P = 0.001) A significant proportion (47%) of normotensive patients with acute PE presents with RV dysfunction; these patients with latent hemodynamic impairment have more PE-related shock and in-hospital mortality and may require aggressive therapeutic strategies.

C-56 | Marijuana Use Associated With Increased Risk of Deep Venous Thrombosis and Pulmonary Embolism: A Nationwide Study

Lower extremity venous disease can be a debilitating disease with poor quality of life and can lead to complications including pulmonary embolism (PE) that confer an increased risk of mortality. The impact of active marijuana use on outcomes with peripheral venous disease including deep venous thrombosis (DVT) and PE has not been well studied and remains rarely reported. De-identified patient data from the National Inpatient Sample (NIS) from 2016-2019 were queried. Inclusion criteria included diagnosis of marijuana use. Patients were further stratified with diagnoses of DVT and PE. Data was analyzed using SPSS software in a binary logistic regression model, a p value <0.001 was considered statistically significant, and samples were standardized for comparison using predicted probabilities. Of the 30m+ patients in the NIS from 2016 to 2019, there were 623,768 patients diagnosed as marijuana users. Of these patients, 409 (0.07%) were diagnosed with a DVT and 3042 (0.49%) were diagnosed with a PE. Marijuana users were at more than double the risk of being diagnosed with a DVT and PE as compared to non marijuana users (OR = 2.263, 2.504, respectively; p<0.001). A total of 979 marijuana users died during hospitalization, but were at no increased risk of mortality when diagnosed with DVT or PE. Marijuana users had an average age of 37.4 years, even distribution across genders, were more likely to be white and more likely to be elective admissions (p<0.001). Marijuana use has been linked to alterations in platelet function and coagulation cascade. Our data reveals that marijuana users have a higher prevalence of DVT and PE than the general population. They were at no increased risk of mortality which may be attributed to patients being younger on average. Further studies need to be conducted to determine whether these patients undergo more interventions and suffer from subsequent complications.

High incidence of common femoral Deep Vein Thrombosis in critically ill Covid19 patients.

To estimate the incidence and prevalence of deep venous thrombosis, and to evaluate the discriminative capacity of D-dimer in its diagnosis. The prospective, observational study was conducted at the critical care unit of a tertiary care hospital in Pakistan from February to September 2021 and comprised consecutively admitted adult critically ill patients who were receiving therapeutic-dose anticoagulation therapy. All patients were screened on day one for deep venous thrombosis by colour doppler and compression ultrasonography. Patients who did not have deep venous thrombosis on the first scan were followed every 72 hours. Data was analysed using SPSS 26. Of the 142 patients, 99(69.7%) were male and 43(30.3%) were female. The overall mean age was 53.20+/-13.3 years. On the first scan, 25(17.6%) patients had deep venous thrombosis. Of the remaining 117 patients, 78(68.4%) were followed every 72 hours, and 23(29.48%) of them developed deep venous thrombosis. The most common site for DVT was the common femoral vein 46(95.8%) and most deep venous thrombosis cases were unilateral 28(58.33%). D-dimer levels showed no discriminative capacity for diagnosis of deep venous thrombosis (p=0.79). There were no significant risk factors for the development of deep venous thrombosis. There was a high incidence and prevalence of deep venous thrombosis despite therapeutic-dose anticoagulation therapy. The most common affected site was the common femoral vein and most deep venous thrombosis were unilateral. D-dimer levels had no discriminative capacity for the diagnosis of deep venous thrombosis DVT.

Prevalence of venous thromboembolism in patients undergoing diagnostic venous ultrasound during the first SARS-CoV-2 pandemic.

Background: Venous thromboembolism appears to be associated with severe COVID-19 infection than in those without it. However, this varies considerably depending on the cohort studied. The aims of this single-centre, multi-site retrospective cross-sectional study were to assess the number of all venous scans performed in the first month of pandemic in a large university teaching hospital, to evaluate the incidence of deep venous thrombosis (DVT), and assess the predictive ability of the clinical information available on the electronic patient record in planning work-up for DVT and prioritising ultrasound scans. Patients and methods: All consecutive patients undergoing venous ultrasound for suspected acute DVT between 1st of March and 30th of April 2020 were considered. Primary outcome was the proportion of scans positive for DVT; the secondary outcomes included association of a positive SARS-CoV-2 PCR test, demographic, clinical factors, and Wells scores. Results: 819 ultrasound scans were performed on 762 patients across the Trust in March and April 2020. This number was comparable to the corresponding pre-pandemic cohort from 2019. The overall prevalence of DVT in the studied cohort was 16.1% and was higher than before the pandemic (11.5%, p=.047). Clinical symptoms consistent with COVID-19, irrespective of the SARS-CoV-2 PCR test result (positive_COVID_PCR OR 4.97, 95%CI 2.31-10.62, p<.001; negative_COVID_PCR OR 1.97, 95%CI 1.12-3.39, p=.016), a history of AF (OR 0.20, 95%CI 0.03-0.73, p=.037), and personal history of venous thromboembolism (VTE) (OR 1.95, 95%CI 1.13-3.31, p=.014), were independently associated with the diagnosis of DVT on ultrasound scan. Wells score was not associated with the incidence of DVT. Conclusions: Amongst those referred for the DVT scan, SARS-CoV-2 PCR test was associated with an increased risk of VTE and should be taken into consideration when planning DVT work-up and prioritising diagnostic imaging. We postulate that the threshold for imaging should possibly be lower.

Prevalence and incidence of deep venous thrombosis and pulmonary embolism in 2 regions in Turkey (A sub-analysis of CAT-TR study)

Aim: Venous thromboembolism (VTE) is a relatively common public health problem. In addition to increasing mortality due to complications, it also causes an increase in the cost of the country's economy and loss of labor due to the morbidity it creates. Considering that the recurrence of VTE is a common condition, the importance of this disease for the society increases even more. Although we have come a long way in treatment and follow-up, we see that VTE and its related complications maintain their place as a significant risk factor in the society at increasing rates. Material and Methods: This is an additional analysis of a multicentral, retrospective descriptive study, CAT-TR (Assessment of Patient Characteristic in Cancer Associated Venous Thrombosis in Turkey). The aim of the CAT-TR study was to evaluate patient characteristic and treatment patterns of cancer-induced VTE in Turkey. This article aims to evaluate the incidence and prevalence of cancer-induced VTE in two regions of Turkey between January 01, 2016 and December 31, 2019. Results: In our study, the 4-year prevalence of Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) in Central Anatolia and Marmara was 86.43, 103.56 and 105.68, 98.04 per 100.000 people, respectively. The cumulative incidence of cancer-related VTE in the Central Anatolian and Marmara populations is 17.22 and 6.71 per 100.000 people, respectively. Conclusion: The values we found in the prevalence and incidence study of VTE will be very valuable in terms of being a reference for us in the treatment and prevention of the disease. We believe that this study will shed light on new studies for diseases that may cause VTE in larger populations and strategies to be followed in prevention.

Concomitant thrombosis in patients with cellulitis as incidental finding.

Although inflammation and thrombosis are tightly connected, only 45% of patients with lower leg cellulitis receive anticoagulant therapy. Available data about the prevalence of concomitant deep venous thrombosis (DVT) in patients with cellulitis of the lower extremity is scarce and general guidelines regarding diagnosis and prevention of venous thromboembolism are missing. We sought to determine how frequently DVT occurs as an incidental finding in patients with cellulitis and to provide recommendations for diagnostics and anticoagulant therapy. Patients' records were analysed and 192 consecutive patients with cellulitis were included in this study. The prevalence of concomitant DVT was examined by duplex ultrasound, as well as comorbidities and risk factors. We detected thrombosis in 12.0% of the patients with lower leg cellulitis, of which 43.5% were located in a proximal vein and 52.2% in the veins of the calf. Our results clearly indicate that cellulitis is not only a differential diagnosis, but should be considered a risk factor for venous thrombosis. Therefore, prophylactic anticoagulation should be considered in patients suffering from cellulitis and a systematic screening for venous thrombosis in patients with cellulitis should be performed.

Distribution of Lower Extremity Deep Vein Thrombosis and Implications for Limited Compression Ultrasound Examinations

BackgroundLimited compression bedside ultrasonography (LCUS) including two-point, three-point, and extended compression examinations have become increasingly popular among emergency physicians to assess for lower extremity deep venous thrombosis (DVT). ObjectiveOur objective in this study was to determine the prevalence and distribution of lower extremity DVT in sites identified by complete duplex ultrasonography (CDUS) that may potentially be missed using limited compression ultrasonography techniques. MethodsThis was a retrospective, multicenter study conducted at 12 hospitals within the Northwell Health system over a span of 4 years. Study participants (emergency department patients) underwent CDUS to assess for possible DVT. Images were reviewed and interpreted by radiologists and vascular surgeons at each of the participating institutions. ResultsA total of 42,487 CDUS examinations were performed, of which 3383 were positive for DVT. DVTs were deemed to be acute in 2664 (79%) and chronic in the remaining 21% on the basis of comparison with previous studies and appearance of the vein. Of the acute DVTs, 136 (5.1%) were confined to the common femoral vein, 116 (4.4%) to the femoral vein, 8 (0.3%) to deep femoral vein, 213 (8.0%) to popliteal vein, and 934 (35.1) to calf veins alone. ConclusionsIn our study, a significant number of DVTs were identified in sites that may have been potentially missed on LCUS examinations, thereby supporting the use of complete duplex ultrasonography when available.

The THROMB-HEM study: first results and future prospects

THROMB-HEM is an observational research study discovering the prevalence, risk factors and features of the course and therapy of deep venous thrombosis (DVT) in children with hemoblastosis and bone marrow aplasia which was conducted on from 2012 to 2017 on the basis of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Aim: assessment of the DVT prevalence in children with hemoblastosis and and bone marrow aplasia based on the results of the THROMB-HEM study. The cumulative incidence rate (CIR) of objectively confirmed DVT, symptomatic (sDVT) and asymptomatic (aDVT) DVT in was assessed in children hospitalized in the center from 01.01.2013 to 12.31.2017 in order to verify and treat various hemoblastosis and bone marrow aplasia. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Data from 1623 patients were included for CIR DVT analysis. Among the patients included in the event analysis, DVT was detected in 361 children (285 aDVT and 73 sDVT, in 3 cases there were no data on the clinical picture of DVT). The maximum patient observation time was 5 years. The median follow-up time for patients was 332.15 days (95 % confidence interval (CI) 295.65–379.60). At the third year of follow-up, CVR DVT was 34.8 % (95 % CI 31.3–38.7), CVR aDVT was 28.9 % (95 % CI 25.7–32.5), while sDVT was 8.2 % (95 % CI 5.8–11.5). Unlike aDVT, most sDVT occurred within the first 6 months of therapy. DVT, mostly aDVT, is a common finding in children receiving inpatient treatment for hemoblastosis and bone marrow aplasia, which dictates the need for further research to assess risk factors and the effectiveness of therapy and prevention of these complications.

Prevalence of Venous Thromboembolism in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: An Indian Perspective

Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death by 2020. Recent studies reveal that pulmonary embolism (PE) may be a trigger of acute deterioration in patients with COPD. Patients with COPD have approximately twice the risk of PE than those without COPD. The primary objective was to assess the prevalence of venous thromboembolism (VTE) in patients with acute exacerbation of COPD (AE-COPD) in India. We conducted this prospective study on patients admitted for AE-COPD in a tertiary care hospital in Mumbai, India. We considered the prevalence of deep venous thrombosis (DVT) to reflect the occurrence of VTE. The screening tool used was a colour Doppler of the bilateral lower limbs. One hundred patients enrolled, were in stage II to stage IV COPD; 9% had DVT. Eight of these nine patients had unilateral DVT. Two patients had developed PE and died. Our results show a lower prevalence of unsuspected DVT in Indian patients admitted for AE-COPD. Future prospective, randomised studies are needed to confirm the findings of the present study and to determine whether a systematic evaluation for VTE is justified in these patients, and hence, be recommended.

Predictors of Deep Venous Thrombosis in Hospitalized Patients With Liver Cirrhosis in the US.

BackgroundPatients with liver cirrhosis were previously considered as anticoagulated; thus, their risk of developing venous thromboembolism (VTE) is lower. Recently, several studies showed contradicting results regarding deep venous thrombosis (DVT) occurrence in cirrhotic patients. The aim of this study is to evaluate the prevalence and risk associated with developing DVT in hospitalized cirrhotic patients in a large US population.MethodsWe queried the commercial database Explorys (IMB Inc., Armonk, New York), an aggregate of electronic health record data from 26 US healthcare systems. After excluding patients under 20 years old, a cohort of patients with a Systematized Nomenclature of Medicine - Clinical Terms of "cirrhosis of the liver" and "inpatient care" between 2015-2019 were identified, and prevalence of DVT was calculated in the exposure and the control groups. Statistical analysis for a multivariable model was performed. Factors adjusted for include gender, race, obesity, hypoalbuminemia, diabetes mellitus, viral hepatitis, and liver malignancy.ResultsAmong 9,990,290 patients who were hospitalized between 2015 and 2019, 157,400 patients had a diagnosis of liver cirrhosis. The prevalence of DVT in hospitalized patients with liver cirrhosis was 3.29% compared to 3.18% in non-cirrhotic patients. Using the multivariate analysis model, DVT was inversely associated with cirrhosis in hospitalized patients [OR: 0.921; p<0.0001] compared to patients without liver cirrhosis. Predictors of developing DVT among patients with cirrhosis were non-Caucasian race, obesity (BMI>30), liver malignancy, hypoalbuminemia, and diabetes mellitus. Cirrhotic patients due to viral hepatitis were less likely to develop DVT [OR: 0.775; p<0.001] compared to non-cirrhotic patients.ConclusionIn this database, although the prevalence of DVT in cirrhotic hospitalized patients was slightly higher than in non-cirrhotic patients (3.29% vs. 3.18%, respectively), cirrhosis as an independent factor was associated with less risk of DVT during hospitalization. This poses a question regarding DVT prophylaxis necessity in this group of patients. Further studies are needed to clarify the benefit and risks of DVT prophylaxis in cirrhotic patients.

Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patellar fracture

PurposeThis study aimed to investigate the incidence, location, and related factors of preoperative deep venous thrombosis (DVT) in patients with isolated patellar fractures.MethodsPatients with an isolated patellar fracture, admitted between January 2013 and December 2019 at our institution, were retrospectively analyzed. Upon admission, patients underwent routine Doppler ultrasound scanning (DUS) of the bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patients in both groups did not perform preoperative off-bed weight-bearing exercises. Data on demographics, comorbidities, and laboratory test results upon admission were extracted. Variables were evaluated between the two groups using univariate analyses, and independent risk factors associated with DVT were identified by logistic regression analysis.ResultsDuring the study period, 827 patients were included, of whom 5.8% (48/827) were found to have preoperative DVT. In DVT patients, 85.4%(41/48) were injured, 8.3%(4/48) were not injured, and 6.3%(3/48) were lower limbs. Multivariate analysis showed that male (male vs. female, odds ratio, OR = 2.25), delayed from injury to DUS (in each day, OR = 1.29), and elevated plasma D-dimer level (> 0.5 µg/mL, OR = 2.47) were independent risk factors associated with DVT.ConclusionsDespite the low prevalence of DVT after an isolated patellar fracture, this study underscores the importance of identifying those with a high risk of DVT, especially those with multiple identifiable factors, and encourage the early targeted use of anti-thromboembolic agents to reduce DVT occurrence.

Prevalence of Deep Venous Thrombosis in Abdominoplasty Patients after COVID-19 Convalescence: An Alarming Flag.

Background:The incidence of thrombotic manifestations during aesthetic procedures may be overwhelming, as it may endanger patients’ lives. Lipoabdominoplasty is one of the precarious aesthetic treatments with risk for thrombosis. COVID-19 convalescent patients may have an abnormally high rate of thrombotic events, which should be studied further. Patients with a history of COVID-19 infection who undergo the aesthetic procedure may have a greater risk of thrombosis than non-COVID-19 patients who undergo lipoabdominoplasty.Methods:Thirty-seven patients who underwent lipoabdominoplasty were followed retrospectively for the occurrence of thrombotic events postoperatively and their relationship to previous COVID-19 infection. The study design comprised an examination of their medical records for prior COVID-19 infection, a history of thrombotic events before, during, or following COVID-19 infection, and D-dimer levels during and after COVID-19 infection. Thrombotic signs were studied in COVID-19 convalescent and non-COVID-19 patients following lipoabdominoplasty. The universal prophylactic measures for anticoagulation were followed.Results:Four patients out of 37 (10.18%) had thrombotic manifestations, with a high incidence in the COVID-19 convalescent group. The occurrence rate in COVID-19 patients was 30.7%, much higher than the global rate (0.2%). The presence of D-dimers was discovered to be abundant.Conclusion:Additional precautions should be taken to closely monitor patients with a prior history of COVID-19 infection who seek aesthetic surgery, particularly riskier procedures such as lipoabdominoplasty.

Prevalence and Clinical Characteristics of Proximal Deep Venous Thrombosis After a High-Density Coronavirus Disease 2019 Cluster in a Japanese Psychiatric Hospital.

The prevalence of deep venous thrombosis (DVT) among hospitalized psychiatric patients after coronavirus disease 2019 (COVID-19) infection remains unclear.Methods and Results:We retrospectively investigated the prevalence of proximal DVT after COVID-19 infection among 50 hospitalized patients in a Japanese psychiatric hospital that in which a COVID-19 cluster developed between August and September 2020. The prevalence of proximal DVT was 10.0%. Patients with proximal DVT had a lower body weight and higher maximum D-dimer levels and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE scores. After COVID-19 infection, hospitalized psychiatric patients are at high risk of DVT and should be carefully followed up.