Diagnosis Of Deep Vein Thrombosis Research Articles

Postmarketing Surveillance of Inferior Vena Cava Filters Among US Medicare Beneficiaries: The SAFE-IVC Study.

Inferior vena cava filters (IVCFs) are commonly used to prevent pulmonary embolism in selected clinical scenarios, despite limited evidence to support their use. Current recommendations from professional societies and the US Food and Drug Administration endorse timely IVCF retrieval when clinically feasible. Current IVCF treatment patterns and outcomes remain poorly described. To evaluate temporal trends and practice patterns in IVCF insertion and retrieval among older US patients and report the incidence of periprocedural and long-term safety events of indwelling and retrieved IVCFs. Prespecified, retrospective, observational cohort of Medicare Fee-for-Service (FFS) beneficiaries, leveraging 100% of samples of inpatient and outpatient claims data from January 1, 2013, to December 31, 2021. First-time IVCF insertion while insured by Medicare FFS. The primary safety outcome was the composite of all-cause death, filter-related complications (eg, fracture, embolization), operating room visits following filter-related procedures, or new diagnosis of deep vein thrombosis (DVT). Events were considered periprocedural if they occurred within 30 days of IVCF insertion or retrieval and long-term if they occurred more than 30 days after. Among 270 866 patients with IVCFs placed during the study period (mean age, 75.1 years; 52.8% female), 64.9% were inserted for first-time venous thromboembolism (VTE), 26.3% for recurrent VTE, and 8.8% for VTE prophylaxis. Of these patients, 63.3% had major bleeds or trauma within 30 days of IVCF insertion. The volume of insertions decreased from 44 680 per year in 2013 to 19 501 per year in 2021. The cumulative incidence of retrieval was 15.3% at a median of 1.2 years and 16.8% at maximum follow-up of 9.0 years. Older age, more comorbidities, and Black race were associated with a decreased likelihood of retrieval, whereas placement at a large teaching hospital was associated with an increased likelihood of retrieval. The incidence of caval thrombosis and DVT among patients with nonretrieved IVCFs was 2.2% (95% CI, 2.1%-2.3%) and 9.2% (95% CI, 9.0%-9.3%), respectively. The majority (93.5%) of retrieval attempts were successful, with low incidence of 30-day complications (mortality, 0.7% [95% CI, 0.6%-0.8%]; filter-related complications, 1.4% [95% CI, 1.2%-1.5%]). In this large, US real-world analysis, IVCF insertion declined, yet retrievals remained low. Strategies to increase timely retrieval are needed, as nonretrieved IVCFs may have long-term complications.

Gout or Deep Vein Thrombosis: Expanding Differential Diagnosis and Avoiding Anchoring Bias

Diagnostic reasoning is a critical skill for a nurse practitioner. Cognitive biases influence nurse practitioner decision making, and anchoring bias is the most common cognitive error. Cognitive error is a systematic deviation from optimal decision making or errors in thinking from reliance on mental shortcuts known as heuristics. Anchoring bias is when initial information dominates decision making, neglecting alternative diagnoses. This case describes a patient with pain, redness, and swelling in the left ankle, attributing it to a gout flare-up. To avoid anchoring on this diagnosis, reflective practice considered alternatives such as deep vein thrombosis. Reflective practice involves examining one’s experiences and adopting a critical perspective toward one’s own methods and practice. The patient was referred to the emergency department where a diagnosis of deep vein thrombosis was confirmed. This case underscores the importance of acknowledging cognitive biases and implementing debiasing strategies.

Evaluation of Lower Extremity Venous Doppler Ultrasonography Outcomes Before And After The COVID-19 Pandemic; A Retrospective Study

Objectives: COVID-19 PCR positivity has been reported among asymptomatic individuals and asymptomatic people are also considered to be at risk for thromboembolic events. The aim of this study was to compare the results of patients who underwent lower extremity Doppler ultrasonography (DUS) with a preliminary diagnosis of deep vein thrombosis (DVT) before and after the pandemic, regardless of COVID-19 PCR testing. Methods: Patients who underwent RDUS in the Department of Radiology during a total period of 35 months (01/08/2018 - 01/07/2021) were analyzed. A total of 599 patients underwent RDUS during the study period. Results: More pozitif DVT findings were observed after the pandemic (n=43, 18.3%, p=0.005) (only two of these patients had a positive COVID-19 PCR result). History of hospitalization in the last three months, D-dimer, PLT, MPV, WBC, neutrophil count, lymphocyte count, NLR values, comorbidity and antiaggregant use were not different (p>0.05). Conclusion: Even individuals (especially elderly individuals) who have been exposed to the virus during the pandemic but who do not show symptoms are at risk of DVT.

Clinical significance and underlying mechanism of long non-coding RNA SNHG12 in lower extremity deep venous thrombosis.

D-dimer is widely used in the diagnosis of deep vein thrombosis (DVT), but the specificity is low. The study examined the diagnostic value of long non-coding RNA (lncRNA) SNHG12 in DVT, and preliminarily discussed its mechanism. SNHG12 levels were detected in 200 elderly fracture patients via RT-qPCR, including 38 DVTs. Logistic regression analysis and receiver operating characteristic (ROC) curve were applied for diagnostic value evaluation. HUVECs were used for function study. Cell proliferation, migration, apoptosis, release of inflammatory cytokines, and adhesion factors were detected. Student's t test and one-way ANOVA were applied for data comparison between two or among three or more groups. Correlation analysis of indicators was completed via Pearson's correlation analysis. Bioinformatics analysis predicted the target miRNAs and genes of SNHG12, with GO and KEGG for the function enrichment. It was found that SNHG12 was at low expression in DVT patients, and negatively correlated with D-dimer concentration (r = -0.535). SNHG12 and D-dimer were independent influence factors related to the development of DVT. SNHG12 and D-dimer combination had the best performance in DVT diagnosis. In HUVECs, SNHG12 promoted cell proliferation and migration and restricted the release of inflammatory cytokines and adhesion factors, but these influences were counteracted by miR-424-5p. A total of 208 overlapping target genes of miR-424-5p were identified, and their function was enriched in cellular cycle and senescence. PI3K-Akt signaling pathway was the most significant pathway based on KEGG results. In conclusion, SNHG12 had good diagnostic potential for DVT combined with D-dimer. SNHG12 maintains vascular endothelial cell function by acting as a competitive endogenous RNA (ceRNA) for miR-424-5p.

Development and internal validation of a simple clinical score for the estimation of the probability of deep vein thrombosis in outpatient emergency department patients.

BackgroundWells score comprises subjective elements, which can lead physicians reluctant to use Wells score or use it incorrectly. ObjectivesTo develop and internally validate a prediction score that is objective and simple for evaluating suspected deep vein thrombosis (DVT), with a safety comparable to Wells score. MethodsWe performed a post-hoc analysis using data from the Ri-Schedule study (NCT02486445), involving suspected DVT patients at Østfold Hospital’s Emergency Department, Norway (2015-2018). Candidate variables were identified through bootstrapping technique, with a confirmed DVT diagnosis as the outcome variable. Sensitivity, specificity, negative and positive predictive values (NPV and PPV) were estimated and compared to the two-tier Wells score. ResultsAmong 1312 patients (median age: 64 years (IQR 52-73), 55% women), 19.9% were diagnosed with DVT. Exploration of 30 variables identified tenderness along deep veins and previous venous thromboembolism as significant predictors (selection frequency>60% in 1000 bootstrapping samples). The derived score categorized 450 patients with zero items as unlikely to have DVT, in whom 8.0% were diagnosed with DVT, compared to 8.2% in DVT-unlikely category according to Wells score. Compared to Wells score, the derived score demonstrated sensitivity of 86.2 (81.4-90.2) vs 80.1 (74.7-84.8), specificity of 39.4 (36.4–42.4) vs 55.3 (52.2-58.3), NPV of 92.0 (89.4–94.0) vs 91.8 (89.7-93.5) and PPV of 26.1 (24.8-27.5) vs 30.8 (28.9-32.8). When incorporating D-dimer cut-off <0.5, the derived score had sensitivity of 99.6 (97.9-99.9), specificity of 16.1 (13.1–18.4), NPV of 99.4 (96.0-99.9) and PPV of 22.8 (22.3-23.3). ConclusionsThe derived DVT score, with two objective variables, had a comparable safety to that of the Wells score. However, an external validation is mandated prior to clinical use.

Novel Strategy for Human Deep Vein Thrombosis Diagnosis Based on Metabolomics and Stacking Machine Learning.

Deep vein thrombosis (DVT) is a serious health issue that often leads to considerable morbidity and mortality. Diagnosis of DVT in a clinical setting, however, presents considerable challenges. The fusion of metabolomics techniques and machine learning methods has led to high diagnostic and prognostic accuracy for various pathological conditions. This study explored the synergistic potential of dual-platform metabolomics (specifically, gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS)) to expand the detection of metabolites and improve the precision of DVT diagnosis. Sixty-one differential metabolites were identified in serum from DVT patients: 22 from GC-MS and 39 from LC-MS. Among these, five key metabolites were highlighted by SHapley Additive exPlanations (SHAP)-guided feature engineering and then used to develop a stacking diagnostic model. Additionally, a user-friendly interface application system was developed to streamline and automate the application of the diagnostic model, enhancing its practicality and accessibility for clinical use. This work showed that the integration of dual-platform metabolomics with a stacking machine learning model enables faster and more accurate diagnosis of DVT in clinical environments.

Thrombosis and Thrombotic Risk in Athletes.

The hemostatic system is characterized by a delicate balance between pro- and anticoagulant forces, and the smallest alteration can cause serious events such as hemorrhages or thrombosis. Although exercise has been shown to play a protective role in athletes, several factors may increase the risk of developing venous thromboembolism (VTE), including hemoconcentration induced by exertion, immobilization following sports injuries, frequent long-distance flights, dehydration, and the use of oral contraceptives in female athletes. Biomarkers such as D-dimer, Factor VIII, thrombin generation, inflammatory cytokines, and leukocyte count are involved in the diagnosis of deep vein thrombosis (DVT), although their interpretation is complex and may indicate the presence of other conditions such as infections, inflammation, and heart disease. Therefore, the identification of biomarkers with high sensitivity and specificity is needed for the screening and early diagnosis of thromboembolism. Recent evidence about the correlation between the intensity of physical activity and VTE is divergent, whereas the repeated gestures in sports such as baseball, hockey, volleyball, swimming, wrestling, or, on the other hand, soccer players, runners, and martial art training represent a risk factor predisposing to the onset of upper and lower DVT. Anticoagulant therapy is the gold standard, reducing the risk of serious complications such as pulmonary embolism. The aim of this review is to provide a general overview about the interplay between physical exercise and the risk of thromboembolism in athletes, focusing on the main causes of thrombosis in professional athletes and underlying the need to identify new markers and therapies that can represent a valid tool for safeguarding the athlete's health.

Abilities of diagnostic tools for deep vein thrombosis of the lower extremities in stroke patients (literature review)

One of the significant causes of disability and mortality both in Russia and around the world remains acute cerebral circulatory disorders, which combines ischemic and hemorrhagic strokes, and transient ischemic attack. Deep vein thrombosis (DVT) has a significant prevalence in patients with stroke, and venous thromboembolism (VTE) significant impact on the prognosis. The development of technologies, the emergence of new research methods made it possible to accurately determine the presence of DVT in patients with stroke using duplex ultrasound, using reserve methods, if necessary — CT, MRI, CV. However, there is currently no data that would allow to effectively determine the timing for the diagnosis of DVT in patients with stroke, as well as to identify patients who need such evaluation. Additional studies are needed to determine the timing of the screening for DVT, by assessing the prevalence of DVT in various periods of stroke, as well as evaluating the identifying factors.

AI-guided DVT diagnosis in primary care: protocol for cohort with qualitative assessment.

Deep vein thrombosis (DVT), a formation of blood clots within deep veins, mostly of the proximal lower limb, has an annual incidence of 1-2 per 1000. Patients who are affected by multiple chronic health conditions and who experience limited mobility are at high risk of developing DVT. Traditional DVT diagnosis involves probabilistic assessment in primary care, followed by specialised ultrasound scans (USS), mainly conducted in hospitals. The emergence of point-of-care ultrasound (POCUS), coupled with artificial intelligence (AI) applications, has the potential to expand primary care diagnostic capabilities. To assess the accuracy and acceptability of AI-guided POCUS for DVT diagnosis when performed by non-specialists in primary care. Diagnostic cross-sectional study coupled with a qualitative evaluation conducted at primary care DVT clinics. First, a diagnostic test accuracy (DTA) study will investigate the accuracy of AI-guided POCUS in 500 individuals with suspected DVT, performed by healthcare assistants (HCAs). The reference standard is the standard of care of USS conducted by sonographers. Second, after receiving both scans, participants will be invited to complete a patient satisfaction survey (PSS). Finally, semi-structured interviews with 20 participants and four HCAs, and three sonographers will explore the acceptability of AI-guided POCUS DVT diagnosis. This study will rigorously evaluate the accuracy and acceptability of AI-guided POCUS DVT diagnosis conducted by non-specialists in primary care.

The Application Value of the D-Dimer Critical Value in Diagnosing Deep Vein Thrombosis in Patients with Bone Trauma.

D-dimer is used as a clinical indicator to predict venous thromboembolism, and some hospitals have included it in the critical value project. We aimed to evaluate whether the setting of a D-dimer critical value is helpful in the diagnosis of deep vein thrombosis in patients with bone trauma and to explore the rationality of setting a D-dimer critical value limit. The clinical data of 4,897 bone trauma patients, hospitalized from April 1, 2022, to March 31, 2023, were retrospectively analyzed. Our hospital set the critical value limit for when the D-dimer value was greater than 15.0 mg/L, and Bayesian model was used to evaluate the relationship between deep vein thrombosis and the D-dimer limit. During this period, 199 times the D-dimer detection value was greater than 15.0 mg/L, and the critical value was reported and accounted for 4.06%. The predicted probability of lower limb venous thrombosis in patients who triggered the critical value of D-dimer was 40.21%, and the actual incidence was 34.67%. There were 376 patients with lower limb venous thrombosis during hospitalization, and 81.38% of the D-dimer value did not reach the critical value limit. The role of D-dimer as a critical value item in predicting DVT in patients with orthopedic trauma is small. Whether to list D-dimer as a critical value item can be comprehensively considered according to the own situation of medical institutions and the recommendations of clinicians. The same can be applied for the setting of critical value boundaries.

Discovery of crucial cytokines associated with deep vein thrombus formation by protein array analysis

BackgroundExpanding the number of biomarkers is imperative for studying the etiology and improving venous thromboembolism prediction. In this study, we aimed to identify promising biomarkers or targeted therapies to improve the detection accuracy of early-stage deep vein thrombosis (DVT) or reduce complications.MethodsQuantibody Human Cytokine Antibody Array 440 (QAH-CAA-440) was used to screen novel serum-based biomarkers for DVT/non-lower extremity DVT (NDVT). Differentially expressed proteins in DVT were analyzed using bioinformatics methods and validated using a customized array. Diagnostic accuracy was calculated using receiver operating characteristics, and machine learning was applied to establish a biomarker model for evaluating the identified targets. Twelve targets were selected for validation.ResultsCytokine profiling was conducted using a QAH-CAA-440 (RayBiotech, USA) quantimeter array. Cross-tabulation analysis with Venn diagrams identified common differential factors, leading to the selection of 12 cytokines for validation based on their clinical significance. These 12 biomarkers were consistent with the results of previous array analysis: FGF-6 (AUC = 0.956), Galectin-3 (AUC = 0.942), EDA-A2 (AUC = 0.933), CHI3L1 (AUC = 0.911), IL-1 F9 (AUC = 0.898), Dkk-4 (AUC = 0.88), IG-H3 (AUC = 0.876), IGFBP (AUC = 0.858), Gas-1 (AUC = 0.858), Layilin (AUC = 0.849), ULBP-2 (AUC = 0.813)and FGF-9 (AUC = 0.773). These cytokines are expected to serve as biomarkers, targets, or therapeutic targets to differentiate DVT from NDVT.ConclusionsEDA-A2, FGF-6, Dkk-4, IL-1 F9, Galentin-3, Layilin, Big-h3, CHI3L1, ULBP-2, Gas-1, IGFBP-5, and FGF-9 are promising targets for DVT diagnosis and treatment.

Commentary on “Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopedic and Sports Academies”

Commentary on “Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopedic and Sports Academies”

Two-point Compression POCUS sebagai Metode Diagnosis Dini Trombosis Vena Dalam Proksimal

Deep vein thrombosis (DVT), especially in the proximal part of the lower extremity, might progress to pulmonary embolism and be fatal. Therefore, it is crucial to prompt the diagnosis of DVT in the emergency room (ER). Due to its efficiency and patient convenience, duplex ultrasound has become the preferred diagnostic method for DVT. Point-of-care ultrasonography (POCUS) was known as a simpler and faster way to use ultrasonography at the bedside. The two-point compression method has become frequently used due to its ability to take less time for examination, yet there are still concerns about its accuracy. This study was conducted to find out whether two-point compression POCUS can be used as an early diagnostic method for proximal DVT. The literature search was carried out in the databases PUBMED, EMBASE, and SCOPUS on March 29, 2023, using keywords “Deep Vein Thrombosis”, “two-point compression POCUS”, and “diagnosis”. Four publications were chosen from the search results. One cross-sectional study was found to have a low validity value because POCUS and Doppler ultrasound operators were not blinded, and the reference test was only performed on positive DVT results on POCUS. All studies had high sensitivity and specificity (&gt;90%) compared to the reference test, except for one cross-sectional study in critical patients in ICU, which had a 63% sensitivity value. In conclusion, the two-point compression POCUS method can be utilized as an early diagnostic method for proximal DVT, with the disclaimer that POCUS operators should get curriculum-based training before doing the examination.

Emergency medicine residents’ learning curve in diagnosing deep vein thrombosis with 3-point venous point-of-care ultrasound

BackgroundMany cases of deep vein thrombosis (DVT) are diagnosed in the emergency department, and abbreviated lower extremity venous point-of-care ultrasound (POCUS) has already shown an accuracy comparable to that of specialists. This study aimed to identify the learning curve necessary for emergency medicine (EM) residents to achieve expertise-level accuracy in diagnosing DVT through a 3-point lower extremity venous POCUS.MethodsThis prospective study was conducted at an emergency department between May 2021 and October 2022. Four EM residents underwent a one-hour POCUS training session and performed DVT assessments in participants with DVT symptoms or confirmed pulmonary embolism. POCUS was performed at three proximal lower extremity sites to evaluate the thrombi presence and vein compressibility, with results validated by specialized radiology ultrasound. Cumulative sum (CUSUM) and the Bush and Mosteller models were used to analyze the learning curve, while generalized estimating equations were used to identify factors affecting diagnostic accuracy.Results91 POCUS scans were conducted in 49 patients, resulting in 22% DVT confirmed by specialized venous ultrasound. In the CUSUM analysis, all four EM residents attained a 90% success rate at the common femoral vein, whereas only half achieved this rate when all three sites were considered. According to Bush and Mosteller models, 13–18 cases are required to attain 90–95% diagnostic accuracy. After 10–16 cases, the examination time for each resident decreased, and a 20% increase in examiner confidence was linked to a 2.506-fold increase in the DVT diagnosis accuracy.ConclusionEM residents generally required 13–18 cases for 90–95% DVT diagnostic accuracy, but proficiency varied among individuals, particularly requiring more cases for regions outside the common femoral vein.

Preliminary clinical analysis and pathway study of S100A8 as a biomarker for the diagnosis of acute deep vein thrombosis

Herein, we aimed to identify blood biomarkers that compensate for the poor specificity of D-dimer in the diagnosis of deep vein thrombosis (DVT). S100A8 was identified by conducting protein microarray analysis of blood samples from patients with and without DVT. We used ELISA to detect S100A8, VCAM-1, and ICAM-1 expression levels in human blood and evaluated their correlations. Additionally, we employed human recombinant protein S100A8 to induce human umbilical vein endothelial cells and examined the role of the TLR4/MAPK/VCAM-1 and ICAM-1 signaling axes in the pathogenic mechanism of S100A8. Simultaneously, we constructed a rat model of thrombosis induced by inferior vena cava stenosis and detected levels of S100A8, VCAM-1, and ICAM-1 in the blood of DVT rats using ELISA. The associations of thrombus tissue, neutrophils, and CD68-positive cells with S100A8 and p38MAPK, TLR4, and VCAM-1 expression levels in vein walls were explored. The results revealed that blood S100A8 was significantly upregulated during the acute phase of DVT and activated p38MAPK expression by combining with TLR4 to enhance the expression and secretion of VCAM-1 and ICAM-1, thereby affecting the occurrence and development of DVT. Therefore, S100A8 could be a potential biomarker for early diagnosis and screening of DVT.

Risk of recurrent venous thromboembolism and bleeding in patients with acute isolated subsegmental pulmonary embolism

IntroductionApproximately 10 % of all diagnosed pulmonary embolism are isolated to the subsegmental vessels. The risk of recurrent venous thromboembolism (VTE) in patients with an acute subsegmental pulmonary embolism (SSPE) managed with or without anticoagulant therapy remains poorly understood. MethodsThis is an observational cohort study including consecutive adult patients diagnosed with acute isolated SSPE between June 01, 2019, and August 31, 2022. We excluded patients with a concomitant diagnosis of deep vein thrombosis and those who had an indication for long-term anticoagulation. The primary outcome was objectively confirmed recurrent VTE. ResultsOverall, 118 patients with acute SSPE were included in the analysis. The mean (± standard deviation [SD]) age of the participants was 59 ± 17 years and 44 % of them had active cancer. Mean (±SD) duration of follow-up was 438 ± 426 days. Seventy-seven patients (65 %) were initially treated with anticoagulation, whereas 41 patients (35 %) were not. Of the 77 patients receiving anticoagulant therapy, 23 (30 %) received extended-duration anticoagulation (beyond 3 months) for secondary prevention. Overall, recurrent VTE events occurred in 6/118 (5 %, 95 % CI 2.4 to 10.7) patients. Four events (4/77 = 5.2 %, 95 % CI 2.0 to 12.6) occurred in initially treated patients. Two recurrent VTE occurred in patients initially left untreated (2/41 = 4.9 %, 95 % CI 1.4 to 16.1). Half of the recurrent VTE occurred in patients with active cancer. ConclusionsMost patients diagnosed with an acute SSPE received anticoagulation. The incidence of recurrent VTE detected over time was relatively high, especially in patients with cancer.

AN UNUSUAL “BLACKBERRY SHAPED” MASS OF DUBIOUS INTERPRETATION (OUT OR IN THE JUGULAR VEIN?) IN A PATIENT WITH METASTATIC MELANOMA. A SPECIAL IMAGING CLINICAL CASE

Abstract A 43 y–o woman, without cardiovascular risk factors, was diagnosed with BRAF+ IIIC melanoma of unknown origin with bilateral axillary lymph node metastases. She started a combined treatment with vemurafenib, cobimetinib (braf/mek inhibitors) and atezolizumab (PDL1 inhibitor) as neoadjuvant therapy, followed after 6 weeks by surgical treatment (that showed pathological complete response) and adjuvant immunotherapy with atezolizumab hitherto ongoing. A serial CT–scan revealed a 0.9x1.3 cm mass (Fig.1) close to the right jugular vein (RJV) with increased contrast enhancement susceptible of vessel ectasia by the radiologist who expressed uncertainty about its site (intra or extravascular?) and asked for further imaging assessment. Therefore, a duplex ultrasound (DU) was performed with the detection of a 0.6x1.2 cm endovascular mobile “blackberry shaped” mass in the RJV and the indication for a vascular surgery evaluation. The patient started enoxaparin 1 mg/Kgx2/die s.c. according to “ex iuvantibus therapy”. However, the vascular surgeon diagnosis confirmed the undetermined site of the mass. The patient decided for a second DU opinion and reached our Cancer Angiology Lab, where a novel DU detected a deep vein thrombosis (DVT) of the RJV (Fig.2–Fig.3). Enoxaparin was replaced with edoxaban 60 mg 1 cp/die since the patient preferred a more manageable root of administration for the requested long–term anticoagulant treatment. After 2 months a DU follow up showed no regression of the mass. Accordingly, the patient proceeded with edoxaban 60 mg/die without any side effects, whereas still in treatment with immunotherapy. Conclusions Thromboembolism is the second leading cause of death in malignancy. Overall, biomarkers and thrombotic risk factors related to patient, tumor and anticancer regimens favor the development of cancer associated thrombosis. Delay in DVT diagnosis and, mostly, in the initiation of a full and long–term anticoagulant treatment, like in this case, enables a chronic evolution of the clot which makes its timely regression more challenging.

Safety and Efficacy of Direct Oral Anticoagulants vs Warfarin in Patients With Obesity and Venous Thromboembolism: A Retrospective Analysis.

Current venous thromboembolism guidelines recommend using direct oral anticoagulants (DOACs) over warfarin regardless of obesity status; however, evidence remains limited for the safety and efficacy of DOAC use in patients with obesity. This retrospective analysis sought to demonstrate the safety and efficacy of DOACs compared with warfarin in a diverse population of patients with obesity in light of current prescribing practices. A retrospective cohort study was conducted at a large academic health system between July 2014 and September 2019. Adults with an admission diagnosis of deep vein thrombosis (DVT) or pulmonary embolism, with weight greater than 120 kg or a body mass index greater than 40, and who were discharged on an oral anticoagulant were included. Outcomes included occurrence of a thromboembolic event (DVT, pulmonary embolism, or ischemic stroke), bleeding event requiring hospitalization, and all-cause mortality within 12 months following index admission. Out of 787 patients included, 520 were in the DOAC group and 267 were in the warfarin group. Within 12 months of index hospitalization, thromboembolic events occurred in 4.23% of patients in the DOAC group vs 7.12% of patients in the warfarin group (hazard ratio, 0.6 [95% CI, 0.32-1.1]; P = .082). Bleeding events requiring hospitalization occurred in 8.85% of DOAC patients vs 10.1% of warfarin patients (hazard ratio, 0.93 [95% CI, 0.57-1.5]; P = .82). A DVT occurred in 1.7% and 4.9% of patients in the DOAC and warfarin groups, respectively (hazard ratio, 0.35 [95% CI, 0.15-0.84]; P = .046). No significant differences could be determined between DOACs and warfarin for cumulative thromboembolic or bleeding events, pulmonary embolism, ischemic stroke, or all-cause mortality. The risk of DVT was lower with apixaban and rivaroxaban. Regardless of patient weight or body mass index, physicians prescribed DOACs more commonly than warfarin.

Diagnosis and treatment of deep vein thrombosis of the lower and upper limbs. 2024 recommendations of the venous thromboembolism group of the Spanish Society of Internal Medicine

Deep vein thrombosis (DVT) of the limbs is a common disease and causes significant morbidity and mortality. It is frequently the prelude to pulmonary embolism (PE), it can recur in 30% of patients and in 25–40% of cases they can develop post-thrombotic syndrome (PTS), with a significant impact in functional status and quality of life. This document contains the recommendations on the diagnosis and treatment of acute DVT from the Thromboembolic Disease group of the Spanish Society of Internal Medicine (SEMI).PE and thrombosis of unusual venous territories (cerebral, renal, mesenteric, superficial, etc.) are outside its scope, as well as thrombosis associated with catheter and thrombosis associated with cancer, which due to their peculiarities will be the subject of other positioning documents of the Thromboembolic Disease group of the Spanish Society of Internal Medicine (SEMI).

Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopaedic and Sports Academies

PURPOSE: Venous thromboembolism can present as either a deep vein thrombosis (DVT) or a pulmonary embolism. The purpose of this study was to determine if there was a difference in physical therapists' estimation of the probability of a patient having a DVT in patient vignettes as compared with the modified Wells criteria prediction. METHODS: Members of the American Academy of Orthopaedics, Academy of Orthopaedic Physical Therapists (AOPT), and American Academy of Sports Physical Therapy (AASPT) completed patient vignettes. Descriptive statistics were calculated, and sign tests assessed for differences between responses of the presence of DVT (likely or unlikely) and whether referral was necessary. RESULTS: Six hundred and seventy consented, and 521 completed the survey of 24,028 members from the AOPT and AASPT. In total, 7.2% did not feel competent to screen for DVT. Descriptive statistics revealed difficulty in determining whether a DVT was likely or unlikely in 4/5 vignettes as compared with the modified Wells criteria, with only vignette 2 having 95.9% correctly answering as DVT being unlikely. In the other 4 vignettes, approximately 60% to 70% of respondents estimated DVT to be likely, despite 2 of these being unlikely. Across the vignettes, between 2.3% and 19.2% more respondents chose to refer when they determined if a DVT was likely. Across vignettes, statistically significant differences between DVT being likely or unlikely and decision to refer were present. Respondents consistently chose to refer even when a DVT was unlikely (P &lt; .001 for vignettes 1, 3–5. P = .038 for vignette 2). CONCLUSIONS: Venous thromboembolisms are potentially life-threatening conditions seen by physical therapists. Members of the AOPT and AASPT have difficulty in determining the presence or absence of DVT in clinical case vignettes, with some demonstrating a conservative management decision to refer despite low probability of DVT. Efforts to educate members should be considered to improve the understanding of DVT assessment. Clinical Pearls: Members of the AOPT and AASPT appear to have difficulty in determining the presence of a DVT in clinical patient vignettes. Respondents chose to refer patients perhaps with conservative caution. Efforts to educate therapists should be considered to improve the understanding of DVT assessment.