Diagnosis Of Deep Vein Thrombosis Research Articles

The Impact of Winter Months on Venous Thromboembolism (VTE) Patients: A Retrospective Analysis of Hospital Outcomes in the United States.

Objective: We aimed to analyze the Health Care Utilization Project’s (HCUP) Nationwide Inpatient Sample (NIS) and compare mortality rates in hospitals by month to determine if there is seasonal variability in outcomes associated with venous thromboembolism (VTE).Methods: The Nationwide Inpatient Sample database was queried from 1998 to 2011. Inclusion criteria were a diagnosis of deep vein thrombosis (DVT) (ICD-9 {International Classification of Diseases, Ninth Revision, Clinical Modification} 453.4, 453.8) and/or VTE (ICD-9 415.1) in patients aged 18 years or more. Admission data was then analyzed to compare mortality rates in teaching and non-teaching hospitals over that time and by month. Demographics, Charlson Comorbidity Index, length of stay (LOS), hospital region, and admission types (emergent/urgent versus elective admissions) were assessed. Linear and logistic models were generated for complex survey design to analyze predictors of mortality and LOS.Results: A total of 1,449,113 DVT/VTE cases were identified in the Nationwide Inpatient Sample (weighted n= 7,150,613), 54.7% female, 56.38% white, 49% in teaching hospitals. Higher mortality was found in the months of November 6.52%, December 6.9%, January 6.94%, and February 6.93% versus overall mortality of 6.4% over 12 months. Higher mortality was noted in these winter months in all regions, along with a significantly increased LOS. Mortality in the total cohort was found to be higher in January, with odds ratio (OR) 1.11 (1.08-1.15), p<0.0001; February, OR 1.11 (1.07-1.15), p<0.0001; and December, OR 1.10 (1.06-1.14), p<0.0001 compared to June. Mortality was significantly lower in the Midwest or North Central regions (OR 0.78 {0.72-0.83}, p<0.0001) and West (OR 0.80 {0.73-0.87}, p<0.0001) compared to the Northeast. Mortality was also significantly higher in teaching hospitals than in non-teaching hospitals (OR 1.16 {1.10-1.22}, p<0.0001), with mortality trending higher in teaching hospitals each month. Emergent/urgent admission, larger hospital size, female sex, age, and urban location were also significantly associated with increased mortality.Conclusions: This national study identified an increased risk of mortality associated with hospitalizations for DVT/VTE in the winter months, independent of hospital teaching status or region.

Ultrasound screening for asymptomatic deep vein thrombosis in critically ill patients: a pilot trial

Deep vein thrombosis (DVT) in critically ill patients still represents a clinical challenge. The aim of the study was to investigate whether a systematic ultrasound (US) screening might improve the management of the antithrombotic therapy in intensive care unit (ICU). In this non-randomized diagnostic clinical trial, 100 patients consecutively admitted to ICU of the University Hospital of Perugia were allocated either in the screening group or in the control group. Subjects in the screening group underwent US examination of lower limbs 48 h after admission, and again after 5 days. Subjects in the control group underwent US examination according to the standard of care (SOC) of the enrolling institution. Retrospectively registered at ClinicalTrials.gov (NCT05019092) on 24.08.2021. Lower limb DVT was significantly more frequent in the screening group (p < 0.001), as well as the subsequent extension of a pre-existing DVT (p = 0.027). In the control group, DVT of large veins was more frequent (p = 0.038). Major bleedings were reported in 5 patients, 4 in the non-screening group and in 1 in the screening group. Patients in the screening group started the antithrombotic treatment later (p = 0.038), although the frequency, dose and duration of the treatment were not different between the two groups. The duration of stay in ICU was longer in the screening group (p = 0.007). Active screening for DVT is associated with an increased diagnosis of DVT. The screening could be associated with a reduced incidence of proximal DVT and a reduction in the bleeding risk.

Prevalence and risk factors of preoperative deep venous thromboembolism in spinal fracture

To investigate the incidence of lower extremity deep vein thrombosis (DVT) before surgery in patients with spinal fracture and analyze its risk factors. The clinical data of 1 046 patients with spinal fracture who underwent surgery from October 2017 to December 2020 were retrospectively analyzed, including patient's age, gender, body mass index (BMI), smoking history, complications, the time from injury to diagnosis of DVT, blood index results on admission. The complications included hypertension, osteoporosis, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), anemia, obesity, hypokalemia, hyponatremia, hypoproteinemia, renal insufficiency, spinal cord injury;blood index results on admission included hematocrit (HCT), creatinine (Cre), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein(LDL), D-dimer(D-D), fibrin/fibrinogen degradation products(FDP), and C-reactive protein(CRP). The patients were divided into group according to whether DVT was diagnosed by the lower extremity venous ultrasonography after admission to pre-operation. The patients with DVT were set as the DVT group, and the patients without DVT were set as the non-DVT group. First, the above-mentioned possible risk factors were analyzed by univariate analysis, and then the risk factors of DVT before spinal fracture surgery were analyzed by multivariate Logistic regression. Among 1 046 patients with spinal fracture, 137 had DVT before operation and 909 had no DVT. There were significant differences in age, the incidence of preoperative osteoporosis, diabetes, anemia, hypoalbuminemia, the levels of LDL, plasma D-D, FDP, and CRP between the two groups (P<0.05). Multivariate Logistic regression analysis showed that osteoporosis (OR=3.116, 95%CI:1.816-5.346, P<0.001), hypoproteinemia (OR=2.508, 95%CI:1.583-3.974, P<0.001), preoperative serum LDL>4.645 mmol/L(OR=2.586, 95%CI:1.394-4.798, P<0.001), plasma D-D>558.00 ng/ml (OR=23.916, 95%CI:15.108-37.860, P<0.001), FDP>13.81 µg/ml(OR=3.873, 95%CI:2.614-5.739, P<0.001) and age were independent risk factors for the occurrence of DVT before spinal fracture surgery, and the incidence of DVT in patients aged 36-50, 51-65 and over 65 years was 2.49, 2.59 and 4.02 times of those aged 18-35 years, respectively. The incidence of preoperative DVT in patients with spinal fracture is 13.10%(137/1 046). Preoperative complicating osteoporosis, hypoalbuminemia, serum LDL>4.645 mmol/L, plasma D-D> 558.00 ng/ml, FDP> 13.81 µg/ml and age are risk factors for DVT. And the older the patient, the higher the risk of DVT.

P56. Incidence of venous thromboembolism after spine surgery at a tertiary care hospital

<h3>BACKGROUND CONTEXT</h3> Spine surgery is considered a moderate risk for developing Venous Thromboembolism (VTE), with an incidence that ranges from 0.5% to as high as 32% depending on the location and the type of surgery done. To our knowledge, no study has been done to determine the incidence of VTE in our local population. <h3>PURPOSE</h3> We aim to study this and determine the factors associated with developing VTE post spine surgery. <h3>STUDY DESIGN/SETTING</h3> We utilized a retrospective chart review study design to collect and analyze all adult patients who underwent spine surgery at our level 1 trauma center. <h3>PATIENT SAMPLE</h3> Convenient sampling technique was used. <h3>OUTCOME MEASURES</h3> Postoperative deep vein thrombosis.Postoperative Pulmonary Embolism. Association between age, length of hospital stay, duration to ambulation and incidence of DVT or PE. <h3>METHODS</h3> A retrospective chart review was conducted to analyze 892 adult patients who were admitted and underwent either an elective or emergency spine surgery at our level 1 trauma center between 2016-2019. Demographics, length of surgery and hospital stay, diagnosis, type, and location of surgery in addition to the type of trauma, if applicable, were collected. Furthermore, spiral computed tomography was used to diagnose pulmonary embolism (PE), and duplex ultrasound was used to diagnose deep vein thrombosis (DVT) pre- and postoperatively. <h3>RESULTS</h3> A total of 800 patients were included. Our sample was predominantly male at 422 patients (52.8%) with a mean age for both genders of 49.8 ± 18.8 years. Mean BMI was 28.9 ± 7. The overall incidence of VTE was found to be 4.1%, with 1.3% of them occurring postoperatively. In addition, lumbar spine was the most common location operated on (Table 1). Increasing age and length of hospital stay were both significantly associated with development of VTE. Furthermore, cervical spine surgery had a lower incidence of VTE compared to other locations which was statistically significant. Lastly, non-ambulatory patients had a higher risk of having VTE compared to patients who were able to ambulate postoperatively (Table 2). <h3>CONCLUSIONS</h3> The incidence of VTE after spine surgery is considered low. Nevertheless, it is a complication that carries high rates of morbidity and mortality. Increased age and prolonged hospital stay increases its risk while early ambulation lowers it. Larger prospective study is needed to identify the best prophylactic anticoagulation regimen. Prophylactic measures against VTE are highly recommended, especially amongst high-risk patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Efficacy and safety of sonographer discretion to terminate a venous duplex ultrasound for diagnosis of deep vein thrombosis in coronavirus disease 2019 patients

ObjectiveSonographers performing venous duplex ultrasound (VDUS) of patients with coronavirus disease 2019 (COVID-19) have an increased risk of exposure owing to their close contact with these patients for an extended period. The objective of the present study was to evaluate the efficacy of a modified COVID-19 VDUS protocol to reduce sonographer exposure to COVID-19 patients. MethodsWe performed a single-center retrospective review. Patients who had undergone VDUS under the modified COVID-19 protocol between March 1, 2020, and June 30, 2020, with a confirmed or presumed COVID-19 diagnosis at the VDUS were included. The modified COVID-19 protocol was defined as the ability of the sonographer to terminate the examination on detection of an acute deep vein thrombosis (DVT). The primary outcome measures were the number of anatomic deep venous segments recorded by the sonographer, which was used as a surrogate measure for sonographer exposure time, and the number of acute DVTs found on follow-up examinations in segments not visualized at the index VDUS. ResultsA total of 160 lower extremity VDUS (LEVDUS) scans and 72 upper extremity VDUS (UEVDUS) scans were performed using the modified COVID-19 protocol. The index VDUS had found an acute DVT for 44 of 160 patients (27.5%) who had undergone LEVDUS and 26 of 72 (36.6%) who had undergone UEVDUS. On follow-up imaging, 7 of 38 LEVDUS scans (17.9%) and 1 of 10 UEVDUS scans (10%) had demonstrated a new acute DVT. Malignancy and surgery 30 days before imaging were significantly associated with acute lower extremity DVT, and mechanical ventilation and extracorporeal membrane oxygenation were associated with acute upper extremity DVT. On the index VDUS, the average was 10.6 of 12 total visualized segments on LEVDUS and 6.4 of 10 total segments on UEVDUS. Of the index VDUS scans, 35.6% of the LEVDUS and 78.6% of the UEVDUS scans had been abbreviated. The index VDUS scans that were positive for acute DVT had had significantly fewer visualized segments for both lower (8.4 vs 11.5; P < .0001) and upper (4.2 vs 7.6) extremities (P < .0001). On the follow-up examinations, only one of eight new acute DVTs had been found in a patient whose index VDUS had been abbreviated and the corresponding segment not assessed. These findings did not affect the patient’s clinical course. ConclusionsThe modified COVID-19 VDUS protocol reduced sonographers’ potential exposure time to COVID-19. Additionally, the clinical efficacy was maintained, with no missed DVTs, despite the abbreviation of the VDUS examinations.

A systematic review of biomarkers among hospitalized patients with COVID‐19 predictive of venous thromboembolism: A communication from the Predictive and Diagnostic Variables Scientific and Standardization Committee of the ISTH

BackgroundThrombosis is reported to occur more often among patients with COVID‐19 than otherwise expected in the setting of viral pneumonia and sepsis. Systemic inflammatory biomarkers may be associated with venous thromboembolism (VTE) risk. The ISTH subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease aimed to report the evidence on prognostic biomarkers for VTE in hospitalized patients with COVID‐19. MethodsUsing a standardized Preferred Reporting Items for Systematic Reviews and Meta‐analysis methodology, we conducted a systematic literature review to identify studies reporting prognostic biomarkers for VTE among hospitalized patients with COVID‐19. Eligible studies included adults hospitalized with COVID‐19 and reported the prognostic associations between any biomarker measured on admission, and the subsequent diagnosis of deep vein thrombosis or pulmonary embolism. Two authors reviewed titles and abstracts, and three authors extracted study data and performed review of bias. Results were displayed descriptively. Meta‐analysis was not possible. ResultsFrom the initial 196 identified studies, full‐text review was performed for 72 studies. Admission D‐dimer levels were associated with VTE during hospitalization in five studies, and elevated platelet count was associated with VTE during hospitalization in one study. The risk of bias ranged from low to high for included studies. Overall, there was a paucity of high‐quality prognostic studies. Studies on other biomarkers did not meet the systematic review inclusion criteria. ConclusionsAdmission D‐dimer was associated with VTE diagnosis during hospitalization for COVID‐19; however, prospective validation of this finding is needed to identify optimal D‐dimer thresholds to guide VTE prophylaxis measures.

Comparison of the Effects of Injectable Enoxaparin With Oral Rivaroxaban in Deep Vein Thrombotic Prophylaxis in Patients With Femoral Peritrochanteric Fracture: A Randomized Clinical Trial

Objectives: The prevalence of deep vein thrombosis (DVT) following orthopedic major surgery, such as peritrochanteric femoral fracture, is high. Also, there is a lack of accurate information about the results of using rivaroxaban in Iran. This study aimed to compare the effects of injectable enoxaparin with oral rivaroxaban in DVT prophylaxis in patients with femoral peritrochanteric fracture. Materials and Methods: This randomized single-blind clinical trial included 88 patients with femoral peritrochanteric fracture in Shohada Hospital of Tabriz, Iran from January 2019 to December 2019. The participants were randomly allocated into two equal groups (n=44 each) receiving enoxaparin (40 mg subcutaneously once daily for 28 days) and rivaroxaban (10 mg orally once daily for 28 days). Using independent t test in SPSS version 20, the results of clinical examinations and ultrasonography for the diagnosis of DVT at the end of intervention were compared between the two groups. A P value less than 0.05 was considered as statistically significant. Results: No significant differences were observed in laboratory results and DVT-related symptoms between the two groups, as well as before and after the intervention (intragroup). Also, the prevalence of DVT at the end of the study was zero. Conclusions: According to our results, there was no difference in the prevalence of DVT and short-term (one-month) complications between the two groups receiving rivaroxaban and enoxaparin after the peritrochanteric femur fracture.

Preventive ultrasound diagnosis of deep vein thrombosis of the lower extremities in patients with COVID-19

Aim: The aim of the study was to determine the risk group for detecting early signs of thrombus formation in the veins of the lower extremities during preventive ultrasound examination in patients with COVID-19. Materials and methods: The study included three groups of patients who were in intensive care units for COVID-19, of which 50 with acute venous thrombosis, 50 with venostasis in the veins of the lower extremities, and 50 patients without vein pathology, which constituted the control group. All patients were determined the level of D-dimer, fibrinogen and underwent duplex ultrasound scanning examination of the veins of the lower extremities. Results: A close correlation was established between the presence of venous thrombosis and the levels of D-dimer and fibrinogen (2.33, 4.66, p=0.0001). According to the data obtained, in the examined patients values ​​>=2.33 µg/ml for D-dimer is a sign of thrombus formation with 87.76% sensitivity and 97% specificity. For fibrinogen values 0. ​​>=4.64 g/L are indicative of thrombus formation with 83.67% sensitivity and 83.00% specificity. The two studied parameters D-dimer (AUC area = 0.9458) and fibrinogen (AUC area = 0.9024) were a very high-quality classifier model. Conclusion: The results of this study make it possible to form risk groups for the development of deep vein thrombosis (DVT) and to carry out timely prevention of this pathology. In patients with COVID-19 with severe respiratory failure and elevated levels of D-dimer (more than 2.33 mg/l) and fibrinogen (more than 4.64 g/l) duplex ultrasound is indicated.

Venous thromboembolism as the first sign of malignancy

BackgroundVenous thromboembolism (VTE) is commonly associated with hypercoagulability in patients with cancer; however, there have been few investigations of VTE as the first sign of malignancy and even fewer performed in the United States. The aim of our study was to evaluate the incidence and predictors of unrecognized malignancy in patients presenting with VTE. MethodsWe performed a 1-year retrospective analysis of the Nationwide Readmission Database, including patients aged 18 years or older, presenting with a primary diagnosis of deep vein thrombosis (DVT) or a pulmonary embolism (PE). Patients known to have preexisting malignant diseases were excluded. Outcomes included the rate of newly diagnosed malignancy within 6 months from the discovery of VTE and demographic or associated illness predictors for the diagnosis of malignancy. A regression analysis was performed, based on which a VTE malignancy score was developed. ResultsA total of 116,048 patients were identified with VTE (49.8% DVT, 41.7% PE, 8.6% DVT and PE), 16% (n = 18,294) with malignancy. Of the remaining 97,754 patients, 31% were readmitted within 6 months. The incidence of newly diagnosed malignancy within 6 months was 2.4% (n = 2354). The most common malignancies were gastrointestinal in origin (29.2%). Demographic and diagnostic predictors for malignancy included age 65 years or older, female sex, inferior vena cava (IVC) thrombus, upper extremity thrombus, and a Charlson Comorbidity Index score of 5 or more. Receiver operating characteristic curve analysis found a cutoff VTE Malignancy score of 3 (sensitivity, 86%; specificity, 89%) to be predictive of an increased risk of a newly discovered malignancy within 6 months. ConclusionsVTE can be a risk indicator of underlying malignancy. Validation of a patient risk stratification score using multiple demographic or comorbid predictors for VTE on index admission may offer an opportunity for earlier diagnosis of occult malignancy.

Impact of deep vein thrombosis on adolescent athletes: Navigating an invisible disability

BackgroundInjury in adolescent athletes that threatens their sport participation can result in a sense of identity loss during critical years for identity development, creating the potential for significant mental health challenges. The specific effect of deep vein thrombosis (DVT) in this vulnerable population has not been characterized. PurposeTo describe the impact of DVT diagnosis, treatment, and long‐term complications on the mental well‐being of athletes who sustained a DVT during adolescence and to identify strategies to improve the quality of care for these patients. MethodsUsing a qualitative study design, athletes with a history of DVT during adolescence and their parents were recruited to participate in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. Participants were recruited until reaching thematic saturation. ResultsIn total, 19 participants (12 athletes, 7 parents) were recruited. Athletes were mainly males (67%), median age at time of DVT was 15 years (range, 12–18 years), and median age at study participation was 19 years (range, 16–34 years). Thematic analysis revealed four main themes: Theme 1: DVT posed a threat to sport participation; Theme 2: at a personal level, there were significant mental health challenges; Theme 3: at a societal level, DVT is an invisible disability; and Theme 4: physical, psychological, and transition support are important to improve the care of these patients. ConclusionDeep vein thrombosis threatens an athlete's participation in sport, resulting in a significant and complex impact on their mental well‐being. Heightened awareness and a multidisciplinary approach are needed to help young athletes navigate the consequences of DVT.

P1697: EVALUATION OF THE DIAGNOSTIC PERFORMANCE OF THE TINA-QUANT D-DIMER GEN. 2 IN PATIENTS WITH SUSPECTED DEEP VEIN THROMBOSIS

Background: Combined with clinical pretest probability evaluation, D-dimer is a central element in the diagnostic work-up of suspected deep vein thrombosis (DVT). Different assays are available for the measurement of D-dimer. However, D-dimer assays are not standardized and the results are not comparable among the different assays. Therefore, the cut-off used to discriminate between positive and negative test results should be evaluated assay-wise in each institution. According to our best knowledge, only one study has evaluated the diagnostic performance of Tina-quant D-Dimer Gen. 2 assay in proximal DVT, and this study excluded patients with recurrent DVT. Aims: The aim of our study was to evaluate the diagnostic performance of the Tina-quant D-Dimer Gen. 2 assay (Roche Diagnostics) in the exclusion of all types of DVT, and to compare its performance with the STA-Liatest D-Di Plus (Stago). Methods: In the Ri-Schedule study (Rivaroxaban for Scheduled Work-up of Deep Vein Thrombosis; NCT 02486445), which was a prospective outcome study, D-dimer was measured with STA-Liatest D-Di Plus in 1653 adult patients referred to the Emergency Department at Østfold Hospital with suspected DVT. Exclusion criteria were failure to consent, and previous inclusion in the Ri-Schedule study within the past 3 months. Patients with D-dimer levels ≥ 0.5 µg/mL fibrinogen equivalent units (FEU) were referred to whole-leg compression ultrasonography (CUS) to confirm/exclude the DVT diagnosis. All patients were followed up after 90 days. To evaluate the diagnostic performance of the Tina-quant D-Dimer Gen. 2 assay, stored frozen plasma samples acquired from 1097 patient in the Ri-Schedule study were analyzed on Cobas t711. These samples were withdrawn simultaneously as the sample that were analyzed with the STA-Liatest D-Di Plus on STA-R. The diagnostic performance of the two assays were depicted and compared using test performance parameters and ROC curve. Results: Of the 1097 patients, 730 patients had a positive D-dimer with the Tina-quant D-Dimer Gen. 2, and 775 patients had a positive D-dimer with the STA-Liatest D-Di Plus; cut-off for both tests was ≥ 0.5 µg/mL FEU. DVT diagnosis was confirmed in 210 (19.2%) by CUS examination. The sensitivity and negative predictive value (NPV) for the Tina-quant D-Dimer Gen. 2 assay were 96.2% (95% CI 92.6–98.3) and 97.8% (95% CI 95.8–98.9) respectively; the specificity and positive predictive value (PPV) were 40.5% (95% 37.2–43.8) and 27.7% (95% CI 26.5–28.9) respectively (Table 1). The sensitivity and NPV for the STA-Liatest D-Di Plus assay were 98.1% (95% CI 95.2–99.5) and 98.8% (95% CI 96.8–99.5) respectively (Table 1). ROC curve analysis showed an AUC of 0.85 for both assays, with no significant differences between the assays. Of those with D-dimer value below the cut-off, 8 patients had DVT diagnosed by CUS at time of initial work up or during the subsequent 90 day with Tina-quant as compared with STA-D-Di Plus. Image:Summary/Conclusion: The Tina-quant D-Dimer Gen. 2 assay on Cobas t711 showed an overall good and comparable performance for the exclusion of DVT when compared with STA-Liatest D-Di Plus assay.

Two-point Compression Ultrasound Technique Risks Missing Isolated Femoral Vein DVTs.

BackgroundDeep vein thrombosis (DVT) is a common vascular problem seen in the emergency department (ED) and is commonly identified using ultrasound performed by a vascular lab, the radiology department, or at the point of care. Previous studies have assessed the utility of a two-point vs sequential technique to identify the presence of a thrombus. One particular study reported a concerning rate of isolated femoral vein thrombi that would be missed by a two-point technique.ObjectivesIn this study we sought to determine whether the two-point technique misses isolated femoral vein thrombi.MethodsWe conducted a retrospective review of patients who had a new diagnosis of DVT in the ED diagnosed with vascular lab, radiology, or point-of-care ultrasound to assess for the presence and rate of thrombi that would be missed using a two-point scanning technique.ResultsWe included in our study 356 patients with a diagnosis of new DVT. In our population, 21 (5.9%; 0.95 confidence interval: 3.7%, 8.9%) patients were identified with thrombi isolated to the femoral vein.ConclusionThe two-point technique for lower extremity vascular ultrasound is insufficient for ruling out proximal DVTs in ED patients.

Analysis of incidence/mortality/cost for thrombotic events in hospitalized patients with lung cancer using the National Inpatient Sample database.

12073 Background: Thrombotic events are a common complication of lung cancer. We performed a retrospective analysis of an inpatient adult population (age ≥18) using the National Inpatient Sample (NIS) database from the years 2003-2014. Methods: The analysis was performed on the NIS database, using IBM SPSS Statistics 28.0.0.0 software. The cases for lung cancer were selected based on ICD-9(International Classification of Disease) codes for lung cancer. The cases were weighted by Weight to discharges in the universe. These cases were checked for a diagnosis of acute lower extremity Deep Vein thrombosis (DVT) and acute Pulmonary Embolism (PE) again using ICD-9 codes. Chi square tests were utilized to check the significance of association between mortality and DVT/PE. Independent T-tests were utilized to check the association of cost of hospitalization and length of stay with DVT/PE. Results: There were a total of 4,940,262 cases (53.0% male) of lung cancer from the years 2003-2014. 112,569 (2.3%) cases had a diagnosis of acute lower extremity DVT, and 164,208 (3.3%) cases had a diagnosis of acute PE. Overall, death for lung cancer cases was 516,070(10.5%). Death rate in patients with DVT was 12.4%(frequency = 13,943). DVT and death during hospitalization were positively associated, X 2 (1, N = 4,936,702) = 578.792, p &lt;.001. Rate of death for PE was 15.5% (25,360). PE and death during hospitalization were positively associated as well, X 2 (1, N = 4,936,702) = 4540.012, p.000. DVT was associated with a prolonged length of stay ( M = 8.66 days, SD = 8.8.624), compared to cases without DVT ( M = 6.42 days, SD = 6.42), t(4,940,122) = 115.02, p =.000. DVT was also associated with increased total charges of hospitalization ( M = $ 62,950, SD = 85,105), compared to cases without DVT ( M = $ 41,764, SD = 55,410), t(4,864,517) = 124.09, p =.000. PE was associated with a prolonged length of stay ( M = 8.01 days, SD = 8.13), compared to cases without PE ( M = 6.42 days, SD = 6.41), t(4,940,122) = 97.89, p =.000. PE was also associated with increased total charges of hospitalization ( M = $ 56,161, SD = 76,585), compared to cases without PE ( M = $ 41,772, SD = 55,468), t(4,864,517) = 100.85, p =.000. Conclusions: DVT and PE are common complications of Lung Cancer. They are associated with increased mortality in these patients. DVT increases the mean LOS by 2.24 days, and mean charges by $21,186. PE increases the mean LOS by 1.59 days, and the mean charges by $14,389. Prevention of DVT and PE could help bring down the mortality, LOS and charges of hospitalization. This data provides support to the usage of prophylactic anticoagulation in patients with lung cancer as shown in recent trails with Direct Acting Oral Anticoagulants(DOACs), and further study of DVT/PE in Lung cancer patients would be warranted.

Development of a prediction model for deep vein thrombosis in a retrospective cohort of patients with suspected deep vein thrombosis in primary care

ObjectiveEarly and accurate prediction and diagnosis of deep vein thrombosis (DVT) is essential to allow for immediate treatment and reduce potential complications. However, all potentially strong risk factors have not been included in pretest probability assessments such as the Wells score. In addition, the Wells score might not be suitable for use in primary care because it was developed for secondary care. We hypothesized that the addition of more risk factors for DVT to existing diagnostic approaches could improve the prediction of DVT. MethodsAll consecutive patients suspected of having DVT from 2004 to 2016 in a primary care setting were included in our retrospective study. All the patients had undergone Wells score, D-dimer, and duplex ultrasound assessments. The available recorded data of the patients were used to develop a model to predict DVT. ResultsOf 3381 eligible patients, 489 (14.5%) had confirmed DVT. The developed model, which included the D-dimer level, Wells score, gender, anticoagulation use, age, and family history of venous thrombosis, was able to distinguish patients with DVT among those with suspected DVT with a sensitivity of 82% (95% confidence interval, 78%-86%) and specificity of 82% (95% confidence interval, 80%-83%). ConclusionsThe proposed model was able to predict for the presence of DVT among all patients with suspected DVT in a primary care setting with reasonable accuracy. Further validation in prospective studies is required.

Large-scale genetic correlation scanning and causal association between deep vein thrombosis and human blood metabolites

Deep vein thrombosis (DVT) refers to the abnormal coagulation of blood in a deep vein. Recently, some studies have found that metabolites are related to the occurrence of DVT and may serve as new markers for the diagnosis of DVT. In this study, we used the GWAS summary dataset of blood metabolites and DVT to perform a large-scale genetic correlation scan of DVT and blood metabolites to explore the correlation between blood metabolites and DVT. We used GWAS summary data of DVT from the UK Biobank (UK Biobank fields: 20002) and GWAS summary data of blood metabolites from a previously published study (including 529 metabolites in plasma or serum from 7824 adults from two European population studies) for genetic correlation analysis. Then, we conducted a causal study between the screened blood metabolites and DVT by Mendelian randomization (MR) analysis. In the first stage, genetic correlation analysis identified 9 blood metabolites that demonstrated a suggestive association with DVT. These metabolites included Valine (correlation coefficient = 0.2440, P value = 0.0430), Carnitine (correlation coefficient = 0.1574, P value = 0.0146), Hydroxytryptophan (correlation coefficient = 0.2376, P value = 0.0360), and 1-stearoylglycerophosphoethanolamine (correlation coefficient = − 0.3850, P value = 0.0258). Then, based on the IVW MR model, we analysed the causal relationship between the screened blood metabolites and DVT and found that there was a suggestive causal relationship between Hydroxytryptophan (exposure) and DVT (outcome) (β = − 0.0378, se = 0.0163, P = 0.0204). Our study identified a set of candidate blood metabolites that showed a suggestive association with DVT. We hope that our findings will provide new insights into the pathogenesis and diagnosis of DVT in the future.

Akut ve Subakut Derin Ven Trombozu Hastalarında Tiroid Disfonksiyonu Birlikteliği

Objective: Coagulation anomalies in patients with thyroid dysfunction may vary from subclinical disorders in laboratory tests to life threatening thrombotic events or bleeding. We aimed to determine the effect of thyroid dysfunction on thrombophilia in patients with acute and subacute deep vein thrombosis (DVT).&#x0D; &#x0D; Materials and Methods: A number of 30 patients with the diagnosis of DVT between November 2015 and June 2016 included in this case - control study. The patients divided into two groups as provoked (with known ethiology, n = 13) and unprovoked (with un-known ethiology, n = 17) patients. Provoked patients group divided as the patients with acquired risk factors (predisposition) and/or the patients with genetic risk factors.&#x0D; &#x0D; Results: The difference of the rate of the thyroid dysfunction between the provoked and unprovoked groups was not significant (p=0.844). The PAI – 1 gene mutation was detected in 70% of the study cohort and none of the patients had prothrombin gene mutation. The most provocative factors for DVT were male gender and undergoing a major surgery in the last three months.&#x0D; &#x0D; Conclusions: There was no correlation between acute – subacute DVT and thyroid dysfunction in this study. Therefore, we think that the ‘provocative factors’ may support the relation of thyroid dysfunction and venous thromboembolism (VTE). We think that more studies with larger cohorts and prospective should be conducted about this subject.

Risk of Ipsilateral Deep Vein Thrombosis After Kidney Transplantation: A Retrospective Study.

Objective: To investigate the incidence and characteristics of deep vein thrombosis (DVT) in kidney transplantation recipients and analyze whether the anatomical side of DVT was associated with the side of the transplanted organ.Methods: A single-center retrospective medical record review of patients who received a kidney transplant between January 2004 and July 2019 and who subsequently developed DVT. Only patients who received unilateral kidney transplants were included in the study. Patients who underwent concomitant pancreatic transplants, bilateral kidney transplants, or repeat procedures were excluded.Results: Of the 2449 kidney transplants performed during the study period, 1482 were included in the analysis (948 men [64%]; mean age 61 years). Of 606 duplex ultrasound tests, 115 results confirmed the presence of DVT. The incidence of symptomatic DVT was 4.7%. The most common time of DVT diagnosis was within four weeks after transplantation. Type 2 diabetes, heart failure, acute myocardial infarction, sepsis, chronic obstructive pulmonary disease/abnormal pulmonary function, and being confined to bed were associated with DVT after kidney transplant (all P < 0.05). Patients with ultrasound-confirmed DVT had higher mean Caprini scores than patients with negative duplex ultrasounds (P < 0.5). Approximately 53% of transplant patients with ultrasound-confirmed DVT had a 1:1 correlation of transplant side to the side of DVT. Cohen kappa statistic 0.03 indicated no correlation between the side of DVT and the side of transplant.Conclusions: The incidence of DVT after kidney transplant was lower than the incidence reported in the literature. Being confined to a bed may be a risk factor for DVT after transplant surgery. Kidney transplant recipients who had a positive duplex ultrasound had higher Caprini risk assessment scores than transplant recipients who had negative duplex ultrasounds. There was no correlation between the side of the DVT and the side of the transplant.

Optimal preoperative timing for prevention of deep vein thrombosis (DVT) in patients over 60years of age with intertrochanteric fractures.

To investigate the incidence and risk factors of preoperative DVT in elderly patients with intertrochanteric fracture of the femur and determine the optimal preoperative time. Electronic medical records of 358 patients over 60years of age with intertrochanteric fractures from May 1, 2016, to May 1, 2019, were retrospectively analyzed. The preoperative group was divided into DVT and non-DVT. Univariate analysis was used for preliminary comparison, and multivariate logistic regression analysis was used to identify independent risk factors associated with DVT development. ROC curve was drawn to analyze the specificity and sensitivity of risk factors for DVT diagnosis. The diagnostic value of the model was analyzed by the ROC curve of multivariable combined diagnosis. A total of 358 patients who met the criteria were enrolled. The total prevalence of DVT before surgery was 8.38%. Multivariate logistic regression analysis showed that smoking status, preoperative time, albumin (ALB), D-dimer level, diabetes mellitus, and hypertension were independent risk factors for preoperative DVT. Preoperative time has the best sensitivity and specificity for diagnosing the occurrence of preoperative DVT. The ROC curve analysis model of multivariable combined diagnosis has a better diagnostic value. In this study, elderly patients with intertrochanteric femur fracture had a higher incidence of deep vein thrombosis before surgery. Early identification of DVT-related risk factors may contribute to individualized risk assessment and preventing adverse outcomes in patients with intertrochanteric fractures.

Development and validation of a clinical prediction model for post thrombotic syndrome following anticoagulant therapy for acute deep venous thrombosis

ObjectivesTo identify independent prediction factors for post thrombotic syndrome (PTS) following acute deep vein thrombosis (DVT) and develop a clinical prediction model assessing the risk of PTS in individual patient. MethodsWe prospectively recruited consecutive adult patients with acute DVT who were managed at Shanxi Bethune Hospital, China between June 2014 and December 2016. Investigator assessed PTS using the Villalta scale at 1, 6, 12, 18 and 24 months following diagnosis of DVT. Variable selection was performed by applying the least absolute shrinkage and selection operator (LASSO) with 10-fold cross-validation. Based on these data, we established a clinical prediction model for the development of PTS following DVT. The Bootstrap method was used for internal validation. During the process of model development, we re-collected the information of DVT patients from 2016 to 2017 for a temporal validation. The performance of the prediction model included discrimination and calibration, and clinical utility of prediction model was also evaluated using a decision curve analysis. ResultsA total of 808 consecutive patients with acute DVT were enrolled in the training and validation datasets, of which 540 patients were included in the training dataset for the development of prediction model and the other 268 patients were in the other dataset for temporal validation. Seventy-six patients in training dataset developed PTS. The prediction factors associated with PTS were ilio-femoral DVT (OR = 4.835, 95% CI: 2.471–9.463), active cancer (OR = 3.006, 95% CI: 1.404–6.435), history of chronic venous insufficiency (OR = 7.464, 95% CI: 3.568–15.616), previous venous thromboembolism (OR = 6.326, 95% CI: 2.872–13.932), and chronic kidney disease (OR = 9.916, 95% CI: 2.238–43.937), duration of compression therapy <6 months (OR = 2.894, 95% CI: 1.595–5.251). The c index of the prediction model was 0.825 (0.774–0.877), and the c index of internal validation and temporal verification were 0.816 and 0.773 (95% CI: 0.699–0.848), indicated that the prediction model had a good discrimination in predicting PTS risk following DVT. All the calibration curve showed the model had a good calibration. The decision curve analysis showed a better net benefit of prediction model predicting PTS risk within threshold probability ranged from 0% to 72% and 86% to 98% in training dataset, and 0% to 58% in the validation datasets. ConclusionOur prediction model can accurately estimate the likelihood of PTS risk and identify high-risk patients who may develop PTS following DVT based on individual characteristics, but further external validation is still required.

Contacts with deep vein thrombosis and pulmonary embolism in the Danish healthcare system from 2005-2016

Background: The combination of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), Venous Thromboembolism (VTE), is the third most frequent cardiovascular disease. It can lead to chronic complications and can be lethal in the acute phase. As age is a risk factor for an increasing incidence of VTE, the growing elderly population is expected to increase the number of VTE. With this study, we aimed to investigate the number of VTE contacts in the Danish healthcare system from 2005-2016 with focus on yearly, monthly and daily variation.&#x0D; Methods: We extracted data on patient contacts to all public Danish hospitals in the period from 2005-2016 with a diagnosis of either DVT or PE (ICD-10 diagnosis of I801, I802, I803, I808, I269, I269, I260 or I817D). Data will be presented descriptively as combined numbers but also stratified by weekday, month and year.Results: We observed 57,804 contacts with DVT and 46,161 PE in the study period. DVT contacts was 5,005 (8.7%) in 2005 and decreased by 5.5% to 4,734 (8.2%) in 2016. For PE it we observed an increase of 96.8% from 2,579 (5.6%) in 2005 to 5,075 (11.0%) in 2016. When sampling months of all years, the month with the highest number of contacts for DVT were March with 5,150 (8.9%) and lowest being February with 4,550 (7.9%). For PE it was January with 4,350 (9.4%) and April with 3,505 (7.6%), respectively. Contacts with either DVT or PE was most likely during weekdays, Monday being the higher with 11,096 (19.2%) for DVT and 8,222 (17.8%) for PE. Weekends was least likely with Saturday being the lowest with 5,085 (8.8%) for DVT and 4,301 (9.3%) for PE.&#x0D; Conclusion: Number of patient contacts to Danish hospitals in the period of 2005-2016 has been decreasing for DVT but increased for PE. We found a small variation in contacts with either diagnosis each month. For day of contact, the most likely was Monday and least likely Saturday.