Distribution Of Deep Vein Thrombosis Research Articles

Incidence and Distribution of Deep Vein Thrombosis Following Total Hip Arthroplasty Using an Anterolateral Supine Approach.

Venous thromboembolism (VTE) is a potential major complication in patients undergoing total hip arthroplasty (THA). However, the incidence of VTE following THA using anterolateral supine approach (ALS) has not been reported. The purpose of this study was to investigate the incidence of perioperative VTE and the distribution and characteristics of deep vein thrombosis (DVT) following ALS THA. This retrospective single-arm study analyzed the 182 consecutive hips of 164 patients who underwent primary ALS THA. Pharmacological prophylaxis consisted of enoxaparin 20 mg twice daily for approximately 6 days starting 24 h postoperatively until duplex ultrasonography was performed to determine whether postoperative DVT was present. DVT was assessed by whole-leg Doppler ultrasound, and the location and characteristics of any thrombus were recorded. If pulmonary thromboembolism was suspected, contrast-enhanced computed tomography was performed. The overall incidence of VTE was 9.9% for DVT (18/182 hips) and 0.5% for pulmonary thromboembolism (1/182 hips). Most DVTs were in the soleal vein on the affected side and showed isoechoic or hypoechoic echogenicity. All thrombi were non-floating. Following ALS THA with standard pharmacological prophylaxis and an early weight-bearing protocol, the incidence of perioperative DVT was approximately 10%, mostly occurring in the lower leg.

Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy.

Background:Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome.Purpose:To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO.Study Design:Case-control study; Level of evidence, 3.Methods:This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model.Results:Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 (P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 (P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 (P = .786) at 2 years after surgery in patients without and those with DVT, respectively.Conclusion:The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.

DVT: Exploring prevalence and rates of malignancy

The Department of Health estimates the annual incidence of deep vein thrombosis (DVT) in the UK to be 1 in 1000, rising with age. Various studies have suggested that approximately 10–20% of patients with DVT are diagnosed with a malignancy before, or at the time of a thrombotic event. This prospective study investigates the prevalence of various factors affecting the occurrence of DVT in patients. All patients diagnosed with DVT at the acute medical unit at Hillingdon Hospital between September 2014 and February 2015 were studied with the use of proforma data collection. The information collection was analysed with SPSS software. The majority of patients with DVT were white males with restricted mobility and an underlying malignancy. It was found that the distribution of DVT for age, sex, ethnicity and risk factors (such as malignancy) was quite similar to previous studies. The physician in primary and secondary care should be aware of the possibility of occult malignancy in DVT patients with similar circumstances.

The anatomical distribution of lower extremity deep vein thrombosis after total knee and hip arthroplasty

Objective To analyze the anatomical distribution of lower extremity deep vein thrombosis (DVT) after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).Methods Data of 272 patients with lower extremity DVT confinned by venography after TKA and THA performed from June 2007 to May 2012 in our hospital were retrospectively analyzed.There were 110 cases in TKA group and 162 cases in THA group.The anatomical distribution of lower extremity DVT after TKA and THA was analyzed and compared.Results In TKA group,there were 10 cases of central DVT,6 cases of mixed DVT,and 94 cases of peripheral DVT.In THA group,there were 3 cases of central DVT,19 cases of mixed DVT,and 140 cases of peripheral DVT.There was a significant difference between two groups in the distribution of DVT.In all DVT patients,intramuscular veins were involved most frequently (71.0％,193/272),followed by posterior tibial veins (36.0％,98/272),peroneal veins (31.3％,85/272),anterior tibial veins (8.8％,24/272),popliteal veins (8.8％,24/272),and iliofemoral veins (7.4％,20/272).For patients with peripheral DVT,the isolated DVT was more frequent in THA group,while multiple DVT was more common in TKA group,and the differences were significant between two groups.No isolated DVT was found in anterior tibial veins.In patients with multiple DVT,the thrombi were commonly found in two or three of posterior tibial veins,peroneal veins and intramuscular veins.Conclusion There is a significant difference in the anatomical distribution of DVT after TKA and THA. Key words: Venous thrombosis; Phlebography; Arthroplasty, replacement

Anatomic Distribution of Deep Vein Thrombosis in Pregnancy

There is a high risk of pulmonary embolism (40%–50%) in patients with proximal deep vein thrombosis (DVT), and maternal morbidity and mortality may be high among women with untreated or unrecognized embolism. Evidence exists that the anatomic distribution of DVT in nonpregnant and pregnant patients may differ, with important clinical implications for optimizing diagnostic imaging protocols. In nonpregnant patients, prospective studies have shown that most DVTs of the lower extremity develop in the calf vein and further extend proximally; the majority of nonpregnant patients with a proximal thrombosis have involvement of the calf veins, and isolated proximal vein thrombi are uncommon. The typical anatomic distribution of DVT in pregnant patients is less clear. The primary aim of this systematic review of the medical literature was to determine the anatomic distribution of DVT of the lower extremity in symptomatic pregnant patients. Previously published studies of cohorts of pregnant women with DVT were examined using MEDLINE (1966–2009), Embase (1980–2009), and the Cochrane Library. Data were extracted from articles that were case series or observational cohorts of 3 or more participants, in which a DVT was diagnosed using objective techniques in unselected or consecutive pregnant women. In all, 6 articles meeting the criteria for inclusion were identified from an initial list of 1098 titles. A total of 124 women had been given a diagnosis of DVT; venography was used in 55 patients, whereas compression ultrasonography was the primary mode of diagnosis for 69 patients. The most common site for acute DVT was the proximal veins without involvement of calf veins (87/122; 71%); in 56 (64%) of these 87 patients, thrombosis was restricted to the iliac and/or femoral vein. Overall, 84 (88%) of the 96 patients (for whom the affected side was reported) had involvement of the left leg. These findings strongly suggest a difference in the anatomic distribution of DVT in pregnant versus nonpregnant women. The data confirm previous findings that, in contrast to the situation in nonpregnant individuals during pregnancy, most DVTs are proximal and restricted to the femoral or iliac veins, and most are on the left side.

Anatomic distribution of deep vein thrombosis in pregnancy

Prospective studies of nonpregnant patients have demonstrated that most deep vein thromboses of the lower extremity originate in the calf veins and progress proximally, but the anatomic distribution of thromboses in pregnant patients is unclear. An understanding of the anatomic distribution of deep vein thrombosis in pregnancy has important implications for optimizing diagnostic imaging protocols. We undertook this study to determine the anatomic distribution of deep vein thrombosis of the lower extremity in symptomatic pregnant patients. We systematically searched MEDLINE (1966 to January 2009), Embase (1980 to January 2009) and the Cochrane Library using prespecified criteria to identify articles providing objective diagnostic and anatomic information for unselected or consecutive symptomatic pregnant patients with deep vein thrombosis. Six articles from an initial list of 1098 titles met the inclusion criteria. These articles provided information for 124 pregnant women with a diagnosis of deep vein thrombosis. Overall, involvement of the left leg was reported in 84 (88%) of the 96 patients for which the side affected was known, and 87 (71%) of 122 thromboses were restricted to the proximal veins without involvement of the calf veins. Among these cases of proximal deep vein thrombosis, 64% (56/87) were restricted to the iliac and/or femoral vein. Despite a paucity of studies in this area, the results of our review suggest that the anatomic distribution of deep vein thrombosis in pregnant women differs from that for nonpregnant patients. In addition to what was previously known--that left-sided deep vein thrombosis is more common in pregnancy--we also found that proximal deep vein thrombosis restricted to the femoral or iliac veins is also more common (> 60% of cases). If confirmed by larger studies, these findings could affect our understanding of the pathophysiology and derivation of diagnostic algorithms for examination of pregnant women with suspected deep vein thrombosis.

Presence of Lower Limb Deep Vein Thrombosis and Prognosis in Patients with Symptomatic Pulmonary Embolism: Preliminary Report

Objectives To investigate the presence of lower limb deep vein thrombosis (DVT) and prognosis in patients with symptomatic pulmonary embolism (PE). Materials and methods A total of 203 consecutive referral patients with PE were included. The distribution of DVT was evaluated with compression ultrasound (CUS), and all patients were then followed for 12 months for investigation of recurrence of venous thromboembolism (VTE) and fatal events as adverse outcome. Results The mean age of the patients was 62.8 years, and 78 (38.4%) were males. DVT was found in 118 (58.1%) patients. Of these patients, 61 (30.0%) had proximal DVT. Multivariate analysis demonstrated that active cancer, inadequate anticoagulation, leg symptoms, male gender, presence of DVT, presence of proximal DVT, and previous DVT were independent risk factors for adverse outcome. A clinical risk score ranging from 0 to 10 points was generated on the basis of multivariate regression coefficients. Receiver operating characteristic curve analysis showed that an appropriate cut-off point for discriminating between the presence and the absence of an adverse event was 4. Using this category, 166 (81.8%) patients were classified as low risk and 37 (18.2%) as high risk for adverse outcome. The adverse event rates were 6.0% for the low-risk group and 59.5% for the high-risk group. Conclusions This study has confirmed the clinical significance of surveillance CUS in patients with a first episode of PE. Furthermore, a simple risk score on the basis of available variables can identify patients at risk of an adverse outcome in patients with PE.

Uses of different D-dimer levels can reduce the need for venous duplex scanning to rule out deep vein thrombosis in patients with symptomatic pulmonary embolism

This study investigated the prevalence and distribution of deep vein thrombosis (DVT) in patients with symptomatic pulmonary embolism (PE) to establish a screening protocol to reduce unnecessary venous duplex scanning using different D-dimer level rather than single cutoff point of 0.5 microg/mL in patients with low and moderate pretest clinical probability (PTP). The PTP score and D-dimer testing were used to evaluate 85 consecutive patients with symptomatically proven PE before venous duplex scanning. After calculating the PTP score, patients were divided into low (<or=0 points), moderate (1 to 2 points), and high (>or=3 points) PTP groups. The receiver operating characteristic (ROC) curves analysis was used to determine the appropriate D-dimer cutoff point in low and moderate PTP, with a negative predictive value of >98%. The study enrolled 81 patients. The prevalence of DVT was 63%, with 27 patients (33%) classified as low, 38 (47%) as moderate, and 16 (20%) as high PTP. DVT was detected in nine patients (33%) in the low PTP group, in 27 (71%) in the moderate group, and in 15 (94%) in the high group. In the low PTP patients, the difference in the value of D-dimer assay between positive-scan and negative-scan patients was statistically significant (9.99 +/- 7.33 vs 3.46 +/- 4.20, respectively; P = .008). Conversely, no significant difference in the D-dimer assay value between positive and negative scan results was found in the moderate PTP patients. ROC curves analysis were used to select D-dimer cutoff points of 2.0 microg/mL for the low PTP group and 0.7 microg/mL for the moderate PTP groups. For both groups, D-dimer testing provided 100% sensitivity and 100% negative predictive value in the diagnosis of DVT. In the low PTP group, specificity increased from 33% to 67% (P = .046). In the moderate PTP group, however, the determined D-dimer level did not improve the specificity. Overall, venous duplex scanning could have been reduced by 17% (14/81) by using different D-dimer cutoff points. A combination of specific D-dimer level and clinical probability score is most effective in the low PTP patients in excluding DVT. In the moderate PTP group, however, the recommended cutoff point of 0.5 microg/mL may be preferable. These results show that a different D-dimer level is more useful than single cutoff point of 0.5 microg/mL in excluding DVT in established PE patients.

Seasonal variation in deep vein thrombosis

In many temperate countries coronary events and stroke, as well as related deaths, are more common in winter than in summer.1 Fatal pulmonary embolism has also been reported more often in winter.2 3 This might be linked to changes in coagulation factors4 and to peripheral vasoconstriction, leading to reduced blood flow in the legs.5 Alternatively, venous stasis due to vasodilatation is greatest in summer. These uncertainties prompted us to study the seasonal distribution of deep vein thrombosis of the legs by reviewing the month of presentation of all patients with this diagnosis referred to our vascular laboratory over six years. All files coded as “suspected” deep vein thrombosis (n=7303, mean (SD) age 63 (19), 58% women, 85% medical patients) or “confirmed” deep vein …

The Phlebographic Distribution of Deep Venous Thrombosis in the Calf and its Relevance to Duplex Ultrasound

Objective: To assess the distribution of deep vein thrombosis in the calf by phlebography. Setting: Department of Vascular Radiology, St. Thomas' Hospital, London, England. Patients: Seventy patients with suspected deep vein thrombosis or pulmonary embolism were examined. Interventions: Bilateral ascending contrast phlebography was performed in all patients. Main Outcome Measures: The sites of any thrombus in the stem or muscle veins of the calf below the popliteal vein were recorded. Results: One hundred legs contained thrombus. In fifty-three legs thrombus was present solely in the calf veins below the popliteal vein. Isolated thrombus in either one or more of the three paired stem veins or the muscle veins was present in twenty-two calves. Conclusions: Because of the difficulty in visualising some calf veins by duplex ultrasound it is suggested that a detailed knowledge of the distribution of thrombus may assist ultrasonographers.