DVT Cases Research Articles

Diagnostic and prognostic potential of long non-coding RNA NORAD in patients with acute deep vein thrombosis and its role in endothelial cell function

BackgroundDeep venous thrombosis (DVT) is the common clinical cardiovascular disease, and easily develops into post-thrombotic syndrome (PTS). The study aimed to examine the clinical value of long non-coding RNA NORAD gene in the development of DVT and PTS. In vitro, the underlying mechanism was explored.MethodsSerum levels of lncRNA NORAD gene in 85 DVT cases and 85 healthy individuals were tested. The role of lncRNA NORAD gene in human umbilical vein endothelial cells (HUVECs) proliferation, migration and inflammation was examined. The candidate downstream target gene was predicted via bioinformatic analysis. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were done for the function annotation and pathway enrichment.ResultsLncRNA NORAD gene was at high expression in the serum of DVT patients, it can distinguish DVT patients from healthy controls with the area under the curve of 0.919. Elevated expression of lncRNA NORAD gene in PTS patients was detected, DVT cases with high expression of lncRNA NORAD gene were more susceptible to PTS. LncRNA NORAD gene knockdown promoted HUVECs’ proliferation, migration while suppressing cell apoptosis and inflammation. MiR-93-5p served as a target of lncRNA NORAD gene, and its overexpression reversed the role of lncRNA NORAD gene in the biological function of HUVECs. The target genes of miR-93-5p were enriched in HIF-1 signaling, TGF-beta signaling and PI3K-Akt signaling, protein-protein interaction (PPI) network indicated STAT3, MAPK1 to be the key targets.ConclusionsUpregulation of expression of lncRNA NORAD gene was a potential diagnostic biomarker for DVT and related to the development of PTS. LncRNA NORAD/miR-93-5p axis was involved in the progress of DVT through regulating endothelial cell function.

Quantification and severity grading of femoral vessel compression by adverse reactions to metal debris in metal-on-metal total hip arthroplasty.

Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions. Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure. MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months-14.5 years). Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD.

The Effect of Serum Electrolyte Levels and Infusion Treatments on the Development of Femoral Central Venous Catheter-Associated Deep Vein Thrombosis in Pediatric Intensive Care Unit.

In this study, we aimed to determine the frequency of symptomatic central venous catheters-associated deep vein thrombosis (CVC-a DVT) among critically ill children with femoral vein implantation in our pediatric intensive care unit (PICU), and to compare the demographic factors, serum electrolyte levels, and types of the infusion treatments performed. A total of 215 patients aged 1 month to 18 years who had femoral CVC implanted between 2019 and 2021 were included in this study. The cases that were clinically symptomatic and had thrombosis diagnosed ultrasonography were accepted as CVC-a DVT (+), and the other cases were considered as CVC-a DVT (-). Of the total 215 cases, 57.2% (n = 123) were female and 42.8% (n = 92) were male. Catheters-associated deep vein thrombosis diagnosis were made in 9.8% of the cases (n = 21). The mean time to diagnose thrombosis in CVC-a DVT (+) cases was 8.33 ± 5.65 days. With regard to gender, age, blood type, intubation status, length of stay on mechanical ventilator, presence of extra hemodialysis catheter, acute and chronic disease status, number of days of PICU hospitalization, and Pediatric Risk of Mortality-3 scoring, no significant differences between CVC-a DVT (-) and CVC-a DVT (+) cases were observed (P > .05). The incidence of thrombosis in refugee cases was found to be significantly higher than in Turkish cases (P = .047; P < .05). There was no statistically significant difference between the groups in baseline, mean, and peak glucose, sodium, and magnesium values and who received magnesium, blood product, inotrope, and 3% hypertonic saline (HTS) infusion (P > .05). No effect of serum glucose, sodium, and magnesium levels on the development of CVC-a DVT was found. Magnesium, blood product, inotrope, and 3% HTS infusion treatments have not been shown to have an effect on the development of CVC-a DVT.

TO ASSESS THE INCIDENCE OF DVT AMONG PATIENTS OF LOWER LIMB SURGERIES /LOWER LIMB TRAUMA ADMITTED TO ST. STEPHEN?S HOSPITAL

Background: This study therefore aimed to assess the incidence of DVT among patients of lower limb surgeries /lower limb trauma admitted to St. Stephen?s hospital&#x0D; Methods: The prospective study was conducted at St Stephen?s hospital from Jan 2019 to December 2019 for duration of 1 year, and 104 patients were part of the study.&#x0D; Results: The overall prevalence of DVT in our study was found to be 2.8%. Out of 3 DVT cases 2 were found in males (3.4%) and 1 was a female (2.1%).&#x0D; Conclusion: There is comparable incidence of DVT in our patients as compared to the incidence found in world literature. There is a need to institute DVT prophylaxis in patients undergoing major lower limb surgeries.&#x0D; Keywords: DVT, Lower limb, Trauma

The anatomic distribution and pulmonary embolism complications of hospital-acquired lower extremity deep venous thrombosis

ObjectiveThe anatomic distribution of lower extremity deep venous thrombosis (LEDVT) plays an important role in its prevention and treatment. This study aimed to evaluate the anatomic distribution of hospital-acquired LEDVT (HA-LEDVT) and its probable role in the occurrence of pulmonary embolism (PE). MethodsWe retrospectively analyzed the demographic data, ultrasound results, and PE-related findings of inpatients with HA-LEDVT in 28 clinical departments at Peking University People's Hospital between January 1, 2007, and December 31, 2018. ResultsThis study included 1431 HA-LEDVT events: 35.8%, 31%, and 33.3% were left, right, and bilateral LEDVT. Isolated distal, proximal, and blended DVT were detected in 83.4%, 7.3%, and 9.3% of the patients, respectively. The distribution of HA-LEDVT in the left and right lower extremities were not significantly different except in patients aged ≥40 years (left: 2.07 vs right: 1.88 per 1000 extremities, P = .04). For anatomic types of HA-LEDVT, isolated distal HA-LEDVT was 5.02 times more prevalent than proximal HA-LEDVT (1.24 vs 0.26 per 1000 extremities, P ＜ .01). The involvement rates of specific deep veins by HA-LEDVT were highest in the muscular calf vein (87.5%) followed by the popliteal vein (10.1%), superficial femoral vein (9.3%), and common femoral vein (9.2%). HA-LEDVT involving multiple vein segments simultaneously occurred in 338 extremities. HA-LEDVT involving the muscular calf vein and at least one of three connected axial veins of the muscular calf vein occurred most frequently. Eighty-eight patients with HA-LEDVT (6.15%) had PE. The frequency of PE among patients with proximal and distal DVT (7.89% vs 6.23% P = .275) was not significantly different. The incidence of PE was highest in patients with bilateral proximal DVT (15.4%) and lowest in patients with a single right distal DVT (4.5%). PE occurred in 6% of muscular calf vein HA-LEDVT. In isolated muscular calf vein DVT cases, PE were more likely to occur in cases with a ＞6.05-mm-diameter thrombus than in those with a ＜6.05-mm-diameter thrombus (10.3% vs 4.2%, P ＜ .0001). ConclusionsHA-LEDVT is characterized by a significantly high percentage of DVT in the muscular calf vein. Muscular calf vein thrombosis may be the primary origin of lower extremity deep vein thrombosis. The diameter of the thrombus in the muscular calf vein may be associated with the occurrence of PE. More prospective studies are needed to more fully determine the natural history of HA-LEDVT and develop prevention and treatment guidelines for HA-LEDVT.

Efficacy of tranexemic acid in controlling perioperative blood loss in TKR patients using intravenous V/s intraarticular route

Preoperative blood loss is common in total knee replacement. Tranexamic acid can reduce active bleeding. It is the most effective antifibrinolytic agent available. Our objective was to compare the efficacy of tranexamic acid in controlling perioperative blood loss in adult patients undergoing total knee replacement using intravenous versus intraarticular route. An analytical cross-sectional study was conducted on 95 patients who underwent total knee replacement surgery in our institution. Patients were selected for intravenous (group A) and intra articular (group B) by simple randomization. During the postoperative period, the amount of blood in the drain and post-operative hemoglobin at 48 hours were collected and total blood loss was calculated. Mean pre-operative hemoglobin in group A was 11.73 and in group, B was 11.86. Average blood loss in the drain was 305 ml and 293 ml in group A and group B respectively. Average total blood loss was 464ml and 438 ml in group A and B respectively. Average fall in Hb was 0.69 and 0.80 in group A and group B respectively at 48hours. One patient in each group was transfused with allogeneic blood. There were no clinically evident DVT cases in either group. In conclusion, both intraarticular and intravenous tranexamic acid were found to be equally effective in controlling perioperative blood loss in total knee arthroplasty patients with no significant increase in thromboembolic complications.

Frequency of Deep Venous Thrombosis after Abdominal Surgery

Objective: To determine the frequency of deep venous thrombosis after abdominal surgery. Study Design: Cross Sectional Study. Settings: Department of Surgery, Bolan Medical Complex, Quetta Pakistan. Duration: Six-months started from 14-06-2014 to 13-12-2014. Methodology: All patients with age 40 years to 70 years of either gender presented with ASA status I or II underwent major abdominal operations lasting more than 30 minutes were enrolled. Patients were followed for 7th postoperative day and final outcome that is DVT was assessed. Results: Patients mean age was 58.40 ±9.59 years. Female preponderance was found to be higher, i.e. 47 (53.40%). Mean BMI of the patients was 25.3 ±5.4Kg/m2. There were 58 (65.9%) patients with HTN, 34 (38.60%) smokers and 42 (47.70%) diabetic patients. There were 14 (15.90%) DVT cases were reported. Conclusion: The frequency of deep venous thrombosis was found in 14 (15.90) patients after abdominal surgery.

Marburg I Polymorphism (G511E) in Adults with Deep Vein Thrombosis.

The Marburg I polymorphism (G511E) in FSAP gene was listed as one of the risk factor for idiopathic DVT among the western population. The frequency of Marburg I polymorphism in India is presently not known. Fifty DVT cases and 50 healthy controls were tested for Marburg I polymorphism using ARMS-PCR technique. The thrombophilic risk factors (Protein C, Protein S, Antithrombin III, Factor V Leiden and antiphospholipid antibodies) were also determined. Marburg I polymorphism (heterozygous) was found in 2 patients (4%) but not in control subjects. These two cases did not have any other thrombophilia markers. Among the thrombophilic markers, heterozygous FVL mutation, PS, PC, AT deficiencies and antiphospholipid antibodies were seen in 10%, 10%, 6%, 6% and 8% of the patients respectively. The controls showed only the presence of antiphospholipid antibodies in 6% of subjects. Marburg I polymorphism among Indians DVT patients was determined for the first time. Its incidence was found in 4% of cases and not in controls. Although not statically significant this may be considered as one of the contributory risk factors for the development of DVT. A larger study is required for the validation of data.

Primary upper extremity DVT involving non-dominant limb in an uncommon profession of occurrence

BackgroundIncidence of primary upper extremity DVT (UEDVT) or effort thrombosis is increasing now a days. It is about 0.4–1 per 10,000 persons per year which accounts for 10% of all DVT Cases. We present a case of primary UEDVT in a non-dominant limb of a male person in an uncommon profession of its occurrence. Case presentationA 40 years male teacher presented to our hospital with 3 months history of pain and swelling of his left upper limb. After multiple consultations he consulted us for his unresolved symptoms. Doppler study showed left subclavian and axillary vein thrombosis. Diagnosis of primary/effort UEDVT (Paget-Schroetter syndrome (PSS)) was made after all the secondary causes were ruled out and there are no bony abnormalities. Patient was started upon anti coagulants. His symptoms got subsided. Follow up scan after 6 months shows minimal residual thrombosis in paired brachial vein. ConclusionAs primary UEDVT occurs in young, functional adults early recognition and treatment requires high index of suspicion to prevent complications and morbidity of disease.

Incidence of venous thromboembolism among patients who underwent major surgery in a public hospital in Singapore

Background: Venous thromboembolism (VTE) is a fatal yet potentially preventable complication of surgery. Routine thromboprophylaxis is still unequivocal prescription is problematic due to perception of low VTE incidence among Asian population. This study aims to investigate the incidence of VTE and thromboprophylaxis prescription among patients undergoing major surgery in a Singapore hospital. Methods: This was a cross-sectional study. Data were obtained from medical record of 1,103 patients who had underwent major orthopaedic or abdominal surgery in 2011-2012 at Khoo Teck Puat Hospital, Singapore. Incidence of VTE events either in the same admission or re-admission in less than one month time were noted as study parameters. Results: Incidence of VTE was 2.1% (95% CI: 1.67 - 2.53) of which 1.3% and 0.8% were DVT and PE cases respectively. Age, gender, history of VTE, ischemic heart disease, and mechanical prophylaxis were associated with VTE incidence based on bivariate analysis. The prescription of pharmacological thromboprophylaxis was associated with prior anticoagulant medication, type of surgery, and incidence of new bleeding. Conclusion: Subsequent to major surgeries, VTE is as common in Asian patients as published data in other populations. Pharmacologic thromboprophylaxis should be considered as recommended in non-Asian guidelines. Keywords: thromboprophylaxis, venous thromboembolism

The use of rivaroxaban for chemical thromboprophylaxis following total knee replacement

BackgroundPulmonary embolism is a leading cause of fatality in elective orthopaedics. Recently introduced oral thromboprophylaxis (rivaroxaban) has a logistic advantage but has also raised early concerns amongst arthroplasty surgeons AimThe aim of this study was to evaluate the impact of rivaroxaban as a chemical thromboprophylaxis following knee arthroplasty in reference to radiologically diagnosed PE and return to theatre following wound complication. MethodFollowing the introduction of new NICE guidelines in our institute 266 consecutive TKR receiving rivaroxaban were studied prospectively and compared with retrospectively collected consecutive 596 TKR prior to adoption of the guidelines. Both of these groups were studied for radiologically diagnosed symptomatic VTE episodes within 90days and return to theatre following wound complication. ResultsA total of 862 cases were studied, out of which 596 were in the retrospective control group and 266 were in the prospective rivaroxaban group. Both the groups had a female predominance with a mean age at the time of surgery as 68 and 69 in control and prospective cohort respectively. There were 24 radiologically diagnosed symptomatic PE and one DVT in the control group whereas, the rivaroxaban prospective group had 2 PE and 2 DVT cases. The return to theatre following wound complication was 2 and 7 in control and prospective group respectively. ConclusionFollowing the introduction of rivaroxaban the number of symptomatic radiologically confirmed PE events declined (p=0.0084) but the return to theatre rate due to wound complications increased (p=0.0049). Level of evidenceIII.

The Validity of ICD-9-CM Codes in Identifying Postoperative Deep Vein Thrombosis and Pulmonary Embolism

Deep vein thrombosis and pulmonary embolism (DVT/PE) are common complications after surgery and are associated with substantial excess mortality and length of stay. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes recorded in hospital claims have been used to identify and study DVT/PE, but the validity of this method is not well studied. Identification of postoperative DVT/PE events were compared using ICD-9-CM codes and medical record abstraction in random samples of hospital discharges of Medicare beneficiaries in 2002-2004. Among 20,868 eligible surgical hospitalizations, 232 DVT cases and 95 PE cases were identified by ICD-9-CM codes; 108 DVT cases and 31 PE cases by medical record abstraction; 72 DVT cases and 23 PE cases by both methods. The resulting estimates of PPV of ICD9-CM coding were 31% (72/232 cases) for DVT, 24% (23/95) for PE, and 29% (90/308) for DVT/PE combined. The resulting sensitivity estimates were 67% (72/108 cases) for DVT, 74% (23/31) for PE, and 68% (90/133) for DVT/PE combined. ICD-9-CM codes in Medicare claims are sensitive but have limited predictive validity in identifying postoperative DVT/PE. Improvements in the validity are needed before the indicator can be used for safety performance assessment.

Extrinsic Venous Compression May Not Be a Sufficient Explanation for Venous Thromboembolism Due to Massive Fibroids.

The relationship between uterine leiomyomata (fibroids) and venous thromboembolism (VTE) is poorly characterised. Fibroids are smooth muscle cell tumours of the uterus; occuring in approximately 40% of women of reproductive age, they are twice as prevalent in women from African compared to Caucasian origin. It is assumed that massive leiomyomata (palpable beyond the level of the umbilicus) cause deep vein thrombosis as a consequence of a direct compressive effect on pelvic veins but this explanation may be insufficient. Other hypotheses for the thrombogenic nature of leiomyomata include the abnormal expression of type 1 basic FGF receptor, increased expression of thrombospondin 1 and nitrogen oxide synthase, abnormal oestrogen regulation and fibroid-induced polycythaemia. We describe the cases of seven women (mean age 41 yrs, range 29–46yrs) with VTE presumed secondary to massive fibroids. The majority of women (86%) were of African or Carribbean origin. Massive uterine leiomyomata were demonstrated in each patient by transvaginal ultrasound scanning. All cases had objectively confirmed (duplex ultrasound) symptomatic DVT, and two had CT-confirmed symptomatic pulmonary embolism (PE) at presentation. Direct venous compression by massive fibroids was demonstrated in only one case using magnetic resonance imaging (MRI)(case 1).Interestingly the two cases with left sided proximal DVT (cases 2 and 5) revealed right-sided lateral and posterior uterine wall fibroids. Data on known acquired risk factors for VTE was recorded for each patient. Thrombophilia screening was performed in all cases at least four weeks following cessation of anticoagulation. Venous compression alone failed to explain six of the cases, where fibroids were not positionally related to the site of DVT. Of these, only one had significant additional risk factors for VTE (case 3). Whereas extrinsic compression of the pelvic veins may contribute to venous stasis and DVT formation in some cases, our findings suggest that it is unlikely that this is the only pathogenic mechanism. In conclusion, we suggest that the occurrence of VTE in women with massive fibroids is unlikely to be due solely to mechanical compression of the pelvic veins. It is possible that biological growth factors produced by the leiomyomata may trigger VTE formation and that oestrogen may have an independent growth promoting effect on both VTE and leiomyomata. Further research is required to characterise the prothrombotic state in these women.Patient CharacteristicsEthnicitySite DVTD-dimer(mcg/l)ThrombophiliaRisk FactorsFibroid SiteFibroid Size (mm)1CaribbeanLeft Proximal1563NoNoLeft lateral wall147 × 134 × 1022CaribbeanLeft Proximal481NoNoPosterior and right lateral wall and fundus99 × 94 × 793CaucasianLeft Distal969YesFlight, Previous DVTPosterior wall and fundus89 × 774AfricanRight Proximal/PE1883NoNoPosterior wall350 × 300 × 2505AfricanLeft Proximal6152NoNoPosterior and right lateral wall136 × 124 × 1246AfricanRight Proximal/PEN/ANoNoMultiple, widespread60 × 58 × 737CaribbeanRight Proximal2503NoNoRight lateral wall130×116

Sequential Treatment of Arterial Occlusions with Porcine Plasmin and Low Dose Streptokinase

Sequential treatment of arterial occlusions of the leg with porcine plasmin and low dose streptokinase results in a strong systemic proteolysis as already seen in deep leg vein thrombosis. In 31 of 45 patients the blood flow through major arterial segments could be restored. Thrombolytic success is possible within the first two treatment days but for the majority of the cases fibrinolytic therapy for 3-6 days is needed. On the average treatment was 1 day shorter than in DVT cases. No statistical relationship between local thrombolysis and systemic proteolysis was detected. The thrombolytic efficacy of this regimen compares favourably with earlier experience on fibrinolytic therapy in arterial occlusions.

Side Effects of Thrombolytic Treatment with Porcine Plasmin and Low Dose Streptokinase

In the sequential thrombolytic therapy with porcine plasmin and low dose streptokinase side effects are mainly due to bleeding, intolerance reactions are less important. Treatment had to be prematurely stopped in 42 (37%) of 114 DVT cases because of severe bleeding and in 12 (10%) due to intolerance reactions. The corresponding figures for the 45 cases with arterial occlusions are 15 (33%) and 2 (4%) respectively. The intensity of systemic proteolysis as represented by the thromboplastin time is significantly correlated with haemorrhagic manifestations. Macrohematuria and bleeding from puncture sites are the most frequent haemorrhagic complications followed by spontaneous bleeding into skin and muscles. Non-fatal intracranial bleeding occurred in 1 DVT case (0.9%) and in 2 patients with arterial occlusions (4.4%). The benefit of this potent thrombolytic regimen would greatly improve if a strong reduction of premature treatment stop could be achieved.