Lower Extremity Deep Venous Thrombosis Research Articles

Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians

BackgroundThe use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill.MethodsA nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student’s t-test, Pearson’s correlation test, Loess method and ROC curve analysis.ResultsA total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level.ConclusionsThe Finnish emergency practitioners’ self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.

Safety and Effectiveness of Mechanical Thrombectomy From the Fully Enrolled Multicenter, Prospective CLOUT Registry.

We report in-hospital outcomes from the multicenter, prospective, single-arm ClotTriever Outcomes (CLOUT) registry, which enrolled up to 500 patients with proximal lower extremity deep vein thrombosis (DVT) treated with percutaneous mechanical thrombectomy using the ClotTriever System (Inari Medical). The CLOUT registry enrolled all-comer patients with DVT, irrespective of symptom duration, thrombus age, prior treatment of the current DVT, or bilateral thrombus. The primary effectiveness end point was defined as complete or near complete (≥75%) reduction in Marder score. Thrombus burden was assessed by an independent core laboratory. Mortality and serious adverse events, including device-relatedness, were adjudicated by an independent medical monitor. Here, safety and outcomes are evaluated through discharge. The median age was 61.9 years (IQR, 48.0-70.8), 50.5% were women, 24.9% had a history of DVT, and 23.2% had previously failed treatment of the current DVT. Nearly all procedures (99.4%) were performed in a single session with negligible procedural blood loss (median 40.0 mL; IQR, 20.0-50.0), and most patients (97.8%) required no subsequent intensive care unit monitoring. The primary effectiveness end point was achieved in 91.2% of limbs. Through discharge, 1 device-related serious adverse event (0.2%) occurred. Health status, as assessed by self-reported pain and circumferential measurements of limb edema, were significantly improved at discharge. Thrombectomy with the ClotTriever System is a safe and effective treatment for proximal lower extremity DVT, while also avoiding the need of intensive care. Early patient improvements are demonstrated, and follow-up is ongoing to 2 years.

Comparison of Small Versus Large Bore Endovascular Devices in the Management of Acute Lower Extremity Deep Vein Thrombosis

Comparison of Small Versus Large Bore Endovascular Devices in the Management of Acute Lower Extremity Deep Vein Thrombosis

Abstract No. 19 Catheter-Directed Thrombolysis versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome in Lower Extremity Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

Abstract No. 19 Catheter-Directed Thrombolysis versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome in Lower Extremity Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis in acute lower extremity deep venous thrombosis patients with severe iliac vein stenosis: a retrospective study.

To investigate the effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis (CDT) in acute lower extremity deep venous thrombosis (DVT) patients with severe iliac vein stenosis. The clinical data of 66 patients with acute lower extremity DVT complicated with severe iliac vein stenosis from May 2017 to May 2020 were retrospectively analyzed. Patients were divided into two groups by timing of iliac vein stent implantation: group A (iliac vein stent implantation before CDT treatment) for 34 and group B (iliac vein stent implantation after CDT treatment) for 32. The detumescence rate of affected limb, the thrombus clearance rate, the thrombolytic efficiency, the complication rate, the hospitalization cost, the stent patency rate within 1year, and the scores (venous clinical severity score, Villalta, and chronic venous insufficiency questionnaire (CIVIQ) score) at 1year postoperatively were compared between the two groups. The thrombolytic efficiency of group A was higher than that of group B, while the incidence of complications and hospitalization expenses in group A were lower than those in group B. There was no statistical significance in the detumescence rate of affected limb, the thrombus clearance rate, the stent patency rate within 1year, and the scores (VCSS, Villalta, and CIVIQ score) at 1year postoperatively between the two groups. For acute lower extremity DVT patients with severe iliac vein stenosis, iliac vein stent implantation before CDT treatment can improve the thrombolytic efficiency, and reduce the incidence of complications and hospitalization costs.

Clinical application of VATS combined with 3D-CTBA in anatomical basal segmentectomy.

This study aimed to summarize the clinical application experience of video-assisted thoracic surgery (VATS) combined with three-dimensional computed tomography-bronchography and angiography (3D-CTBA) in anatomical basal segmentectomy. Clinical data of 42 patients who underwent bilateral lower sub-basal segmentectomy by VATS combined with 3D-CTBA in our hospital from January 2020 to June 2022 were retrospectively analyzed; the patients included 20 males and 22 females, with a median age of 48 (30-65) years. Combined with the preoperative enhanced CT and 3D-CTBA techniques to identify the altered bronchi, arteries, and veins during the operation, the anatomical resection of each basal segment of both lower lungs was completed through the fissure approach or inferior pulmonary vein approach. All operations were successfully completed without conversion to thoracotomy or lobectomy. The median operation time was 125 (90-176) min, the median intraoperative blood loss was 15 (10-50) mL, the median postoperative thoracic drainage time was 3 (2-17) days, and the median postoperative hospital stay was 5 (3-20) days. The median number of resected lymph nodes was 6 (5-8). There was no in-hospital death. Postoperative pulmonary infection occurred in 1 case, lower extremity deep vein thrombosis (DVT) in 3 cases, pulmonary embolism in 1 case, and persistent air leakage in the chest in 5 cases, all of which were improved by conservative treatment. Two cases of pleural effusion after discharge were improved after ultrasound guided drainage. Postoperative pathology showed 31 cases of minimally invasive adenocarcinoma, 6 cases of adenocarcinoma in situ (AIS), 3 cases of severe atypical adenomatous hyperplasia (AAH), and 2 cases of other benign nodules. All cases were lymph node-negative. VATS combined with 3D-CTBA is safe and feasible in anatomical basal segmentectomy; consequently, this approach should be promoted and applied in clinical work.

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis.

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening sequelae. While whole leg compression ultrasound with color and spectral Doppler is commonly performed in radiology and vascular labs, point-of-care ultrasound (POCUS) is becoming more common in the acute care setting. Providers appropriately trained in focused POCUS can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. This paper describes a simplified yet validated approach to POCUS by describing a three-zone protocol for lower extremity DVT POCUS image acquisition. The protocol explains the steps in obtaining vascular images at six compression points in the lower extremity. Beginning at the level of the proximal thigh and moving distally to the popliteal space, the protocol guides the user through each of the compression points in a stepwise manner: from the common femoral vein to the femoral and deep femoral vein bifurcation, and, finally, to the popliteal vein. Further, a visual aid is provided that may assist providers during real-time image acquisition. The goal in presenting this protocol is to help make proximal lower extremity DVT exams more accessible and efficient for POCUS users at the patient's bedside.

The First Reported Case of Pulmonary Embolism and Deep Vein Thrombosis Associated with Intraductal Papillary Mucinous Neoplasm: A Case Report

Background: Reported cases of Intraductal papillary mucinous neoplasm (IPMN) are becoming more and more frequent. The risk of hypercoagulability associated with IPMN is not clearly established in the literature as it was only reported in four cases. Therefore, we present a unique case of a patient with IPMN who subsequently developed acute pulmonary embolism (PE) and deep venous thrombosis (DVT). Case presentation: A 70-year-old healthy female patient complained of palpitation, chest pain, and dyspnea at rest. She had normal vital signs and findings on physical examination. Laboratory tests showed an increase in the D-Dimer level of 3,730 ng/mL fibrinogen equivalent unit (FEU). Bilateral DVT ultrasound (DVT-US) of the lower extremities was positive for acute calf DVT in the right lower extremity involving the soleal vein. CT-PE chest with IV contrast was remarkable for segmental and subsegmental pulmonary arteries thrombosis. She was started on a heparin drip and then transitioned to rivaroxaban for the treatment of PE and DVT. She was discharged in stable condition with outpatient follow-up. Conclusion: IPMN of the pancreas is an exocrine pancreatic neoplasm often detected on Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). It is usually non-malignant but was found to be more prone to progress into cancer in contrast to the other types of pancreatic cysts. An increased risk of hypercoagulability with pre-malignant pancreatic lesions such as IPMN has not yet been well established. As far as we know, this case report is the first article presenting IPMN associated with both acute DVT and PE in a relatively healthy individual with no prior risk factor for hypercoagulability. Although there is scattered evidence suggesting an increased risk of thromboembolic events with IPMN, this unique case of DVT and PE associated with IPMN highlights the importance of close monitoring of these patients, especially those who have risk factors for thrombosis.

Abstract WP95: Combination Of Steroid And Anticoagulant Therapy To Treat Acute/subacute Severe Cerebral Venous Thrombosis

Introduction: Endovascular treatment combined with standard anticoagulant treatment often fails to improve functional outcomes of patients with severe cerebral venous thrombosis (CVT). Accumulating evidence suggests that inflammatory response plays a vital role in severe CVT pathogenesis and is strongly associated with a poor prognosis. Hypothesis: To investigate the efficacy and safety of steroids combined with anticoagulant therapy in acute/subacute severe CVT patients. Methods: Patients with first-episode acute/subacute CVT between January 2018 and June 2021 were enrolled. We retrospectively reviewed data of patients with acute/subacute severe CVT treated with and without 500mg methylprednisolone pulse therapy for 3 days. We compared functional outcomes and major adverse events 6 months after discharge between two groups using propensity score matching for the purpose of completion. Results: In this study, 248 patients with acute/subacute severe CVT were included, and 93 (37.50%) patients with severe CVT were treated with steroids. After propensity score matching, there were 85 patients each in the steroid and nonsteroid groups. Patients in the steroid group had lower mRS scores (0-2) (P=0.03) and a lower likelihood of residual headache (19.28% vs. 47.50%, P<0.01) than patients in the nonsteroid group at the 6-month follow-up after discharge. Regarding steroid safety, the likelihood of CVT recurrence (6.02% vs. 6.25%, P=0.95), lower extremity deep venous thrombosis (3.61% vs. 1.25%, P=0.33), pulmonary embolism (1.20% vs. 1.25%, P=0.98), infection (1.20% vs. 1.25%, P=0.98), and mortality (2.35% vs. 5.88%, P=0.25) did not differ between both groups. Steroid treatment (OR: 4.685, 95% CI: 1.629-13.476, P=0.00) was independently associated with favorable outcomes in the matched cohort. During the follow-up period, patients treated with steroids did not experience spontaneous fractures, osteonecrosis, or gastroduodenal ulcers. Discussion: Steroid pulse therapy combined with anticoagulant therapy may be effective and safe for improving the prognosis of patients with acute/subacute severe CVT. These findings shed light on the potential ameliorative effects of anti-inflammatory treatments in acute/subacute severe CVT.

Biological Agent Use in Behçet's Patients Who Are Resistant to Conventional Treatments: A Multidisciplinary Retrospective Study

Background Comparing treatment modalities is difficult in Behcet's syndrome, even if tumour necrosis factor-alpha (TNF-α) inhibitors are a treatment option for all involvements resistant to conventional therapy. This study evaluated how different departments dealt with treatment, particularly with TNF-α inhibitors.
 Material and Methods The study comprised 111 patients from our Behcet's syndrome cohort who were treated with TNF-α inhibitors between 2010 and 2019. Data on patients were retrieved retrospectively from the rheumatology, ophthalmology, and dermatology clinics' patient records. 
 Results Patients followed up in rheumatology (n: 40) were classified as Group 1, and patients followed up in ophthalmology (n: 49) and dermatology (n: 5) as Group 2. In Group 1, genital ulcers, erythema nodosum (p=0.009, p=0.003, respectively), lower extremity deep vein thrombosis, arterial aneurysm and neurological involvement were more common (p=0.005, p=0.008, p=0.001, respectively). In Group 2, the use of cyclosporine and interferon-α before the anti-TNF agent was higher (p

Application of hierarchical management based on bleeding risk assessment in patients with catheter-directed thrombolysis for treatment of lower extremity deep venous thrombosis

Application of hierarchical management based on bleeding risk assessment in patients with catheter-directed thrombolysis for treatment of lower extremity deep venous thrombosis

Effectiveness of point of care ultrasound (POCUS) simulation course and skills retention for Japanese nurse practitioners

BackgroundIn Japan, the nurse practitioner (NP) system has only been in place for a short time, and there is no ultrasound (US) simulation course for NPs. Therefore, NPs may have to attend US simulation courses for physicians. We evaluated whether US simulation course for physicians lead to improved image acquisition and interpretation amongst NPs and, if so, if these changes would be maintained over time.MethodsA 2-day point-of-care ultrasound (POCUS) course designed for physicians in cardiac US, lung US, lower extremity deep vein thrombosis (DVT) US, and abdominal US was held for Japanese nurse practitioners (JNP) and JNP trainees in 2018 and 2019. Participants kept a record of the number of US examinations they performed for 3 months before and 3 months after the course. The number of US exams performed was grouped into six categories. All participants underwent pre-course, immediate post-course, and 4-month post-course testing to assess image interpretation skills, image acquisition skills, and confidence.ResultsThirty-three participants from 21 facilities completed the program. Before and immediately after the course, test scores of the image interpretation test, image acquisition test, and confidence increased significantly (37.1, 72.6: P < 0.001), (13.7, 53.6: P < 0.001), and (15.8, 35.7: P < 0.001), respectively. Comparing the follow-up tests immediately after the course and 4 months later, there was no decrease in scores on the image interpretation test, the image acquisition test, or confidence (72.6, 71.8: P = 1.00) (53.6, 52.9: p = 1.00) (35.7, 33.0: P = 0.34). There was a statistically significant increase (P < 0.001) in both the total number of ultrasound examinations and in the number of ultrasound examinations by category (cardiac, lung, lower extremity DVT, and abdominal) in the 3 months before and 3 months after the course.ConclusionsThe POCUS simulation course for physicians is useful for JNPs to acquire US examination skills even if it is not arranged for JNPs. Image interpretation skill, image acquisition skill, and confidence improved significantly and were maintained even after 4 months of the course. It leads to behavioral changes such as increasing the number of US examinations in daily practice after the course.

D-Dimer and Fibrinogen Values according to the Localization of Deep Venous Thrombosis

AbstractD-dimer and fibrinogen are nonspecific diagnostic biomarkers for venous thromboembolism (VTE). The aim of this article was to present the values of D-dimer and fibrinogen in relation to the anatomical localization of deep vein thrombosis (DVT). This was an observational study, which included 1,142 patients hospitalized from 2010 to 2019 at the Department of Angiology, Clinical Center University of Sarajevo. Data on gender, age, and thrombosis location were collected of all patients. Fibrinogen and D-dimer values were available for 983 and 500 patients, respectively. Thrombosis location was classified as iliofemoral (521–45.6% patients), femoral–popliteal (486–42.6% patients), isolated calf DVT (63–5.5% patients), and upper extremity DVT (UEDVT in 72–6.3% patients). A majority, 448 (89.6%), of patients had high D-dimer (the cutoff is 0.55 mg/L) and 662 (67.3%) patients had high fibrinogen (reference range: 1.8–3.8 g/L).The highest D-dimer was detected in patients with iliofemoral DVT (mean: 10.48 mg/L), χ2 = 50.78, p = 0.00. The highest fibrinogen was detected in patients with iliofemoral DVT as well (mean 4.87 g/L), χ2 = 11.1, p = 0.01. D-dimer and fibrinogen values are significantly higher in patients iliofemoral DVT than femoral–popliteal and isolated calf DVT, and D-dimer values are significantly higher in lower extremity DVT than UEDVT, but these biomarkers cannot be used alone to discriminate between thrombosis locations. Further imaging is required.

Risk factors and a predictive model for nonfilter-associated inferior vena cava thrombosis in patients with lower extremity deep vein thrombosis.

Nonfilter-associated inferior vena cava thrombosis (IVCT) is an under-recognized but severe state of venous thromboembolism. The aims of this study were to investigate risk factors and develop a prediction model based on clinical data and imaging findings to evaluate the probability of IVCT in patients with lower extremity deep vein thrombosis (LEDVT). A single-center retrospective cohort study was conducted. We analyzed the clinical data and multimodal imaging findings of consecutive patients with confirmed LEDVT between February 2016 and January 2022. The demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed using an independent t-test, Chi-square test, Fisher's exact test, and regression analysis to determine the univariable and multivariable associations and to establish a predictive model to assess the probability of IVCT. A total of 267 eligible patients were included, of whom 40 were in the IVCT group and 227 were in the non-IVCT group. The incidence of nonfilter-associated IVCT was 15.0% (40/267). Age < 63.5 years [odds ratio (OR) 2.54; 95% confidence interval (CI), 1.10-5.85, p = 0.029], male sex (OR 2.82; 95% CI, 1.19-6.72, p = 0.019), proximal DVT (OR 8.21; 95% CI, 1.01-66.76, p = 0.049), bilateral DVT (OR 7.30; 95% CI, 3.28-16.21, p < 0.001), and D-dimer >4.72 μg/ml (OR 4.64; 95% CI, 1.80-11.72, p = 0.001) were risk factors for IVCT's occurrence. Then, we established a prediction model based on these risk factors. The diagnostic efficiency [area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.858] for predicting IVCT was superior to that of isolated risk factors, including age < 63.5 years (AUC of ROC curve was 0.624) or D-dimer >4.72 μg/ml (AUC of ROC curve was 0.656). Age < 63.5 years, male sex, proximal LEDVT, bilateral LEDVT and D-dimer >4.72 μg/ml were risk factors. The diagnostic efficiency of the predictive model for predicting IVCT was superior to that of a single risk factor alone. It may be used for predicting the probability of nonfilter-associated IVCT in patients with LEDVT.

Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems.

Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy. Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n = 9,769) and externally validated it using the Veterans Affairs (VA) health care system (n = 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS). Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set. The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months (v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies.[Media: see text].

A nomogram for prediction of deep venous thrombosis risk in elderly femoral intertrochanteric fracture patients: A dual-center retrospective study.

Deep venous thrombosis (DVT) of the lower extremity is a common perioperative complication of femoral intertrochanteric fracture. This study aimed to identify the risk factors of lower extremity deep vein thrombosis (DVT) in elderly femoral intertrochanteric fracture patients and establish a nomogram model. From August 2014 to June 2021, a total of 1,652 femoral intertrochanteric fracture patients over the age of 65 were enrolled in our study. We distinguished independent risk factors by univariate and multivariate Cox analyses. A nomogram model was then built, and the discriminative and calibration of the model was evaluated through receiver operating characteristics (ROC) and calibration plots. A total of 378 patients developed DVT (292 in the training group, 86 in the validation group) while the remaining patients did not. According to the univariate and multivariate Cox analyses results, age (OR = 1.07, 95% CI: 1.04-1.10), fibrinogen (OR = 2.09, 95% CI: 1.68-2.60), D-dimer (OR = 1.33, 95% CI: 1.27-1.40), time from injury to admission (OR = 1.78, 95% CI: 1.55-2.05), functional status (OR = 4.21, 95% CI: 2.86-6.20), and diabetes (OR = 1.65, 95% CI: 1.10-2.48) were identified as independent risk factors of DVT. The ROC values for DVT of the training and validation group were 0.862 and 0.912, and the P-value of the Hosmer-Lemeshow calibration test was 0.767. This nomogram model can be used to predict the probability of preoperative DVT in elderly patients with femoral intertrochanteric fracture and guide physician in perioperative thrombosis management.

Association Between Inferior Vena Cava-Involved Thrombosis, Severe Iliac Vein Stenosis, and Proximal Pulmonary Embolism in Patients With Deep Vein Thrombosis.

To investigate the possible risk factors for proximal pulmonary embolism (PE) in patients with lower extremity deep vein thrombosis (LEDVT). A single-center, retrospective cohort study was conducted. Consecutive patients diagnosed with unilateral LEDVT and confirmed PE by computed tomography (CT) pulmonary angiography and indirect CT venography between September 2015 and January 2022 were included. Patient demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed to determine the univariable and multivariable associations. The associations between thrombus location, stenosis, and proximal PE were assessed using a stratified analysis. A total of 115 eligible patients (60.08 ± 15.18 years, 59.1% male) were included. Of these patients, 40 (34.8%) were in the proximal PE group (proximal thrombus involved main or lobar pulmonary artery), and 75 (65.2%) were in the distal PE group (without main and labor pulmonary artery involvement). The univariable analysis showed that onset time of LEDVT symptoms ≤ 7 days (P = .041), inferior vena cava (IVC) involvement (P = .035), and severe iliac vein stenosis (IVS) (stenosis ratio > 61.3%) (P = .010) were associated with the occurrence of proximal PE. Further multivariant analysis showed that IVC involvement was associated with an increased odds of proximal PE (OR: 4.45, 95% CI: 1.083 - 18.248, P = .038), whereas severe IVS (stenosis ratio > 61.3%) was associated with a decreased odds of proximal PE (OR: 0.294, 95% CI: 0.110-0.783, P = .014). Among patients with unilateral LEDVT, IVC involvement increased the risk of proximal PE; patients with severe IVS (stenosis ratio > 61.3%) had a lower risk of developing proximal PE compared with distal PE; and severe IVS seemed to be a protective factor for proximal PE.

Nomogram Prediction for Lower Extremity Deep Vein Thrombosis in Acute Ischemic Stroke Patients Receiving Thrombolytic Therapy.

This study developed and evaluated a tailored nomogram to predict the potential occurrence of early lower extremity deep vein thrombosis (LDVT) in patients receiving thrombolytic therapy. We performed several logistic analyses on the training cohort and created a corresponding nomogram to forecast early LDVT. The classification accuracy and the accuracy of predicted probabilities of the multiple logistic regression model were evaluated using area under the curve (AUC) and the calibration graph method. According to the multivariate logistic regression model homocysteine, previous history of hypertension and atrial fibrillation, indirect bilirubin, age, and sex was identified as independent determinants of early LDVT. The nomogram was constructed using these variables. The calibration plots showed a good agreement between the predicted and observed LDVT possibilities in the training and validation cohorts with AUCs being 0.833 (95% CI: 0.774-0.892) and 0.907 (95% CI: 0.801-1.000), respectively. Our nomogram offers clinicians a tool for predicting the individual risk of LDVT in the early stage of acute ischemic stroke in patients receiving thrombolytic therapy, which could lead to early intervention.

Spontaneous Heparin-Induced Thrombocytopenia Presenting as Concomitant Bilateral Cerebrovascular Infarction and Acute Coronary Syndrome

Background: Spontaneous heparin-induced thrombocytopenia is a pro-thrombotic syndrome in which anti-heparin antibodies develop without heparin exposure. Case presentation: A 78-year-old man who underwent a successful lumbar laminectomy presented to the hospital 5 days after discharge for stroke-like symptoms and was found to have acute infarcts of the bilateral frontal lobes. The patient was found to be severely thrombocytopenic and was incidentally found to have an inferior wall myocardial infarction. Further investigation led to the diagnosis of bilateral lower extremity deep vein thromboses. His overall clinical presentation prompted a detailed hematologic workup that indicated positivity for heparin-induced thrombocytopenia despite no previous exposure to heparin products. Conclusions: This case illustrates a patient with no prior lifetime heparin exposure who underwent laminectomy with subsequent development of acute infarcts of the bilateral frontal lobes, an inferior wall myocardial infarction, and bilateral lower extremity deep vein thromboses, with concern for sequelae of spontaneous heparin-induced thrombocytopenia.