Extremity Deep Venous Thrombosis Research Articles

F-47 | Outcomes of Upper Extremity Deep Venous Thrombosis in Octogenarians, Nonagenariansand Centenarians: A population-based study

F-47 | Outcomes of Upper Extremity Deep Venous Thrombosis in Octogenarians, Nonagenariansand Centenarians: A population-based study

Outcomes following interval delayed first rib resection for acute axillosubclavian deep venous thrombosis

BackgroundCurrent management of axillosubclavian deep venous thrombosis (DVT) often uses thrombolysis for the DVT, prompt first rib removal, and occasional venoplasty or stenting. Our institution has increasingly used anticoagulation alone followed by interval first rib resection. We sought to analyze the effectiveness of this simplified technique. MethodsBetween September 2012 and April 2021, 27 patients were identified within the institution's electronic medical record as having undergone first rib resection for upper extremity DVT. Seven of these patients had undergone preoperative thrombolysis before referral and were excluded. Among the remaining 20 patients, preoperative clinic charts were evaluated for age, venous segment involvement, contralateral limb involvement, presence of documented hypercoagulable state, duration of preoperative and postoperative anticoagulation, and postoperative outcomes. ResultsOf the 20 patients (mean age, 26.2 years; 13 males) presenting with acute axillosubclavian DVT, all patients had right (n = 8) or left (n = 12) arm swelling. Five patients had extremity pain and four had extremity discoloration. Ten had axillosubclavian vein involvement, 9 had subclavian vein involvement, and 1 had axillary vein involvement. Two patients were on oral contraceptives and no patients had any other diagnosed hypercoagulable conditions. The mean duration of preoperative and postoperative anticoagulation was 3.2 ± 2.6 months and 2.1 ± 2.1 months, respectively. Nineteen patients underwent supraclavicular first rib resection and 1 patient underwent transaxillary resection. Twelve patients (60%) demonstrated complete DVT resolution by venous duplex examination during the postoperative period and 8 patients (40%) demonstrated partial recanalization/chronic DVT. Complications included one hemothorax and one thoracic duct injury. All 20 patients remain asymptomatic without arm swelling, with a mean follow-up of 55.1 ± 34.7 months. ConclusionsAmong patients presenting with acute axillosubclavian DVT, anticoagulation alone followed by interval first rib resection proved to be successful in providing symptomatic relief in the short to medium term. By eliminating the need for preoperative thrombolysis and postoperative venograms, this potentially cost-saving algorithm simplifies our management for acute venous thoracic outlet syndrome while maintaining good clinical outcomes. Because this study only analyzed our management algorithm's effectiveness in the short to medium term, the long-term effectiveness of this treatment will need to be demonstrated.

Magnetic Resonance Imaging as a Diagnostic Tool for Ilio-Femoro-Caval Deep Venous Thrombosis.

This study aimed to test the accuracy of a magnetic resonance imaging (MRI)-based method to detect and characterise deep venous thrombosis (DVT) in the ilio-femoro-caval veins. Patients with verified DVT in the lower extremities with extension of the thrombi to the iliac veins, who were suitable for catheter-based venous thrombolysis, were included in this study. Before the intervention, magnetic resonance venography (MRV) was performed, and the ilio-femoro-caval veins were independently evaluated for normal appearance, stenosis, and occlusion by two single-blinded observers. The same procedure was used to evaluate digital subtraction phlebography (DSP), considered to be the gold standard, which made it possible to compare the results. A total of 123 patients were included for MRV and DSP, resulting in 246 image sets to be analysed. In total, 496 segments were analysed for occlusion, stenosis, or normal appearance. The highest sensitivity compared occlusion with either normal or stenosis (0.98) in MRV, while the lowest was found between stenosis and normal (0.84). Specificity varied from 0.59 (stenosis >< occlusion) to 0.94 (occlusion >< normal). The Kappa statistic was calculated as a measure of inter-observer agreement. The kappa value for MRV was 0.91 and for DSP, 0.80. In conclusion, MRV represents a sensitive method to analyse DVT in the pelvis veins with advantages such as no radiation and contrast and the possibility to investigate the anatomical relationship in the area.

Incidental deep venous thrombosis diagnosed on lower extremity computed tomography is a rare but clinically impactful finding

BackgroundIn the setting of a known thrombotic event, computed tomography (CT) studies provide reasonable sensitivity for the diagnosis of deep venous thrombosis (DVT). However, the incidence and accuracy of a DVT diagnosis on CT studies not targeted for the detection of DVT are not well described. In addition, the clinical impact of DVTs incidentally identified on CT is unknown. MethodsIn this single-institution retrospective study, we queried all contrasted CT studies of the lower extremities performed over a 10-year period. Regular expressions applied to the radiology reports associated with the CT studies identified studies with positive findings associated with DVT. These selected reports were then manually reviewed to confirm the presence of a DVT. Patient demographics and relevant medical and surgical history were obtained through a chart review. Follow-up information was obtained for 1 year after the incident CT and included treatment course, additional imaging, and adverse events. An incidental DVT was one identified in a patient in whom the DVT was not noted in a prior study and for whom the study indication did not include concern for DVT or pulmonary embolism. ResultsOf 16,637 lower extremity contrasted CT studies queried, 37 study reports identified a DVT. However, only 13 patients had a finding of an incidental DVT (10-year incidence of 0.08%). Among these 13 patients, 11 underwent additional imaging, including 9 who had a subsequent venous duplex and 2 who had subsequent CT studies. Among those with a subsequent duplex, DVT was not identified in eight cases, whereas in one case, DVT was confirmed. Among those with subsequent CT studies, DVT was not identified in one case and was confirmed in one case. Of the 13 patients with incidental DVTs, 3 were initiated on anticoagulation based on their initial CT findings alone. Among these, two did not experience any complications from their DVT or anticoagulation regimen. One did experience major bleeding complications, requiring additional procedures. ConclusionsIncidental DVTs are a rare finding in lower extremity CT studies, noted to occur in only 0.08% of studies. Most patients with incidental DVTs receive additional imaging, with negative findings in 80% of cases. This study identified that 23% of patients were initiated on anticoagulation due to the CT findings, with a 33% rate of significant complications. Currently, a CT venogram is not recommended as a first-line modality for the diagnosis of DVT. However, there is no guidance regarding the need for repeat imaging in patients with incidentally diagnosed lower extremity DVTs identified on CT. Additional study is needed to provide evidence for guideline development.

Improvement of Nutritional Status of Patients with Adenomyosis Combined with Lower Extremity Deep Venous Thrombosis by Combination Therapy

This study aims to explore the effect of a comprehensive treatment scheme comprising conservative surgery, postoperative continuous subcutaneous infusion of gonadotrophin-releasing hormone agonist, rehabilitation training, and rivaroxaban on patients with adenomyosis complicated with lower extremity deep venous thrombosis and to provide a clinical reference. The study results showed that compared to the conventional treatment regimen, patients with adenomyosis combined with lower extremity deep venous thrombosis exhibited significant improvements in uterine function, thrombotic status, and coagulation after the combination therapy. In addition, they demonstrated superior nutritional status and a reduced risk grade for malnutrition. Based on these results, we believe that the combination of conservative surgery, postoperative continuation of gonadotrophin-releasing hormone agonist, rehabilitation, and rivaroxaban has higher clinical value in the treatment of adenomyosis combined with lower extremity deep venous thrombosis than the conventional treatment regimen.

Analysis of Risk Factors of Postoperative Lower Extremity Deep Venous Thrombosis in Patients With Cervical Cancer.

Deep venous thrombosis (DVT) has a significant negative impact on surgical and tumor patient's safety and quality of life. There was no specific report on the incidence and risk factors of postoperative lower extremity DVT in cervical cancer patients. Analysis of the risk factors of postoperative DVT in patients with cervical cancer is of great clinical significance for prevention and treatment. We retrospectively analyzed 309 cervical cancer patients treated by the Hubei Cervical Cancer Prevention Center and used a logistic regression model to test the risk variables of postoperative lower extremity deep venous thrombosis in cervical cancer patients. By univariate analyses, the results of the study showed that the incidence of postoperative DVT was significantly increased in cervical cancer patients complicated with old age, obesity, high preoperative plasma D-dimer level, increased preoperative triglyceride level, chronic diseases (hypertension, diabetes, and cardiovascular disease), open surgery, long operation time, intraoperative blood transfusion, advanced tumor stage, and preoperative chemotherapy/radiotherapy. Advanced age, obesity, elevated preoperative D-dimer level, high preoperative triglyceride level, and open surgery were independent risk factors for postoperative lower extremity DVT in patients with cervical cancer by multivariate regression analyses (all P < .05). In gynecologic patients with cervical cancer, there is a high incidence of postoperative lower extremity DVT. Clinicians should develop systematic and comprehensive prevention and treatment measures for the risk factors to lower this morbidity and improve patient prognosis.

The Below-the-Knee Approach to Percutaneous Mechanical Thrombectomy for Lower Extremity Deep Venous Thrombosis: A Retrospective Single-Centre, Single-Arm Study.

The objective of this study was to evaluate the safety, efficacy, and feasibility of percutaneous mechanical thrombectomy (PMT) through a below-the-knee (BTK) approach for acute lower extremity deep venous thrombosis (DVT). A retrospective review of DVT patients treated with PMT by the BTK approach at our center from April 2022 to August 2023 was performed. Their preoperative demographics, intraoperative data, and postoperative outpatient outcomes were analyzed. A total of 12 patients (67% men; mean age, 63 years) met the inclusion criteria. The BTK approach was successfully achieved in all patients through the posterior tibial vein (n = 1), anterior tibial vein (n = 2), and peroneal vein (n = 9). PMTs were achieved in 11 (92%) patients. Successful lysis (grade II and grade III lysis) was achieved in all patients with PMT. Four (33%) patients had residual venous occlusion over the popliteal vein. No intraoperative complications or bleeding events occurred in any of the patients. PMT via BTK puncture seems to be a safe and effective approach for treating lower extremity DVT. It is reserved for highly select patients with a low risk of bleeding and is performed at centers that have experience with this procedure.

Retracted: Influences of Antithrombotic Elastic Socks Combined with Air Pressure in Reducing Lower Extremity Deep Venous Thrombosis for Patients Undergoing Cardiothoracic Surgery

Retracted: Influences of Antithrombotic Elastic Socks Combined with Air Pressure in Reducing Lower Extremity Deep Venous Thrombosis for Patients Undergoing Cardiothoracic Surgery

Recurrent Thromboembolism in Patients with Congenital Heart Disease and Prior Thromboembolism: A Prospective Cohort Study

Introduction: Patients with congenital heart disease (CHD) are at increased risk of thromboembolism (TE) due to changes in blood flow, type of cardiac lesion, exposure to cardiopulmonary bypass, and cardiac catheterization. There are limited data describing the rate of and risk factors associated with recurrent TE in pediatric patients with CHD and prior TE. Therefore, the primary aim of this study was to describe the rate of recurrent TE in pediatric patients with CHD and a prior episode of TE. Secondary aims included: characterize the type of index and recurrent TE and site, as well as compare characteristics and risk factors of patients with CHD and history of index TE who developed recurrent TE versus to those who did not develop a recurrent TE. Methods: Patients in this study were enrolled and prospectively followed in the Johns Hopkins All Children's (St. Petersburg, FL) Institution-wide Prospective, Inception Multi-Cohort Study of Pediatric TE anytime between 2013 to present. For this analysis, patients were eligible for inclusion if they were &amp;lt;21 years of age, presented with an index TE, and had a diagnosis of CHD. Data collection included patient characteristics, clinical laboratory testing, radiologic results, type and site of TE, acute and chronic risk factors, and treatment agents. Frequencies/proportions were compared between groups by chi-squared or Fisher's exact test, as appropriate. Results: Thirty patients with CHD and index TE were included in this study. Of these, 11 (36.7%) patients had a total of 23 recurrent TEs. Five (45.5%) patients had one recurrent TE, 3 (27.3%) had two recurrent TEs, and another 3 patients had &amp;gt;2 recurrent TEs. Of the 23 recurrent TE, 3 events (13%) were arterial and 20 (87%) were venous. All 3 (100%) arterial TEs were provoked, and catheter related. Of the 20 venous TEs, 16 (80) were provoked and of these, 15 (93.8%) were catheter related. When compared to those who did not develop recurrent TE, patients who developed recurrent TE were more likely to have immobility (p=0.005), an arterial TE (p=0.041), or a lower extremity deep venous thrombosis (p=0.045) at the time of index TE. A greater proportion of patients with recurrence had a central catheter-associated TE compared to those with no recurrent TE but this difference was not statistically significant (73% vs 55%, p=0.057). Conclusions: In this single center prospective cohort we describe a high rate of recurrent TE (37%) among children with CHD and history of prior TE, and identified risk factors for TE recurrence. The vast majority of recurrent TE was provoked and catheter associated. Identified risk factors include immobility, and type and location of the index TE. Future multicenter prospective cohort studies are needed to validate these findings and identify additional risk factors.

Incidence and Risk Factors for Thrombosis in Cancer Patients with COVID-19

Introduction: Cancer is a leading cause of morbidity and mortality in the United States, and cancer patients infected with COVID-19 are at increased risk of death. Given that cancer and COVID-19 are both risk factors for thrombosis, it has been hypothesized that cancer patients with COVID-19 may be at greater risk for thromboembolic events than patients with COVID-19 alone. This risk could necessitate the need for more vigilant thrombosis prophylaxis. However, studies investigating risk factors for thromboembolic events in this population are limited with mixed results. We aimed to determine the incidence and risk factors for thromboembolic events in patients with cancer and COVID-19. Methods: We performed a retrospective cohort review of all cancer patients hospitalized with COVID-19 at our institution between January 1, 2021 and April 1, 2023. Patients over the age of 18 who had previously been diagnosed with cancer, received treatment within the prior 6 months, and had been hospitalized due to COVID-19 were included in the study. We assessed whether patients had experienced a thromboembolic event during their hospital stay, which included thrombosis of the extracorporeal circuit, distal or proximal lower extremity deep venous thrombosis (DVT), upper extremity DVT, pulmonary embolism, superficial thrombophlebitis, ischemic stroke, or other arterial event. Information regarding comorbidities and clinical course was extracted from the patient's record. Descriptive analysis was performed, and association between qualitative variables was studied with the Chi-squared test and the Fisher Exact test, when appropriate. For quantitative variables, the t-test or the Mann-Whitney U test was performed. Multivariate logistic regression was used to assess variables predictive of thromboembolic events. Results: 456 patients with cancer and COVID-19 were included in the study. The median age was 69 years (IQR 62 - 78) and 55% of patients were male. The majority (85%) of patients were White. Most patients had either lung (19%) or bone marrow (17%) cancer, and 196 (43%) had received chemotherapy in the 6 months prior to hospitalization. 37 patients (8.1%) had thromboembolic events during their hospital stay. Age, race, receipt of chemotherapy, and history of hypertension, heart disease, obesity, and stroke were not predictive of thromboembolic events. Patients with thromboembolic events experienced significantly longer lengths of hospital stay than those without thromboembolic events (9 days vs 12 days, p&amp;lt;0.05). Conclusion: Thromboembolic events affect many cancer patients with COVID-19 and may complicate their treatment course during hospitalization. Patients who experienced a thromboembolic event had prolonged hospital stays, which may lead to increased financial and emotional burden in this patient population. Evidence-based strategies for preventing thrombosis, including pharmacologic and mechanical methods, should be emphasized in hospitalized cancer patients with COVID-19, which may decrease thrombotic complications. Further, methods of secondary thrombosis prophylaxis, such as early detection with screening methods or treatment of subclinical methods, should be encouraged. Future studies should promote risk classification in this patient population and optimal prophylaxis paradigms.

[Correlation analysis of serum MMP-1 and MMP-2 levels with lower extremity deep venous thrombosis after operation for lower limb fracture].

To investigate the relationship between serum matrix metalloproteinase-1(MMP-1) and matrix metalloproteinase-2(MMP-2) and the formation of deep venous thrombosis(LDVT) in lower extremity patients after surgery for lower extremity fracture, and to analyze the value of MMP-1 and MMP-2 in predicting the occurrence of LDVT after lower extremity fracture. From June 2018 to December 2021, 352 patients who planned to receive surgical treatment of lower limb fracture in our hospital were selected as the research objects. Venous blood was collected at 1, 2 and 3 days after surgery, respectively, and serum MMP-1 and MMP-2 levels were detected. The incidence of LDVT during hospitalization was analyzed, and the risk factors of postoperative LDVT in patients with lower limb fracture surgery and the predictive value of MMP-1 and MMP-2 for LDVT were analyzed. LDVT occurred in 40 patients (LDVT group), the incidence of LDVT was 11.36%, and 312 patients did not occurred(no occurred group). The serum levels of MMP-1 and MMP-2 in LDVT group increased gradually after surgery; the serum levels of MMP-1 and MMP-2 in the no occurred group increased slightly after surgery at 2 days and then decreased at 3 days after surgery (P<0.01);the serum levels of MMP-1 and MMP-2 in LDVT group were higher than those in the no occurred group at 2 days and 3 days after surgery (P<0.05). Serum levels of MMP-1 and MMP-2 were positively correlated with serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor -α (TNF-α) in LDVT patients at 2 days and 3 days postoperatively (P<0.05). Operative time, MMP-1 and MMP-2 postoperative 3 days were related to the occurrence of LDVT after lower limb fracture (P<0.01). The area under the curve(AUC) predicted by MMP-1 and MMP-2 postoperative 3 days for LDVT after lower limb fracture was 0.738 and 0.744 respectively, and the AUC predicted by combined MMP-1 and MMP-2 was 0.910, which was higher than that predicted by single indicator(Z=2.819 and 2.025, P<0.05). High levels of MMP-1 and MMP-2 after lower extremity fracture are closely related to the occurrence of LDVT, and 3 d mMP-1 and MMP-2 after surgery maybe used as evaluation indexes for LDVT risk prediction.

Effect of Information/Knowledge/Attitude/Practice Theory-Based Progressive Rehabilitation Care on the Risk of Lower Extremity Deep Venous Thrombosis and Nutritional Status of Patients Undergoing Percutaneous Coronary Intervention for Coronary Heart Disease

Coronary heart disease is one of the cardiovascular disorders with a high risk of morbidity and mortality among older adults. Percutaneous coronary intervention is the most effective treatment for coronary heart disease. However, there are substantial safety concerns for postoperative lower-extremity deep venous thrombosis and nutrient loss. Herein, we randomly divided 112 patients with coronary heart disease into an experimental group who received progressive rehabilitation nursing care based on the information/knowledge/attitude/practice theory and a control group who received conventional nursing care. We found that the experimental group had a lower incidence of deep venous thrombosis, better cardiac function, enhanced physical fitness, and nutritional status than the control group after nursing care. Moreover, we observed better self-care ability, quality of life, and higher nursing satisfaction in the experimental group than in the control group. We demonstrated the importance of information/knowledge/attitude/practice theory-based progressive rehabilitation care in providing a more reliable safety guarantee for deep venous thrombosis and nutritional status for patients with coronary heart disease after percutaneous coronary intervention, as recommended in clinical practice.

Biomimetic platelet-camouflaged drug-loaded polypyrrole for the precise targeted antithrombotic therapy

Lower extremity deep venous thrombosis (LEDVT) affects patient’s quality of life for a long time, and even causes pulmonary embolism, which threatens human health. Current anticoagulant drugs in clinical treatment are hampered by the risk of bleeding due to poor targeting and low drug penetration. Here, we used platelet (PLT)-like biological targeting to enhance the delivery and accumulation of nanomedicines in thrombus and reduce the risk of bleeding. Meanwhile, the parallel strategy of “thrombus thermal ablation and anticoagulation” was applied to increase the permeability of drugs in thrombus and achieve the optimal antithrombotic effect. Polypyrrole (PPy) and rivaroxban (Riv, an anticoagulant drug) were co-assembled into platelet membrane-coated nanoparticles (NPs), PLT-PPy/Riv NPs, which actively targeted the thrombotic lesion at multiple targets in the platelet membrane and were thermally and drug-specific thrombolysed by 808 nm laser irradiation. The combination therapy resulted in up to 90% thrombolysis in a femoral vein thrombosis model compared to single phototherapy or drug therapy. The results showed that the nanoformulation provided a new direction for remote precise and controlled sustained thrombolysis, which was in line with the trend of nanomedicine towards clinical translation.

Remote Expert DVT Triaging of Novice-User Compression Sonography with AI-Guidance

Compression ultrasonography of the leg is established for triaging proximal lower extremity deep vein thrombosis (DVT). AutoDVT, a machine-learning software, provides a tool for nonspecialists in acquiring compression sequences to be reviewed by an expert for patient triage. The purpose of this study was to test image acquisition and remote triaging in a clinical setting. Patients with a suspected DVT were recruited at 2 centers in Germany and Greece. Enrolled patients underwent an artificial intelligence-guided two-point compression examination by a nonspecialist using a handheld ultrasound device prior to a standard scan. Images collected by the software were uploaded for blind review by 5 qualified physicians. All reviewers rated the quality of all sequences on the American College of Emergency Physicians (ACEP) image quality scale (score 1-5, ≥ 3 defined as adequate imaging quality) and for an ACEP score ≥3, chose "Compressible", "Incompressible", or "Other". Sensitivity and specificity were calculated for adequate quality scans with an assessment as "Compressible" or "Incompressible". We define this group as diagnostic quality. To simulate a triaging clinical algorithm, a post hoc analysis was performed merging the "incomplete", the "low quality", and the "Incompressible" into a high-risk group for proximal DVT. Seventy-three patients (average age 64.2years, 44% females) were eligible for inclusion and scanned by 3 nonultrasound-qualified healthcare professionals. Three patients were excluded from further analysis due to incomplete scans. Sixty two of 70 (88.57%) of the completed scans were judged to be of adequate image quality with an average ACEP score of 3.35. Forty seven of 62 adequate AutoDVT scans were assessed as diagnostic quality, of which 8 were interpreted as positive for proximal DVT by the reviewers resulting in a sensitivity of 100% and specificity of 95.12%. When simulating a triaging algorithm, 34/73 (46.58%) of patients would be triaged as high risk and 8 would be confirmed as positive for proximal DVT (6 in the diagnostic and 2 in the low-quality cohort). Of 39/73 patients triaged as low risk, all were negative for proximal DVT in standard duplex; thus, this triaging algorithm could potentially save 53.42% of standard duplex scans. Machine learning software was able to aid nonexperts in acquiring valid ultrasound images of venous compressions and allowed remote triaging. This strategy allows faster diagnosis and treatment of high-risk patients and can spare the need for multiple unnecessary duplex scans, the vast majority being negative.

Crocin improves lower extremity deep venous thrombosis by regulating the PIM1/FOXO3a axis.

Lower extremity deep venous thrombosis (LEDVT) has a high incidence and mortality. Crocin has the potential to ameliorate thrombosis. The study aimed to clarify whether crocin affects LEDVT. Human umbilical vein endothelial cells (HUVECs) were exposed to thrombin and crocin (0, 5, 10, 20, 40, and 80 μM). Cell viability was assessed by MTT assay. Cellular behaviors were assessed using flow cytometry, TUNEL assay, and tube formation assay. The binding relationship between crocin and PIM1 was analyzed by molecular docking. The underlying mechanism of PIM1 was determined by reverse transcription-quantitative PCR, dual-luciferase reporter assay, and RIP. We found that crocin (5, 10, 20, and 40 μM) promoted thrombin-treated HUVEC viability in a dose-dependent manner. Crocin inhibited apoptosis and promoted the angiogenesis of HUVECs induced by thrombin. PIM1 was a target of crocin and was upregulated in patients with LEDVT and thrombin-treated cells. Foxo3a could interact with PIM1 and positively related to PIM1 expression. Moreover, the knockdown of PIM1 suppressed apoptosis and promoted angiogenesis in thrombin-HUVECs treated with crocin, while overexpression of Foxo3a reversed the effects. In conclusion, crocin inhibited apoptosis and promoted the angiogenesis of HUVECs induced by thrombin via the PIM1/Foxo3a axis, suggesting that crocin may be effective for LEDVT therapy.

Biomarkers and the post-thrombotic syndrome: A systematic review of biomarkers associated with the occurrence of the post-thrombotic syndrome after lower extremity deep venous thrombosis.

Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep venous thrombosis (DVT). Biomarkers are potentially valuable clinical tools for handling PTS. The purpose of this review was to examine which biomarkers are associated with the development of PTS in adults with lower extremity DVT. We performed a systematic review of all English language prospective studies of biomarkers and PTS published in PubMed and EMBASE. Studies were included if diagnosing DVT by diagnostic imaging and assessing PTS by clinical scales, for example, the Villalta scale. Biomarkers of thrombophilia and pathological clot properties were not assessed. Data was reported qualitatively. 15 prospective studies were included. Studies varied widely in study design and methods of data analysis. Forty-six different biomarkers were examined, with seven being measured in two or more studies. The most frequently studied biomarkers were D-dimer, CRP, and IL-6. Associations between PTS and D-dimer were predominantly significant, while results on CRP and IL-6 were inconsistent. ICAM-1 was consistently associated with PTS in all studies and at all timepoints. IL-10 was significantly related to PTS development in the largest study and at all time points. Adiponectin, tPA, HRG and TAFI, MMP-1 and -8, and TIMP-1 and -2 were significantly associated with PTS in single studies. (1) Further research on biomarkers and PTS is clearly warranted. (2) Significant differences in study designs made it difficult to draw reliable conclusions regarding individual biomarkers. We suggest the implementation of a standardized framework for the study of biomarkers and PTS, to make comparison of future studies more feasible. (3) D-dimer, ICAM-1, IL-10, MMP-1 and 8, TIMP-1, TIMP-2, and adiponectin are clinical biomarkers of particular interest to include in future studies of PTS. Large scale systemic quantitative proteomic analyses of DVT patients could help identify novel biomarkers of interest in PTS-patients.

High systemic inflammation response index level is associated with an increased risk of lower extremity deep venous thrombosis: a large retrospective study

Background The association between inflammation and venous thromboembolism (VTE) has attracted increasing research interest. Recently, the systemic inflammation response index (SIRI) has been proposed as a novel inflammatory biomarker, but its potential association with lower extremity deep venous thrombosis (LEDVT) has not been investigated. Thus, this study aimed to explore the association between SIRI and LEDVT risk in a large sample over a 10-year period (2012–2022). Methods All hospitalized patients who underwent lower extremity compression ultrasonography (CUS) examinations were consecutively identified from our hospital information system database. Multivariate logistic regression analysis was used to investigate the association between SIRI and LEDVT risk. Sensitivity, restricted cubic spline and subgroup analyses were also performed. Results In total, 12643 patients were included, and 1346 (10.6%) LEDVT events occurred. After full adjustment, a higher SIRI level was significantly associated with an increased risk of LEDVT (odds ratio [OR] = 1.098, 95% confidence interval [CI]: 1.068–1.128, p < 0.001), and patients in quartile 4 had a 2.563-fold higher risk of LEDVT than those in quartile 1 (95% CI: 2.064–3.182, p < 0.001). A nonlinear relationship was observed (P for nonlinearity < 0.001), with an inflection point of 4.17. Below this point, each unit increase in SIRI corresponded to a 35.3% increase in LEDVT risk (95% CI: 1.255–1.458, p < 0.001). No significant difference was found above the inflection point (OR = 1.015, 95% CI: 0.963–1.069, p = 0.582). Sensitivity and subgroup analyses confirmed the robustness of the association. This association also existed in both distal and proximal LEDVT. Conclusion A High SIRI is significantly associated with an increased risk of LEDVT in hospitalized patients. Given that the SIRI is a readily available biomarker in clinical settings, its potential clinical use deserves further exploration.

Effect of co-administered dalteparin sodium and alteplase on clinical and biochemical parameters in postpartum patients with lower extremity deep venous thrombosis

Purpose: To investigate the clinical efficacy of co-administration of dalteparin sodium and alteplase in the treatment of postpartum lower extremity deep venous thrombosis.Methods: A total of 88 patients with postpartum lower extremity deep venous thrombosis admitted to Jiangxi Provincial People's Hospital of The First Affiliated Hospital of Nanchang Medical College, Nanchang, China from January 2020 to December 2022 were enrolled in this study and divided into study group (treated with dalteparin sodium and alteplase) and control group (treated with alteplase only), with 44 patients in each group. Clinical parameters (limb circumference, pigmentation and ulcer area), hemorheological parameters [D-Dimer (D_D), fibrinogen (FIB), centipoise (CP), red cell assembling index (RCAI)], inflammatory factors (hs-CRP, IL-6, THF-a, NMP-9) and cell adhesion factors {platelet endothelial cell adhesion molecule-1 (PECAM-1) and vascular cell adhesion molecule 1 (VCAM-1)} were determined and recorded.Results: Post-treatment, all the clinical and biochemical parameters in the study group were significantly improved compared with pre-treatment levels and the respective levels in the control group (p &lt; 0.05). The overall response rate (ORR) in the study group was 95.45 %, which was higher than the 79.55 % for the control group (p &lt; 0.05).Conclusion: Concomitant administration of dalteparin sodium and alteplase is more efficacious than treatment of with alteplase alone in the management of postpartum lower extremity deep venous thrombosis. However, further clinical trials on this combination therapy is required for the validation of findings obtained in this work.

Initial Analysis of Computer-aided Thrombectomy in the Management of Proximal Acute Lower Extremity Deep Venous Thrombosis

Initial Analysis of Computer-aided Thrombectomy in the Management of Proximal Acute Lower Extremity Deep Venous Thrombosis

French Canadian cross-cultural adaptation of CAPTSure©, an index for the Clinical Assessment of Post-Thrombotic Syndrome in children

PurposePost-thrombotic syndrome (PTS) is the most common complication of deep venous thrombosis (DVT). The index for the Clinical Assessment of Post-Thrombotic Syndrome in children (CAPTSure©) is a clinical tool for the diagnosis and severity rating of PTS in pediatric patients. The purpose of this study was to translate and adapt CAPTSure© for French-speaking patients.MethodsWe conducted a cross-sectional study to perform linguistic and cultural adaptation of CAPTSure©, using a rigorous translation process followed by cognitive debriefings in twenty French-speaking pediatric patients aged up to 18 years old with a history of upper or lower extremity DVT at least 6 months prior.ResultsForward and backward translations were used to produce a pre-final French version of CAPTSure©, followed by cognitive debriefings in twenty participants (median age: 11.5 years, 55% male, median CAPTSure© score: 26). The participants felt that the questionnaire was thorough, with an adequate length. Eight out of fourteen (57%) items in the LE questionnaire and 7/12 (58%) of the items in the UE questionnaire were modified following participants’ and a multidisciplinary expert committee’s input, leading to the final French version of CAPTSure©.ConclusionsCAPTSure© was successfully adapted for French-speaking pediatric patients. This will ease the diagnosis and severity rating of PTS in children in clinical practice and allow international research collaborations for additional non-English-speaking patients.