High Incidence Of Deep Vein Thrombosis Research Articles

Seasonal Effects on Postoperative Complications After Spinal Surgery: A National Database Analysis

To investigate the role of seasonality on postoperative complications after spinal surgery. Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2018. Current Procedural Terminology codes were used to identify the following procedures: posterior cervical decompression and fusion, cervical laminoplasty, posterior lumbar fusion, lumbar laminectomy, and spinal deformity surgery. The database was queried for deep vein thrombosis (DVT), pulmonary embolism, pneumonia, sepsis, septic shock, Clostridium difficile infection, stroke, cardiac arrest, myocardial infarction, urinary tract infection (UTI), and early unplanned hospital readmission (readmission). Warm season was defined as April-September, whereas cold season was defined as October-March. Statistical analysis included computing overall complication rates and comparison between seasons using univariate analysis and multivariable logistic regression. A total of 208,291 individuals underwent spinal surgery from 2011 to 2018. There was a statistically significant increase in UTI (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.07-1.26; P= 0.0002) and readmission (OR, 1.06; 95% CI, 1.02-1.11, P= 0.007) in the warm season compared with the cold season. An investigation into the July effect showed increases in DVT (OR, 1.24; 95% CI, 1.03-1.48; P= 0.020) and thromboembolic events (OR 1.17; 95% CI, 1.01-1.35; P= 0.032) in July-September compared with the preceding 3 months. The results showed a higher incidence of UTI and readmission among spine surgery patients in the warm season and a higher incidence of DVT and thromboembolic events from July to September. In both cases, the effect of seasonality is statistically significant, but the absolute difference is small and may not suggest policy changes.

Comparison of deep vein thrombosis risks in acute respiratory distress syndrome caused by COVID-19 and bacterial pneumonia: a retrospective cohort study

BackgroundHigh incidence of deep vein thrombosis (DVT) has been observed in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 and those by bacterial pneumonia. However, the differences of incidence and risk factors of DVT in these two groups of ARDS had not been reported before.Study design and methodsWe performed a retrospective cohort study to investigate the difference of DVT in incidence and risk factors between the two independent cohorts of ARDS and eventually enrolled 240 patients, 105 of whom with ARDS caused by COVID-19 and 135 caused by bacterial pneumonia. Lower extremity venous compression ultrasound scanning was performed whenever possible regardless of clinical symptoms in the lower limbs. Clinical characteristics, including demographic information, clinical history, vital signs, laboratory findings, treatments, complications, and outcomes, were analyzed for patients with and without DVT in these two cohorts.ResultsThe 28-days incidence of DVT was higher in patients with COVID-19 than in those with bacterial pneumonia (57.1% vs 41.5%, P = 0.016). Taking death as a competitive risk, the Fine-Gray test showed no significant difference in the 28-day cumulative incidence of DVT between these two groups (P = 0.220). Fine-Gray competing risk analysis also showed an association between increased CK (creatine kinase isoenzyme)-MB levels (P = 0.003), decreased PaO2 (partial pressure of arterial oxygen)/FiO2 (fraction of inspired oxygen) ratios (P = 0.081), increased D-dimer levels (P = 0.064) and increased incidence of DVT in COVID-19 cohort, and an association between invasive mechanical ventilation (IMV; P = 0.001) and higher incidence of DVT and an association between VTE prophylaxis (P = 0.007) and lower incidence of DVT in bacterial pneumonia cohort. The sensitivity and specificity of the corresponding receiver operating characteristic curve originating from the combination of CK-MB levels, PaO2/FiO2 ratios, and D-dimer levels ≥0.5 μg/mL were higher than that of the DVT Wells score (P = 0.020) and were not inferior to that of the Padua prediction score (P = 0.363) for assessing the risk of DVT in COVID-19 cohort.ConclusionsThe incidence of DVT in patients with ARDS caused by COVID-19 is higher than those caused by bacterial pneumonia. Furthermore, the risk factors for DVT are completely different between these two ARDS cohorts. It is suggested that COVID-19 is probably an additional risk factor for DVT in ARDS patients.

High incidence of venous thrombosis in patients with moderate-to-severe COVID-19.

Increasing evidence suggests that COVID-19 may be associated with venous thromboembolism, and much data exists regarding high incidence of venous thrombosis in critical COVID-19 patients. However, evidence on this complication in less severe patients is not widely available. The aim of this study was to investigate the incidence of deep-vein thrombosis (DVT) in patients with moderate-to-severe COVID-19, to assess the prevalence of DVT with duplex ultrasound, and to compare patients with DVT and those without it using lung computerized tomography (CT), clinical information and lab data. The subjects of this study were 75 consecutive patients (aged 27–92 y, median–63 y; 36 males and 39 females) with moderate-to-severe COVID-19. DVT was found in 15 patients (20%). The vast majority of those with DVT (13 patients, 86.7%) had thrombi in calf veins and 2 (13.3%) had ileofemoral thrombosis. High incidence of DVT (20%) is observed even in patients with moderate-to-severe COVID-19. These patients require early anticoagulation therapy as part of their treatment. Such therapy may be continued after hospital discharge and these patients may also require follow-up vein ultrasonography after recovery to rule out DVT.

Incidence of Deep Vein Thrombosis in Hepato-Biliary Pancreatic Patients

Aim and methods: More than 20% of Japanese patients was reported to have asymptomatic postoperative deep vein thrombosis (DVT). Considering the aggressiveness of surgery, hepato-biliary pancreatic (HBP) patients may have higher incidence of DVT. To evaluate the risk, a consecutive 196 patients were examined by doppler ultrasonography before and after major HBP surgery since November 2015 until July 2019. All the patients received intermittent pneumatic compression of the lower thigh but did not receive prophylactic anticoagulant.

DVT incidence and risk factors in critically ill patients with COVID-19

Few data are available on the incidence of deep vein thrombosis (DVT) in critically ill COVID-19 with thrombosis prophylaxis. This study retrospectively included 88 patients in the ICU with critically ill COVID-19 at Jinyintan Hospital in Wuhan, China. All patients underwent compression ultrasonography for identifying DVT. Firth logistic regression was used to examine the association of DVT with sex, age, hypoalbuminemia, D-dimer, and SOFA score. The median (interquartile range [IQR]) age and SOFA score of 88 patients were 63 (55–71) years old and 5 (4–6), respectively. Despite all patients receiving guideline-recommended low-molecular-weight heparin (LMWH) thromboprophylaxis, the incidence of DVT was 46% (95% CI 35–56%). Proximal DVT was recognized in 9% (95% CI 3–15%) of the patients, while 46% (95% CI 35–56%) of patients had distal DVT. All of the proximal DVT combined with distal DVT. Risk factors of DVT extension occurred in all distal DVT patients. As Padua score ≥ 4 or IMPROVE score ≥ 2, 53% and 46% of patients had DVT, respectively. Mortality was higher in patients with acute DVT (30%) compared with non-DVT (17%), but did not reach statistical significance. Hypoalbuminemia (odds ratio [OR], 0.17; 95% CI 0.06–0.05, P = 0.001), higher SOFA score (OR per IQR, 2.07; 95% CI 1.38–3.39, P = 0.001), and elevated D-dimer (OR per IQR, 1.04; 95% CI 1.03–1.84, P = 0.029) were significant DVT risk factors in multivariable analyses. High incidence of DVT was identified in patients with critically ill COVID-19, despite the use of guideline-recommended pharmacologic thromboprophylaxis. The presence of hypoalbuminemia, higher SOFA score, and elevated D-dimer were significantly independent risk factors of DVT. More effective VTE prevention and management strategies may need to be addressed.

Anatomical distribution of lower-extremity deep venous thrombosis in patients with acute stroke

ObjectivePost-stroke paralysis is a common contributor to deep vein thrombosis (DVT) of the lower extremities, but little is known about its epidemiology and anatomy. This prospective study aimed to investigate the clinical incidence and anatomical distribution of lower-extremity DVT in acute stroke. Patients and MethodsA total of 679 patients diagnosed with acute stroke (ischemic stroke, n = 507; hemorrhagic stroke, n = 172) were enrolled. Lower-extremity DVT was evaluated using vascular ultrasonography, and classified into three subtypes: central type, peripheral type and mixed type. Then, the incidence and anatomical distribution of DVT were analyzed. ResultsFor patients with ischemic stroke, a total of 107 patients (21.1%) were affected by DVT, and 119 extremities were found with DVT, which included 114 extremities with peripheral-type DVT and five extremities with mixed-type DVT. For patients with hemorrhagic stroke, a total of 49 patients (28.5%) were affected by DVT, and 55 extremities were found with DVT, which included 51 extremities with peripheral-type DVT and four extremities with mixed-type DVT. The incidence of DVT was significantly higher in patients with hemorrhagic stroke than in patients with ischemic stroke (P < 0.05). Intermuscular veins were the most commonly affected (96.6%), followed by peroneal veins (15.5%), posterior tibial veins (9.2%), popliteal veins (4.0%), and femoral veins (4.0%). There was no significant difference in the anatomical distribution of DVT between ischemic and hemorrhagic stroke (P > 0.05). ConclusionDVT is a common complication of acute stroke, and hemorrhagic stroke is associated with a higher incidence of DVT. The anatomical distribution of DVT revealed no heterogeneity between ischemic and hemorrhagic stroke, and isolated DVT in intermuscular veins were the most common.

Analysis of related factors of deep venous thrombosis after spinal cord injury

To explore the high-risk factors of deep vein thrombosis (DVT) formation in patients after spinal cord injury (SCI) and to provide some reference value for the prevention of DVT. Eighty-five patients with spinal cord injury caused by thoracolumbar burst fracture from January 2016 to December 2017 were selected as subjects. All patients were followed up for 6 months, of which 5 cases were lost and 80 cases were finally included. According to whether there was deep vein thrombosis, the patients were divided into DVT group (35 cases) and control group (45 cases). The clinical data were statistically analyzed by SPSS 22.0 statistical software, and the high-risk factors of spinal cord injury were analyzed by multivariate Logistic regression. Thirty-five of the 80 patients with spinal cord injury developed deep venous thrombosis (incidence rate was about 43.7%). The average age of DVT group [(47.77±10.76) years ] was higher than that of non-DVT group [(37.35±10.20) years ], and there was a significant difference between two groups (χ2=19.56, P<0.000). Patients with body mass index≥28 kg/m2, combined with diabetes mellitus, smoking history, no limb pressure therapy and ankle pump exercise had a high incidence of DVT. The incidence of ASIA grade A in the spinal cord injury was higher in the DVT group (48.5%) than in the non-DVT group (20%) (P<0.05). The ROC curve was drawn by MedCalc 15.8 software : when the age was more than 45 years old, the incidence of deep venous thrombosis was higher, the specificity was 84.4%, and the sensitivity was 72.6%. Multivariate Logistic regression analysis showed the following factors : patient age >45 years [OR=1.665, 95% CI (1.102-2.516)], diabetes history [OR=3.273, 95% CI (1.291-8.295)], smoking history [OR=3.302, 95% CI (1.267-8.605)], spinal cord injury ASIA grade A [OR=5.736, 95% CI (3.152-11.74)], non-limb air pressure therapy and ankle pump exercise [ OR=3.013, 95% CI (0.116-0.789)] was statistically significant (P<0.05) and was a high risk factor for deep vein thrombosis. The incidence of DVT is still high in patients with spinal cord injury after surgery. When one or more risk factors such as age >45 years, history of diabetes, smoking history, and ASIA grade A of spinal cord injury is present, preventive measures should be taken in advance, it is of great significance to prevent the formation of deep vein thrombosis.

Analysis of related factors of deep venous thrombosis after spinal cord injury

To explore the high-risk factors of deep vein thrombosis (DVT) formation in patients after spinal cord injury (SCI) and to provide some reference value for the prevention of DVT. Eighty-five patients with spinal cord injury caused by thoracolumbar burst fracture from January 2016 to December 2017 were selected as subjects. All patients were followed up for 6 months, of which 5 cases were lost and 80 cases were finally included. According to whether there was deep vein thrombosis, the patients were divided into DVT group (35 cases) and control group (45 cases). The clinical data were statistically analyzed by SPSS 22.0 statistical software, and the high-risk factors of spinal cord injury were analyzed by multivariate Logistic regression. Thirty-five of the 80 patients with spinal cord injury developed deep venous thrombosis (incidence rate was about 43.7%). The average age of DVT group [(47.77±10.76) years ] was higher than that of non-DVT group [(37.35±10.20) years ], and there was a significant difference between two groups (χ2=19.56, P<0.000). Patients with body mass index≥28 kg/m2, combined with diabetes mellitus, smoking history, no limb pressure therapy and ankle pump exercise had a high incidence of DVT. The incidence of ASIA grade A in the spinal cord injury was higher in the DVT group (48.5%) than in the non-DVT group (20%) (P<0.05). The ROC curve was drawn by MedCalc 15.8 software : when the age was more than 45 years old, the incidence of deep venous thrombosis was higher, the specificity was 84.4%, and the sensitivity was 72.6%. Multivariate Logistic regression analysis showed the following factors : patient age >45 years [OR=1.665, 95% CI (1.102-2.516)], diabetes history [OR=3.273, 95% CI (1.291-8.295)], smoking history [OR=3.302, 95% CI (1.267-8.605)], spinal cord injury ASIA grade A [OR=5.736, 95% CI (3.152-11.74)], non-limb air pressure therapy and ankle pump exercise [ OR=3.013, 95% CI (0.116-0.789)] was statistically significant (P<0.05) and was a high risk factor for deep vein thrombosis. The incidence of DVT is still high in patients with spinal cord injury after surgery. When one or more risk factors such as age >45 years, history of diabetes, smoking history, and ASIA grade A of spinal cord injury is present, preventive measures should be taken in advance, it is of great significance to prevent the formation of deep vein thrombosis.

Medical Treatments for Hypogonadism do not Significantly Increase the Risk of Deep Vein Thrombosis Over General Population Risk

ObjectiveTo evaluate the risk of deep vein thrombosis (DVT) in men treated with testosterone replacement therapy (TRT) or Clomiphene Citrate (CC) and assess other etiologies for DVT as contributing factors. MethodsRetrospective chart review of 1180 consecutive hypogonadal men who were treated with either TRT or CC. Sixty-four percent had mixed, 16% had primary, and 20% had secondary hypogonadism. ResultsOf the 1180 men with hypogonadism, 694 were treated with TRT, while 486 were treated with CC. Overall, 10 of 1180 (0.8%) men were diagnosed with a DVT during the treatment, 9 of whom were on TRT and 1 on CC. Of the 10 men diagnosed with DVT while on treatment, 7 (70%) had potential identifiable etiologies for DVT other than treatment for hypogonadism. None of the men were found to be polycythemic at the time of DVT diagnosis. There was a higher incidence of DVT in men treated with TRT than CC, however; the overall percentages of DVT in both treatment groups were relatively low. There was no difference in the percentages of men found to have other identifiable etiologies for DVT besides being on treatment between the TRT and CC groups. There was not a difference in testosterone levels between the TRT and CC groups. ConclusionThe overall rates of DVT for TRT and CC treated patients are relatively low, and the majority of patients with DVT had other identifiable etiologies for DVT. Polycythemia was not found to be a risk factor in the patients diagnosed with DVTs.

Acute traumatic coagulopathy is associated with deep vein thrombosis in severely traumatic patients

Objective To investigate the risk factors of deep vein thrombosis (DVT) as well as the association between acute traumatic coagulopathy (ATC) and DVT. Methods A retrospective observational study was carried out during the 12 month period in 2014 in emergency intensive care unit (EICU) of acute trauma center of Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Data including age, gender, body mass index, injury severity score (ISS), mechanism of injury, injury sites, international normalized ratio (INR) and DVT of each patient were recorded. Patients were divided into ATC group and non-ATC group according to INR to compare the incidence of DVT. Results A total of 200 trauma patients were enrolled in this cohort. Sixty(30%) patients suffered from ATC. And eighty-seven patients (43.5%) were subjected to DVT. Patients with ATC had a significant higher incidence of DVT (71.7% vs. 31.4%, P<0.01). Multiple logistic regression revealed that patients in ATC group were highly associated with DVT in the magnitude of more than five fold (OR=5.74, 95%CI: 2.80-11.74, P<0.01) compared with non-ATC group. It was more significant (OR=9.80, 95%CI: 2.09-45.90, P=0.004) in patients with lesser severe trauma (9≤ISS<16). Meanwhile, spinal cord injury and long-bone fracture of lower extremities were independent risk factors for the development of DVT. Conclusions Severe trauma patients admitted to EICU within 24 hours post-injury have a high incidence of ATC. And those patients with ATC have a significantly higher incidence of DVT, especially in lesser severe trauma (9≤ISS<16). Spinal cord injury and long-bone fracture of lower extremities were independent risk factors for developing DVT. Key words: Trauma; Coagulopathy; Deep vein thrombosis; Injury site; Injury severity; Age; Body mass index; Risk factors

The Incidence of Deep Vein Thrombosis in Asian Patients With Chronic Obstructive Pulmonary Disease

Most studies have focused on the prevalence of deep vein thrombosis (DVT) and pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation in Caucasian populations. DVT is supposedly less likely to occur among Asians than Caucasians, and the primary purpose of this study was to determine the actual incidence of DVT in patients with COPD in Asian populations.We enrolled patients over the age of 40 with a diagnosis of COPD (International Classification of Diseases, Ninth Revision [ICD-9]: 490–492, 496; A-code: A323 and A325) between 1998 and 2008. The index date was the date of first-time COPD diagnosis. We excluded the patients who had been diagnosed with COPD and DVT (The International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 453.8) before index date. The control group was frequency-matched according to age (3-year stratum), sex, and the year of admission, at a 2:1 ratio. Patients were followed from index date to when either a diagnosis of DVT was made, death occurred, December 31, 2009 was reached, or when the patients withdrew from the National Health Insurance program.The overall incidence rate of DVT was 18.78 per 10,000 person-years in patients with COPD, and the adjusted hazard ration of DVT in patients with COPD was 1.38 (95% confidence interval 1.06–1.80), which was greater than patients without COPD after adjusting for age, sex, atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accident, congestive heart failure, lower leg fracture or surgery, and cancer.Asian patients with COPD had a higher incidence of DVT than non-COPD patients.

Safety and Efficacy of Tranexamic Acid in Total Knee Arthroplasty.

BackgroundThe prevalence of total knee arthroplasty (TKA) is increasing, which is one of the most frequent operations in orthopedic practice. To further investigate the safe and effective role of using tranexamic acid (TA) in reducing transfusion rate and blood loss in total knee arthroplasty.Material/MethodsThis meta-analysis was conducted according to the Cochrane methodology. Twenty-eight superior quality and well designed randomized controlled trials (RCT) were collected to analyze for this study. Patients who had undergone primary unilateral TKA were chosen. The software, RevMan 5.2, was used to analyze collected data.ResultsFinally, 28 RCTs were collected to analyze for this study. Total blood loss was dramatically decreased via the application of TA, by a mean of 420 ml [95% CI: −514 to −327]. A significant reduction about blood transfusion rate was also found in patients who received TA. [RD: −0.26, 95%CI: −0.33 to −0.19]. Moreover, no significant differences were found between TA and control groups in incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE).ConclusionsThis meta-analysis demonstrates that the application of TA in TKA could decrease total blood loss and transfusion rate. On the other hand, the application of TA is not associated with high incidence of DVT or other adverse events. TA should be taken into account in routine use in primary knee arthroplasty to benefit the patients.

An interconnected duplicated femoral vein and its clinical significance

Anatomical variations in the femoral vein are of great clinical importance especially in cases of deep vein thrombosis (DVT). Knowledge of the variable anatomy of the femoral vein is important to minimise false-negative findings on ultrasound examination in patients with DVT and help to explain the 'silent' DVT. Furthermore, the presence of a duplicated femoral vein itself is associated with higher incidence of DVT. These venous anomalies are usually due to the truncular venous malformation. In the present study, while dissecting the right lower limb, we found a case of variation of the femoral vein. In this case, besides a duplicated femoral vein, we also noticed a 3rd interconnecting channel near the apex of the femoral triangle joining the two veins. This variation has not been reported previously by other authors. Considering its uniqueness and clinical importance, we decided to report this case.

Analysis of venous thromboembolic events after saphenous ablation.

Venous thromboembolic events after saphenous vein ablation procedures for varicose veins have been reported. Current knowledge of these events is based on single-institution studies or studies with small numbers of patients. The National Surgical Quality Improvement Program (NSQIP) database (2005-2009) was used to identify 3874 patients who underwent radiofrequency ablation (RFA) or endovenous laser ablation (EVLA) of the saphenous veins with or without stab phlebectomy. Outcome variables included documented postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). Bivariate and multivariate logistic regression analyses were performed to identify factors associated with venous thromboembolic events after ablation procedures. Procedures for lower extremity varicose veins included RFA in 2897 patients (74.8%) and EVLA in 977 (25.2%). Patients who underwent RFA were more likely to be older, obese, diabetic, hypertensive, and to have undergone procedures involving more than one vein (24% vs 4%; P< .0001). Patients who underwent EVLA were more likely to have received general anesthesia (56.9% vs 40.8%; P< .0001) and to have undergone concomitant stab phlebectomy (44.9% vs 31.7%; P< .0001). The incidences of DVT (1.74% vs 1.52%; P= .63) and pulmonary embolus (0.07% vs 0%; P >.99) were similar between EVLA and RFA. No significant predictors of DVT in the postoperative period were identified on bivariate or multivariate analyses. In the subgroup of 2514 patients who underwent ablation procedures without stab phlebectomy, those undergoing EVLA showed a trend toward a higher incidence of DVT (2.6% vs 1.4%; P= .057). After adjusting for patient demographics, DVT was 2.4 times more likely to develop in patients presenting with lower extremity ulcers than in those without ulcers (odds ratio, 2.4; 95% confidence interval, 1.01-6.11; P= .04). Although not statistically significant, the multivariate model found that when only ablation procedures were performed, EVLA was associated with an 83% increase in odds of DVT compared with RFA (odds ratio, 1.83; 95% confidence interval, 0.95-3.52; P= .06). The incidence of venous thromboembolic events after saphenous ablation is low. However, given that patients with lower extremity ulcers experienced an increased risk of DVT, care should be taken to ensure that the ablation catheter is positioned an appropriate distance from the saphenofemoral or sapheno-popliteal junction and that periprocedural preventative measures, such as anticoagulation prophylaxis, early ambulation, and lower extremity compression, are emphasized. The finding of a trend toward increased venous thromboembolic events in patients undergoing EVLA warrants further investigation in a large patient population.

Population-Based Analysis of Venous Thrombotic Events Following Saphenous Ablation

Background: Venous thrombotic events following great and small saphenous vein ablation procedures for varicose veins have been reported. Current knowledge of these events is based on single institution studies with small sample sizes. Methods: The National Surgical Quality Improvement Program (NSQIP) database (2005-2009) was used to identify a total of 3,874 patients who underwent radiofrequency ablation (RFA) or endovenous laser ablation (EVLA) of the great and small saphenous veins with or without stab phlebectomy. Outcome variables included clinically documented postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). Bivariate and multivariate logistic regression analyses were performed to identify factors associated with venous thrombotic events after ablation procedures. Results: A total of 2,897 (74.8%) patients underwent RFA and 977 (25.2%) underwent EVLA for lower extremity varicose veins. Patients who underwent RFA were more likely to be older (53.8 y vs 51.8 y, P .0001), obese (42.8% vs 38%, P .009), diabetic (8.5% vs 6.4%, P .01) hypertensive (31.9% vs 26.8%, P .002) and to have undergone procedures involving both veins (24% vs 4%, P .0001). Patients who underwent EVLA were more likely to have received general anesthesia (56.9% vs 40.8%, P .0001), to have undergone concomitant stab phlebectomy (44.9% vs 31.7%, P .0001), and had longer operative times (63.6 min vs. 57.3 min, P .0001). The incidence of DVT (1.74% vs 1.52%, P .63) and pulmonary embolus (0.07% vs 0%, P 1) were similar between EVLA and RFA. No significant predictors of DVT in the postoperative period were identified on bivariate or multivariate analyses. In the subgroup of patients who underwent ablation procedures only (no stab phlebectomy, N 2514), there was a trend toward higher incidence of DVT in patients undergoing EVLA (2.6% vs 1.4%, P .057). After adjusting for patient demographics, patients presenting with lower extremity ulcers were 2.4 times more likely to develop DVT compared to those without ulcers (OR 2.4, 95% CI 1.01-6.11, P .04). In the multivariate model when only ablation procedures were performed, EVLA was associated with an 83% increase in odds of DVT compare to RFA, although not statistically significant (OR 1.83, 95% CI 0.95-3.52, P .06). Conclusions: The incidence of venous thrombotic events after saphenous ablation is low. However, given that patients with lower extremity ulcers experienced an increased risk of DVT, care should be taken to ensure that the ablation catheter is positioned an appropriate distance from the sapheno-femoral or sapheno-popliteal junction, and postprocedural preventative measures such as early ambulation and lower extremity compression should be emphasized. The finding of a trend toward increased venous thrombotic events in patients undergoing EVLA warrants further investigation in a large patient population.

Deep Vein Thrombosis After Total Knee Arthroplasty in Asian Patients Without Prophylactic Anticoagulation

Deep vein thrombosis (DVT) is an important complication following total knee arthroplasty (TKA). However, the incidence of DVT is generally underestimated due to subclinical or minor symptoms and signs. In Western countries, prophylactic agents against DVT are administered routinely after TKA. However, in Asia, no regular prophylaxis is generally given to patients undergoing TKA. This article presents a prospective study evaluating the incidence of DVT in 724 consecutive Taiwanese patients who underwent TKA without prophylactic anticoagulation therapy. Of these, 328 patients (45.3%) showed positive Homan's sign with calf swelling >3 cm. Ultrasonographic examination revealed the overall incidence of DVT to be 8.6% (62/724). The incidence of DVT was significantly higher in women (P=.035), in patients who underwent bilateral TKA (P=.002), and in patients with a body mass index ≥30 kg/m(2) (P=.026). The incidence of DVT appeared to be increased in patients with higher tourniquet time; however, the difference was not statistically significant. In all of the suspected cases of DVT, the symptoms subsided after the administration of enoxaparin with uneventful follow-up. No patient developed pulmonary embolism. Our results showed a relatively high incidence of DVT in an Asian population following TKA. We therefore consider that following TKA, prophylactic anticoagulation therapy should be administered to high-risk patients.

Diagnosis of Deep Vein Thrombosis (DVT) In Critically Ill Patients

AbstractAbstract 5123 Introduction:The assessment of existences of DVT is important to prevent pulmonary embolism for hospitalized patients. Especially, there is a high incidence of DVT in critically ill patients in the intensive care unit (ICU). Because almost all the patients in the ICU have limitations of their activities of daily living due to unstable vital status, controlled under the analgesia, or multiple injuries. The aim of the present study is to evaluate D-dimer levels as a diagnostic marker of DVT in critically ill patients. Methods:One-hundred ten adult patients (66 men, 44 women; age range 20–94 [median 64.5]) who admitted in our medico-surgical ICU in a university hospital were enrolled in this study. Serum D-dimer test and ultrasonic duplex scanning (ALOKA, Co., Ltd, Tokyo) were performed within one week after admission to the ICU. Serum D-dimer levels (μ g/mL) were measured by latex agglutination test (Sekisui Medical®, Tokyo) (normal <1.0μ g/mL). PT-INR (Quick one method) and APTT ratio (Langdell method) were also measured (Sysmex®, Kobe, Japan). DVT was diagnosed by ultrasonic duplex scanning. Value was expressed by median. Data were analyzed by Fisher's exact probability test and Mann-Whitney U test. A p < .05 was considered as statistically significant. Results:There were 32 patients (29.0 %) with DVT and 78 without DVT (71%) in the ICU. Primary diagnoses on admission were 31 cerebrovascular disease, 30 trauma patients, 16 sepsis, 9 acute respiratory failure, 8 hemorrhagic shock, 8 cardiogenic failure and 8 others. Between patients with DVT and without DVT, there were no significant differences in age (67.5 vs. 64.0, p=0.71), sex (19 men and 13 women vs. 47 men and 31 women, p=0.93), primary diagnosis (p=0.13), PT-INR (1.06 vs. 1.07, p=0.97) or APTT ratio (1.02 vs. 1.04, p=0.81), respectively. D-dimer level was also no statistically significant difference (10.4 vs. 7.3μ g/mL, p=0.21) between patients with DVT and without DVT. D-dimer level was higher in all DVT patients with DVT and in 95 per cent of non-DVT patients than normal range. Moreover, thromobosis tended to exist in soleal vein and femoral vein (Table)TableCases of DVT in each deep veinVeinRightLeftVeinRightLeftsoleal1415gastrocnemius13femoral49peroneal35anterior tibial52popliteal15posterior tibial44 Conclusion:The present study suggests that D-dimer level could not be a useful marker for assessment of existence of DVT in critically ill patients. And DVT almost existed in soleal and femoral veins. D-dimer level elevates because of the primary disease and/or complications of patients in the ICU. The ultrasonic duplex scanning is an easy and non-invasive examination at the bed side, while there is a limitation to perform it for ICU patients due to their unstable vital status, difficulty of appropriate posture, such as prone positioning, or injured lower limbs. But at least the examination by duplex scan of soleal and femoral veins, which have more possibility to develop to pulmonary embolism, could be significance in the ICU patients. Disclosures:No relevant conflicts of interest to declare.

Predictors of deep vein thrombosis (DVT) in newly diagnosed multiple myeloma (MM) patients with and without prophylactic recombinant erythropoietin (EPO) therapy

9554 Background: DVT, a complication among newly diagnosed MM patients, is most common during the first 3–4 months of therapy. EPO, given to treat anemia in patients receiving chemotherapy, has been associated with increased DVT risk and the mechanism, thought to be related to rise in hemoglobin, remains unknown. Methods: All 604 patients with newly diagnosed MM who completed the induction phase (∼ 3–4 months) of treatment were included. Induction consisted of multiagent chemotherapy with upfront randomization to thalidomide (THAL) or no THAL. 122 patients were also enrolled in an exercise study that included prophylactic EPO. Venous thromboembolism, defined as Doppler confirmed DVT and/or pulmonary embolus during induction, was the primary endpoint. Univariate analyses provided group comparisons. Logistic regression analysis determined predictors of DVT. Results: EPO and No EPO groups were similar for THAL use, age, race, gender, BMI, DVT history, and key baseline laboratory values except for lower cytogenetics risk score (p = 0.010) and higher albumin (p = 0.005), hemoglobin (p = 0.025) and fibrinogen (p = 0.0005) in the EPO group. EPO patients had a higher incidence of DVT 25 (20.5%) vs. 47 (9.8%) (p = 0.001). Risk factors for DVT by univariate analysis were THAL (p =0.001) and baseline platelets &gt; 350,000/μL (p = 0.018) but not hemoglobin (at baseline or throughout study). There were no significant differences in MM response or survival between the groups with and without DVT. Compared to the No EPO group, EPO-treated patients had a better MM response (p = 0.023) and a higher survival (p = 0.0005). The main predictors of DVT by logistic regression were THAL and prophylactic EPO. Conclusions: THAL and prophylactic EPO predict for higher risk of DVT among newly diagnosed MM patients. Hemoglobin levels were not related to higher risk of DVT. DVT and EPO did not decrease treatment response or survival. No significant financial relationships to disclose.

Risk of Deep Vein Thrombosis Following Laparoscopic Rectosigmoid Cancer Resection in Chinese Patients

The aim of this study was to evaluate the incidence of postoperative deep vein thrombosis (DVT) in Chinese patients who underwent laparoscopic resection of rectal or sigmoid cancer in the absence of thromboprophylaxis. Patients with adenocarcinoma of the sigmoid colon or rectum scheduled for laparoscopic resection were recruited. Neither chemoprophylaxis nor mechanical methods against DVT were employed. They were scheduled to have routine duplex ultrasound of both lower limbs perioperatively. In a 12-month period, 50 patients were recruited. Postoperative DVT occurred in 19 (38%) patients. None needed anticoagulation. Complete resolution of the thrombus was noted in 10 (53%) patients 12 weeks after operation, and in six patients 36 weeks after operation. Female sex was identified as being associated with a higher incidence of DVT. Age, smoking, preoperative neoadjuvant chemoirradiation, preoperative metastasis, duration of operation, conversion and postoperative complications did not appear to be risk factors for DVT. The incidence of asymptomatic calf vein DVT is relatively high after laparoscopic resection for rectosigmoid cancers in the Chinese population. However, complete resolution occurred without the use of anticoagulant therapy in the majority of cases. It is thus difficult to advocate the routine use of anticoagulant prophylaxis.

Guidelines on use of vena cava filters

Summary of key recommendations • VC filters are indicated to prevent pulmonary embolus(PE) in patients with venous thromboembolism (VTE)who have a contraindication to anticoagulation (grade B,level III).• Anticoagulation should be considered in patients with aVC filter when a temporary contraindication to antico-agulant therapy is no longer present. Insufficient dataexists to support a recommendation that all filter recip-ients should be treated with indefinite anticoagulationregardless of their risk of recurrent thrombosis (grade C,level IV). The decision as to whether or not to introduceanticoagulant therapy should be based on the perceivedunderlying thrombotic risk of the condition and thelikelihood of anticoagulant therapy-related bleeding.• VC filters are not indicated in unselected patients withVTE who will receive conventional anticoagulant therapy(grade A, level Ib).• VC filter insertion may be considered in selected patientswith PE despite therapeutic anticoagulation. Alternativetreatment options, such as long-term high-intensity oralanticoagulant therapy [international normalised ratio(INR) target 3AE5] or low molecular weight heparin(LMWH), should be considered prior to VC filterplacement, particularly in patients with thrombophilicdisorders (e.g. antiphospholipid syndrome) or cancer(grade C, level IV).• VC filter insertion may be considered in pregnantpatients who have contraindications to anticoagulationor develop extensive VTE shortly before delivery (within2 weeks). Retrievable filters should be considered (gradeC, level IV).• Free-floating thrombus is not an indication for insertionof a VC filter (grade B, level III).• Thrombolysis is not an indication for filter insertion. If afilter is used a retrievable filter should be used if available(grade C, level IV).• VC filters should be considered in any pre-operativepatient with recent VTE (within 1 month) in whomanticoagulation must be interrupted. Retrievable VCfilters should be considered in this situation where atemporary contraindication to anticoagulation exists(grade C, level IV).• No particular filter appears superior to others. Removablefilters should be used, if available, for patients with ashort-term contraindication to anticoagulant therapy(e.g. approximately 2 weeks) (grade C, level IV).