Incidence Of Symptomatic Venous Thrombosis Research Articles

Performance and safety of PowerPICC catheters and accessories: a prospective observational study

ObjectiveThis study aimed to evaluate the safety and performance of PowerPICC catheters in a real-world setting.DesignProspective, observational, multicentre study.SettingNine European countries, involving 14 centres.ParticipantsGeneral patient population.InterventionPowerPICC catheter inserted by the...

Low incidence of symptomatic venous thrombosis associated with peripherally inserted central catheter

Low incidence of symptomatic venous thrombosis associated with peripherally inserted central catheter

Venous thrombosis in patients after intracardial catheter interventions: incidence, risk factors, special aspects of the diagnosis

Rationale: Thrombosis of the puncture site in the femoral veins is one of the potentially dangerous complications of intracardial catheter interventions associated with thromboembolic risk related to its proximal location. According to the literature, the incidence of symptomatic venous thrombosis (VT) is 1–3%. No special studies on the assessment of risk factors for this complication, its diagnosis and treatment have been conducted.Aim: To study the incidence, risk factors and special aspects of VT diagnosis in patients undergoing intracardial electrophysiological studies (EFI) and/or catheter ablation.Materials and methods: This prospective study included 408 patients (194 men and 214 women, with median age of 51±10.1 years), who were admitted to the hospital with various cardiac rhythm disorders for intracardial EFIs and/or catheter ablations from 2016 to 2018. Before the interventions, in addition to common laboratory and instrumental work-up, all the patients underwent ultrasound duplex scanning (USDS) of the iliac-femoral segment; in 269 patients the level of D-dimer was measured. Latest at 24 hours after the intervention, all patients underwent a control ultrasound scan of the femoral vein puncture site. In case of VT occurrence anticoagulant therapy was started in all patients and they were followed up till complete VT resolution and at least for 3 months (the study endpoint). The VT incidence and its risk factors including the prognostic value of D-dimer levels were evaluated.Results: The VT incidence after catheter interventions was 11.7% (n=48). There was a significant correlation between VT occurrence and such risk factors as diabetes mellitus (p=0.001) and obesity (p<0.001). No association between elevated baseline D-dimer values (>500 ng/mL) and subsequent VT development was found (p>0.05). The quartile analysis revealed an association between baseline D-dimer levels exceeding 434 ng/mL (which corresponds to the range of 75 to 100%) and the presence of the following risk factors: age over 65 years (p<0.001), female gender (p=0.001), arterial hypertension (p=0.003), chronic coronary heart disease (p=0.044).Conclusion: In this study, all VTs (11.7%) detected after catheter transvenous interventions by USDS were asymptomatic. VTs were most frequent in patients with diabetes mellitus and obesity. D-dimer had no predictive value in the development of VT; however, its increased baseline values were more common in women, patients over 65 years, and in patients with arterial hypertension and chronic coronary heart disease.

Efficacy of treatments in patients with symptomatic venous thrombosis after knee arthroscopic surgery

Objective: To confirm the incidence of the symptomatic venous thrombosis and evaluate the efficacy of early treatments in patients with symptomatic venous thrombosis after knee arthroscopic surgery. Methods: From June 2010 to December 2015, 19 patients with symptomatic venous thrombosis hospitalized after knee arthroscopy were retrospectively analyzed by visual analogue scale (VAS) in Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Results: The incidence of symptomatic venous thrombosis after knee arthroscopy in our hospital was about 1.27%.15 cases were completely followed up to the end point.The clinical symptoms of those patients were statistically relieved[(4.74±0.73)vs(1.89±0.66), (1.60±0.51), P<0.05)]; [(46.68±4.09) cm vs (45.00±4.07)cm, P>0.05; (46.68±4.09) cm, (43.73±4.04)cm, P<0.05)]; and in one month ultrasonic review, 5 cases were confirmed to get revascularization, while with 4 cases get partially response.No significance was found in symptomatic relief-revascularization correlation and background factors comparison.No pulmonary embolism were observed among those cases. Conclusion: Although the incidence of symptomatic venous thrombosis after knee arthroscopy is relatively low, caution should still be needed to get early detection, diagnosis and intervention.The conventional conservative treatments can usually get a relatively good and safe clinical outcome.

Thrombophilia and Thrombotic Disorders in Newborns

incidence in children is estimated at about 0.7 cases of venous thrombosis per 100,000 population, 1.0 of stroke and 0.1 of myocardial infarction, while in adults the incidence reported is 74.2, 45.4 and 175.6 cases respectively. The lower incidence of venous thromboembolic disease (VTE) in children compared to adults is mainly due to the integrity of the vessels and the enhanced anticoagulant activity of the endothelium, and additionally to the reduced capacity of thrombin generation, inactivation of thrombin by a2-macroglobulin, the increased concentration of which, counterbalances the physiological deficiency of antithrombin and protein C / S, to the decreased levels of tissue factor in cord blood and concentration of eicosanoids and proteoglycans, depending on age [2,3]. The incidence of thromboembolic events (VTE) is higher in infants than in older children. About 10% of VTE occur in the first four weeks of life, frequently in critically ill neonates (2.4 symptomatic VTE cases per 1000 admissions in Neonatal Intensive Care Units-NICU). The incidence of symptomatic venous thrombosis (VTE) in newborns is 5.1/100,000 live births [4]. Although it is considered that the thromboembolic events are under diagnosed, newborns are nearly 40 times more likely to suffer a VTE than during the entire childhood, but certainly the above probability is significantly less than that referred in adults [5,6]. The hemostatic system both in preterm and full-term newborns differs significantly from that of older children and much more than that of adults, however, normally in newborns there is a balance in between bleeding or thrombosis diathesis. The increased incidence of VTE in critically ill infants is attributed to the derangement of equilibrium of the hemostatic mechanism, because of the lower concentrations of natural inhibitors and impaired fibrinolytic activity and also due to elevated levels of factor von Willebrand [7]. The combination of the above with both the high viscosity of blood due to the high hematocrit and the small vascular diameter of newborns results in low capillary flow, especially on coexistence of dehydration or hypercoagulable state because of infection or prematurity. Furthermore, the use of venous or arterial catheters is one of the major risk factors for thrombosis in neonatal period. Nowadays, 15% of infants in NICU and at least 50% of preterm infants of birth weight 90% of cases) or congenital risk factors. For the manifestation of VTE in neonates, several coincidental risk factors (variety of underlying diseases or triggering events of the child or maternal) are required. Studies so far, have not revealed thrombophilic factors contributing to the occurrence of asymptomatic or symptomatic VTE [8]. Genetic factors are related to the risk of VTE in children and newborns but no causal relationship is established for most of them [9]. The frequency of presence of thrombophilic factors in children with VTE is reported 13-79% in several studies. The huge discrepancy is attributed mainly to variation in the design of the trials, the difficulty in the definition of related prothrombotic disorders, and also to the small number and different patient populations. Regarding thromboembolic events of central venous system (CNS) [10], and although the high frequency of idiopathic arterial ischemic events (AIS) [11], the prevalence of thrombophilic factors varies in different studies from 20 to 50%, while increased appears the possibility of the presence of congenital thrombophilia in neonates with renal, hepatic or portal vein thrombosis [12]. Furthermore, maternal thrombophilia has been associated with the occurrence of perinatal AIS, venous sinus thrombosis or renal vein thrombosis [13]. However, in neonates there is scepticism about the interpretation of results of the various studies due to the complexity of the mechanism of hemostasis and the interaction of several acquired factors. Thrombosis in neonates is generally a multifactorial process [14]. Future studies may clarify both causative background and therapeutic choices in this group of patients.

Symptomatic Thromboembolism after One-stage Bilateral THA with a Multimodal Prophylaxis Protocol

To determine the incidence of thromboembolism after one-stage bilateral total hip arthroplasty and the role of two different chemoprophylaxis agents, we retrospectively studied 644 consecutive patients who underwent one-stage bilateral total hip arthroplasties. All patients received a similar multimodal prophylaxis protocol, which differed only in the postoperative chemoprophylaxis: 292 patients received warfarin (Group 1) and 352 received aspirin (Group 2). All patients were followed for a minimum of 3 months. We observed no difference in the incidence of symptomatic venous thrombosis, pulmonary embolism, or mortality in the two groups. Twenty patients in each group had deep venous thrombosis (7% and 5.7%, respectively) develop. Seven patients (2.39%) in Group 1 and eight (2.27%) in Group 2 had proximal deep venous thrombosis. Four patients in each group had a nonfatal pulmonary embolism (1.36% and 1.13%, respectively). There were two deaths in each group, neither related to venous thromboembolism. One-stage bilateral total hip arthroplasties were associated with a low rate of venous thrombosis and embolism with our multimodal prophylaxis protocol, and we found no difference in the incidence of either in patients who received warfarin or aspirin for chemoprophylaxis.

A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism

Diagnostic strategies in patients with suspected pulmonary embolism have been extensively studied in outpatients; their value in hospitalized patients has not been well established. Our aim was to determine the safety and clinical utility of a simple diagnostic strategy in hospitalized patients with suspected pulmonary embolism. Prospective management study. Twelve teaching hospitals (five academic, seven general hospitals). A total of 605 hospitalized patients with clinically suspected pulmonary embolism. All patients completed the study. First the clinical decision rule (CDR)-score was calculated. An unlikely CDR-score in combination with a normal D-dimer excluded pulmonary embolism. All other patients underwent helical computed tomography (CT). CT either diagnosed or excluded pulmonary embolism, in which case anticoagulants were started or withheld. All patients were instructed to report symptoms of venous thrombosis. Objective tests were performed to confirm venous thromboembolism. The primary outcome was the incidence of symptomatic venous thrombosis during 3-month follow-up. The combination of an unlikely CDR-score and a normal D-dimer excluded pulmonary embolism in 60 patients (10% of all patients); no venous thromboembolic event occurred during follow-up (0%; 95% CI 0-6.7%). CT excluded pulmonary embolism in 380 patients; during follow-up venous thromboembolism occurred in five patients (1.4%; 95% CI 0.4-3.1%). An unlikely CDR-score in combination with a normal D-dimer appears to exclude pulmonary embolism safely in hospitalized patients. Before clinical implementation it is important this safety is confirmed by others. CT testing was obviated in only 10% of patients. CT can safely exclude pulmonary embolism in hospitalized patients.

Incidence of symptomatic venous thrombosis in cervical and vulvo-vaginal carcinoma treated with concurrent chemoradiation, erythropoietin, and coumadin

8101 Background: We had previously reported an increase in the incidence of symptomatic deep vein thrombosis (DVT) in 144 cervical and vulvo-vaginal cancer patients receiving recombinant human erythropoietin (rHuEpo) compared to patients not receiving rHuEpo in conjunction with chemoradiation therapy (Cancer 2003; 98: 1514-20). From April 2002, we instituted a policy of prophylactic low dose coumadin in an attempt to prevent DVT in this cohort receiving rHuEpo. Methods: A retrospective analysis of 56 consecutive patients with cervical or vulvo-vaginal carcinoma (FIGO Stage IB-IVA) who received chemoradiation and rHuEpo from 2001 to 2003 were performed. Subjects were divided into two groups: 32 subjects received rHuEpo alone, 24 subjects received daily coumadin (1–2 mg) in addition to rHuEpo. Primary endpoint was symptomatic DVT proven by duplex ultrasound. Results: There was no difference in baseline characteristics (e.g. age, stage, body mass index, mean and peak hemoglobin, WBC and platelet counts recorded at the time of peak hemoglobin, and number of transfusions) between these two cohorts (p ≥ 0.06, Wilcoxon rank sum test). 9 out of 24 patients (37.5%) had a symptomatic DVT while receiving coumadin compared to 10 out of 32 patients (31.3%) not on any anticoagulation. The incidence of thrombosis was not different between the two groups studied (p=0.62, Chi-square test; OR=1.32, 95% CI=(0.43,4.02)). Out of the 9 patients who had a DVT while receiving coumadin, 7 developed upper extremity (UE) DVT while 3 had lower extremity (LE) DVT (1 patient had both UE and LE thromboses). For the 10 patients who were not on coumadin and developed thromboses, 9 were UE DVT and 2 were LE DVT (1 patient had both UE and LE DVT). There was no difference between the two groups in the percentage of patients with UE DVT (p=0.83, Chi-square test; OR=1.14, 95% CI=(0.35,3.74)) or LE DVT (p=0.64, Fisher's test; OR=2.2, 95% CI=(0.33,14.79)). Conclusions: Daily low dose coumadin did not alter the incidence of symptomatic DVT in patients with cervical or vulvo-vaginal cancer who received rHuEpo in conjunction with chemoradiation therapy. No significant financial relationships to disclose.

Incidence of symptomatic venous thrombosis in cervical and vulvo-vaginal carcinoma treated with concurrent chemoradiation, erythropoietin, and coumadin

8101 Background: We had previously reported an increase in the incidence of symptomatic deep vein thrombosis (DVT) in 144 cervical and vulvo-vaginal cancer patients receiving recombinant human eryt...

Erythropoietin-induced thrombosis as a result of increased inflammation and thrombin activatable fibrinolytic inhibitor.

Chronic inflammation is a major cause of morbidity and mortality in end-stage renal disease. The associated anemia in these patients due to renal cortical atrophy and erythropoietin deficiency is treated with recombinant erythropoietin. Recent reports suggest a growing incidence of symptomatic venous thrombosis in cancer patients treated with recombinant erythropoietin. Several investigators have reported on different mechanisms of thrombosis in these patients. We hypothesize that thrombosis in patients with end-stage renal disease due to increased expression of C-reactive protein (CRP) as a result of chronic inflammation promotes the release of thrombin activatable fibrinolytic inhibitor causing fibrinolytic deficit and eventually thrombosis. Furthermore, because endothelial nitric oxide is responsible for the maintenance of the normal vascular function, the decreased levels of nitric oxide in chronic inflammation cause endothelial damage and result in thrombosis. To test this hypothesis, blood samples were collected from 106 patients (49 male and 57 female, aged 59.8+/-15.7 years) with end-stage renal disease undergoing hemodialysis and treated with recombinant erythropoietin at a mean dose of 201.8 U/kg/week. Blood samples were drawn in 5-mL tubes containing 3.2% sodium citrate just before the hemodialysis procedure. These blood samples were immediately centrifuged to obtain platelet-poor plasma, which was aliquoted and frozen at -70 degrees C until further analysis. Erytropoietin antibodies were measured using an anti-EPO enzyme-linked immunosorbent assay (ELISA) method developed in our laboratory. Nitric oxide was measured using a NO analyzer (Sievers 280I, Ionics, Boulder, CO). Plasma CRP levels were measured with a highly sensitive ELISA method IMUNOCLONE CRP ELISA (American Diagnostica, Greenwich, CT). TAFI antigen levels in plasma were analyzed with an IMUCLONE TAFI ELISA kit (American Diagnostica, Greenwich, CT). TAFI functional activity was assayed with an ACTICHROME TAFI activity kit. The measured levels of nitric oxide, CRP, TAFI antigen, and TAFI functional were 37.36+/-36.8 (normal value, 37.49+/-18.96; range, 19.3-102 microM), 12.27+/-10.6 (normal value, < 1 microg/mL), 146.9+/-28.4% NHP (normal, 100% NHP), and 102.55+/-37% NHP (normal range, 22.3-165.7; mean, 89.5% NHP), respectively. The erythropoietin antibody was detected in 9.4% of the patient group. While 20% of the erythropoietin antibody-positive and 27.1% of the erythropoietin antibody-negative patients experienced chest pain, thrombotic events developed in 9.4% of the erythropoietin antibody-negative patients. These data provide the rationale for a novel mechanism of thrombosis through increased activity of CRP, nitric oxide, and TAFI, leading to fibrinolytic deficit and thrombosis in patients treated with erythropoietin.

Increased Incidence of Symptomatic Venous Thrombosis in Patients With Cervical Carcinoma Treated With Concurrent Chemotherapy, Radiation, and Erythropoietin

Obstetrical & Gynecological Survey: January 2004 - Volume 59 - Issue 1 - p 34-35 doi: 10.1097/01.OGX.0000103403.79267.07

Increased incidence of symptomatic venous thrombosis in patients with cervical carcinoma treated with concurrent chemotherapy, radiation, and erythropoietin

Because studies have suggested that anemia has an adverse effect on outcome for patients with cervical carcinoma who are treated with radiation, recombinant human erythropoietin (rHuEpo) has been used increasingly to maintain hemoglobin levels in these patients. Erythropoietin may increase the risk of thrombosis. The authors performed a retrospective analysis to determine whether there was an increased rate of symptomatic venous thrombosis associated with the use of rHuEpo in patients with carcinoma of the uterine cervix and vagina. A retrospective, case-control study was performed on consecutive patients with localized carcinoma of the uterine cervix or vagina who were treated with chemotherapy and radiation (chemoradiotherapy). The primary outcome was symptomatic venous thrombosis. One hundred forty-seven patients were reviewed. When they were divided into women who received rHuEpo (n = 75 patients) and women who did not receive rHuEpo (n = 72 patients), there were no significant differences in age, height, weight, disease stage, or body mass index. Fewer patients in the rHuEpo group required transfusions. In the rHuEpo group, 17 of 75 patients had either an upper extremity thrombosis (n = 12 patients) or a lower extremity thrombosis (n = 7 patients): 2 patients had both, and 2 patients had more than 1 event. Two of 72 patients who did not receive rHuEpo had symptomatic thrombosis. Patients who received rHuEpo had an odds ratio (OR) of developing thrombosis of 10.3 (95% confidence interval [95% CI], 2.3-46.2). Multiple logistic regression revealed that only the use of rHuEpo was associated with an increased risk of thrombosis (OR, 15.3; 95% CI, 3.1-76.7). Patients with cervical carcinoma who received chemoradiotherapy and rHuEpo had an increased risk of symptomatic venous thrombosis.

Thrombosis prophylaxis in hospitalised medical patients: does prophylaxis in all patients make sense?

Most studies on thrombosis prophylaxis focus on postoperative venous thrombosis. In medical wards thrombosis prophylaxis is generally restricted to patients who are immobilised. Our primary aim was to investigate the incidence of venous thrombosis in a general internal ward, to assess whether more rigorous prophylaxis would be feasible. We investigated the incidence of venous thrombosis in patients hospitalised from 1992 to 1996 and related our findings to literature reports. The incidence of symptomatic venous thrombosis in internal patients during hospitalisation was 39/6332 (0.6%). Among these 39 patients, 24 had a malignancy, whereas 876 out of all 6332 patients had a known malignancy. So, the incidence in this group with cancer was 2.7% compared with 0.3% (15/5456) in the non-cancer group (relative risk for venous thrombosis due to malignancy was 10.0 (95%C.I. 5.3-18.9). The incidence of venous thrombosis during hospitalisation in a department of general internal medicine is low and does not justify prophylaxis in all internal patients. Cancer is a strong risk factor for hospital-acquired thrombosis in the medical ward. Further studies may answer the question as to whether thrombosis prophylaxis in this subgroup is feasible.