Incidence Of Venous Thromboembolic Disease Research Articles

Venous Thromboembolic Disease in Trauma and Surveillance Ultrasonography

The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates. We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service. We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT. Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings.

Incidence of Venous Thromboembolic Disease Following Hip Arthroscopy

Venous thromboembolic disease is a known complication of orthopedic surgery. Hip arthroscopy is a technically demanding procedure with a significant learning curve and low reported complication rate. Few reports document the incidence of venous thromboembolic disease following hip arthroscopy. Our hypothesis was that the incidence of venous thromboembolic disease following hip arthroscopy was comparable to that reported for knee arthroscopy. Eighty-one consecutive patients undergoing hip arthroscopy were retrospectively reviewed. All patients underwent standard diagnostic hip arthroscopy under traction of the operative leg against a well-padded perineal post. All procedures were performed on an outpatient basis. Three of 81 patients (3.7%) developed a clinically symptomatic venous thromboembolic disease in the postoperative period. The diagnosis was suspected clinically and confirmed with the use of a Doppler ultrasound. No patient developed symptomatic pulmonary emboli. One patient used oral contraceptives and 2 had no known risk factors for venous thromboembolic disease. All patients were successfully treated with anticoagulation. This is the first study to document multiple occurrences of venous thromboembolic disease following hip arthroscopy. This study demonstrated the incidence of symptomatic venous thromboembolic disease after hip arthroscopy to be 3.7%. Further study investigation is warranted regarding the incidence of symptomatic and asymptomatic venous thromboembolic disease following hip arthroscopy.

Venous thromboembolism in acutely ill hospitalized medical patients

Background Acute and chronic illness, immobility, and procedural and pharmacologic interventions may predispose patients in the Internal Medicine Wards to venous thromboembolic disease (VTE). The purpose of this study was to determine the incidence of VTE in these patients. Materials and Methods A retrospective chart review of cohort of consecutive patients admitted to Internal Medicine wards in Spain between January 1st 2005 and December 31st 2007 was performed. For each patient, demographic data, risk factors for VTE and the diagnosis of VTE during hospitalization was recorded. Results We analyzed 1,567,659 patients, excluding 28,226 patients who had DVT or PE before admission, and 196,555 who were discharged in the first 48 hours. We identify 12,458 new diagnosed VTE events among 1,344,959 patients (incidence 0.93%) hospitalized more than two days. Hospitalized-acquired VTE risk factors were feminine gender (odds ratio [OR] 1.31; CI95% 1.26-1.35), age > 70 (OR 1.08 CI95% 1.04-1.13), acute infectious disease (OR 1.27 CI95% 1.17-1.38), acute respiratory disease (OR 1.23 CI95% 1.17-1.28), dementia (OR 1.22 CI95% 1.14-1.31), neoplasic disease (OR 2.29, CI95% 2.19-2.49), and hemiplegia (OR 1.49, CI95% 1.31-1.69). Conclusions The number of patients with VTE in an Internal Medicine ward is higher than expected. Several independent risk factors for VTE were identified. Based on the large number of patients who developed a VTE during hospitalization, our data add strength to the argument that VTE prevention should be high on the list of priorities when health care policies are being formed.

Recurrent deep vein thrombosis and pulmonary embolism in a young man with Klinefelterʼs syndrome and heterozygous mutation of MTHFR-677C>T and 1298A>C

Klinefelter's syndrome is characterized by hypogonadism and infertility and commonly has an XXY karyotype. Within the population of men with this disorder, there is an increased incidence of venous thromboembolic disease. Although the precise mechanisms underlying this prothrombotic state have not been elucidated, it is thought that the increased incidence of thromboembolism is associated with a hypofibrinolytic state secondary to androgen deficiency. We present the case of a 26-year-old man with Klinefelter's syndrome who had recurrent episodes of deep venous thrombosis and pulmonary embolism while undergoing therapeutic anticoagulation. Coagulation studies were significant for the heterozygous mutations of MTHFR-677C>T and 1298A>C gene and hyperhomocystenemia. Our aim is to raise awareness of this association and discuss management for these patients.

Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period.

Venous thromboembolic disease (TED), although rare, is a major cause of maternal mortality and morbidity, hence methods of prophylaxis are often used for women at risk. This may include women delivered by caesarean section, those with a personal or family history of TED and women with inherited or acquired thrombophilias (conditions that predispose people to thrombosis). Many methods of prophylaxis carry a risk of side effects, and as the risk of TED is low, it is possible that the benefits of thromboprophylaxis may be outweighed by harm. Current guidelines for clinical practice are based on expert opinion only, rather than high quality evidence from randomised trials. To determine the effects of thromboprophylaxis in women who are pregnant or have recently delivered and are at increased risk of TED on the incidence of venous TED and side effects of treatment. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009). Randomised trials comparing one method of thromboprophylaxis with placebo or no treatment, and randomised trials comparing two (or more) methods of thromboprophylaxis. Two review authors extracted data independently and resolved any discrepancies by discussion. Sixteen trials met the inclusion criteria but only 13 trials, involving 1774 women, examining a range of methods of thromboprophylaxis, contributed data for the outcomes of interest. Four of them compared methods of antenatal prophylaxis: low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) (two studies), and heparin versus no treatment (two studies). Eight studies assessed postnatal prophylaxis after caesarean section; one compared hydroxyethyl starch with unfractionated heparin; four compared heparin with placebo; and the other three compared UFH with LMWH. One study examined prophylaxis in the postnatal period.The small number of statistically significant findings in this review are largely derived from trials which are not of high methodological quality. It was not possible to assess the effects of any of these interventions on most outcomes, and especially on rare outcomes such as death, TED and osteoporosis, because of small sample sizes and the small number of trials making the same comparisons.There was some evidence of side effects associated with thromboprophylaxis. There is insufficient evidence on which to base recommendations for thromboprophylaxis during pregnancy and the early postnatal period. Large scale randomised trials of currently-used interventions should be conducted.

Update on acute pulmonary embolism

The annual incidence of venous thromboembolic disease (VTE) is approximately one to two cases per 1,000 persons and is strongly age dependent, as the incidence rises to nearly 1% per year in those aged >75 yrs [1, 2]. A recent epidemiological study confirmed that VTE is a major public health burden with an estimated 370,000 related deaths in 2004 in six European countries [3]. Moreover, pulmonary embolism (PE) may lead to persistent chronic disease, i.e. chronic thromboembolic pulmonary hypertension, which can be severely disabling [4–8]. Recent published data on risk factors, diagnosis, prognosis and treatment of acute PE will be the main focus of this update. VTE is currently considered to be the result of an interaction between patient-related and setting-related risk factors [9]. Patient-related predisposing factors are usually permanent, whereas setting-related risk factors are more often temporary (table 1⇓). However, the predictive values of these factors are not equal and VTE can occur in patients without any identifiable predisposing factors. View this table: Table. 1— Predisposing risk factors for pulmonary embolism ### Pregnancy and post-partum period VTE is one of the leading causes of maternal morbidity and mortality. About two-thirds of VTE cases occur during pregnancy and one-third post-partum. A recent case–control study showed that the risk of VTE was increased five-fold (OR 4.6, 95% CI 2.7–7.8) during pregnancy and increased 60-fold (OR 60.1, 95% CI 26.5–135.9) during the first 3 months following delivery compared with nonpregnant females [10]. The risk was highest in the third trimester of pregnancy and during the first 6 weeks after delivery. The risk of thrombosis during pregnancy is affected by the presence of pro-thrombotic abnormalities. Females with Factor V Leiden or prothrombin 20210A, two common pro-thrombotic genetic variants, have a 30 to 50-fold increased risk of VTE during pregnancy and post-partum relative to …

Prevención de la enfermedad tromboembólica venosa en cirugía general

Postoperative venous thromboembolic disease (VTED) affects approximately one in four general surgery patients who do not receive preventive measures. In addition to the risk of pulmonary embolism, which is often fatal, patients with VTED may develop long-term complications such as post-thrombotic syndrome or chronic pulmonary hypertension. In addition, postoperative VTED is usually asymptomatic or produces clinical manifestations that are attributed to other processes and consequently this complication is often unnoticed by the surgeon who performed the procedure. Thus, the most effective strategy consists of effective prevention of VTED using the most appropriate prophylactic measures against the patient's thromboembolic risk. There is sufficient evidence that VTED can be prevented by pharmacological methods, especially heparin and its derivatives and with mechanical methods such as support tights or intermittent pneumatic compression of the lower extremities. To reduce the incidence of VTED as far as possible, strategies have been proposed that include a combination of drugs and mechanical methods, new antithrombotic drugs, or prolonging the duration of prophylaxis in patients at very high risk, such as those who have undergone surgery for cancer. Another important aspect is the optimal moment to initiate prophylaxis with anticoagulant drugs with the aim of achieving an adequate equilibrium between antithrombotic efficacy and the risk of hemorrhagic complications. The present article reviews the available evidence to attempt to optimize prevention of VTED in general surgery and in some special groups, such as laparoscopic surgery, short-stay surgery and obesity.

Estrogen-TNF interactions and vascular inflammation

cardiovascular disease (CVD), especially coronary heart disease (CHD), is by far the leading cause of death in women ([29][1], [40][2]). As the prevalence of these diseases increases after menopause, much effort has been devoted to determining whether endogenous estrogen confers a protective effect

Diagnostic et traitement de la maladie thromboembolique veineuse en pédiatrie

Thromboembolic events are an increasingly commonly recognized secondary complications in children treated for serious, life-threatening primary diseases. Nevertheless the incidence of venous thromboembolic disease remains 100 times less frequent in hospitalized children than hospitalized adults, as recent data suggest an incidence of 5,3/10.000 pediatric patients compared to an incidence of 2,5-5/100 in adult patients. Diseases usually associated with thromboembolic events in children are neoplasia, autoimmune or cardiac malformative disease. Contrarily to what is observed in the adult, the majority of deep vein thrombosis events occur at the upper limbs veins, usually at the place where devices for venous access like port-a-cath or central venous lines are inserted. Because of the relatively low incidence of venous thromboembolic events in children, the diagnostic approach used are largely extrapolated from guidelines obtained from adult studies. However, the diagnostic performances of some diagnostic tools like Doppler-Ultrasound are probably diminished in children. Moreover, the concept of developmental hemostasis, which stresses the point that the hemostatic system in children is quite different from the adult one, is widely accepted and clearly suggests that the diagnostic and therapeutic approach in pediatric patients may not be simply extrapolated from data obtained in adult studies. From a more practical point of view, the fact that the hemostatic system in children is a dynamic and evolving system, renders the therapeutic approach quite complex. In particular, doses of anticoagulants vary markedly across the pediatric age. The absence of adapted formulations of commonly used anticoagulants, for example the absence of liquid formulations of anti-vitamin K drugs, further complicates the administration and the correct monitoring of anticoagulation in children, and may diminish observance in adolescent patients. Even though the concept that “children are not little adults” is nowadays widely accepted, there is an urgent need for prospective studies to better assess the modalities of diagnosis and treatment of venous thromboembolic disease in this particular population. (J Mal Vasc 2006; 31: 135-142)

Incidence of Venous Thromboembolism on a Burn Service

The exact incidence of venous thromboembolic disease (VTE) in burn patients has yet to be defined. This was a prospective observational study to determine the incidence of VTE in patients in the burn unit. VTE was defined as a pulmonary embolism, a lower extremity deep vein thrombosis or an upper extremity deep vein thrombosis. Patients chosen for this study were only patients who fit a risk profile such as immobilization, need for mechanical ventilation, paralysis or major surgical procedures. We administer low dose unfractionated heparin at 5000–7500 unit twice a day as well as place pneumatic compression stockings on the patients as a method of VTE prophylaxis. Patients were screened with duplex sonography for the presence of a lower extremity DVT. If there was central venous catheter (CVP) an upper extremity duplex sonogram was performed. There were 310 patients admitted to the burn service during July 2004 and June 2005....

Pulmonary embolism in hospital practice

A pulmonary embolism is an obstruction of part of the pulmonary vascular tree, usually caused by a thrombus that has travelled from a distant site—for example, the deep veins in...

Inherited Thrombophilia due to Factor V Leiden Mutation.

Inherited thrombophilia due to activated protein C resistance is now recognized as one of the major genetic risk factors in the development of venous thromboembolic disease. Activated protein C resistance is secondary to a point mutation in the factor V gene, factor V Leiden. The high prevalence of this mutation in the general population, mainly in Caucasians of European descent, is a major contributing factor to the high incidence of venous thromboembolic disease in the United States, affecting one in 1000 individuals annually. Heterozygosity and homozygosity for factor V Leiden increase the risk for thrombosis 5- to 10-fold and 50- to 100-fold, respectively, compared with genotypically normal individuals. Factor V Leiden is more common than all other known genetic risk factors for thrombosis, and its presence results in a compounded risk in patients with simultaneous inherited abnormalities such as protein C, protein S, antithrombin III deficiencies, hyperhomocysteinemia, and/or acquired risk factors. Therefore, detection of activated protein C resistance and genotyping for factor V Leiden are important for establishing risk for thrombosis and ultimately for patient management.

Venous thromboembolism associated with hip and knee replacement over a ten-year period

This population-based study investigated the incidence and trends in venous thromboembolic disease after total hip and knee arthroplasty over a ten-year period. Death or readmission for venous thromboembolic disease up to two years after surgery for all patients in Scotland was the primary outcome. The incidence of venous thromboembolic disease, including fatal pulmonary embolism, three months after surgery was 2.27% for primary hip arthroplasty and 1.79% for total knee arthroplasty. The incidence of fatal pulmonary embolism within three months was 0.22% for total hip arthroplasty and 0.15% for total knee arthroplasty. The majority of events occurred after hospital discharge, with no apparent trend over the period. The data support current advice that prophylaxis should be continued for at least six weeks following surgery. Despite the increased use of policies for prophylaxis and earlier mobilisation, there has been no change in the incidence of venous thromboembolic disease.

L’âge, un facteur indépendant de risque de thrombose: Données épidémiologiques

The incidence of thrombosis--arterial and venous--increases with age. This is the case for atheromatous diseases, atrial fibrillation and even venous thromboembolic disease. Ischemic heart disease is the most common cause of death in the elderly. Atrial fibrillation, an independent risk factor for cerebral vascular accidents, affects around 10% of persons older than 80 years. The incidence of venous thromboembolic disease increases with age, reaching 12.5 per 1000 people older than 75 years, compared with 5 per 1000 aged 60-75 and 2.5 per 1000 aged 40-59. Elderly persons often have two or more cardiovascular or venous thromboembolic risk factors and thus a still higher risk of thrombotic events. Their risk of thrombosis justifies the systematic search for acquired risk factors to assess the level of risk and take appropriate prevention measures.

Síndrome del pasajero de clase económica

Comfort, safety and time saving makes air travel more and more popular and widely use by an increased number of people in a range of extended age frame. Recent concerns in the global news have again raised an issue about the association of thromboembolic disease and air travel. Although there are numerous studies in the literature examining venous thromboembolic disease (VTE), variability of population demographics makes difficult a right and prospective assessment in the context of the cabin environment and air travel. Literature review clearly demonstrate that VTE is multicausal in nature, resulting in differing etiologic and predisposing factors across different age groups. Many questions are still to be answered, How many cases?, Direct association to Air Travel?, How to prevent it in the aviation environment? In this paper we analyze the incidence of VTE and some additional epidemiological aspects, risk and predisposing factors, diagnostic, and preventive measures given by the airline, the user, aviation authorities, aeromedical especialist in order to cope this complication. Finally we discuss the physiopathological bases in which VTE is developed and related considerations of this syndrome in the context of the aviation environment.

Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period.

Venous thromboembolic disease (TED), although very rare, is a major cause of maternal mortality and morbidity, hence methods of prophylaxis are often used for women at risk. This may include women delivered by caesarean section, those with a personal or family history of TED and women with inherited or acquired thrombophilias (conditions that predispose people to thrombosis). Many methods of prophylaxis carry a risk of side effects, and as the risk of thromboembolic disease is low, it is possible that the benefits of thromboprophylaxis may be outweighed by harm. Current guidelines for clinical practice are based on expert opinion only, rather than high quality evidence from randomised trials. To determine the effects of thromboprophylaxis in association with pregnancy in women who are pregnant or have recently delivered on the incidence of venous thromboembolic disease and side effects. The register of trials maintained by the Cochrane Pregnancy and Childbirth Group, the Cochrane Controlled Trials Register, MEDLINE, EMBASE and bibliographies of reviews. Date of last search: January 2002. Randomised trials comparing one method of thromboprophylaxis with placebo or no treatment, and randomised trials comparing two (or more) methods of thromboprophylaxis. Data were extracted independently by all reviewers. Discrepancies were resolved by discussion. Eight trials involving 649 women were included. Four of them compared methods of antenatal prophylaxis; low molecular weight versus unfractionated heparin (two studies), aspirin plus heparin versus aspirin alone (one study), and unfractionated heparin versus no treatment (one study). Four studies assessed postnatal prophylaxis after caesarean section; one compared hydroxyethyl starch with unfractionated heparin, two compared heparin with placebo (one low molecular weight heparin, one unfractionated heparin) and the other compared unfractionated heparin with low molecular weight heparin. It was not possible to assess the effects of any of these interventions on most outcomes, especially rare outcomes such as death, thromboembolic disease and osteoporosis, because of small sample sizes and the small number of trials making the same comparisons. There is insufficient evidence on which to base recommendations for thromboprophylaxis during pregnancy and the early postnatal period. Large scale randomised trials of currently-used interventions should be conducted.

Travellers' thrombosis.

Anecdotal reports have suggested a link between flying and the development of blood clots. A recent prospective study looking at passengers before and after flying has demonstrated a much higher incidence of asymptomatic venous thrombosis than we expected. In the same paper, graduated elastic compression stockings reduced this incidence of asymptomatic venous thrombosis. Further studies are required to see how many passengers develop symptomatic deep vein thrombosis and to assess the overall incidence of venous thromboembolic disease. A major epidemiological study, an interventional study to assess the efficacy of mechanical methods of venous thrombosis prophylaxis and the effect of graduated compression stockings, and studies to look at the effect of the cabin environment on thromboembolism are planned.

Morphologic and biochemical features affecting the antithrombotic properties of the inferior vena cava of rabbit pups and adult rabbits.

The incidence of venous thromboembolic disease is reduced in children compared with adults. Thromboprotective mechanisms, some of which have already been identified in plasma, must be present in children. Blood vessel walls have important antithrombotic properties that maintain blood fluidity. This is in part due to proteoglycan (PG)-related glycosaminoglycan (GAG) molecules within vessel walls. PGs are macromolecules with covalently attached GAG chains, either chondroitin, dermatan, heparan, or keratan sulfate. The influence of age on the concentration and anticoagulant activities of PGs and GAGs, within vein walls before puberty has not been previously investigated. We hypothesized that developmental differences in vein walls may contribute to the reduced risk of thrombosis in children. We used a rabbit model to examine morphologic and biochemical features of inferior venae cavae (IVCs). We assessed IVC wall morphology, PG distribution, GAG mass, and GAG antithrombin activity. Morphologically, there were only minor differences between pups and adult rabbits' IVCs. However, there was a significant increase in GAGs by mass in IVCs from pups compared with adult rabbits (p = 0.012). In addition the total antithrombin activity (p = 0.04), and especially that of heparan sulfate (p = 0.01) was significantly increased in pups compared with adult rabbits. These results demonstrate important differences in the antithrombotic properties of IVC walls in pups and adult rabbits. In summary, developmental differences in vein wall PG content and activity exist which may contribute to the reduced risk of venous thromboembolism in children. Further characterization of these differences is required.

Economics of thromboprophylaxis in total hip replacement surgery.

In 1997, 50,000 hip replacements will be performed in the UK, and over 1 million worldwide. Venous thromboembolism is the most frequent serious complication following joint replacement; its effective and economic management is essential. Antithrombotic prophylaxis can be used to reduce the incidence of venous thromboembolic disease, which presents as either deep vein thrombosis or pulmonary embolism. A number of published studies have shown that prophylaxis against venous thromboembolism is financially beneficial in terms of reduced diagnostic and treatment costs. Cost-effectiveness studies have provided a comparison of the costs and consequences resulting from alternative prophylactic programmes. This article reviews the epidemiology of venous thromboembolism after total hip replacement, prophylaxis against it and a model for cost-effectiveness analysis. Its aim is to highlight inadequacies in the available data and areas of uncertainty within the model that require further research. Pharmacoeconomic studies published to date have all used a similar framework to allow prophylactic options to be compared. However, assumptions made about the frequency of clinical disease have varied widely between studies. This degree of uncertainty calls into question the validity of reported incremental cost savings between treatments. Some studies have also failed to address the cost of complications resulting from the prophylactic method under consideration. Future studies must carefully consider the validity of their models, understand the limitations on current knowledge of outcome rates, and carefully consider all outcomes (both beneficial and detrimental) that result from the intervention.

Myocardial infarction and oral contraceptives, a retrospective case control study in England and Scotland ('MICA' Study).

Recent studies have shown that modern (third generation), oral contraceptives (OC) are associated with an increased incidence of venous thromboembolic disease compared to older (second generation), OC. It is not known, however, whether this association is also true for arterial thrombosis, in particular myocardial infarction. In fact, it has been suggested that third generation OC may even be protective against myocardial infarction (MI), compared to second generation OC. The protocol for a multicentre case-control study, involving the whole of England and Scotland, is described. Cases will be female patients aged 16-44 years, who suffered an MI between 1.10.93 and 1.10.95. Controls will be drawn from the community, using the GP list, to which the case belonged. Odds ratios will be calculated primarily to compare current users of third generation OC with current users of second generation OC.