Lower Extremity Deep Venous Thrombosis Research Articles

The incidence and significance of iliac vein stenosis in patients with deep vein thrombosis.

ObjectiveThe role of iliac vein stenosis (IVS) in the development of DVT is poorly understood. This study determines the incidence of IVS in patients diagnosed with DVT and assesses its impact on presentation and outcomes. Our hypothesis is that the presence of IVS increases the risk of long-term ipsilateral DVT recurrence. MethodsA retrospective study of the electronic medical records of consecutive adult patients treated for lower extremity DVT was performed. Only patients with cross-sectional imaging (CT or MR with intravenous contrast) were included. Patient and DVT characteristics were recorded. Cross-sectional imaging was reviewed for the presence or absence of ipsilateral IVS (≥50%). Patients were divided into 2 groups based on the presence or absence of IVS to compare characteristics and outcomes. Subgroup analyses on patients with provoked DVT, Cancer-related DVT, and unprovoked DVT were performed. ResultsThere were 548 patients with DVT and 32% had evidence of ipsilateral IVS on cross-sectional imaging. There were no significant differences in baseline characteristics or treatment methods between the 2 groups. There was a trend toward patients with IVS having less incidence of PE on presentation (22.9% vs 29.7%, P=0.1) but that difference did not reach statistical significance in the overall comparison. Subgroup analysis in patients with Cancer-related DVT (n=227) showed that patients with IVS were significantly more likely to develop ipsilateral recurrent DVT compared to patients with no IVS (12.9% vs 4.5%, P=0.045). Patients with unprovoked DVT with IVS had significantly lower PE on presentation compared to patients with unprovoked DVT without IVS (24.2% vs 39.8%, P<0.03). ConclusionIpsilateral ≥50% IVS is present in approximately a third of patients presenting with DVT. The presence of IVS seems to play a differential role in ipsilateral DVT recurrence and prevention of pulmonary embolization in different groups of patients presenting with DVT.

Construction of a risk prediction model for postoperative deep vein thrombosis in colorectal cancer patients based on machine learning algorithms

BackgroundColorectal cancer is a prevalent malignancy of the digestive system, with an increasing incidence. Lower extremity deep vein thrombosis (DVT) is a frequent postoperative complication, occurring in up to 40% of cases.ObjectiveThis research aims to develop and validate a machine learning model (ML) to predict the risk of lower limb deep vein thrombosis in patients with colorectal cancer, facilitating preventive and therapeutic measures to enhance recovery and ensure safety.MethodsIn this retrospective cohort study, we collected data from 429 colorectal cancer patients from January 2021 to January 2024. The medical records included age, blood test results, body mass index, underlying diseases, clinical staging, histological typing, surgical methods, and postoperative complications. We employed the Synthetic Minority Oversampling Technique to address imbalanced data and split the dataset into training and validation sets in a 7:3 ratio. Feature selection was performed using Random Forest (RF), XGBoost, and Least Absolute Shrinkage and Selection Operator algorithms (LASSO). We then trained six machine learning models: Logistic Regression (LR), Naive Bayes (NB), Gaussian Process (GP), Random Forest, XGBoost, and Multilayer Perceptron (MLP). The model’s performance was evaluated using metrics such as area under the Receiver Operating Characteristic curve, accuracy, sensitivity, specificity, F1 score, and confusion matrix. Additionally, SHAP and LIME were used to enhance the interpretability of the results.ResultsThe study combined Random Forest, XGBoost algorithms, and LASSO regression with univariate regression analysis to identify significant predictive factors, including age, preoperative prealbumin, preoperative albumin, preoperative hemoglobin, operation time, PIKVA2, CEA, and preoperative neutrophil count. The XGBoost model outperformed other ML algorithms, achieving an AUC of 0.996, an accuracy of 0.9636, a specificity of 0.9778, and an F1 score of 0.9576. Moreover, the SHAP method identified age and preoperative prealbumin as the primary determinants influencing ML model predictions. Finally, the study employed LIME for more precise prediction and interpretation of individual predictions.ConclusionThe machine learning algorithms effectively predicted postoperative lower limb deep vein thrombosis in colorectal cancer patients. The XGBoost model demonstrated strong potential for improving early detection and treatment in clinical settings.

From rare anomaly to clinical reality; managing venous thrombosis in the setting of congenital inferior vena cava agenesis

A congenital absence of the inferior vena cava (IVC) is a rare anomaly known to be linked with idiopathic deep venous thrombosis (DVT). This anomaly is more commonly observed in individuals with other congenital cardiac anomalies, with an incidence ranging from 0.6% to 2%. Here we are reporting a rare case of missing IVC presented with extensive bilateral lower extremity and iliac veins DVT. The symptoms responded well to therapeutic doses of heparin. In this article, we will review some other cases of IVC agenesis and different management including medical, interventional, and surgical approaches.

Gender-specific relationships between hyperuricemia and idiopathic deep venous thrombosis in the Chinese population: a case‒control study

BackgroundMany studies have indicated that hyperuricemia is positively correlated with secondary deep venous thrombosis (DVT); however, the risk factors for idiopathic DVT based on gender differences, such as serum uric acid (SUA) and hyperuricemia, have not been fully examined.ObjectivesTo investigate the association between hyperuricemia and the occurrence of idiopathic lower extremity DVT based on gender differences.MethodsThis was a retrospective analysis of 4299 patients who were hospitalized at the Affiliated Hospital of Qingdao University from January 2012 to October 2021 and who underwent ultrasound of the lower limbs. A total of 930 patients were diagnosed in the DVT group, and 3369 patients were diagnosed in the control group without DVT. The baseline SUA and other important baseline data were compared between the two groups, and sex was stratified. Multivariate logistic regression analysis models adjusted for potential confounders were used to investigate the associations between hyperuricemia and idiopathic lower extremity DVT.ResultsThe SUA level in patients with idiopathic DVT was significantly greater than that in patients without DVT (total: 6.00 ± 1.75 vs. 5.40 ± 1.56 mg/dL, respectively; male: 6.42 ± 1.60 vs. 5.87 ± 1.57 mg/dL, respectively; female: 5.58 ± 1.79 vs. 4.72 ± 1.27 mg/dL, respectively; all P < 0.001). The proportion of patients with hyperuricemia in the idiopathic DVT group was significantly greater than that in the control group (total: 29.03% vs. 16.10%, respectively; male: 35.26% vs. 23.19%, respectively; female: 22.73% vs. 5.74%, respectively; all P < 0.001). The incidence of DVT in patients with hyperuricemia was significantly greater than patients with normouricemia (33.29% vs. 18.92%, respectively), and this difference was particularly prominent among women (58.01%). According to the univariate model, hyperuricemia was significantly associated with a grester risk of idiopathic DVT. After adjustment for potential confounders, this association remained significant. The risk of idiopathic lower extremity DVT in patients with hyperuricemia was 2.643-fold greater than that in patients with normouricemia (Model 3: OR: 2.643, 95% CI: 2.165–3.228). After stratification by sex, the risk of idiopathic lower extremity DVT in female patients with hyperuricemia was 7.482-fold greater than that in patients with normouricemia (Model 3, OR: 7.482, 95% CI: 4.999–11.199).ConclusionIn the Chinese population, hyperuricemia is closely related to an increased risk of idiopathic lower extremity DVT, especially in female patients.

Early Thrombus Removal for Acute Lower Extremity Deep Vein Thrombosis: Update on Inclusion, Technical Aspects, and Postprocedural Management.

Acute lower extremity deep vein thrombosis (DVT) is a common disorder with significant associated morbidity, including pain and swelling, as well as the risk of pulmonary embolism (PE), recurrent venous thromboembolism (VTE) and chronic debilitating post-thrombotic syndrome (PTS). Anticoagulation is standard of care for DVT treatment. It assists in reducing thrombus progression and the occurrence of PE, but incomplete DVT resolution increases the risk of recurrent VTE, valvular insufficiency, and PTS. Endovascular DVT interventions, such as catheter-directed thrombolysis, pharmacomechanical thrombectomy, and large-bore mechanical thrombectomy offer an alternative therapeutic strategy for DVT management. This paper will discuss technical factors and current issues when performing lower extremity DVT interventions including patient selection, anticoagulation, choice of device for endovascular thrombus removal, adjunctive techniques, and venous stent management.Level of Evidence: No level of evidence for: review articles, basic science, laboratory investigations, and experimental study articles.

Abstract 4129839: Successful Left Atrial Appendage Occlusion (LAAO) with WATCHMAN FLX via Transhepatic Approach

Left atrial appendage occlusion (LAAO) with the WATCHMAN FLX (Boston Scientific) has been proven to reduce stroke risk in patients with paroxysmal atrial fibrillation (PAF). Certain circumstances may preclude LAAO1. In this case, transhepatic vein access was used to successfully deploy a WATCHMAN FLX in a 72 year old male with PAF not on anticoagulation due to recent subdural hemorrhage and recurrent bilateral lower extremity deep venous thrombosis (DVT) post IVC filter placement. Recent attempt at LAAO was unsuccessful due to total occlusion of bilateral femoral veins (Figure 1 A-B) and inability to cross the IVC. Access to the inferior branch of the right hepatic vein was achieved by micropuncture technique at the right mid-axillary line at the level of the 12th rib, which was confirmed by venogram (Figure 2A). The 4F microsheath was upsized to 16F. Intraoperative TEE was used for device sizing and delivery (Figure 3A). The transseptal sheath and dilator were positioned in the right atrium at the level of the fossa ovalis (Figure 3B) before successfully crossing into the left atrium (Figure 2B). After confirming placement (Figure 3C), a pigtail catheter was positioned within the LAA (Figure 3D) and an angiogram was performed (Figure 2C). A 24 mm WATCHMAN FLX was partially unsheathed and positioned (Figure 3E). Repeat LAA angiogram was performed through the WATCHMAN delivery sheath (Figure 2D). A Tug test was performed. The device was released (Figure 3F). Repeat venogram was performed to confirm location (Figure 2E) of the access site, and coil embolization closure of the venotomy access site was performed (Figure 2F). The patient was discharged the following day on dual antiplatelet (aspirin, clopidogrel) without complication. Venous access via right hepatic vein is a viable option for LAAO using the WATCHMAN FLX device.

Establishment and validation of a predictive model for lower extremity deep vein thrombosis in patients with traumatic pelvic fractures

BackgroundPatients with traumatic pelvic fracture (TPF) are at high risk for developing deep vein thrombosis (DVT). However, there is still no unified standard on how to distinguish high-risk groups for DVT in patients with TPF and how to accurately use anticoagulants at present.ObjectivesThis observational study aimed to establish a DVT risk nomogram score (DRNS) model for TPF patients, and to explore the value of the DRNS model as a clinical guideline in the prevention of DVT with low molecular weight heparin (LMWH).MethodsIndependent risk factors of lower extremity DVT were screened through Lasso regression and logistic regression. A DRNS model was established per this.ResultsThe independent risk factors of DVT included combined femoral fractures, age ≥ 40 years old, BMI (body mass index) ≥ 24 kg/m2, ISS score, fibrinogen concentration, and the minimum concentration of ionized calcium within 48 h after admission. The optimal cutoff value for DRNS was 78.5. In the low-risk population of DVT (DRNS < 78.5), there was no statistical significance of variation about the incidence of DVT progression between the LMWH once a day (qd) group and the LMWH once every 12 h (q12h) group, with P = 0.323. In the high-risk population of DVT (DRNS ≥ 78.5), the incidence of DVT progression in the LMWH qd group was significantly higher than that in the LMWH q12h group, with P = 0.002.ConclusionsThe DRNS model based on independent risk factors of DVT could stratify the risk of DVT for TPF patients, and it was able to provide more precise DVT drug prevention plans for clinicians.

MicroRNA-181b-5p/HEY2 axis is involved in the progress of deep venous thrombosis via mediating vascular endothelial injury

ABSTRACT Objectives: Deep-venous thrombosis (DVT) refers to abnormal blood clotting in the deep vein cavity, and post-thrombotic syndrome (PTS) is the most frequent complication. The study explored the impact of microRNA 181b-5p on DVT progression based on human umbilical vein endothelial cells (HUVECs). Methods: Levels of miR-181b-5p were examined in 150 cases with acute lower extremity DVT. ROC curve and K-M plot were drawn for clinical value assessment. The role of miR-181b-5p in HUVECs viability, migration, apoptosis, inflammatory response and adhesion factors’ release was investigated. Target gene of miR-181b-5p was predicted, and its role in cell function was explored. Results: Low-expressed miR-181b-5p showed favorable diagnostic performance in differentiating DVT with the AUC of 0.948. Patients with low miR-181b-5p had a high incidence of PTS. miR-181b-5p overexpression promoted HUVECs’ viability and migration, while inhibiting cell apoptosis and release of inflammatory and adhesion cytokines. As the target gene of miR-181b-5p, HEY2 overexpression reversed the role of miR-181b-5p in HUVECs. Conclusion: MiR-181b-5p serves as a potential biomarker for DVT diagnosis and PTS development. Overexpression of this miRNA targeted HEY2 to alleviate endothelial cell damage.

Residual popliteal vein thrombosis after endovascular treatment of mixed-type lower extremity deep vein thrombosis is relevant to post-thrombotic syndrome

ObjectivePatients with mixed-type lower extremity deep vein thrombosis (LEDVT) have a higher incidence of post-thrombotic syndrome (PTS) following endovascular treatment (EVT). This study aimed to identify risk factors associated with PTS in these patients post-EVT. MethodsThis retrospective study included patients diagnosed with acute mixed-type LEDVT who underwent EVT between January 2020 and December 2022. Patient assessments were conducted using ultrasound and the Villalta scale. Baseline characteristics, management details, and follow-up findings were compared between patients who developed PTS and those who did not at six months after EVT. Cox regression and nomogram analyses were performed to identify risk factors associated with the development of PTS. ResultsThe study enrolled 118 patients, of which 103 completed the follow-up. Among them, 24.3% developed post-thrombotic syndrome (PTS) within six months. Significant differences between the PTS and non-PTS groups were found concerning residual thrombosis in the popliteal, common femoral, and femoral veins. Multivariate Cox regression analysis indicated that residual popliteal vein thrombosis (RPVT) (HR 4.93, 95% CI 1.61-15.11) and preoperative iliac vein stenosis (HR 3.21, 95% CI 1.11-9.33) were significant risk factors for PTS. Additionally, subgroup analysis for preoperative iliac vein stenosis and sensitivity analysis confirmed that RPVT remained a risk factor for PTS (HR 4.48, 95% CI 1.27-15.84). ConclusionOur study demonstrated a positive association between residual popliteal vein thrombosis (RPVT) and PTS in patients with extensive mixed-type LEDVT after EVT. These findings suggest that intensive monitoring and aggressive therapeutic interventions may be required for patients with RPVT to reduce the risk of PTS.

US of Lower Extremity Deep Vein Thrombosis: A Review.

The standard protocol for lower extremity venous US extends from the common femoral vein through the deep calf veins with color and spectral Doppler sampling, allowing evaluation of acute deep vein thrombosis and differentiation from postthrombotic change.

Rationale and Design of the DEFIANCE Study: A Randomized Controlled Trial of Mechanical Thrombectomy Versus Anticoagulation Alone for Iliofemoral Deep Vein Thrombosis

BackgroundDeep vein thrombosis (DVT) is a common medical condition that is associated with clinically significant sequelae, including postthrombotic syndrome (PTS). Anticoagulation alone remains the guideline-recommended treatment for many patients with iliofemoral DVT. Recent technological advances have led to an increase in the use of mechanical thrombectomy for DVT, but mechanical thrombectomy-based procedures have not yet been compared with standard-of-care anticoagulation therapy in randomized studies. MethodsThe DEFIANCE study (ClinicalTrials.gov: NCT05701917) is an international and actively enrolling randomized controlled trial (RCT) in lower extremity DVT assessing an interventional strategy that includes mechanical thrombectomy with the ClotTriever System (Inari Medical, Irvine, CA) versus anticoagulation alone. Approximately 300 patients with unilateral iliofemoral DVT and symptom duration ≤12 weeks will be randomized 1:1. Study conduct includes an independent core laboratory for duplex ultrasound assessment, an independent medical monitor for safety adjudication, and evaluation of PTS severity on the Villalta scale using best clinical practices. The primary endpoint is a composite outcome structured as a hierarchal win ratio of 1) the occurrence of treatment failure or therapy escalation as adjudicated by the medical monitor, with failure defined as amputation or gangrene of the target leg or venous thromboembolism-related mortality, and 2) the assessment of PTS severity at the 6-month follow-up visit. In addition to being a component of the primary endpoint, the severity of PTS at 6 months is also evaluated as a stand-alone secondary endpoint. An additional secondary endpoint is a composite of outcomes at the 10-day visit and is structured as a hierarchal win ratio of 1) vessel compressibility on duplex ultrasound, 2) patient-reported pain, and 3) improvement of edema. The safety endpoints are access site complications requiring endovascular or surgical repair and the occurrence through the 30-day visit of mortality, major bleeding, or new symptomatic pulmonary embolism. ConclusionsDEFIANCE will be the first RCT to evaluate a mechanical thrombectomy-based interventional approach versus anticoagulation therapy alone for DVT. The results will inform the treatment of patients with iliofemoral DVT and the prevention of PTS-associated morbidity. Trial RegistrationDEFIANCE: RCT of ClotTriever System Versus Anticoagulation In Deep Vein Thrombosis (DEFIANCE), ClinicalTrials.gov: NCT05701917, URL: https://clinicaltrials.gov/study/NCT05701917?cond=Deep%20Vein%20Thrombosis&term=defiance&rank=1

Construction of nomogram for wound recurrence in elderly patients with venous leg ulcers.

Venous Leg Ulcers (VLUs) are one of the most serious and intractable complications of chronic venous insufficiency. This study aims to develop a nomogram based on a theoretical model to predict the probability of wound recurrence in older patients with VLUs. The elderly patients with VLUs attending the five hospitals between September 2021 and October 2022 were enrolled in this research, and randomized to the training and validation cohorts based on the corresponding ratio (7:3). Recurrent events were recorded during a six-month follow-up after the baseline data collection. The univariate analysis, the least absolute shrinkage and selection operator (LASSO) regression method were used to screen variables, and multiple logistic regression was used to establish a risk prediction model, which was presented by nomogram. Receiver operating curves (ROC), Hosmer-Lemeshow test, as well as calibration curves, were adopted to assess the effectiveness of the nomogram. The prognostic value of the nomogram was also examined. A total of 608 elderly patients with VLUs were included in the study. They were randomly divided into the training cohort (N = 421) and the validation cohort (N = 187). In the training cohort, Lasso regression and multivariate logistic regression analysis indicated that previous recurrence number, last ulcer duration, lower extremity DVT history, and frailty were independent risk factors for wound recurrence in elderly patients with VLUs, while daily exercise time and self-efficacy were protective factors. A nomogram was established with a good discrimination capacity and predictive efficiency with and the area under the curve (AUC) of 0.869 (95%CI: 0.831-0.908) in the training set and 0.890 (95%CI: 0.841-0.938) in the validation set. The p values of the Hosmer-Lemeshow test for both sets were 0.887 and 0.772, respectively, both greater than 0.05. The calibration degree charts showed that the data point connection was similar to the diagonal, indicating that the model's prediction probability of wound recurrence in elderly VLUs patients is close to the actual probability. This study constructed a new nomogram to predict the risk of wound recurrence in elderly patients with VLUs. The nomogram has excellent accuracy and reliability, which can help healthcare workers and patients actively monitor and follow up with patients to prevent the recurrence of ulcers and make clinical decisions.

A 12-Year Review of Upper Extremity Deep Vein Thrombosis-Are They the Same as Lower Extremity Deep Vein Thrombosis?

Background: Upper extremity deep vein thrombosis (UEDVT) is uncommon but not insignificant. The current literature is limited, and the management is largely extrapolated from the treatment of lower extremity DVTs (LEDVT). Methods: A retrospective review was conducted on patients diagnosed with UEDVT at Northern Health, Victoria, Australia, between December 2010 and December 2022. Medical records were reviewed to assess baseline characteristics and treatment outcomes. The results were compared to our previously collected data for LEDVTs. Results: 137 patients with UEDVT were identified (52.6% females; median age 62 years, IQR 46-74 years). A total of 105 patients (76.6%) had at least one provoking factor at the time of diagnosis, most commonly malignancy (45.7%) and/or indwelling venous devices (58.1%). Fourteen patients (10.1%) were subsequently diagnosed with Paget-Schroetter syndrome, with nine receiving endovascular or surgical intervention. A total of 109 patients (79.6%) received limited therapeutic anticoagulation (median 3 months, IQR 1.5-6.0 months) with enoxaparin, the most common anticoagulant used. Six patients had major bleeding (5.2/100-patient-years), and seven developed clot progression while on anticoagulation (6.0/100-patient-years). Ten patients had recurrent VTE following anticoagulation cessation (4.6/100-patient-years). There were no significant differences seen in the complication rate between catheter-related UEDVT and other UEDVTs. Compared to LEDVT, UEDVT was more likely provoked with comparable complication rates. Conclusions: UEDVTs were commonly associated with a provoking factor, with indwelling catheters and/or malignancies being the most common. Interestingly, catheter-related UEDVT had comparable clot progression/recurrence and major bleeding compared to other UEDVTs and LEDVTs, which may be confounded by relatively high rates of malignancy.

Epidemiology of Deep Venous Thrombosis Among United States Emergency Departments Over an Eight-Year Period.

Deep vein thrombosis (DVT) is a significant cause of morbidity and mortality worldwide, accounting for substantial healthcare utilization. However, as management strategies have evolved, there is a critical need for current data on incidence, admission rates, and medical management of DVT in the ED setting. This cross-sectional study analyzed ED presentations for DVT from 2016-2023 using the Cosmos database. Inclusion criteria comprised patients aged ≥18 years with an ICD-10 code for acute extremity DVT. Outcomes included incidence rates, admission rates, and anticoagulant prescriptions. Data were analyzed using descriptive statistics, and subgroup analyses were performed for upper and lower extremity DVTs. Out of 190,144,463 total ED encounters, DVT represented 368,044 cases (0.2%). Among these cases, 119,986 (32.6%) were admitted, with admission rates stable over the study period. Apixaban was the most prescribed anticoagulant (40.3%), followed by rivaroxaban (28.3%), enoxaparin (7.9%), warfarin (3.6%), and dabigatran (0.3%). Use of apixaban increased from 12.4% in 2016 to 56.2% in 2023. Lower extremity DVTs comprised 88.5% of cases, with a 32.1% admission rate, while upper extremity DVTs accounted for 11.7% of cases, with a 37.0% admission rate. This study provides a summary of DVT presentations and management in United States EDs over an eight52 year period. The findings highlight stable incidence rates, reduced admission rates compared to historical data, and a significant shift towards the use of DOACs, particularly apixaban, for outpatient management. These trends underscore the importance of evidence-based practices 54 and ongoing research to optimize DVT management and improve patient outcomes.

12243 The Case of a Metastatic Papillary Thyroid Cancer Presenting as an Unresectable Pelvic Mass

Abstract Disclosure: M. Tucktuck: None. Y. El Soufi: None. O.G. Adeniran: None. A.A. Gliwa: None. Background: Papillary thyroid cancer (PTC) represents around 85% of all thyroid cancers, of which 2-10% of patients will present with metastasis distant to the neck. The frequency of bone metastasis in PTC occurs in only 1-4% of patients. Studies have shown that distant and multi-organ metastasis is associated with higher mortality rates. Clinical case: A 69-year-old woman with diabetes mellitus, cerebrovascular accident, and right lower extremity deep venous thrombosis, presented with right foot and hip pain for 1 week after a mechanical fall. She had a 50 pound weight loss over a year without personal or family history of thyroid cancer or disease or radiation exposure. A soft and nontender mass in the right lower abdomen was noted during a physical exam. Imaging revealed a large heterogeneous lesion (16.3 x 13.3 x 15.5 cm) in the right bony pelvis with internal necrosis, destructing the right iliac bone, and extending into the right sacrum, acetabulum, and musculature, with mass effect on the surrounding vasculature, and enlarged lymph nodes suspicious for metastasis. Thyroid imaging showed a hypervascular hyperechoic 1.3 cm nodule within the right thyroid gland and a large 2 cm left thyroid nodule with scattered microcalcifications. Thyroid function tests were within normal limits. The patient underwent an initial ultrasound guided biopsy of the pelvic mass with indiscriminate results, and later a laparoscopic excisional biopsy of the pelvic mass showed neoplastic papillary proliferation with typical nuclear features, without necrosis or associated ovarian tissue. The immuno-histopathological profile was positive for PAX-8, TTF-1, thyroglobulin, and CK7, and the Ki-67 proliferation index was ∼20-30%. The patient was diagnosed with papillary thyroid cancer with metastasis to the pelvic bone, and was classified as stage IV, cT1bN0M1. As the pelvic mass was inoperable, the patient completed total thyroidectomy and was started on hormone replacement therapy. Subsequent thyroid pathology report was negative for papillary carcinoma. Further review of imaging did not show ectopic thyroid tissue in the neck or an ovarian pathology. Before the patient’s next visit to evaluate for struma ovarii, she passed away. Conclusion: Thyroid cancer is usually treated through thyroidectomy or lobectomy, with radioiodine (RAI) therapy as an effective treatment for differentiated cancers. Our patient, who presented with extremity pain revealing a distant metastasis, completed thyroidectomy with plans to undergo RAI therapy. Our case highlighted the importance of recognizing musculoskeletal presentations as an initial and possibly only finding of a distant metastasis. It also emphasized the utility of multidisciplinary collaboration in detecting and recognizing PTC as a primary thyroid cancer, as early management can reduce mortality and lead to more favorable outcomes. Presentation: 6/2/2024

12330 Progestogen Experience And Perception Among Transfeminine Adults - A National Survey

Abstract Disclosure: J.J. Chang: None. N. Khai Tran: None. A. Flentje: None. M.E. Lubensky: None. J. Obedin-Maliver: Consulting Fee; Self; Ibis Reproductive Health, Hims, Incorporated, Folx, Incorporated, Upstream, Incorporated. M.R. Lunn: Consulting Fee; Self; Hims, Incorporated, Otsuka Pharmaceutical Development and Commercialization, Inc., American Dental Association. D. Ariel: None. Background: Current guidelines recommend estradiol with consideration of anti-androgens for gender-affirming hormone therapy (GAHT) in transfeminine adults. Many individuals also seek progestogens as part of feminizing GAHT, particularly to enhance breast development. Though progestogen use seems common, few studies describe its use, reported benefits, and side effects. SpecificAims: 1) To describe progestogen use in feminizing GAHT among transfeminine individuals in the U.S. 2) To evaluate reasons for progestogen initiation and perceived physical and emotional impact; 3) To investigate side effects and adverse events. Materials and Methods: In this cross-sectional study, participants were recruited from The PRIDE Study, a U.S.-based longitudinal cohort study of LGBTQIA+-identifying adults. Included participants were assigned male sex at birth and had a feminine/transfeminine or non-binary gender identity. Those assigned female sex at birth (AFAB) or born with 1 or more ovaries were excluded. Descriptive statistics were used to describe socio-demographic characteristics, progestogen use patterns, initiation reasons, perceived physical and mental impacts, side effects, adverse events, and care satisfaction. Results: 543 participants were eligible and completed the study. Mean age was 43.2 years (standard deviation: 14.9). Of 310 progestogen users, the most common progestogen forms were micronized progesterone (58.4% oral; 10.6% rectal) and medroxyprogesterone acetate (7.7% oral). Median progestogen use duration was 2 years (interquartile range: 1-4). Breast development (85.2%) and mimicking the hormone pattern of those AFAB (58.1%) were the two most reported reasons for progestogen initiation. Most progestogen users reported improved breast development (79.7%); none reported worsening. Sex drive, sleep, and concentration did not change with progestogen use in 46.5%, 51.3%, and 73.9% of participants, respectively. Adverse events included lower extremity deep vein thrombosis (n = 6) and pulmonary embolism (n = 4). The most common side effects were breast pain (28.7%), mood fluctuation (21.9%), fatigue (19.7%), and weight gain (19.0%). Most users expressed satisfaction with progestogens (71.9%) and would recommend to others (73.5%). Among 68 former progestogen users, 20.6% reported stopping progestogens due to negative side effects, and 32.4% stopped due to lack of perceived efficacy. Conclusions: In the largest study describing progestogens in GAHT to date, over half of transfeminine adults used progestogens, particularly for breast development. Most reported improvement with breast development and overall satisfaction. However, perceived impacts on other effects were variable. Future prospective studies are needed to investigate the effects of progestogens versus other components of feminizing GAHT. Presentation: 6/1/2024

12330 Progestogen Experience And Perception Among Transfeminine Adults - A National Survey

Abstract Disclosure: J.J. Chang: None. N. Khai Tran: None. A. Flentje: None. M.E. Lubensky: None. J. Obedin-Maliver: Consulting Fee; Self; Ibis Reproductive Health, Hims, Incorporated, Folx, Incorporated, Upstream, Incorporated. M.R. Lunn: Consulting Fee; Self; Hims, Incorporated, Otsuka Pharmaceutical Development and Commercialization, Inc., American Dental Association. D. Ariel: None. Background: Current guidelines recommend estradiol with consideration of anti-androgens for gender-affirming hormone therapy (GAHT) in transfeminine adults. Many individuals also seek progestogens as part of feminizing GAHT, particularly to enhance breast development. Though progestogen use seems common, few studies describe its use, reported benefits, and side effects. SpecificAims: 1) To describe progestogen use in feminizing GAHT among transfeminine individuals in the U.S. 2) To evaluate reasons for progestogen initiation and perceived physical and emotional impact; 3) To investigate side effects and adverse events. Materials and Methods: In this cross-sectional study, participants were recruited from The PRIDE Study, a U.S.-based longitudinal cohort study of LGBTQIA+-identifying adults. Included participants were assigned male sex at birth and had a feminine/transfeminine or non-binary gender identity. Those assigned female sex at birth (AFAB) or born with 1 or more ovaries were excluded. Descriptive statistics were used to describe socio-demographic characteristics, progestogen use patterns, initiation reasons, perceived physical and mental impacts, side effects, adverse events, and care satisfaction. Results: 543 participants were eligible and completed the study. Mean age was 43.2 years (standard deviation: 14.9). Of 310 progestogen users, the most common progestogen forms were micronized progesterone (58.4% oral; 10.6% rectal) and medroxyprogesterone acetate (7.7% oral). Median progestogen use duration was 2 years (interquartile range: 1-4). Breast development (85.2%) and mimicking the hormone pattern of those AFAB (58.1%) were the two most reported reasons for progestogen initiation. Most progestogen users reported improved breast development (79.7%); none reported worsening. Sex drive, sleep, and concentration did not change with progestogen use in 46.5%, 51.3%, and 73.9% of participants, respectively. Adverse events included lower extremity deep vein thrombosis (n = 6) and pulmonary embolism (n = 4). The most common side effects were breast pain (28.7%), mood fluctuation (21.9%), fatigue (19.7%), and weight gain (19.0%). Most users expressed satisfaction with progestogens (71.9%) and would recommend to others (73.5%). Among 68 former progestogen users, 20.6% reported stopping progestogens due to negative side effects, and 32.4% stopped due to lack of perceived efficacy. Conclusions: In the largest study describing progestogens in GAHT to date, over half of transfeminine adults used progestogens, particularly for breast development. Most reported improvement with breast development and overall satisfaction. However, perceived impacts on other effects were variable. Future prospective studies are needed to investigate the effects of progestogens versus other components of feminizing GAHT. Presentation: 6/1/2024

Cost-effectiveness analysis of anticoagulation, percutaneous mechanical thrombectomy, and catheter-directed thrombolysis treatments for acute lower extremity deep venous thrombosis.

There is a lack of health economics studies on the treatment of acute lower extremity deep venous thrombosis to measure the benefits to patients. The purpose of this study was to evaluate the cost-effectiveness of anticoagulation (AC), percutaneous mechanical thrombectomy (PMT), and catheter-directed thrombolysis (CDT). The above 3 methods were selected according to the patient's treatment wishes. Related complications, clinical effective, occurrence of post-thrombotic syndrome (PTS) after 2 years, and total hospitalization costs of patients between the patients in these 3 treatment groups were analyzed. In the cost-effectiveness analysis, costs were expressed in monetary terms and the effect was expressed as the effective rate of clinical treatment. In addition, we used sensitivity analyses to validate the results. The effective rate of clinical treatment for the AC, CDT, and PMT groups were 44.23%, 86.84%, and 92.59%, respectively. No serious complications occurred in any of the treated patients. There was no significant difference in the incidence of PTS among the 3 groups during the follow-up period. After 12 months, compared with the AC group, there were statistically significant differences in moderate-severe reduction in PMT group and CDT group separately. At 24 months, the incidence of moderate-severe disease in PMT group was significantly lower than that in CDT group. All 3 treatment methods have good safety. Compared with AC therapy alone, both PMT and CDT therapy resulted in a higher clinical efficacy rate, reduced the severity of PTS within 2 years, and reduced the cost of PTS. From the perspective of the cost-effectiveness ratio, within a certain range of treatment efficacy, AC therapy alone incurs the lowest cost per 1% improvement in therapeutic effect. The cost-effectiveness results show that if decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be lower than the ratio of incremental cost to effect, then AC therapy alone is chosen. If decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be higher than the ratio of incremental cost to effect, then the choice is AC plus CDT treatment.

The causal relationship between gut microbiota and lower extremity deep vein thrombosis combined with pulmonary embolism.

Over the years, numerous studies have explored the relationship between gut microbiota and lower extremity deep vein thrombosis (LEDVT) and pulmonary embolism (PE). The present study utilized Mendelian randomization (MR) to assess the causal link between gut microbiota and LEDVT combined with PE. Human gut microbiota genome-wide association study (GWAS) summary data from the MiBioGen consortium (n = 18,340) were utilized. Summary-level data on LEDVT (2,116 cases and 359,078 controls) and LEDVT combined with PE (4,319 cases and 356,875 controls) were obtained from the IEU Open GWAS project. MR analysis was conducted using the inverse variance weighted (IVW) method as the primary analysis. Additionally, MR-Egger, weighted median, weighted mode, and simple mode were employed as supplementary methods. Sensitivity analyses, including tests for heterogeneity and horizontal pleiotropy, were performed. Lastly, reverse MR analysis was performed. The IVW analyses revealed seven causal relationships between genetic liability in the gut microbiota and LEDVT and five causal relationships between genetic liability in the gut microbiota and LEDVT combined with PE. The intersection of these outcomes identified that the genus Butyricicoccus reduced the risk of both LEDVT and LEDVT combined with PE, while the genus Clostridium innocuum increased the risk for both conditions. This study demonstrates that the gut microbiota is causally associated with LEDVT and LEDVT combined with PE. Our findings provide valuable insights into the underlying mechanisms and suggest potential avenues for further clinical investigations of these conditions.

Machine learning-based prediction model of lower extremity deep vein thrombosis after stroke.

This study aimed to apply machine learning (ML) techniques to develop and validate a risk prediction model for post-stroke lower extremity deep vein thrombosis (DVT) based on patients' limb function, activities of daily living (ADL), clinical laboratory indicators, and DVT preventive measures. We retrospectively analyzed 620 stroke patients. Eight ML models-logistic regression (LR), support vector machine (SVM), random forest (RF), decision tree (DT), neural network (NN), extreme gradient boosting (XGBoost), Bayesian (NB), and K-nearest neighbor (KNN)-were used to build the model. These models were extensively evaluated using ROC curves, AUC, PR curves, PRAUC, accuracy, sensitivity, specificity, and clinical decision curves (DCA). Shapley's additive explanation (SHAP) was used to determine feature importance. Finally, based on the optimal ML algorithm, different functional feature set models were compared with the Padua scale to select the best feature set model. Our results indicated that the RF algorithm demonstrated superior performance in various evaluation metrics, including AUC (0.74/0.73), PRAUC (0.58/0.58), accuracy (0.75/0.77), and sensitivity (0.78/0.80) in both the training set and test set. DCA analysis revealed that the RF model had the highest clinical net benefit. SHAP analysis showed that D-dimer had the most significant influence on DVT, followed by age, Brunnstrom stage (lower limb), prothrombin time (PT), and mobility ability. The RF algorithm can predict post-stroke DVT to guide clinical practice.