Lower Limb Deep Venous Thrombosis Research Articles

Compression Therapy in Acute Deep Venous Thrombosis of the Lower Limb and for the Prevention of Post-Thrombotic Syndrome.

After an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS. 12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search. Two RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptomoriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44]). Compression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment.

The incidence of venous thromboembolism after curative colon cancer surgery within an enhanced recovery after surgery programme

AimBased on three randomised controlled trials performed more than a decade ago, several national guidelines recommend prolonged venous thromboprophylaxis for 28 days following elective surgery for colon cancer. None of these studies were conducted within enhanced recovery after surgery setting. Newer studies indicate that prolonged prophylaxis might not be necessary with enhanced recovery after surgery. We aimed to provide further evidence to this unresolved discussion. MethodRetrospective study of patients undergoing elective surgery for colon cancer stage I-III with enhanced recovery after surgery in the Capital Region of Denmark from 2014 to 2017. Patients were excluded if discharged on postoperative day 28 or later, dying before discharge, undergoing concomitant rectum resection, or discharged with vitamin K antagonists, direct-oral anticoagulants, or low molecular weight heparin treatment. All patients received only low-dose low molecular weight heparin as prophylaxis during their admission.The primary endpoint was symptomatic lower limb deep venous thrombosis or pulmonary embolism diagnosed within 60 days postoperatively. ResultsOut of the included population of 1806 patients, only three experienced a symptomatic venous thromboembolic event; none was fatal. Two had pulmonary embolism associated with pneumonia, while one patient was diagnosed with lower limb deep venous thrombosis at postoperative day 15 after an uncomplicated course with first discharge at postoperative day 2. ConclusionThe risk of symptomatic venous thromboembolism after elective surgery for colon cancer with enhanced recovery after surgery seems negligible even without prolonged prophylaxis. The current guidelines need to be reconsidered.

Role of Color Doppler Ultrasound to Evaluate the Lower Limb Deep Venous Thrombosis in Diabetic Patients

Diabetes mellitus is one of the main risk factors for peripheral arterial disease (PAD), and its occurrence is on the rise. In patients with deep vein stenosis, it is quite prevalent. Deep vein thrombosis is a serious health issue in the United States that impacts more than 2.5 million individuals each year. We searched a variety of search engines and databases, including Google Scholar, PubMed, and NCBI, for papers pertaining to our subject. Data on the assessment of lower limb DVT in diabetic patients were extracted from just 20 articles. The current study examined the assessment of DVT in the lower leg. Individuals with diabetes experience different rates of deep vein thrombosis. The result is not statistically significant, though. The anatomic location of the thrombus indicated that patients with diabetes had a higher likelihood of involvement of the popliteal vein, femoral vein, and common femoral vein compared to non-diabetics. 

The Prevalence of JAK2 Mutation in High-Altitude Patients with Unprovoked Thrombosis and Thrombosis at Unusual Sites

Introduction Thrombosis, both arterial and venous, is a major source of morbidity and mortality in patients with myeloproliferative neoplasms (MPNs). Thrombosis can be the initial presentation of MPN and sometimes can predate its diagnosis. Most MPN-related thrombosis occurs on usual sites such as the cerebral and coronary arteries, and lower limbs deep venous thrombosis and pulmonary embolism. Rare thromboses can also occur with MPN, such as splanchnic and cerebral dural vein thromboses, with the former having a stronger correlation. Stroke in young people (under 50) and venous thrombosis at unusual sites (cerebral, splanchnic, renal and upper limbs) represent special scenarios for which workup includes exploring unusual etiologies, including inherited and acquired hypercoagulable states. JAK2 mutation is invariably present in polycythemia vera (PV), occurs in a significant proportion of other classical MPNs, and is directly associated with risk of thrombosis due to associated leukocytosis, platelet activation, and altered vascular endothelial function. JAK2-mutated MPNs are associated with higher thrombosis risk compared to JAK2 unmutated MPNs, and greater allele burden corresponds to greater risk. The association of JAK2 mutation with hepatic and splanchnic vein thrombosis is well established. There are evidence-based guidelines for testing in idiopathic splanchnic vein thrombosis; however, its association with other unusual site thrombosis is unclear. Clinicians may request JAK2 mutation testing in individuals with unprovoked VTE and VTE at unusual sites to uncover the underlying etiology. This is despite a low diagnostic yield, particularly in people with normal CBC. Cerebral sinus thrombosis, for example, occurs in 1% of MPNs, and an underlying MPN accounts for only 3.8% of CVT. Most documented MPNs presenting with thrombosis had abnormal CBC at presentation, either thrombocytosis or erythrocytosis. The aim of this analysis is to explore whether JAK2 mutation without overt MPN contributes to the unusual site venous thrombosis and stroke in young people in a high altitude population. Method: We collected lab records for all JAK2 requests made over three years (2020-2022) in two referral hospitals serving a population residing at an altitude of 2,270-3,000 meters above sea level. Requests that listed thrombosis as an indication were analyzed, and labs and imaging related to the corresponding requests were reviewed. Results: Among 208 JAK2 tests, 40 (19.2%) were requested during the evaluation of thrombotic events. Patients were relatively young, with a median age of 41, and the gender breakdown was 17 (42.7%) males and 23 females. About half (23, 57.5%) of the cohort had normal CBC. Those with abnormal CBC at presentation included 3 patients with leukocytosis, 10 with thrombocytosis, and 10 with erythrocytosis. Among males, 2 had an ischemic stroke, 5 had cerebral sinus thrombosis, 5 had splanchnic vein thrombosis, 4 had unprovoked DVT/PEs, and 1 had renal vein thrombosis. Among females, 4 experienced ischemic strokes, 3 had cerebral venous thrombosis, 10 had splanchnic vein thrombosis, 5 had unprovoked DVT/PEs, and 2 had renal vein thrombosis. Only 2 patients (5%) were positive for JAK2 mutations: a 17-year-old boy who presented with portal vein thrombosis and was diagnosed with polycythemia vera and a 31-year-old lady who presented with hepatic vein thrombosis and normal CBC. Conclusion: JAK2 mutation was rare in our high-altitude cohort with unprovoked DVT/PE/thrombosis at unusual sites. Outside the splanchnic venous system and with normal CBC, the diagnostic yield of JAK2 mutation testing is low. Hence, such testing might not be indicated.

Venous thromboembolism in users of hormonal contraception and non-steroidal anti-inflammatory drugs: a nationwide cohort study

Abstract Objective To study the influence of concomitant use of hormonal contraception and non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of venous thromboembolism. Design: Nationwide cohort study. Setting: Denmark through national registries. Participants: All 15-49-year-old women living in Denmark between the years 1996-2017 with no medical history of any venous or arterial thrombotic event, cancer, thrombophilia, hysterectomy, bilateral oophorectomy, sterilisation, or infertility treatment. Main outcome measure: A first-time discharge diagnosis of lower-limb deep venous thrombosis or pulmonary embolism. Results Among 2.0 million women followed for 21.0 million person-years, 8710 venous thromboembolic events occurred. Compared to non-use of NSAIDs, use of NSAIDs was associated with an adjusted incidence rate ratio of venous thromboembolism of 8.1 (95% confidence interval (CI) 6.9 to 9.6) in women not using hormonal contraception, 12.1 (10.6 to 13.9) in women using high-risk hormonal contraception, 8.7 (6.5 to 11.6) in users of medium-risk hormonal contraception, and 5.1 (2.9 to 9.1) with low/no-risk hormonal contraception. Compared to non-use of NSAIDs, the number of extra venous thromboembolic events per 100,000 one-week NSAID treatments was 4 in women not using hormonal contraception, 18 in women using high-risk hormonal contraception, 9 in users of medium-risk hormonal contraception, and 2 in women using low/no-risk hormonal contraception. Conclusions NSAID use was positively associated with the development of venous thromboembolism. The association was stronger in women concomitantly using high-risk hormonal contraceptives and weaker in women using low/no-risk hormonal contraception. Women requiring both hormonal contraception and regular use of NSAIDs should be advised accordingly.

Correlation between the preoperative maximum soleal vein diameter and the postoperative bilateral deep venous thrombosis in THA: a case-control study.

Patients with bilateral lower limb deep venous thrombosis (DVT) have a higher risk of pulmonary thromboembolism (PTE) and mortality than patients with unilateral lower limb DVT. Preoperative dilatation of the soleal vein (SV) diameter is a predictor of postoperative DVT. The purpose of this study is to investigate the cutoff value for SV diameter as a risk factor for VTE development. The authors examined 274 patients with unilateral THA who met the inclusion criteria in a retrospective study. The mean age of the patients was 65.7±11.2 years, with 70 males and 204 females. Bilateral lower limb vein ultrasonography was performed preoperatively and ~1 week after THA. The frequency and localization of DVT were investigated in postoperative ultrasonography. The patients were divided into three groups: no DVT (non-DVT), unilateral lower limb DVT (Uni-DVT), and bilateral lower limb DVT (Bi-DVT). The three groups were compared in terms of preoperative venous vessel maximum diameter. There were 62 patients (22.6%) who had postoperative DVT. There are no symptomatic PTE patients. DVT was found in 44 patients (16.0%) of the Uni-DVT group and 18 patients (6.6%) of the Bi-DVT group. The SV maximum diameter was 6.41±1.79mm in the non-DVT group, 7.06±2.13mm in the Uni-DVT group, and 8.06±2.26mm in the Bi-DVT group, with a significant difference (P=0.001) between the non-DVT and Bi-DVT groups. In the Bi-DVT group, the cutoff value for preoperative SV maximum diameter was 6.75mm (95% CI: 0.625-0.831; P=0.001; sensitivity, 77.8%; specificity, 60.4%; area under the curve, 0.728). In THA, preoperative ultrasonography with a maximum SV diameter of 6.75mm or greater was the risk of bilateral DVT leading to fatal PTE is increased.

Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study

ObjectiveTo study the influence of concomitant use of hormonal contraception and non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of venous thromboembolism.DesignNationwide cohort study.SettingDenmark through national registries.ParticipantsAll 15-49 year old women...

Metastatic duodenal carcinoma presenting as severe anaemia and extensive bilateral lower limb deep venous thrombosis

No abstract available

Practice of quality control circle activities in improving the standardized implementation rate of peripheral venous thrombolysis for lower-limb deep venous thrombosis

Practice of quality control circle activities in improving the standardized implementation rate of peripheral venous thrombolysis for lower-limb deep venous thrombosis

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study.

There is growing evidence that misdiagnosis contributes to the high mortality rate in lung cancer patients complicated with pulmonary embolism (PE). This current study analyzed predictors of PE in lung cancer patients with lower extremity deep venous thrombosis (DVT) with the aim of personalizing the treatment and management of patients with PE. This retrospective case-control study included lung cancer patients with DVT at the emergency department of Shanghai Chest Hospital from January 2018 to December 2019. Patients were classified as having DVT with or without PE. The following characteristics were examined, including age, gender, smoking, hypertension, surgical trauma, hyperlipidemia, long-term bedridden status, calf swelling, coronary heart disease, chronic pulmonary disease, DVT location, DVT type, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer, and univariate and multivariate analyses were performed. A total of 90 patients with lung cancer and DVT were analyzed, of whom 60% (54/90) had PE. Those variables independently associated to PE were hypertension [odds ratio (OR): 7.883, 95% confidence interval (CI): 2.038-30.495, P=0.003], long-term bedridden status (OR: 4.166, 95% CI: 1.236-14.044, P=0.021), and D-dimer levels (OR: 2.123, 95% CI: 1.476-3.053, P=0.000) were identified as independent risk factors for PE. The cut-off value of the receiver operating characteristic (ROC) curve for predicting PE by presented scoring system according to the risk factors was 1.5 and the area under the curve (AUC) was 0.84 (P<0.001). Hypertension, being bedridden for an extended period, and elevated serum D-dimer levels were independent risk factors of PE in lung cancer patients with lower extremity DVT. Novel strategies for patient management should be developed to decrease the risk of PE.

[Analysis of the Incidence of Lower Limb Deep Venous Thrombosis 
and Its Related Risk Factors in the Postoperative Patients with Lung Cancer].

Lung cancer is the first leading cause of morbidity and mortality among the malignant tumors, which has become a hot issue in current research. Clinically, lung cancer is divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) according to the pathological types. NSCLC includes adenocarcinoma, squamous cell carcinoma and other types of lung cancer, accounting for about 80% of all lung cancer. Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE), which is a recognized complication in lung cancer patients with higher morbidity and mortality. The aim of this study is to determine the incidence of DVT and reveal the risk factors for DVT in the postoperative patients with lung cancer. We collected 83 postoperative patients with lung cancer admitted to the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital from December 2021 to December 2022. All these patients were examined by color Doppler ultrasound of lower extremity vein upon admission and after operation to analyze the incidence of DVT. In order to explore the possible risk factors for DVT in these patients, we further analyzed the correlations between DVT and their clinical features. At the same time, the changes of coagulation function and platelet were monitored to investigate the value of blood coagulation in the patients with DVT. DVT occurred in 25 patients after lung cancer operation, and the incidence rate of DVT was 30.1%. Further analysis found that the incidences of postoperative lower limb DVT were higher in lung cancer patients of stage III+IV or over 60 years of age (P=0.031, P=0.028). D-Dimer level in patients with thrombosis was significantly higher than that in non-thrombus patients on the 1st, the 3rd, and the 5th day after operation (P<0.05), and there was no significant difference in platelets and fibrinogen (FIB) (P>0.05). The overall incidence of DVT in our center after lung cancer patients operation was 30.1%. Late-stage and older postpatients were more likely to develop DVT, and these patients with higher D-Dimer values should be considered the possibility of VTE events.

The role of D-dimer and fibrinogen testing in catheter-directed thrombolysis with urokinase for deep venous thrombosis.

During catheter-directed thrombolysis (CDT), D-dimer (D-D) are generated in large quantities and fibrinogen (FIB) is continuously consumed. Reduction of FIB increases the risk of bleeding. However, there are currently few studies on the relationship between D-D and FIB concentrations during CDT. To evaluate the relationship of D-D and FIB concentrations during CDT with urokinase for deep venous thrombosis (DVT). 17 patients with lower limb DVT were enrolled and treated with CDT. The concentrations of plasma D-D and FIB were measured every 8 h during thrombolysis. The degree of thrombolysis was evaluated, the change rules of D-D and FIB concentrations were analyzed, and the change curve graphs were drawn. The "thrombus volume," "thrombolysis time," "thrombolysis ratio," "D-D peak," "D-D rising speed," "FIB falling speed," and "duration of D-D elevation" were calculated in each patient. The mixed model was used to simulate the time change trend of the plasma D-D and FIB concentrations. Pearson method and linear regression were used to analyze the correlation and linear relationship, respectively. The D-D concentration first increased rapidly and then decreased gradually, and the FIB concentration continued to decrease during thrombolysis. The rate of the decline of FIB varies with the urokinase dose. The thrombus volume is positively correlated with D-D rising speed, duration of D-D elevation, D-D peak, and FIB falling speed; the D-D rising speed is positively correlated with the D-D peak and FIB falling speed; and the D-D peak is positively correlated with the FIB falling speed. The correlation coefficients were all statistically significant (p < 0.05). Efficacy reached level I-II in 76.5% patients. No major bleeding occurred in any of the patients. During CDT with urokinase for DVT, the concentrations of D-D and FIB show specific changes, and there are some specific relationships between each other. Understanding these changes and relationships may be helpful to adjust the thrombolysis time and urokinase dose more rationally.

Management of a case of large uterine leiomyoma with deep vein thrombosis

Deep venous thrombosis (DVT) is a potentially fatal condition. The association of this condition with uterine leiomyoma has rarely been reported in the medical literature. In this report we present a rare case of left lower limb DVT in a 30-year-old woman with a large fibroid. She is sub fertile for 8 years and had a history of heavy menstrual bleeding for 6 months. Examination revealed 20-week size abdominopelvic mass. She had developed left lower limb DVT, 3 months back and imaging investigation confirmed DVT in left femoral vein. She was on an oral anticoagulant. The patient was successfully managed with Inferior Vena Cava (IVC) filter insertion and abdominal myomectomy. Multidisciplinary involvement involving gynaecologist, haematologist, interventional radiologist and anaesthetist are crucial for successful outcome.

Use of Bedside Ultrasound at Wexford General Hospital Emergency Department: Compliance to NICE Guidelines [NG158] for Venous Thromboembolic Disease

Introduction:Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.Method:A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.Statistical analysis was conducted using PRISM v9.Results:80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.Conclusion:Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.

Risk factors for postoperative thrombosis-related complications in patients undergoing malignant brain tumor resection: a retrospective cohort study.

Patients with malignant brain tumors frequently exhibit hypercoagulation and are at a high risk of postoperative thrombosis-related complications. However, the risk factors for postoperative thrombosis-related complications remain unclear. In this retrospective, observational study, we consecutively enrolled elective patients undergoing resection of malignant brain tumors from 26 November 2018 to 30 September 2021. The primary objective of the study was to identify risk factors for a composite of three major adverse events including postoperative lower limb deep venous thrombosis, pulmonary embolism, and cerebral ischemia. A total of 456 patients were enrolled in this study, where 112 (24.6%) patients had postoperative thrombosis-related complications, 84 (18.4%) with lower limb deep venous thrombosis, 0 (0.0%) with pulmonary embolism, and 42 (9.2%) with cerebral ischemia. In a multivariate model, age more than 60 years (OR: 3.98, 95% CI: 2.30-6.88, P < 0.001), preoperative abnormal APTT (OR: 2.81, 95% CI: 1.06-7.42, P = 0.037), operation duration longer than 5 h (OR: 2.36, 95% CI: 1.34-4.16, P = 0.003), and admission to ICU (OR: 2.49, 95% CI: 1.21-5.12, P = 0.013) were independent risk factors of the postoperative deep vein thrombosis. Intraoperative plasma transfusion (OR: 6.85, 95% CI: 2.73-17.18, P < 0.001) was associated with significantly increased odds of deep vein thrombosis. Patients with craniocerebral malignant tumors have a high incidence of postoperative thrombosis-related complications. There is an increase in the odds of postoperative lower limb deep venous thrombosis in patients; over 60 years old, with preoperative abnormal APTT, undergoing surgeries longer than 5-h, admission to ICU, or receiving intraoperative plasma infusion. Fresh frozen plasma infusion should be used more cautiously, especially in patients with a high risk of thrombosis.

Removal of inferior vena cava filter by open surgery after failure of endovenous retrieval.

The permanent placement of inferior vena cava (IVC) filters may lead to numerous complications and their removal is recommended once the risk of pulmonary embolism is reduced. Removal of IVC filters by endovenous means is preferred. But failure of endovenous removal happens when recycling hooks penetrate the vein wall and filters are left in place for too long time. In these scenarios, open surgery may be effective for removal of IVC filters. We aimed to describe the surgical approach, outcomes, and 6-month follow-up of the removal of IVC filter by open surgery, after the failure of removal via the endovenous method. A total of 1,285 patients with retrievable IVC filters were admitted from July 2019 to June 2021, including 1,176 (91.5%) endovenous filter removals, and 24 (1.9%) open surgical IVC filter removals after the failure by endovenous method, of whom 21 (1.6%) were followed-up and eligible for analysis of the study. Patient characteristics, filter type, filter removal rate, IVC patency rate, and complications were retrospectively analyzed. Twenty-one patients were left with IVC filters for 26 (10, 37) months, of which 17 (81.0%) patients had non-conical filters and 4 (19.0%) had conical filters; all 21 filters were successfully removed, with a 100% removal rate, no deaths, no serious complications, and no symptomatic pulmonary embolism. At the 3rd month follow-up after surgery and 3rd month follow-up after discontinuation of anticoagulation therapy, only 1 case (4.8%) had IVC occlusion, but without any occurrence of new lower limb deep venous thrombosis and silent pulmonary embolism. Open surgery can be used for the removal of IVC filters after failure of removal by endovenous method or when accompanied by complications without symptoms of pulmonary embolism. Open surgical approach can be used as an adjunctive clinical intervention for the removal of such filters.

Prevalence of Asymptomatic Deep Vein Thrombosis in Preoperative State of Spine Surgeries

Deep venous thrombosis (DVT) is considered the most common cause of preventable death among hospitalized patients. A few studies have investigated the risk of venous thromboembolic events (VTE) in patients undergoing elective spine surgery and reported varying incidences. We aim to assess the incidence of preoperative lower limb DVT in lumbar degenerative disease patients undergoing elective surgery. This is a retrospective review of prospectively collected data on adult patients with lumbar degenerative spine diseases (lumbar stenosis; LST, lumbar spondylolisthesis; SPL, or lumbar disc herniation; LDH) who were scheduled for operative management. Each patient underwent a preoperative lower limb venous Duplex (LLVD). Incidence of DVT, risk factors, and clinical course of patients were reported. Forty-nine patients (32 females; 65%) were included. All patients were diagnosed clinically and radiologically with lumbar degenerative diseases; LST (44.9%), SPL (36.7%), and LDH (18.4%), requiring surgical management. Three patients (6.1%) were found to have positive DVT studies, leading to the cancellation or rescheduling of their procedures (p < 0.01). These included one patient with LST (p = 0.045) and two patients with SPL (p = 0.006). Among patients with LST and SPL, higher disability (modified Rankin scale; mRS ≥3) was significantly associated with positive LLVD (p = 0.035). Patients with LST or SPL with higher preoperative disability scores were at higher risk to have preoperative DVT. Further research is needed to evaluate the feasibility and value of preoperative LLVD to detect DVT in patients planned for lumbar degenerative surgery.

INTRACEREBRAL HEMORRHAGE POSTPHARMACOMECHANICAL CATHETER-DIRECTED THROMBOLYSIS: CAN WE PREVENT IT?

SESSION TITLE: Pulmonary Procedures: Creativity and ComplicationsSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 10:15 am - 11:10 amINTRODUCTION: Pharmaco-mechanical catheter-directed thrombolysis (PCDT) has revolutionized the treatment of deep venous thrombosis (DVT) in the recent decade. Despite the mixed data on efficacy and procedure risk, PCDT has been linked with a very low risk of intracranial hemorrhage (ICH). We describe a case of fatal intracranial hemorrhage (ICH) occurring post-PCDT for bilateral DVT's.CASE PRESENTATION: A 61-year-old male with post-thrombotic syndrome (PTS), provoked left lower limb DVT with pulmonary embolism following left foot fracture in 2009, presented to our emergency department with complaints of new back pain and right leg swelling for one-day duration. Doppler ultrasound revealed extensive bilateral acute DVT's involving the right external iliac vein, proximal left common iliac vein, and lower inferior vena cava. After a multidisciplinary team discussion, he underwent bilateral lower limb PCDT. He was later transferred to our critical care unit post-operatively for close monitoring. His fibrinogen level post-op was 242 mg/dL; twelve hours later, a repeat fibrinogen level had decreased to 66 mg/dL. tPA was momentarily held; however, six hours later, the decision was made to restart tPA. Twenty-four hours later, the patient developed an acute change in mental status, tPA was discontinued, and an urgent computed tomogram (CT) head revealed multiple bilateral supratentorial and infratentorial intraparenchymal hemorrhages at the gray-white interface (Image). Despite our supportive measures, a repeat CT head the next day showed progressive hemorrhages with early herniation (Image). After discussion with the patient's family, he was transitioned to comfort care and terminally extubated.DISCUSSION: Anticoagulant therapy remains the gold standard for treating DVT, although up to 20% to 50% of patients will develop post-thrombotic syndrome. (1) It has been proposed that early thrombus removal for selected patients with acute DVT, particularly iliofemoral, reduces PTS morbidity and improves long-term quality of life. In contrast to anticoagulation, thrombolytic therapy used in PCDT activates fibrinogen-bound plasminogen, causing fibrinolysis and decreasing circulating fibrinogen. (2) Although low fibrinogen as a predictor of hemorrhagic complications has conflicting data in scientific studies, several large studies have shown that drops in fibrinogen correlate with bleeding complications. According to a recent study by Liu et al, (3), testing D-dimer and fibrinogen as a thrombolysis-monitoring approach every 8 hours resulted in just one bleeding event compared to three bleeding events in the comparison group using venography and fibrinogen testing every 24 hours.CONCLUSIONS: Due to insufficient data, different monitoring methods during PCDT are still debatable, and further research is needed to elucidate the significance of fibrinogen monitoring and replacement in preventing life-threatening ICH.Reference #1: Kahn SR, Comerota AJ, Cushman M, et al. ; American Heart Association Council on Peripheral Vascular Disease, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014;130(18):1636-1661Reference #2: Raabe RD. Ultrasound-accelerated thrombolysis in arterial and venous peripheral occlusions: fibrinogen level effects. J Vasc Interv Radiol. 2010 Aug;21(8):1165-72. doi: 10.1016/j.jvir.2010.03.020. PMID: 20656221Reference #3: Liu Q, Chen W, Wang YL, Wang ZY, Peng ZQ, Xiang JF, Chen L, Pan YC, Sha Y. A new method of monitoring catheter-directed thrombolysis for deep venous thrombosis-application of D-dimer and fibrinogen testing. Phlebology. 2022 Apr;37(3):216-222. doi: 10.1177/02683555211064026. Epub 2022 Mar 2. PMID: 35236191DISCLOSURES: No relevant relationships by Janhavi AthaleNo relevant relationships by Sreeja Biswas RoyNo relevant relationships by John Makram Fanous SESSION TITLE: Pulmonary Procedures: Creativity and Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Pharmaco-mechanical catheter-directed thrombolysis (PCDT) has revolutionized the treatment of deep venous thrombosis (DVT) in the recent decade. Despite the mixed data on efficacy and procedure risk, PCDT has been linked with a very low risk of intracranial hemorrhage (ICH). We describe a case of fatal intracranial hemorrhage (ICH) occurring post-PCDT for bilateral DVT's. CASE PRESENTATION: A 61-year-old male with post-thrombotic syndrome (PTS), provoked left lower limb DVT with pulmonary embolism following left foot fracture in 2009, presented to our emergency department with complaints of new back pain and right leg swelling for one-day duration. Doppler ultrasound revealed extensive bilateral acute DVT's involving the right external iliac vein, proximal left common iliac vein, and lower inferior vena cava. After a multidisciplinary team discussion, he underwent bilateral lower limb PCDT. He was later transferred to our critical care unit post-operatively for close monitoring. His fibrinogen level post-op was 242 mg/dL; twelve hours later, a repeat fibrinogen level had decreased to 66 mg/dL. tPA was momentarily held; however, six hours later, the decision was made to restart tPA. Twenty-four hours later, the patient developed an acute change in mental status, tPA was discontinued, and an urgent computed tomogram (CT) head revealed multiple bilateral supratentorial and infratentorial intraparenchymal hemorrhages at the gray-white interface (Image). Despite our supportive measures, a repeat CT head the next day showed progressive hemorrhages with early herniation (Image). After discussion with the patient's family, he was transitioned to comfort care and terminally extubated. DISCUSSION: Anticoagulant therapy remains the gold standard for treating DVT, although up to 20% to 50% of patients will develop post-thrombotic syndrome. (1) It has been proposed that early thrombus removal for selected patients with acute DVT, particularly iliofemoral, reduces PTS morbidity and improves long-term quality of life. In contrast to anticoagulation, thrombolytic therapy used in PCDT activates fibrinogen-bound plasminogen, causing fibrinolysis and decreasing circulating fibrinogen. (2) Although low fibrinogen as a predictor of hemorrhagic complications has conflicting data in scientific studies, several large studies have shown that drops in fibrinogen correlate with bleeding complications. According to a recent study by Liu et al, (3), testing D-dimer and fibrinogen as a thrombolysis-monitoring approach every 8 hours resulted in just one bleeding event compared to three bleeding events in the comparison group using venography and fibrinogen testing every 24 hours. CONCLUSIONS: Due to insufficient data, different monitoring methods during PCDT are still debatable, and further research is needed to elucidate the significance of fibrinogen monitoring and replacement in preventing life-threatening ICH. Reference #1: Kahn SR, Comerota AJ, Cushman M, et al. ; American Heart Association Council on Peripheral Vascular Disease, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014;130(18):1636-1661 Reference #2: Raabe RD. Ultrasound-accelerated thrombolysis in arterial and venous peripheral occlusions: fibrinogen level effects. J Vasc Interv Radiol. 2010 Aug;21(8):1165-72. doi: 10.1016/j.jvir.2010.03.020. PMID: 20656221 Reference #3: Liu Q, Chen W, Wang YL, Wang ZY, Peng ZQ, Xiang JF, Chen L, Pan YC, Sha Y. A new method of monitoring catheter-directed thrombolysis for deep venous thrombosis-application of D-dimer and fibrinogen testing. Phlebology. 2022 Apr;37(3):216-222. doi: 10.1177/02683555211064026. Epub 2022 Mar 2. PMID: 35236191 DISCLOSURES: No relevant relationships by Janhavi Athale No relevant relationships by Sreeja Biswas Roy No relevant relationships by John Makram Fanous

Primary and secondary antiphospholipid syndrome characteristics in an Egyptian cohort

Aim of the workTo describe the clinical and laboratory characteristics of patients with primary and secondary antiphospholipid syndrome (APS) in an Egyptian cohort. Patients and methodsSixty APS patients were enrolled. 12 had primary APS and 48 had secondary. Patients were further classified according to the presence of double or triple antiphospholipid antibodies (aPL). ResultsThe study included 55 (91.7 %) females and 5 (8.3 %) males, with a mean age of 33.9 ± 9.1 years, and mean disease duration of 6.2 ± 93.04 years. The obstetric complication in the form of fetal loss was the commonest manifestation of APS (70 %), followed by lower limb deep venous thrombosis (DVT) (50 %), recurrent abortion (45 %), thrombocytopenia (25 %), cutaneous manifestations (20 %), and Raynaud’s phenomenon (18.3 %). Urinary findings are mostly related to secondary APS. 15 (25 %) patients were thrombocytopenic and 1 (1.7 %) had autoimmune hemolytic anemia. Primary APS patients showed higher frequency of cutaneous manifestations compared to secondary (50 % vs 12.5 %; p = 0.04), and higher levels of β2 glycoprotein I IgG (71.8 ± 22.4 U/ml vs 59.3 ± 17.1 U/ml; p = 0.047). Secondary APS patients showed positive antinuclear antibodies (ANA) and anti-double stranded deoxyribonucleic acid antibodies (anti-dsDNA) in 97.9 % and 93.8 % respectively and were negative in all primary APS patients. On comparing patients with double (n = 34) and triple (n = 26) aPL, no differences were found between both groups except for platelet count being significantly lower in the triple aPL (p = 0.045). ConclusionEgyptian APS patients showed a high frequency of obstetric complications and lower limb DVT. Primary APS patients had higher frequency of cutaneous manifestations.

Effect of Special Orthopedic Care on Prevention of Lower Limb Deep Venous Thrombosis in Elderly Patients after Lower Limb Fracture Surgery

Effect of Special Orthopedic Care on Prevention of Lower Limb Deep Venous Thrombosis in Elderly Patients after Lower Limb Fracture Surgery