Management Of Deep Venous Thrombosis Research Articles

Exploration on the effect of anserine on the alleviation of DVT and its molecular mechanism

BackgroundThis study aimed to explore the regulatory effect of anserine on HUVEC cell injury and thrombosis in deep venous thrombosis (DVT) rats, and to elucidate the underlying molecular mechanisms.MethodsNon-targeted metabolomics data analyses were conducted using an ultra-performance liquid chromatography system Vanquish UHPLC and mass spectrometer to detect plasma metabolism profiles. The transcriptome sequencing and gene intervention experiments were performed to verify the regulatory effect. Further in vivo and in vitro experiments were performed. Enzyme-linked immunosorbent assay was used to detect the levels of P-selectin, E-selectin, and vWF, hematoxylin-eosin (HE) staining was performed to observe thrombotic and inflammatory cell infiltration, flow cytometry and TUNEL assays were performed to detect apoptosis, and qPCR and WB assays were conducted to determine the gene and protein expression.ResultsAnserine alleviated HUVECs injury, reduced adhesion molecule expression, and inflammation. It decreased P-selectin, E-selectin, vWF, THBD, TFPI levels, and apoptosis while promoting NOS3, ET-1, and NO release in HUVECs. In DVT rats, anserine reduced P-selectin, E-selectin, vWF, thrombosis, cell infiltration, apoptosis, and promoted NO release. Transcriptome sequencing and gene intervention confirmed anserine’s regulation of the PI3K-Akt pathway and coagulation via MYB. CARNMT1, a regulatory enzyme for anserine metabolism, increased anserine content, inhibiting coagulation, thrombosis, cell infiltration, and promoting NO release in rats.ConclusionThis study confirmed anserine could alleviate DVT by improving the inflammatory response, inhibiting blood agglutination, and promoting vasodilation, providing new potential therapeutic targets, important scientific evidence for the development of DVT management, and new clues for an in-depth understanding of its molecular mechanisms.

Endothelial Repair, a Novel Approach on Acute Deep Venous Thrombosis Management

Endothelial Repair, a Novel Approach on Acute Deep Venous Thrombosis Management

The Venous Thrombectomy Armamentarium: An Expanding World.

Acute deep venous thrombosis (DVT) is a common and important public health problem. It affects more than 350,000 people in the United States annually and has a substantial economic impact. Without adequate treatment, there is significant risk of development of post-thrombotic syndrome (PTS) resulting in patient morbidity, worse quality of life, and costly long-term medical care. Over the past decade, the treatment algorithm for patients with acute DVT has significantly changed. Prior to 2008, the treatment recommendation for patients with acute DVT was limited to anticoagulation and conservative management. In 2008, national clinical practice guidelines were updated to include interventional strategies such as surgical- and catheter-based techniques for the treatment of acute DVT. Early strategies for debulking of extensive acute DVT primarily consisted of open surgical thrombectomy and administration of thrombolytics. In the intervening period, a plethora of advanced endovascular techniques and technologies have been developed which reduced the morbidity of operative intervention and risks of hemorrhage associated with thrombolysis. This review will focus on the novel technologies commercially available for management of acute DVT, denoting unique features inherent to each device. This expanded armamentarium gives vascular surgeons and proceduralists the opportunity to individualize their treatment approach to the specific patient's anatomy, lesion, and history.

Endothelial Repair, a Promising Target for the Acute Approach of Deep Venous Thrombosis Management

Endothelial Repair, a Promising Target for the Acute Approach of Deep Venous Thrombosis Management

Rivaroxiban versus Warfarin in management of deep venous thrombosis (DVT)

Rivaroxiban versus Warfarin in management of deep venous thrombosis (DVT)

Peripartum management of deep venous thrombosis in the context of antithrombin deficiency and May-Thurner syndrome.

Literature regarding the management of thrombus refractory to first-line treatment in the setting of pregnancy is limited, and management is made even more complicated in the context of thrombophilia. This case reviews the management of a patient with antithrombin deficiency who developed a massive thrombus during pregnancy, which was complicated by May-Thurner syndrome, lack of improvement with heparin, and preterm labor. The patient received multidisciplinary care throughout the pregnancy. At 35 weeks, anticoagulation was paused as she underwent induction of labor and delivery followed by postpartum placement of inferior vena cava filter and restarting heparin. Successful management of our pregnant patient with thrombus refractory to heparin hinged on individualized treatment for medical optimization with anticoagulation and antithrombin concentrate prior to labor followed by immediate postpartum placement of inferior vena cava filter.

Role of colour Doppler ultrasonography in the evaluation of deep vein thrombosis of peripheral limbs at a tertiary care centre in Kathmandu

Deep venous thrombosis is the development of blood clots in the deep veins. The management of deep venous thrombosis has been irreversibly altered after the introduction of Doppler ultrasound. This study aims to find out the prevalence of deep vein thrombosis of lower limbs diagnosed with colour Doppler ultrasonography at a tertiary care centre. A descriptive cross-sectional study was conducted in the Department of Radiology at a tertiary care hospital from October, 2021 to March, 2022. The study was conducted among 100 patients with clinically suspected deep venous thrombosis. Data were entered and analyzed using Microsoft Excel. Point estimate at 95.0% confidence limits was calculated and results were expressed in frequency and proportion for binary data. Among 100 patients, deep venous thrombosis was diagnosed in 88 (88.0%) patients (95% CL: 81.63-94.37). The patients had a mean age of 48.4±1.6 years. Out of 88 patients, 46 (52.3%) were male and 42 (47.7%) were female. Seventy-three (82.9%) patients had acute DVT. Multiple contiguous veins were predominantly involved (75.0%) than isolated veins (25.0%). Coexisting pathological conditions were seen in 41 cases (46.6%). The prevalence of deep vein thrombosis of lower limbs diagnosed with colour Doppler ultrasonography was higher when compared to other similar reported literatures.

Characteristics of Deep Venous Thrombosis in Isolated Lower Extremity Fractures and Unsolved Problems in Guidelines: A Review of Recent Literature.

Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs and is a common complication in orthopaedics. Therefore, relevant professional organizations domestic and overseas had formulated and constantly updated relevant guidelines to prevent the occurrence of DVT. According to the management strategy of the guidelines, the incidence of DVT can be significantly reduced. However, due to the variety of fractures types, the guidelines cannot expound precautions and characteristics of DVT for all fracture types at present, and there are other related unresolved problems. For example, there is still a lack of consistent optimal strategies for the management of DVT following isolated lower extremity fractures with a higher incidence. The best anticoagulant strategies for patients with upper limb fractures, pediatric fractures, and those combined with other injuries are rarely described in orthopaedic guidelines, but such fractures are common in clinical orthopaedics. The long‐term complications after DVT, such as post‐thrombotic syndrome, are not well‐understood. In the absence of clear guidance, orthopaedic surgeons often resort to empiric anticoagulation or conservative treatment, so the prevention effects of DVT are inconsistent. The purpose of this review is to summarize the characteristics of DVT events after isolated lower extremity fractures and to discuss the unsolved issues in the guidelines by reviewing the previous literature and tracing the history of DVT discovery, to provide more scientific and comprehensive recommendations for the prediction and prevention of DVT.

Abstract No. 157 Mechanical thrombectomy vs pharmacomechanical thrombolysis for deep venous thrombosis in cancer patients

Pharmacomechanical thrombolysis has been the mainstay of management for patients with deep venous thrombosis (DVT); however, thrombolytics are often contraindicated in this patient population. Therefore, mechanical thrombectomy has played an increasing role, particularly with the recent advent of newer devices. The purpose of this study was to evaluate patient characteristics and outcomes for the management of DVT with pharmacomechanical thrombolysis versus mechanical thrombectomy.

Imaging findings and interventional management of deep venous thrombosis.

Deep venous thrombosis (DVT) is a subtype of venous thromboembolism. Lower extremity DVT affects about 1-2% of hospitalized patients. If not managed properly, these thrombi can embolize, causing further complications. Thrombosis risk factors include vascular endothelial injury, venous stasis, and hypercoagulability states. This triad is also known as Virchow’s triad. Although clinical features of lower extremity DVT are nonspecific and many patients are asymptomatic, physicians should maintain a high index of suspicion in patients presenting with leg swelling, pain, warmth, and erythema. Several diagnostic approaches for suspected first DVT have been proposed, and management depends on multiple factors such as location, duration of symptoms, cause of the thrombosis, and recurrence rate.

Invasive and Pharmacological Treatment of Deep Vein Thrombosis: A Scoping Review.

The annual occurrence of venous thromboembolism (VTE) is 300,000-600,000 cases in the United States and 700,000 in Europe. VTE includes deep venous thrombosis (DVT) of upper or lower extremities, superior and inferior vena cava thrombosis, and pulmonary embolism (PE) as well. The primary treatment of DVT includes oral anticoagulation to prevent the progression of the thrombus and decrease the risk of pulmonary embolism. Depending on the symptoms, more invasive treatments can be applied to target the iliofemoral thrombus and its removal. However, less emphasis is given to acute symptomatology, early recovery of function, quality of life improvement, and the individualized likelihood of developing post-thrombotic syndrome. While invasive therapy has been used to enhance the acute management of iliofemoral DVT, our knowledge about the overall outcomes associated with the invasive treatment of VTE is still limited. In this review, we illustrate the available data on pharmacological and endovascular management of iliofemoral VTE, including therapies such as catheter-directed thrombolysis (CDT), mechanical thrombectomy (PMT), and pharmacomechanical catheter-directed thrombolysis (PCDT).

Deep Vein Thrombosis in Intravenous Drug Users: An Invisible Global Health Burden.

The prevalence of intravenous drug use has increased in the past decade and it represents an important risk factor for deep vein thrombosis. Intravenous drug use is a global problem, with the main culprit being heroin. Peer pressure and poverty in high-risk groups such as sex workers, females, and young adults raise the risk of intravenous drug use, which expresses itself in the form of venous thromboembolism eventually. Deep vein thrombosis typically manifests itself eight years after the initial intravenous drug administration, rendering it a silent killer.Aiming to review and summarize existing articles in this context, we performed an exhaustive literature search online on PubMed and Google Scholar indexes using the keywords “Deep Venous Thrombosis (DVT)” and “Intravenous Drug Users (IVDU).” English articles that addressed epidemiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, management, and outcomes of DVT, including those in IVDU, were selected and analyzed.The pathogenesis of DVT development in IVDU is mainly attributed to the interplay of trauma to the vessel by repeated injection and the injected drug itself. The right-sided femoral vein is the most common vein affected. Prevalent clinical presentations include local pain, swelling, and redness with typical systemic symptoms including fever, cough, dyspnea, and chest pain on top of addiction features. There appeared to be a delay in reporting symptoms, which was most likely due to the social stigma attached to IVDU.There are over 50 conditions that present with swollen and painful limbs comparable to DVT in IVDU, making precise diagnosis critical for timely treatment. Venous ultrasound is the method of choice for diagnosing DVT. Extended anticoagulant therapy with low-molecular-weight heparin combined with warfarin is the recommended treatment. Intravenous drug abusers having DVT are affected by multiple complications and poorer outcomes such as slower recovery, recurrent venous thromboembolism (VTE), and a longer hospital stay, which put them at higher risk of morbidity, mortality, reduced productivity, and economic burden.

Management of Deep Venous Thrombosis in Stroke Rehabilitation

Management of Deep Venous Thrombosis in Stroke Rehabilitation

In-Hospital Risks and Management of Deep Venous Thrombosis According to Location of the Thrombus

BackgroundWhether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity deep venous thrombosis is not known. MethodsThis was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016, 2017. Patients hospitalized with a primary diagnosis of deep venous thrombosis at known locations were identified by International Classification of Diseases-10-Clinical Modification codes. ResultsIn-hospital all-cause mortality with deep venous thrombosis involving the inferior vena cava in patients treated only with anticoagulants was 2.2% versus 0.8% with pelvic vein deep venous thrombosis (p<0.0001), 0.7% with proximal deep venous thrombosis (p<0.0001) and 0.2% with distal deep venous thrombosis (p<0.0001). Mortality with anticoagulants was similar with pelvic vein deep venous thrombosis compared with proximal lower extremity deep venous thrombosis, 0.8% versus 0.7% (p=0.39). Lower mortality was shown with pelvic vein deep venous thrombosis treated with thrombolytics than with anticoagulants, 0% versus 0.8% (p<0.0001). In-hospital pulmonary embolism occurred in 11% to 23%, irrespective of the site of deep venous thrombosis. ConclusionPatients with deep venous thrombosis involving the inferior vena cava had higher in-hospital mortality than patients with deep venous thrombosis at other locations. Pelvic vein deep venous thrombosis did not result in higher mortality or more in-hospital pulmonary embolism than proximal lower extremity deep venous thrombosis. The incidence of in-hospital pulmonary embolism was considerable with deep venous thrombosis at all sites.

Healthcare professionals\u2019 knowledge, attitudes, and practices regarding graduated compression stockings: a survey of China\u2019s big-data network

BackgroundThe accurate identification of venous thromboembolism prophylaxis implementation barriers is an important part of prophylaxis prevention. However, in China, data to help identify these barriers is limited. This study has two objectives: 1) to determine the knowledge, attitudes, and practices (KAPs) of healthcare professionals regarding graduated compression stockings (GCS) since the launch of the National Program for the Prevention and Management of Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT) in October 2018 and 2) to identify the obstacles and assist the program.MethodsThis was a cross-sectional study of 5070 healthcare professionals in China. We used exploratory factor and reliability analyses to evaluate the researcher-designed questionnaire’s reliability and validity. The formal questionnaire, which included demographic data, knowledge, attitudes, and clinical practice patterns, was distributed to healthcare professionals.ResultsOf the 5070 respondents, 32.5% had a good knowledge of GCS, 78.5% had a positive attitude towards their use, and 34.0% exhibited normative behavior when applying them. The KAPs of healthcare professionals towards GCS were significantly correlated with one another. Binary logistic regression suggested that the training received by healthcare professionals was an important factor affecting their knowledge regarding GCS usage.ConclusionsThe training provided for the use of GCS in China cannot meet medical staff needs and deserves more attention from policy makers. This represents an obstacle for venous thromboembolism prophylaxis, which restricts the effective implementation of the National Program for Prevention and Management of PE and DVT.

Outcomes with catheter‐directed thrombolysis compared with anticoagulation alone in patients with acute deep venous thrombosis

The authors aimed to investigate the benefits and risks of catheter-directed thrombolysis (CDT) in acute deep venous thrombosis (DVT). The role of CDT in the management of DVT is evolving. Data on CDT versus anticoagulation alone in acute DVT is sparse. We performed a systematic review and meta-analysis of published studies that compared CDT to anticoagulation alone in patients with acute DVT. We included 11 studies (four randomized control trials [RCTs] and seven observational studies) with a total of 8,737 patients. During hospital stay, patients who received CDT had higher odds of major bleeding (2.5% vs. 1.6%; OR 1.46, 95% CI [1.07, 1.98], p = .02), blood transfusion (10.8% vs. 6.2%; OR 1.8, 95% CI [1.52, 2.13], p < .001), and thromboembolism (15.5% vs. 10%; OR 1.67, 95% CI [1.47, 1.91], p < .001) compared with anticoagulation alone. At 6-month follow-up, patients who received CDT had higher venous patency (71.1% vs. 37.7%; OR 5.49, 95% CI [2.63, 11.5], p < .001) and lower postthrombotic syndrome (PTS; 27% vs. 40.7%; OR 0.44, 95% CI [0.22, 0.86], p = .02). During a mean follow-up duration of 30.5 ± 28 months, CDT group continued to have higher venous patency (79.6% vs. 71.8%; OR 3.79, 95% CI [1.54, 9.32], p = .004) and lower PTS (44.7% vs. 50.5%; OR 0.43, 95% CI [0.23, 0.78], p = .006), but no difference in thromboembolism. Compared with anticoagulation alone, CDT for patients with acute DVT was associated with a higher risk of complications, but a higher rate of venous patency and lower risk of postthrombotic syndrome at 2.5 years follow-up.

Disease cognition and its influencing factors in patients with lower extremity DVT

Objective To investigate the deep venous thrombosis (DVT) cognition and its influencing factors in patients with lower extremity DVT first time diagnosed so as to provide a basis for DVT management. Methods From December 2018 to September 2019, we selected patients with lower extremity DVT first time diagnosed at Peking Union Medical College Hospital by convenience sampling. The cross-sectional investigation was carried out with the self-designed questionnaire including the general information, disease data, DVT knowledge. This study analyzed the influencing factors of DVT cognition of patients. Results A total of 100 questionnaires were sent out and 99 valid questionnaires were collected. The standardized score of DVT knowledge was (45.76±28.05) . Single factor analysis showed that there were statistical differences in the scores of DVT knowledge among patients with different ages, education levels, types of thrombosis, diagnosis time of DVT, swelling, affecting life and work, awareness of intervention (P<0.05) . Multiple linear regression analysis showed that the influencing factors of disease cognition of patients with lower extremity DVT first time diagnosed including the education levels and awareness of intervention with statistical differences (P<0.05) . Conclusions Patients with DVT first time diagnosed have the low level of disease cognition. Nurses should provide individualized health education and guide based on patients' personal and disease characteristics to improve patients' cognition on DVT, and DVT prevention to improve patients' long-term prognosis. Key words: Venous thrombosis; Lower extremity; Deep venous thrombosis; Disease cognition; Influencing factors; Health education

A Prospective Study of Clinical Profile, Predisposing Factors and Management of Deep Venous Thrombosis

A Prospective Study of Clinical Profile, Predisposing Factors and Management of Deep Venous Thrombosis

Popliteal Access in the Supine Position for Endovenous Management of Deep Vein Thrombosis.

IntroductionThe preferred venous access site for percutaneous management of deep venous thrombosis (DVT) is the popliteal vein, with the patient in the prone position. Owing to the need for additional venous access, including the jugular or femoral veins, popliteal access in the prone position requires supine repositioning of the patient. A technique for puncturing the popliteal vein in the supine position is proposed, which allows for additional venous access in the same position in patients with DVT.ReportUltrasound guided popliteal vein access was obtained in the supine position and then pharmacomechanical thrombectomy and iliocaval stent placement was performed for the management of DVT when indicated.DiscussionEight patients were included (four men, four women; mean ± standard deviation age of 44.2 ± 14.1 years). Popliteal access was performed successfully in the supine position in all patients. An inferior vena cava filter was inserted in five patients and stents were placed in four. Complete recanalisation of occluded vein segments was obtained successfully with popliteal access in supine position in all patients. None of the patients had early or late complications, including arterial puncture, bleeding, haematoma, or neurological disorder. Veins and stents were patent on duplex ultrasound in all seven patients reaching the six month follow up. One patient with patent veins and stents has not yet reached the six month follow up. The technique of popliteal vein access in the supine position for percutaneous endovenous interventions appears to provide a reliable alternative to access in the prone position.

SUN-581 An Unusual Presentation of Hypothyroidism

Introduction: Hashimoto’s thyroiditis (HT) rarely presents with clinical myopathy, with elevated muscle enzymes and acute kidney injury (AKI) due to rhabdomyolysis. A pilot study has suggested an increased prevalence of subclinical hypothyroidism in patients with unprovoked deep venous thrombosis (DVT). We report a case of HT presenting with asymmetric myopathy, AKI, and bilateral lower extremity DVTs, who responded well to thyroid hormone replacement. Case Description: A 58-year-old man with history of psoriasis presented with new erythematous plaques over the trunk and extremities for one month. He had episodic numbness and heaviness in the arms, thighs, and hands, especially when he held objects for sometime (e.g. steering wheel or holding a cell phone). He had difficulty in getting up from a sitting position. He also felt that his calves were swollen. He experienced stiffness in the hands. On examination, he had an asymmetric decrease in muscle power (4/5) in the proximal muscles of the upper and lower extremities. He had small circumscribed psoriatic plaques on the elbows, knees, and trunks. In addition, bilateral pitting edema was noted. Laboratory evaluation was remarkable for elevated creatinine phosphokinase 2310 IU/L, aldolase 15.6 U/L, elevated serum creatinine at 1.34 mg/dl, and elevated CRP at 9.5 mg/dl. Serological tests for connective tissue disease were all negative. Myositis associated and specific antibodies were negative. Electromyography was consistent with myopathic process with changes in numerous muscle groups bilaterally, most prominent in gluteus medius, lumbar, thoracic and cervical paraspinals. Nerve conduction study showed bilateral carpal tunnel syndrome. Three weeks later, his lower extremity swelling worsened. Ultrasound venous dopplers revealed bilateral DVT in the posterior tibial and peroneal veins. Thyroid function tests revealed elevated TSH (103.26 micro-IU/mL) and low free T4 (0.22 ng/dl). He has elevated thyroid peroxidase and thyroglobulin antibodies. He was hospitalized for management of unprovoked DVT and severe hypothyroidism secondary to HT. He was started on levothyroxine. Four weeks later, the myopathy resolved and muscle enzymes normalized. TSH improved to 35 micro-IU/ML. Discussion: HT presenting with clinical myopathy and DVT is extremely rare. Few features in this case raised the question of an alternative etiology for the myopathy – asymmetric proximal muscle involvement, acute to subacute course, and absence of myositis specific antibodies. In a pilot cross sectional study, increased prevalence of subclinical hypothyroidism was found in patients with unprovoked DVT, as noted in our case. This case highlights the atypical presentation of hypothyroidism due to HT. The identification of the hypothyroidism and initiation of thyroid hormone replacement improved the quality of life and physical function in our patient.