Predictors Of Deep Vein Thrombosis Research Articles

Hospital predictors of deep vein thrombosis after ischemic stroke: A systematic review

Hospital predictors of deep vein thrombosis after ischemic stroke: A systematic review

Prevalence, Risk Factors of Deep Venous Thrombosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

Introduction: It is important to increase awareness and identify the predictors of Deep Vein Thrombosis (DVT) in Chronic Obstructive Pulmonary Disease (COPD) patients presenting with worsening dyspnoea, as they are at a high-risk for Venous Thromboembolism (VTE) due to immobility, inflammation, and comorbidities. Aim: To determine the prevalence of DVT in hospitalised patients with acute exacerbation of COPD, as well as to identify associated risk factors for DVT in this group. Materials and Methods: A cross-sectional study was conducted from March 2021 to June 2022 in the Department of Respiratory Medicine at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. The sample population consisted of hospitalised patients with acute exacerbation of COPD who were aged over 40 years. All patients underwent routine blood investigations, Electrocardiograph (ECG), echocardiogram, arterial blood gas analysis, D-dimer test, chest radiograph, and lower-limb venous Doppler. Risk assessment was performed using the Modified Well’s criteria for DVT, and pretest probability was determined for all patients. The Chi-square test was used as a test of significance, with a p-value <0.05 considered statistically significant in all analyses. Results: The mean age of the study population was found to be 60.80±10.21 years. Among the 74 patients included in the study, it was found that 3 (4.05%) patients had DVT. There was no statistically significant difference between the DVT and non DVT groups regarding age, sex, obesity, modified Medical Research Council (mMRC) grade of breathlessness, smoking status, severity of airflow obstruction in spirometry, COPD class, type of respiratory failure, and presence of comorbidities. However, there was a statistically significant difference between the DVT and non DVT groups in terms of elevated D-dimer (>500 ng/mL), history of immobilisation for more than three days, and Modified Wells’ score (>2). Conclusion: Patients with acute exacerbation of COPD, associated with a significant history of immobilisation and high D-dimer values, along with a high-risk pretest probability using clinical predictors such as the Modified Wells’ score for DVT, should be considered for evaluation of VTE and early initiation of prophylactic anticoagulation therapy to prevent Pulmonary Thromboembolism.

Evaluation of perioperative D-dimer concentration for predicting postoperative deep vein thrombosis following hepatobiliary-pancreatic surgery

PurposeThis study was performed to investigate the predictive value of the perioperative D-dimer concentration for the development of postoperative deep vein thrombosis (DVT) after hepatobiliary-pancreatic (HBP) surgery.MethodsThe subjects of this retrospective study were 178 patients who underwent HBP surgery in our hospital between January, 2017 and December, 2021. The D-dimer concentration was measured preoperatively and on postoperative days (POD) 1, 3, and 5. Postoperative DVT was diagnosed based on compression ultrasonography in both lower limbs on POD 6 or 7.ResultsPostoperative DVT developed in 21 (11.8%) of the 178 patients. The D-dimer concentration was significantly higher in the patients with than in those without postoperative DVT before surgery and on PODs 1, 3, and 5. The highest area under the curve of the D-dimer concentration for predicting DVT was 0.762 on POD 3. Multivariate analysis revealed that the D-dimer concentration on POD 3 was an independent predictive risk factor for postoperative DVT, along with the preoperative estimated glomerular filtration rate. Preoperative albumin and D-dimer concentrations were also identified as independent predictive factors of an increase in D-dimer concentration on POD 3.ConclusionsThe D-dimer concentration on POD 3 is a useful predictor of DVT after HBP surgery.

Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients.

Numerous tools, including nutritional and inflammatory markers, have been evaluated as the predictors of poor outcomes in COVID-19 patients. This study aims to verify the predictive role of the prognostic nutritional index (PNI), CONUT Score, and inflammatory markers (monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in cases of deep vein thrombosis (DVT) and acute pulmonary embolism (APE) risk, as well as mortality, in COVID-19 patients. The present study was designed as an observational, analytical, retrospective cohort study, and included 899 patients over the age of 18 who had a COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and were admitted to the County Emergency Clinical Hospital and Modular Intensive Care Unit of UMFST "George Emil Palade" of Targu Mures, Romania between January 2020 and March 20212. Non-Surviving patients were associated with a higher incidence of chronic kidney disease (p = 0.01), cardiovascular disease (atrial fibrillation (AF) p = 0.01; myocardial infarction (MI) p = 0.02; peripheral arterial disease (PAD) p = 0.0003), malignancy (p = 0.0001), tobacco (p = 0.0001), obesity (p = 0.01), dyslipidemia (p = 0.004), and malnutrition (p < 0.0001). Multivariate analysis showed that both nutritional and inflammatory markers had a high baseline value and were all independent predictors of adverse outcomes for all enrolled patients (for all p < 0.0001). The presence of PAD, malignancy, and tobacco, were also independent predictors of all outcomes. According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, CONUT Score, and lower PNI values at admission strongly predict DVT risk, APE risk, and mortality in COVID-19 patients. Moreover, PAD, malignancy, and tobacco, all predicted all outcomes, while CKD predicts APE risk and mortality, but not the DVT risk.

Thrombin antithrombin complex concentration as an early predictor of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty

AimEarly predictive markers of venous thromboembolism (VTE) after total hip arthroplasty (THA)/total knee arthroplasty (TKA) remain unclear. Our study identified early predictive markers for VTE after THA/TKA.MethodsA single-institution retrospective review study was conducted between May 2020 and April 2022 (n = 256). All patients underwent Doppler ultrasounds exam in preoperation and seventh day after surgery. Deep vein thrombosis (DVT) was defined by Doppler ultrasound of the lower extremities, which revealed thrombosis. Thrombin-antithrombin complex (TAT), thrombomodulin (TM), and plasmin-antiplasmin complex (PIC) concentration were tested from each patient’s preoperative and postoperative days 1, 4, 7, 14. These values were then accessed via receiver operating characteristic (ROC) curve analysis and further quantified the level of this risk by concentration.ResultsOn postoperative day 1 (pod-1), all patients’ TAT and PIC concentrations were significantly higher than those preoperatively (p < 0.05). The levels of TAT and PIC in patients in the DVT group on pod-1 were significantly higher than those in the non-DVT group (p < 0.05). At pod-1, the TAT concentration for DVT patients was 49.47 ng/mL compared to 20.70 ng/mL for non-DVT patients, PIC was 3.72μg/mL compared to 1.65μg/mL. ROC curve analysis demonstrated that a TAT concentration of 24.3 ng/mL had a sensitivity of 87.9% and a specificity of 69.1%.ConclusionTAT levels on pod-1 may predict DVT early after THA/TKA, which makes it possible for early intervention to decrease the incidence of DVT.

Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study

BackgroundLimited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures.MethodsThis retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients’ clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT.ResultsThe overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT.ConclusionsA high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.

Is Preoperative Plate-Lymphocyte Ratio a Predictor of Deep Vein Thrombosis in Patients With Oral Cancer During Surgery?

Detecting deep vein thrombosis (DVT) is necessary to reduce the morbidity of venous thromboembolism, and platelet-lymphocyte ratio (PLR) is a novel marker for predicting DVT. This study aimed to investigate the association between preoperative PLR and risk of developing DVT in patients receiving surgical treatment of oral cancer. We designed a retrospective cohort study, and the source of study sample was patients with oral cancer and who underwent surgery between 2015 and 2019. Patients were excluded if they did not undergo surgical treatment and had preoperative DVT and history of hypercoagulable disorders. The primary predictor variable was PLR. We calculated the receiver operating characteristic curve and area under the curve to determine the best-defined risk groups. The best cutoff value for PLR was 187.4 (area under the curve, 0.772; sensitivity, 75.0%; specificity, 74.2%; P=.002). The primary outcome variable was DVT, and the other variables were patient characteristics, blood examination data, and therapeutic data. A logistic regression analysis was used to adjust the effects of potential confounders. A total of 101 patients were included in this study, and DVT was observed in 12 (11.9%) patients. Free flap reconstructive surgery was performed in 8 of the 12 (66.7%) patients in the DVT group. Statistical analyses showed that DVT was significantly associated with PLR (≤187.4 vs >187.4; P=.001). Logistic multivariate analysis of the preoperative parameters identified the following 2 independent predictive factors for DVT: PLR (≤187.4 vs >187.4) (odds ratio, 13.735; 95% confidence interval, 2.950 to 63.944; P=.001) and free flap reconstructive surgery (odds ratio, 6.584; 95% confidence interval, 1.504 to 28.822; P=.012). High PLR (>187.4) and free flap reconstructive surgery, considered as preoperative predictive factors, were associated with DVT.

Fibrinolysis Index as a new predictor of deep vein thrombosis after traumatic lower extremity fractures

BackgroundDeep vein thrombosis (DVT) is a common complication in patients with traumatic injury. The purpose of this study was to develop a potential predictor of DVT. MethodsThis case-control study enrolled adult trauma patients and healthy volunteers. Patients underwent angiography before surgery to diagnose DVT. Patients with or without DVT were matched by gender, age and fracture sites. Laboratory parameters included lysis potential (LP), lysis time (LT), blood cell counts, conventional coagulation tests, tissue plasminogen activator inhibitor complex (tPAIC) and others. Results41 of 319 patients with DVT were matched with 41 patients without DVT and 80 healthy volunteers were controls. LP and LT were significantly decreased in patients with DVT than without (P = 0.043 and P = 0.014, respectively). The level of tPAIC in the DVT group was significantly higher than in patients without DVT (P = 0.042). We defined the Fibrinolysis Index as (−10.707) × LP + (−0.607) × LT (min) + 0.012 × fibrinogen (mg/dl) + 0.299 × tPAIC (ng/ml) + 9.917, and found that the area under the receiver operating characteristic curve for the Fibrinolysis Index was 0.802, making it a novel indicator. ConclusionThe Fibrinolysis Index represents a new discriminator for predicting DVT after traumatic lower extremity fractures.

Predictors of deep-vein thrombosis in subarachnoid hemorrhage: a retrospective analysis.

BackgroundSubarachnoid hemorrhage is a severe subtype of hemorrhagic stroke, and deep-vein thrombosis is a frequent complication detected in these patients. In addition to other well-established risk factors, the early activation of coagulation systems present in patients with subarachnoid hemorrhage could potentially play a role in the incidence of deep-vein thrombosis. This study aims to identify possible predictors for deep-vein thrombosis related to subarachnoid hemorrhage.MethodsWe conducted a retrospective cohort study on patients with a diagnosis of subarachnoid hemorrhage who presented to our institution between 1 January 2014 and 1 August 2018. We reviewed electronic medical records and analyzed several parameters such as Fisher scale, World Federation of Neurosurgical Surgeons scale, aneurysm site, surgical or endovascular treatment, decompressive craniectomy, vasospasm, infection (meningitis and pneumonia), presence of motor deficit, length of stay in the ICU, length of hospital stay, number of days under ventilator support, d-dimer at hospitalization, and the time to thromboprophylaxis (days).ResultsThe univariate analysis showed that intraparenchymal cerebral hemorrhage, d-dimer at hospitalization, the time to thromboprophylaxis, motor deficit, and aneurysm located at the internal carotid artery were statistically significant factors. Intraparenchymal cerebral hemorrhage (OR 2,78 95%CI 1.07–7.12), motor deficit (OR 3.46; 95%CI 1.37–9.31), and d-dimer at hospitalization (OR 1.002 95% CI 1.001–1.003) were demonstrated as independent risk factors for deep-vein thrombosis. Length of hospital stay was also found to be significantly longer in patients who developed deep-vein thrombosis (p value 0.018).ConclusionElevated d-dimer level at the time of hospitalization, motor deficit, and the presence of an intraparenchymal hemorrhage are independent risk factors for deep-vein thrombosis. Patients with DVT also had a significantly longer hospital stay. Even though further studies are needed, patients with elevated d-dimer at hospitalization and intraparenchymal cerebral hemorrhage may benefit from a more aggressive screening strategy for deep-vein thrombosis.

Preoperative femoral vein velocity in maximal flexion is a predictor of deep vein thrombosis in patients undergoing total hip arthroplasty.

SUMMARYThe aim of the study was to investigate if preoperative blood flow velocity in femoral vein in different positions of the hip during total hip arthroplasty (THA) is a predictor of postoperative deep vein thrombosis (DVT). In patients undergoing THA, blood flow velocity and diameter of proximal femoral vein on THA side were measured preoperatively in four flexion positions of the hip. After THA, patients were followed up for 42 days for DVT occurrence, and clinical features of patients with and without postoperative DVT were compared. The mean blood flow velocity in maximal flexion (90º+) preoperatively was significantly lower in patients with postoperative DVT (19/103) compared to patients without it (8.4±2 cm/s vs. 10.6±2.3 cm/s; p<0.001). Using the receiver operating characteristic curve analysis, the cut-off value for blood flow velocity during maximal flexion was 8.24 cm/s. In addition, anesthesia duration, duration of surgical position of the patient, body mass index, amount of blood transfused after surgery, and clinical signs of DVT were markedly different between patients with and those without postoperative DVT. Blood flow velocity in femoral vein in maximal flexion of the hip (90º+) measured prior to THA is an independent predictor of postoperative DVT.

P5587Elevated D-dimer level after 1 month anticoagulant therapy as a predictor for adverse outcomes in patients with venous thromboembolism: 10-year follow-up results

Abstract Background Our previous study showed that elevated D-dimer (D-D) level after 1 month of the anticoagulant therapy was an independent predictor of deep vein thrombosis (DVT) recurrences and combined endpoint (DVT recurrence and/or death from any causes) during 18 months. Prognostic value of elevated D-D level after 1 month of the anticoagulant therapy for the long-term venous thromboembolism (VTE) outcomes is unknown. Purpose To estimate the elevated D-D level influence after 1 month of the anticoagulant therapy on the 10-year prognosis in VTE pts. Methods One hundred and twelve pts (77 men) aged 18–76 (mean 54±14) years with DVT and/or pulmonary embolism were included in the study. Pts received unfractionated or low molecular weight heparin for at least 5 days followed by the long-term warfarin therapy (target international normalized ratio 2,0–3,0). D-D level was measured after 1 month from the start of the anticoagulant therapy by a quantitative assay with an estimated cut-off level of 0,5 ug/ml. The follow-up period was 10 years. Endpoints were VTE recurrence and combined endpoint (VTE recurrence and/or death from any causes). Results In all pts, median of follow-up was 2,77 years (min 2 weeks, max 11,61 years, IQR 1,44 to 10,31 years). Seventy seven (69%) pts had ended the 10-year follow-up period completely or achieved the endpoint. In these pts, median of follow-up was 9,23 years (IQR 1,70 to 10,53 years). Thirty-five cases were censored. During 10 years, the VTE recurrences rate was 27,7%, 14 pts died, the combined endpoint rate was 36,6%. Kaplan-Meier analysis showed that pts with elevated D-D level after 1 month of the anticoagulant therapy had higher 10-year cumulative risk for adverse outcomes (chi-square=6,0, p=0,014 for VTE recurrence; chi-square=13,7, p&lt;0,001 for combined endpoint). Cox regression confirmed that elevated D-D level after 1 month of the anticoagulant therapy was associated with a 2,5-fold increase in the 10-year VTE recurrences risk (HR 2,52; 95% CI 1,18–5,42; p=0,018) and a 3,2-fold increase in the 10-year combined endpoint risk (HR 3,21; 95% CI 1,68–6,15; p&lt;0,001) compared pts with normal D-D level after 1 month of the anticoagulant therapy. Conclusions During 10 years, the VTE recurrences rate was 27,7%, combined endpoint rate (VTE recurrence and/or death from any causes) was 36,6%. Elevated (&gt;0,5 ug/ml) D-D level after 1 month of the anticoagulant therapy had a prognostic value and was associated with the 2,5-fold increase in the 10-year VTE recurrences risk and the 3,2-fold increase in the 10-year adverse outcomes risk.

Incidence and Predictors of Deep Vein Thrombosis in Patients with Elevated Serum D-Dimer Prior to Surgery for Urologic Malignancy

Objectives: To analyze the incidence and predictors of deep vein thrombosis (DVT) in patients with elevated D-dimer prior to surgery for urologic malignancy. Methods: Between January 2015 and September 2017, 987 consecutive patients underwent surgery for urologic malignancy under general anesthesia in our institution. Of these, 191 patients underwent preoperative venous ultrasonography of the lower extremities for DVT due to elevated D-dimer. We analyzed the incidence and predictors of DVT in these patients. Results: The median age was 69 years. DVT was detected in 18% of patients (35/191). Multivariate analysis showed that the primary site of urologic malignancy (p < 0.01) and older age (p < 0.01) were independent predictors of DVT. Patients with bladder cancer had the highest incidence of DVT. When bladder cancer and age of 70 or older were defined as predictors for DVT, the incidence of DVT in zero, 1, and 2 predictors was 3.4% (3/89), 29% (22/77), and 44% (11/25), respectively. Conclusions: DVT was found in 18% of patients with elevated D-dimer prior to surgery for urologic malignancy. Bladder cancer patients and older patients in whom D-dimer has been elevated should undergo careful early examination for DVT.

Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography.

Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes. This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence. Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence (P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis (P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay (P = .35) or mortality (P = .34). Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.

Preoperative Soleal Vein Diameter Determined by Ultrasonography is an Independent Predictor of Deep Vein Thrombosis Regardless of the Site of Major Orthopedic Surgery

Preoperative Soleal Vein Diameter Determined by Ultrasonography is an Independent Predictor of Deep Vein Thrombosis Regardless of the Site of Major Orthopedic Surgery

Clinical and Laboratory Predictors of Deep Vein Thrombosis in Ovarian Malignant Tumor

Objective: To investigate the clinical and laboratory predictors of symptomatic deep vein thrombosis (DVT) in ovarian malignant tumor.&#x0D; Methods: One hundred sixteen patients with suspected ovarian malignant tumor were recruited. Age, body mass index (BMI); D-dimer, fibrinogen, thrombocyte level, comorbid, tumor diameter, staging, distant metastasis, ascites, histopathology, length of surgery, blood loss and transfusion were recorded.&#x0D; Results: Incidence of symptomatic DVT was 16.5% and 88.2% cases occurred before surgery. No case of symptomatic DVT during postoperative care was found. Predictors of DVT were distant metastasis (OR 28.99; 95% CI 3.83-219.52, BMI ≥ 22.7 kg/m2 (OR 15.52, 95% CI 2.24-107.37), D-Dimer ≥ 1700 mg/ml (OR 13.30, 95% CI 2.40- 73.84), advanced stage (OR 6.66; 95% CI 1.05-42.27), epithelial tumor (OR 6.5; 95% CI 0.34-125.75), tumor’s diameter ≥ 18.25 cm (OR 2.36, 95% CI 0.48-11.54), and comorbidity (OR 2.49, 95% CI 0.53-11.66). Prediction score of DVT were score 3 for distant metastasis, BMI ≥ 22.7 kg/m2, D-Dimer ≥ 1700 mg/ml, score 2 for advanced stage, score 1 for tumor diameter ≥ 18.25 cm, comorbid, epithelial tumor and score 0 for the absence of variables or its value less than the cut off. Total score ≥ 8 of 14 is the least score which has a good predictive value for DVT with AUC 0.92, 95% CI 0.86-0.92, probability 86.46%.&#x0D; Conclusion: Distant metastasis and D-dimer are independently associated with the development of DVT in ovarian malignant tumor.&#x0D; [Indones J Obstet Gynecol 2017; 5-3: 180-184]&#x0D; Keywords: deep vein thrombosis, D-dimer, ovarian malignant, tumor predictor

P5246Preoperative soleal vein diameter determined by ultrasonography is an independent predictor of deep vein thrombosis regardless of the type of major orthopedic surgery

P5246Preoperative soleal vein diameter determined by ultrasonography is an independent predictor of deep vein thrombosis regardless of the type of major orthopedic surgery

Clinical and laboratory predictors of deep vein thrombosis after acute stroke

BackgroundDeep vein thrombosis (DVT) is a common complication of acute stroke, but the new incidence in the era of improved specialist input in stroke care is yet unknown. The models for VTE diagnosis is well established, but prediction models to target at-risk patients for pharmacological prophylaxis is lacking and requires further research, particularly in the aftermath of acute stroke. ObjectivesTo predict DVT after acute stroke using markers of haemostatic activation and stroke severity scores. MethodsWe examined the clinical utility of laboratory factors such as thrombin generation, D-dimer, fibrinogen alongside clinical factors (National Institute of Health Stroke Scale and Barthel Index) in the prediction of asymptomatic DVT, among 92 consecutively admitted patients. ResultsOne in five patients (19.6%) had objectively confirmed DVT (6 proximal, 12 distal). Thrombolytic therapy did not protect against DVT, with 21% (6/29) of patients treated with r-tPA went on to develop DVT. Thrombin generation and fibrinogen had no clinical utility, but D-dimer at baseline and week 2 had high clinical potential in the prediction of asymptomatic DVT (2425ng/mL versus 1010ng/mL; p=0.001) and (2240 Vs 970ng/mL; p<0.001) respectively. Patients with DVT had worse stroke severity, and are functionally less able, with lower Barthel index (p=0.05), and high National Institute of Health Stroke Score (p=0.07). ConclusionThrombolytic therapy and specialist stroke intervention does not protect against DVT risk. D-dimer concentration within 48h of acute stroke is independently associated with development of DVT. This observation would require confirmation in a large study.

The role of postoperative levels of neutrophil extracellular traps in deep vein thrombosis after total knee arthroplasty

Objective To investigate the role of circulating neutrophil extracellular trap (NET) levels in the postoperative formation of deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA). Methods Circulating NET levels were measured preoperatively and on postoperative days 1, 3, and 7 in 30 patients diagnosed with DVT by venography after TKA and 30 controls from May 2014 to July 2015. Results In patients with DVT, the mean circulating NET levels were significantly higher on postoperative days 1 and 3 compared with those in the non-DVT group (postoperative day 1, 1.598±0.067 vs. 1.212± 0.037,t=7.514,P=0.000; postoperative day 3, 1.305±0.044 vs. 1.167±0.032,t=2.675,P=0.015). ROC curve analysis revealed the inferior sensitivity and specificity of NET levels on postoperative day 3 compared with postoperative day 1. Area under the curve (AUC) postoperative day 1 was 0.828 (95%CI: 0.722, 0.933,P=0.000); AUC postoperative day 3 was 0.677 (95%CI: 0.541, 0.814, P=0.018). The cutoff point for NET levels on postoperative day 1 was 1.294, with a sensitivity of 80%, a specificity of 80%, a positive predictive value of 80%, and a negative predictive value of 80%. After Logistic regression, the NET level on postoperative day 1 was considered an independent predictor of DVT (OR: 24.08, 95%CI: 4.94, 117.28,P=0.000). Conclusion High circulating NET levels are associated with DVT in patients who undergo TKA. NETs may serve as a potential biological marker to delineate patients undergoing TKA who are most at risk for DVT. Key words: Arthroplasty, replacement, knee; Venous thrombosis; Neutrophils

СONGENITAL ABNORMALITIES OF THE INFERIOR VENA CAVA AND ITS TRIBUTARIES: THEIR RADIOLOGICAL DIAGNOSIS AND CLINICAL SIGNIFICANCE

Abnormalities of the inferior vena cava (IVC) and its tributaries are a very rare congenital defect with an incidence of 0.6 to 3% and a wide variety of anatomical variants. In most cases, it is an accidental diagnostic finding in patients undergoing examination for other pathologies. Not infrequently, the anatomic IVC variants are ignored at the stage of exploratory diagnostic assessment due to their rarity, difficulties of identification and perhaps insufficient awareness of a radiologist in this field. It is known that some IVC abnormalities are associated with certain symptoms, and others could be a predictor of deep vein thrombosis. The information on characteristics of the IVC anatomical structure is necessary during interventional manipulation on the retroperitoneal organs and vasculature, because the presence of an atypically located vessel can lead to significant variations in the surgery protocol and potential intraoperative complications. The problems of embryogenesis, classification, variant anatomy, clinical significance and diagnostics of various abnormalities of IVC and its tributaries are discussed in this review.

Evaluation of D-Dimer in Screening Deep Vein Thrombosis in Hospitalized Japanese Patients with Acute Medical Diseases/Episodes.

Objective: To investigate the usefulness of D-dimer as a screening method as well as to explore potent predictors of deep vein thrombosis (DVT) in hospitalized Japanese patients with acute medical diseases/episodes. Methods and Subjects: This study was a multi-center, prospective, observational study. The inclusion criteria were hospitalized patients at high risk of developing venous thromboembolism with; (1) congestive heart failure, acute exacerbation of chronic obstructive pulmonary disease, infectious diseases, or inflammatory diseases, (2) bed rest ≥4 days, and (3) ≥60 years old. D-dimer was measured on the same day as ultrasonography. Multivariate logistic regression analysis was performed to investigate predictors associated with the presence of DVT. Results: Sixty-nine patients were enrolled. The prevalence of DVT was 33.3% (23/69; 95% C.I., 19.4% to 47.3%). D-dimer was measured in 42 patients and the sensitivity and negative predictive value reached 100%, while the specificity (13.3%) and positive predictive value (31.6%) were low (cut-off value: 0.9 or 1.0 µg/mL). Statistically significant predictor was not assigned. Conclusion: As the sensitivity and negative predictive value of D-dimer reached 100%, D-dimer have a role in excluding patients who might otherwise undergo diagnostic imaging for DVT in hospitalized Japanese patients with acute medical diseases/episodes.