Proximal Deep Vein Thrombosis Research Articles

Evaluation of short training session for venous limited compression ultrasonography: prospective multicenter study

BackgroundVenous limited compression ultrasonography (VLCU) is recommended in case of suspicion of deep venous thrombosis (DVT). Current training pathways are rather long and include experiential phase. This aim of this study was to investigate the efficacy of a short training session for VLCU without experiential phase. The training session was applied in residents without previous ultrasound skills. Program included operation of ultrasound device and interpretation of venous images. Included patients were older than 18 years and had a suspicion of DVT. After realization of VLCU using usual technique, residents reported the dynamic compressibility of the femoral and popliteal veins, the presence or not of a visible thrombus, self-reported difficulty and duration. Patients then underwent a whole leg ultrasonography (WLCU) in the local laboratory which was blinded to VLCU results. The main criterion was the negative-predictive value (NPV) of VLCU for the absence of proximal DVT diagnosed with WLCU. Secondary criteria were VLCU diagnostic performances, rate of inability to conclude, difficulty and duration. For a NPV of 95 ± 6%, the needed number of patients was 96. This study was approved by the ethical committee.Results102 patients were analyzed. 46 residents were trained. A DVT was diagnosed by WLCU in 18 patients (prevalence of 17.6% [95% CI 11–26%]). VLCU detected 15 DVT (NPV of 96% [95% CI 89–99%]). The positive likelihood ratio was 9.9, the negative likelihood ratio 0.19 and Cohen’s Kappa 0.62 [95% CI 0.52–0.71]. The sensitivity was 83% [CI 95% 60–94%] and specificity 88% [CI 95% 79–93%]. The mean number of VLCU by residents was 2.3 ± 2.1, median 2 (minimum 1, maximum 8). Mean duration was 3.4 min, difficulty was 3.7 ± 2.ConclusionThe principal objective, NPV 96% [95% CI 89–99%], was achieved. However, this short training session was inadequate to allow ruling-out a DVT with sufficient security. Thus, the experiential phase seems to be essential.

Asymptomatic Trauma Patients Screened for Venous Thromboembolism Have a Higher Risk Profile with Lower Rate of Pulmonary Embolism: A Five-Year Single-Institution Experience

Deep vein thrombosis (DVT) is linked to reimbursements and publicly reported metrics. Some hospitals discourage venous duplex ultrasound (VDUS) screening in asymptomatic trauma patients because they often find higher rates of DVT. We aim to evaluate the association between lower extremity (LE) VDUS screening and pulmonary embolism (PE) in trauma patients. Trauma patients admitted to an urban Level-1 trauma center between 2010 and 2015 were retrospectively analyzed. We characterized the association of asymptomatic LE VDUSs with PE, upper extremity DVT, proximal LE DVT, and distal LE DVT by univariate and multivariable logistic regression controlling for confounders. Of the 3959 trauma patients included in our study-after adjusting for covariates related to patient demographics, injury, and procedures-there was a significantly lower likelihood of PE in screened patients (odds ratio (OR) = 0.02, P < 0.001) and a higher rate of distal LE DVT (OR 11.1, P = 0.004). Screening was not associated with higher rates of proximal LE DVT after adjustment for covariates (OR = 1.8, P = 0.193). PE was associated with patient transfer status, pelvis fracture, and spinal procedures in unscreened patients. After adjusting for covariates, we have shown that LE VDUS asymptomatic screening is associated with lower rates of PE in trauma patients and not associated with higher rates of proximal LE DVT. Our detailed institutional review of a large cohort of trauma patients over five years provides support for ongoing asymptomatic screening and better characterizes venous thromboembolism outcomes than similarly sized purely administrative data reviews. As a retrospective cohort study with a large sample size, no loss to follow-up, and a population with low heterogeneity, this study should be considered as level III evidence for care management.

Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, High-Risk Trauma Patients

BackgroundVenous thromboembolism (VTE) risk increases with age. Scarce data exist for patients age ≥65 y. This study evaluated VTE incidence in elderly, high-risk trauma patients receiving unfractionated heparin (UFH) or enoxaparin chemoprophylaxis. Materials and methodsThis retrospective, single-center, cohort study included trauma patients age ≥ 65 y with risk assessment profile (RAP) ≥ 5 who received UFH or enoxaparin chemoprophylaxis. The primary outcome was VTE incidence requiring therapeutic anticoagulation. An age-modified RAP (RAP-AM) was calculated as RAP without age distribution points. Logistic regression analyses were performed to identify independent predictors for VTE development and chemoprophylactic agent selection. Bleeding incidence compared packed red blood cells utilized. ResultsA total of 1090 patients were included (UFH, n = 655; enoxaparin, n = 435). VTE occurred in 39 (3.6%) patients with no difference between groups in proximal deep vein thrombosis (2.1% versus 3.0%, P = 0.52) or pulmonary embolism (1.2% versus 1.4%, P = 0.96). Weight ≥125 kg (OR 4.12, 95% CI 1.06-16.11) and RAP-AM ≥ 5 (OR 6.52, 95% CI 2.65-16.03) were independently associated with VTE development. Increasing age (OR 1.04, 95% CI 1.03-1.06), initiation ≤ 24 h (OR 2.17, 95% CI 1.66-2.84) and creatinine clearance ≤ 30 mL/min (OR 1.61, 95% CI 1.17-2.21) were independent predictors of receiving UFH whereas increasing ISS (OR 0.97, 95% CI 0.95-0.99) was associated with receiving enoxaparin. ConclusionsVTE incidence may be similar for high-risk, elderly trauma patients receiving UFH and enoxaparin chemoprophylaxis. Further research is necessary to determine noninferiority of UFH to enoxaparin in this patient population.

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial\u2014the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

BackgroundPoint-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality.Methods/designA prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs.DiscussionThis study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020.Trial registrationAustralian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.

Role of D-dimer in guiding duration of anticoagulant therapy in the management of first unprovoked proximal lower limb deep venous thrombosis

Background The optimal duration of anticoagulant therapy in management of patients with first episode of unprovoked deep venous thrombosis is uncertain. D-dimer test may play a role in the assessment of duration of anticoagulant therapy to decrease the rate of recurrence. Aim To evaluate if D dimer test can be used as predictor to guide the duration of anticoagulation in patients with first unprovoked proximal lower limb deep venous thrombosis. Patients and Methods One hundred patients with a first unprovoked proximal deep-vein thrombosis who completed 3 months of Vitamin K Antagonists (VKAs) and had elevated d dimer test 1 month after discontinuation of anticoagulation were randomly assigned either to resume (group A) or to discontinue treatment (group B). The patients were followed up for 1 year for recurrent venous thromboembolism and treatment complications. Results The mean age of the patients was 49.96±7.88 and 51.78±7.98 years for group A and B respectively. Male to female ratio was nearly similar in both groups 3:2 . The base line D-dimer level was 3.05±0.84 and 3.15±1.00 for group A and B respectively with no statistical significant difference. The mean duration of follow up was 10.6 months for both groups. The recurrence rate was higher in group B (7 cases) compared to group A (1 case) (P value 0.027) and this difference was statistically significant. No major bleeding or pulmonary embolism have been noticed in any patients during follow up. Conclusion Elevated D dimer test 1 month after discontinuation of 3 months anticoagulation, in the absence of recent thrombosis, could be an indicator for resumption of anticoagulant therapy for another 3 months.

Chronic Venous Insufficiency and Post-thrombotic Syndrome; Approach to Management and Health Resort Treatment

Introduction: Post- thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT), and develops in 20–50% of patients after a proximal DVT. Balneotherapy and hydrotherapy is justified in treatment of primary or post-thrombotic chronic venous insufficiency (CVI). M aterial: A review of articles was done in electronic databases Pubmed and Medline by keywords: postthrombotic syndrome, chronic venous insufficiency in conjunction with balneotherapy, hydrotherapy, kinesitherapy, coagulation. Results: Main risk of PST is considered as extensive proximal character of DVT, pre-existing CVI, older age, high body mass index, pre-existent varicosities. PTS refers to clinical manifestations of CVI, and is common cause of unilateral CVI. The thrombus itself may lead to venous valves destruction and reflux. The Villalta PTS scale may define and classify the severity of PTS Venous leg ulcers is the most advanced clinical manifestation of the disease. Prevention of PTS begins with prevention of initial and recurrent DVT includes use of compression stockings and anticoagulant medications. Treatment guidelines recommend anticoagulant therapy - five days with heparin followed by three months of oral anticoagulant after acute event, with subsequent long-term of extended therapy depending on patient’s risk of recurrence. Recent clinical trials indicate that the use of new anticoagulants (NOAS) reduces the incidence of PTS. Ultrasound compression test of the leg veins evaluates the degree of obstruction by clots. Medical therapy of CVI has still not efficient. Carbon dioxide baths and ozone baths have favorably affect hemostasis system. However there are only a few controlled studies evaluating effects of balneotherapy in primary and post-thrombotic CVI. The favorable effect of these mineral baths may result from both hydrostatic effects as well as the contribution with specific chemico-physical properties. The controlled trials (in patients with C3 -C5 stage) shown that balneohydrotherapy and kinesitherapy have decreased signs and symptoms in patients with primary and post - thrombotic CVI. Conclusions: The Health Resort treatment of patients with CVI in the mechanism of post-thrombotic syndrome should be preceded by evaluation of the venous system of the lower limb by compression ultrasound. Balneotherapy and hydroteraphy seem to be effective and safe procedures even in patients with advanced primary and post-thrombotic CVI stage.

Treatment Decision-Making of Secondary Prevention After Venous Thromboembolism: Data From the Real-Life START2-POST-VTE Register.

Patients with venous thromboembolism (VTE) should receive a decision on the duration of anticoagulant treatment (AT) that is often not easy to make. Sixteen Italian clinical centers included patients with recent VTE in the START2-POST-VTE register and reported the decisions taken on duration of AT in each patient and the reasons for them. At the moment of this report, 472 (66.9%) of the 705 patients included in the registry were told to stop AT in 59.3% and to extend it in 40.7% of patients. Anticoagulant treatment lasted ≥3 months in >90% of patients and was extended in patients with proximal deep vein thrombosis because considered at high risk of recurrence or had thrombophilic abnormalities. d-dimer testing, assessment of residual thrombus, and patient preference were also indicated among the criteria influencing the decision. In conclusion, Italian doctors stuck to the minimum 3 months AT after VTE, while the secondary or unprovoked nature of the event was not seen as the prevalent factor influencing AT duration which instead was the result of a complex and multifactorial evaluation of each patient.

Manifestations of Glucagonoma Syndrome

Glucagonoma is a rare neuroendocrine tumor of the pancreas. We present the case of a young female patient who presented with the major clinical manifestations of glucagonoma syndrome. The major clinical manifestations of glucagonoma syndrome are described in a 44-year-old, female patient. Beyond glucagonoma, the patient also displayed deep venous thrombosis, depression, diabetes, and necrolytic migratory erythema. We discuss the difficulty of treatment of patients with glucagonoma due to the low prevalence of the disorder, scarcity of medical evidence, lateness of diagnosis with liver metastases in most cases, and poor response to chemotherapy with high rates of relapse after surgery. In this case, pancreatectomy and hepatic lobectomy followed by somatostatin analogue therapy was the chosen treatment strategy. The clinical findings were pancreatic and hepatic masses, proximal deep venous thrombosis, depression, diabetes, and necrolytic migratory erythema. The patient also had elevated levels of glucagon. Pancreatectomy and right hepatic lobectomy were performed and confirmed the glucagonoma. Our case adds new knowledge about glucagonoma which is important due to the low incidence of the disease and the particular characteristics of the syndrome.

Game changers in vascular and endovascular surgery

Game changers in vascular and endovascular surgery

Derin Venöz Tromboz Tanılı Hastaların Kateter Yönlendirmeli Tromboliz tedavisi ile Endovasküler Tedavisi: Erken Dönem ve Birinci Yıl Sonuçları

INTRODUCTION: Deep Vein Thrombosis leads to post thrombotic syndrome in the long term. The risk of developing a post thrombotic syndrome increases when anticoagulation is the only treatment. Catheter-directed thrombolysis methods were developed because of the high bleeding risk of systemic thrombolytic therapy. Along with hybrid approaches Catheter-directed thrombolysis aim to reduce the frequency of post thrombotic syndrome. We retrospectively report the early and follow-up results of our patients in whom we performed Catheter-directed thrombolysis. METHODS: 31 patients(aged 23-87) had been diagnosed with acute proximal Deep Vein Thrombosis(≤15 days’ duration). Catheter-directed thrombolysis and if needed stent implantations were performed successfully. The patients who had a thrombosis of the inferior vena cava also underwent the placement of a vena cava filter. Patients were evaluated at 1, 6 and 12 months. Villalta scores were also determined for the diagnosis of post thrombotic syndrome. RESULTS: 19 had a thrombus in the iliofemoral. The thrombus was extending to the inferior vena cava in six patients. In 12 patients the thrombus was femoropopliteal. The six patients whose thrombus extended to the inferior vena cava, underwent venous filter placement. In five of the iliofemoral-thrombus patients, intraoperative control venography revealed iliac stenosis. This stenosis was treated with iliac stent implantation. Clot-lysis was completely(&gt;90% lysis) in twelve, partially(50-90% lysis) in seven of the 19 iliofemoral-thrombus patients. Ten of the femoropopliteal-thrombus patients achieved a complete and two a partial clot-lysis. There was minor bleeding in two patients. Major bleeding was not reported. DISCUSSION AND CONCLUSION: Catheter-directed thrombolysis reduce the frequency of post thrombotic syndrome. Residual venous obstruction after Catheter-directed thrombolysis should be treated by balloon dilatation/stent implantation to prevent re-thrombosis. We believe that treatment with a hybrid approach may be more effective in protecting patients from post thrombotic syndrome.

Comparison of Long-Term Outcomes of Regional Catheter Thrombolysis and Standard Conservative Treatment for Proximal Deep Vein Thrombosis of Lower Extremities

Comparison of Long-Term Outcomes of Regional Catheter Thrombolysis and Standard Conservative Treatment for Proximal Deep Vein Thrombosis of Lower Extremities

INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS WITH FRACTURE AROUND HIP: A PROSPECTIVE STUDY USING SERIAL COLOUR DOPPLER ULTRASOUND

Background: The incidence of DVT in Asian countries has been presumed to be low and is not comparable to the western literature. Method: The current article is based on a prospective study carried out on 95 Indian patients. All patients undergoing Hip arthroplasty and internal fixation of fractures around hip were enrolled for the study. A pre operative colour Doppler ultrasound was carried out to screen all the patients for pre operative DVT, followed by a postoperative scan on 4th and 10 postoperative day. Results: Seven patients were found to have developed proximal DVT during hospitalization. Five patients was found to have DVT in the injured leg preoperatively. The prevalence of preoperative DVT was 5.26%. The incidence of postoperative DVT was 2.22%. Conclusion: while the incidence of DVT was relatively low in our study still we believe that postoperative DVT is as common in the Indian population as any other parts of the world and routine prophylaxis for DVT in high risk patients should be recommended. Keywords: Deep vein thrombosis, colour Doppler ultrasound, prophylaxis

Direct costs for treatment of venous thromboembolism complication 90-day after surgery

Study object: Describe the direct treatment costs due to venous thromboembolism complications 90 days after surgery by using national health insurance reimbursement database. Patients: 824,947 adult patients who underwent major surgeries were enrolled from January 1, 2017 to September 31, 2018. Method: Study was conducted by using cross-sectional descriptive design. Patients were considered VTE case if they had a diagnostic code up to 90 days after the first surgery, thus 1472 were diagnosed as having VTE after surgery. The study using propensity score matching method shows that there were 913 pairs of patients with the same propensity score included in analysis. Results: The rate of hospital re-admission and outpatient visit were 41.7% and 60.8% in group of VTE patient after matching, respectively. The mean 90-day postoperative cost in VTE group after matching was found to be 89.652 ± 107.928 thousand VNĐ, which is 1.5 times higher than the expenditure of non-VTE group with 61.474± 81.115 thousand VNĐ. Conclusion: The costs related to VTE treatment can be used to evaluate the potential economic benefit and cost-savings from efforts of VTE prevention.&#x0D; Keywords&#x0D; Venous thromboembolism, direct treatment costs.&#x0D; References&#x0D; [1] W.H. Geerts, G.F. Pineo, J.A. Heit, et al, Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest 126 (2004) 338-400. https:// doi.org/10.1378/chest.126.3_suppl.338S.[2] V.V. Tam, N.V. Thong, The rate of deep venous thrombosis related to hip and knee arthroplasty – A study in Cho Ray Hospital (in Vietnamese), Ho Chi Minh City Medical Journal 18(2) (2014) 250-256.[3] A.C. Spyropoulos, J.S. Hurley, G.N. Ciesla, et al, Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin, Chest 122 (2002) 108-14. https://doi.org/10.1378/chest.122.1.108.[4] D.A. Ollendorf, M. Vera-Llonch ,G. Oster., Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients, Am J Health Syst Pharm 59(18) (2002) 1750-4. https://doi.org/10.1093/ajhp/59.18.1750[5] J.Y.S. Ng, R.V. Ramadani, D. Hendrawan, et al,National Health Insurance Databases in Indonesia, Vietnam and the Philippines, Pharmacoecon Open (2019). https://doi.org/ 10.1007/s41669 -019-0127-2.[6] H. Assareh, J. Chen, L. Ou, et al, Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study, BMJ Open 4(10) (2014) 5502. https://doi.org/10.1136/bmjopen-2014-005502.[7] Agency for Healthcare Research and Quality (AHRQ), Patient safety indicator v4.5 benchmark data tables, (2013).[8] I.A. Naess, S.C. Christiansen, P. Romundstad, et al.,Incidence and mortality of venous thrombosis: a population-based study, J Thromb Haemost 5(4) (2007) 692-9. https://doi.org/10.1111/j.1538-7836.2007.02450.x.[9] D.C. Sutzko, P.E. Georgoff, A.T. Obi, et al, The Association Of Venous Thromboembolism Chemoprophylaxis Timing on Venous Thromboembolism After Major Vascular Surgery, J Vasc Surg 67(1) (2018) 262-271. https://doi.org/ 10.1016/j.jvs.2017.06.087.[10] F.A. Anderson, F.A. Spencer, Risk factors for venous thromboembolism, Circulation 107(23) (2003) 9-16. https://doi.org/ 10.1161/01.CIR.0000078 469.07362.E6[11] J. Lin, A.C. Spyropoulos, Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations, J Manag Care Pharm 13(6) (2007) 475-86. https://doi.org/10.18553/jmcp.2007.13.6.475[12] D.J. Tillman, S.L. Charland, D.M. Witt, Effectiveness and economic impact associated with a program for outpatient management of acute deep vein thrombosis in a group model health maintenance organization, Arch Intern Med, 160(19) (2000) 2926-32. https://doi.org/ 10.1001/archinte.160.19.2926.[13] M. Sakon, Y. Maehara, T. Kobayashi, et al, Economic Burden of Venous Thromboembolism in Patients Undergoing Major Abdominal Surgery, Value in Health Regional Issue 6 (2015) 73-79. https://doi.org/10.1016/j.vhri. 2015. 03.017.[14] A. Sepasso, F. Chingcuanco, E. Gordon, et al, Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study, Journal of Medical Economics 21(6) (2018) 595-602. https://doi.org/10.1080/13696998.2018.1445635.[15] Shinro Takai, Masao Akagi, Bruce Crawford, et al, Economic Impact of Venous Thromboembolism Following Major Orthopaedic Surgery in Japan, Value in Health Regional Issues 2(1) (2013) 81-86. https://doi.org/ 10.1016/j.vhri.2013.01.001.&#x0D;

In-hospital outcomes of catheter-directed thrombolysis versus anticoagulation in cancer patients with proximal deep venous thrombosis

ObjectiveThe objective of this study was to determine the rate of complications of catheter-directed thrombolysis (CDT) in cancer patients with deep venous thrombosis (DVT) compared with anticoagulation therapy alone. MethodsThis observational study used the National Inpatient Sample database to screen for any cancer patients who were admitted with a principal discharge diagnosis of proximal lower extremity or caval DVT between January 2005 and December 2013. Patients treated with CDT plus anticoagulation were compared with those treated with anticoagulation alone using propensity score matching for comorbidities and demographic characteristics. The primary end point was in-hospital mortality. Secondary end points were acute intracranial hemorrhage, inferior vena cava filter placement, acute renal failure, blood transfusion rates, length of stay, and hospital charges. ResultsWe identified 31,124 cancer patients with lower extremity proximal or caval DVT, and 1290 (4%) patients were treated with CDT. Comparative outcomes as assessed in the two matched groups of 1297 patients showed that there was no significant difference in in-hospital mortality of patients undergoing CDT plus anticoagulation compared with those treated with anticoagulation alone (2.6% vs 1.9%; P = .23). However, CDT was associated with increased risk of intracranial hemorrhage (1.3% vs 0.4%; P = .017), greater blood transfusion rates (18.6% vs 13.1 %; P < .001), and higher rates of procedure-related hematoma (2.4% vs 0.4%; P < .001). The length of stay (6.0 [4.0-10.0] days vs 4.0 [2.0-7.0] days; P < .001) and hospital charges ($81,535 [$50,968-$127,045] vs $22,320 [$11,482-$41,005]; P < .001) were also higher in the CDT group compared with the control group. ConclusionsThere was no significant difference in in-hospital mortality of cancer patients who underwent CDT plus anticoagulation compared with anticoagulation alone. CDT was associated with increased in-hospital morbidity and resource utilization compared with anticoagulation alone. Further studies are needed to examine the effect of CDT on the development of PTS in this population.

Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis

BackgroundAfter deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT. MethodsThe Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups. ResultsOf 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P < .0001) and 6 months (8.8; P < .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups. ConclusionsAmong patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.

Pharmacomechanical Catheter Thrombolysis for Pregnancy-Related Proximal Deep Venous Thrombosis: Prevention of Post-Thrombotic Syndrome

Pharmacomechanical thrombolysis (PMT) may reduce the incidence of pregnancy-induced post-thrombotic syndrome (PTS).

Patient Management Strategies and Long-term Outcomes in Isolated Distal Deep-Vein Thrombosis Versus Proximal Deep-Vein Thrombosis: Findings from XALIA

Patients who experience isolated distal (calf vein) deep venous thrombosis (DVT) tend to be healthier and younger and to have less frequent recurrent DVTs.

Long-term Treatment of Proximal Deep Vein Thrombosis with Micronized Purified Flavonoid Fraction Additionally to Oral Rivaroxaban Improves Clinical and Ultrasound Outcomes

Long-term Treatment of Proximal Deep Vein Thrombosis with Micronized Purified Flavonoid Fraction Additionally to Oral Rivaroxaban Improves Clinical and Ultrasound Outcomes

Presence of Residual Venous Thrombus at Warfarin Withdrawal: a Predictor for Recurrence after a First Episode of Symptomatic Provoked Proximal Deep Venous Thrombosis in Thai Population?

Objective: To assess the risk for venous thromboembolism (VTE) recurrence by presence of residual venous thrombus (RVT) at warfarin withdrawal following symptomatic first provoked proximal DVT.Methods: Medical records of 45 consecutive patients with symptomatic first provoked proximal DVTs who had undergone warfarin surveillance for ≥ 3 months were reviewed retrospectively. Altogether, 22 patients discontinued anticoagulation after ≥ 3 months regardless of duplex ultrasonography results of RVT diagnosed by compression ultrasonography. Another 23 patients discontinued anticoagulation after the RVT disappeared. Primary outcome was recurrent VTE.Results: Four of the 45 patients experienced recurrent VTE (8.89%), including 2 (9.00%) of 22 patients who had discontinued anticoagulant regardless of duplex ultrasonography results and 2 (8.70%) of 23 patients who discontinued anticoagulation after RVT disappearance (p = 0.963). All of the recurrent VTE were recurrent DVT.Conclusion: RVT at warfarin withdrawal was not a predictor for recurrence VTE following a first symptomatic provoked proximal DVT.

Perioperative deep venous thrombosis in patients with tibiofibular fracture

Objective To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture. Methods A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital from September 2014 to February 2018. They were 114 males and 66 females, aged from 16 to 83 years (average, 47.6 years). The levels of plasma D-dimer were detected at admission, one day preoperation, and 1, 3, 5 days postoperation. B-ultrasound examination of both lower extremities was performed before and after surgery. According to the results of B-ultrasound, the patients were divided into a DVT group and a non-DVT group. The 2 groups were compared in the plasma D-dimer levels measured at different time points. DVT risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. Results Of this cohort, 54 cases (30%) developed DVT and 39 cases (21.7%) did preoperation. Of the 39 cases (mixed DVT in one and distal DVT in 38 ones), DVT disappeared in 14 postoperation. Of the 40 cases (22.2%) of postoperative DVT (proximal DVT in one, mixed DVT in one and distal DVT in 38 ones), 15 developed newly postoperation. Multivariate logistic regression analysis showed that age, time from injury to operation, pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients. The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation, and 1, 3, 5 days postoperation (P<0.05). The area under the receiver operating characteristic curve was 0.704. When the critical value of D-dimer was 1.4 mg/L, its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor). When the concentration of D-dimer was 4.45 mg/L, its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest). Conclusions Perioperative DVT may happen in patients with tibiofibular fracture, mostly at the distal end beyond the popliteal vein. Clinically, patients who are advanced in age, have plasma D-dimer elevation at admission and after operation, and have waited long for operation should be alert to the occurrence of DVT. The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture. Key words: Tibia; Fibula; Fractures, bone; Deep vein thrombosis; Risk factors; D-dimer