Proximal Lower Limb Deep Vein Thrombosis Research Articles

Statin use and mortality in patients with deep vein thrombosis. Data from the RIETE Registry

BackgroundThe association between statin use and mortality in patients with deep vein thrombosis (DVT) has not been rigorously evaluated. MethodsWe used the data in the RIETE registry to examine the association between statin use and mortality at 3 months. We used mixed effects survival models accounting for clinical covariates and clustering of patients in enrolling centers. ResultsFrom January 2009 through April 2022, there were 46,440 patients with isolated DVT in RIETE (in the lower-limbs 42,291, in the upper limbs 4149). Of these, 21 % and 18 %, respectively, were using statins. Statin users were older than non-users (72 ± 12 vs. 62 ± 18 years), and more likely had diabetes, hypertension, prior myocardial infarction or ischemic stroke, or were receiving antiplatelets. The 3-month mortality rates were: 6.0 % vs. 5.8 %, respectively. On multilevel multivariable analysis, the adjusted hazard ratio (aHR) for all-cause death in statin users vs. non-users was 0.77 (95%CI: 0.69–0.86). The 3-month risk of death in statin users was significantly lower than in non-users in patients with upper-limb DVT (aHR: 0.81; 95%CI: 0.72–0.91), distal lower-limb DVT (aHR: 0.48; 95%CI: 0.32–0.72), or proximal lower-limb DVT (aHR: 0.69; 95%CI: 0.50–0.95), and in those receiving simvastatin (aHR: 0.73; 95%CI: 0.60–0.90), atorvastatin (aHR: 0.70; 95%CI: 0.59–0.85), or rosuvastatin (aHR: 0.47; 95%CI: 0.27–0.80). Major bleeding, used as a falsification endpoint, did not show an association with use of statins at 3-month follow-up. ConclusionsStatin users with isolated DVT were at significantly lower risk for death at 3 months than non-users.

Assessment of patient characteristics in cancer-associated venous thrombosis in Türkiye (CAT-TR study)

Aim: In cancer patients, the overall risk of venous thromboembolism (VTE) is increased 7-fold, and in cases of certain malignancies, this risk increases to 28-fold. The main objectives of this study are to describe patterns of use of anticoagulants for the treatment of cancer-related VTE in Türkiye and to assess patient characteristics. Material and Methods: This was a multicenter, retrospective, descriptive study utilizing data from 17 centers across Türkiye. We included 2936 patients with a diagnosis of any cancer and a diagnosis of proximal lower-limb deep vein thrombosis (DVT) and/or pulmonary embolism (PE) between January 1, 2016, and December 31, 2019. These patients were only included if the cancer diagnosis was made at least 6 months before the diagnosis of VTE or within 30 days following the diagnosis of VTE. Patients were followed from the day after the index date until the earliest date among the dates of death, the end of the study, or the end of the 6-month treatment period. Results: The study included 2796 patients with VTE between 2016 and 2019. While 41.4% of the participants were female, 58.6% were male, and 66.1% of the patients had DVT while 45.2% had PE. Furthermore, 52.7% had a history of smoking and only three patients had known hereditary thrombophilia. Lung cancer was the most common type of cancer, diagnosed in 872 patients (29.3%), followed by colon cancer diagnosed in 255 patients (8.6%) and breast cancer diagnosed in 202 patients (6.8%). Among these patients, 70.3% were in an advanced stage of the disease. Chemotherapy was administered to 469 (65.7%) patients at the time of disease onset. Among the patients with VTE, 99.5% were treated, and low-molecular-weight heparin was used in 97.5% of these cases while 3% of the patients were treated with direct oral anticoagulants. Bleeding was observed in 1.6% of the patients who participated in this study, and 39.1% of the bleeding events whose type was specified were categorized as major bleeding. Bleeding was most intense in the gastrointestinal tract (56.7%). Recurrence was observed in 1.5% of the patients and improvement was observed in 42.1%. In the first 6 months after diagnosis, 14.3% of the patients died. Causes of mortality could not be obtained from the patients’ records. Conclusion: VTE is common in patients with active cancer and associated with high recurrence and mortality rates. Efforts are needed to prevent VTE, diagnose it in time, and reduce the recurrence rates, especially in the first year after VTE diagnosis.

Prevalence of deep vein thrombosis and associated factors in adult medical patients admitted to the University Teaching Hospital, Lusaka, Zambia


 
 
 
 
 
 
 
 Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) collectively referred to as venous thromboembolism (VTE) are associated with significant morbidity and mortality worldwide.
 DVT is common in hospitalized patients with acute medical illness. Routine use of thromboprophylaxis has been shown to reduce prevalence of DVT in hospitalized patients with acute medical illness. Thromboprophylaxis is not routinely given to hospitalized medical patients in most hospitals in Zambia.
 Objectives: The objectives of this study were: todetermine the prevalence and anatomical distribution of DVT in medical patients admitted to the UTH for at least 7 days; establish demographic and clinical characteristics of medical patients with DVT and finally determine the accuracy of the Well's score for DVT.
 Methods: This was a descriptive, cross sectional analytical study. The sample size comprised 296 medical patients admitted for at least 7 days. A questionnaire was used to obtain demographic characteristics and relevant clinical history. A focused detailed physical examination was conducted to screen for DVT of the lower limbs and Well's score for DVT computed. Laboratory tests including HIV test and full blood count were done. Biochemical and genetic studies to evaluate for inherited and acquired thrombophilias could not be done due limited financial resources. Compression ultrasound scans (USS) were done on lower limbs of recruited patients to determine the presence of DVT. Variables of interest were compared by chi-square, Kruskal-wallis and t-tests. Multivariate and univariate logistic regression analysis were used to assess for associations between DVT and independent variables of interest.
 Results: The Prevalence of DVT of the lower limbs was 11.1 % (33/296). Prevalence of proximal lower limb DVT was 9.1%. Eighty two percent (27/33) of all patients with DVT had proximal lower limb DVT. Asymptomatic lower limb DVT was noted in 85 % (28/33) of all patients with DVT.
 The Mean age of patients with DVT was 42.12 years (SD 12.71).The mean duration of hospital admission was 11.91 (SD 7.77) days. Seventy six percent (25/33) of all patients with DVT had an infectious disease as a primary diagnosis. Tuberculosis was the most common infectious disease among patients with DVT accounting for 60.6 % (20/33) of all infections. Up to 70 % (23/33) of all patients with DVT were HIV positive.
 The specificity for the Wells score specificity for DVT was 73.4% while the sensitivity was 100%. The accuracy was 76.3%.The positive and negative predictive values were 32% and 100% respectively.
 Conclusion: Proximal Lower limb DVT is common among HIV positive medical patients admitted for at least 7 days at the UTH. In our study, lower extremity proximal DVT was more common in patients with Tuberculosis and a low BMI. Up to 85% of lower limb DVT was asymptomatic. Without a high index of suspicion, lower limb DVT is likely to be missed. The pretest Wells score correlated well with the USS findings and could be used as a rule out test for those with suspected DVT.A follow up study to evaluate for genetic and biochemical factors that predispose to DVT need to be undertaken in the near future. There is need to advocate for thromboprophylaxis in medical patients with acute illness and prolonged hospital stay.
 
 
 
 
 
 
 

Prevalence of deep vein thrombosis and associated factors in adult medical patients admitted to the University Teaching Hospital, Lusaka, Zambia

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) collectively referred to as venous thromboembolism (VTE) are associated with significant morbidity and mortality worldwide. DVT is common in hospitalized patients with acute medical illness. Routine use of thromboprophylaxis has been shown to reduce prevalence of DVT in hospitalized patients with acute medical illness. Thromboprophylaxis is not routinely given to hospitalized medical patients in most hospitals in Zambia. Objectives: The objectives of this study were: todetermine the prevalence and anatomical distribution of DVT in medical patients admitted to the UTH for at least 7 days; establish demographic and clinical characteristics of medical patients with DVT and finally determine the accuracy of the Well's score for DVT. Methods: This was a descriptive, cross sectional analytical study. The sample size comprised 296 medical patients admitted for at least 7 days. A questionnaire was used to obtain demographic characteristics and relevant clinical history. A focused detailed physical examination was conducted to screen for DVT of the lower limbs and Well's score for DVT computed. Laboratory tests including HIV test and full blood count were done. Biochemical and genetic studies to evaluate for inherited and acquired thrombophilias could not be done due limited financial resources. Compression ultrasound scans (USS) were done on lower limbs of recruited patients to determine the presence of DVT. Variables of interest were compared by chi-square, Kruskal-wallis and t-tests. Multivariate and univariate logistic regression analysis were used to assess for associations between DVT and independent variables of interest. Results: The Prevalence of DVT of the lower limbs was 11.1 % (33/296). Prevalence of proximal lower limb DVT was 9.1%. Eighty two percent (27/33) of all patients with DVT had proximal lower limb DVT. Asymptomatic lower limb DVT was noted in 85 % (28/33) of all patients with DVT. The Mean age of patients with DVT was 42.12 years (SD 12.71).The mean duration of hospital admission was 11.91 (SD 7.77) days. Seventy six percent (25/33) of all patients with DVT had an infectious disease as a primary diagnosis. Tuberculosis was the most common infectious disease among patients with DVT accounting for 60.6 % (20/33) of all infections. Up to 70 % (23/33) of all patients with DVT were HIV positive. The specificity for the Wells score specificity for DVT was 73.4% while the sensitivity was 100%. The accuracy was 76.3%.The positive and negative predictive values were 32% and 100% respectively. Conclusion: Proximal Lower limb DVT is common among HIV positive medical patients admitted for at least 7 days at the UTH. In our study, lower extremity proximal DVT was more common in patients with Tuberculosis and a low BMI. Up to 85% of lower limb DVT was asymptomatic. Without a high index of suspicion, lower limb DVT is likely to be missed. The pretest Wells score correlated well with the USS findings and could be used as a rule out test for those with suspected DVT.A follow up study to evaluate for genetic and biochemical factors that predispose to DVT need to be undertaken in the near future. There is need to advocate for thromboprophylaxis in medical patients with acute illness and prolonged hospital stay.

Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous Doppler follow-up at 1-year.

Functional outcome of venous stent placement for the management of acute iliofemoral deep vein thrombosis (DVT) following catheter-directed thrombolysis (CDT), remain undefined. The purpose of this study was to assess immediate and intermediate term outcomes among patients treated with venous stenting following CDT in patients with proximal lower limb DVT. Thirty consecutive patients aged between 20-70years with proximal lower limb DVT formed the study group. The mean duration of CDT done with streptokinase was 4.5±1.3days. Patients with residual venous obstruction and/or large clot burden were treated further with venous angioplasty and/or stenting. Primary endpoint was to evaluate the safety, efficacy and patency of venous stenting in the management of incomplete result following CDT. After 12months, post-thrombotic syndrome (PTS) was assessed clinically using Villalta scale and deep venous patency was assessed through duplex ultrasound. We studied 8 (5 female and 3 male) patients with 9 (3 left and 6 right) limb involvement and 13 stent (4 balloon expandable and 9 self expandable) placement. All patients improved clinically immediately following venous stenting. Technical success was achieved in all patients. One patient developed pulmonary embolism during course of hospital stay. One patient had stent thrombosis and PTS and another patient died due to carcinoma breast during follow-up. Deep venous stenting is an effective mode of treatment in proximal acute lower limb DVT with high late patency rate up to 1-year.

An open-label, comparative study of the efficacy and safety of once-daily dose of enoxaparin versus unfractionated heparin in the treatment of proximal lower limb deep-vein thrombosis

Background: Treatment of deep-vein thrombosis (DVT) with a once-daily regimen of enoxaparin, rather than a continuous infusion of unfractionated heparin (UFH) is more convenient and allows for home care in some patients. This study was designed to compare the efficacy and safety of these two regimens for the treatment of patients with proximal lower limb DVT. Methods: 201 patients with proximal lower limb DVT from 13 centers in Brazil were randomized in an open manner to receive either enoxaparin [1.5 mg/kg subcutaneous (s.c.) OD] or intravenous (i.v.) UFH (adjusted to aPTT 1.5–2.5 times control) for 5–10 days. All patients also received warfarin (INR 2–3) for at least 3 months. The primary efficacy endpoint was recurrent DVT (confirmed by venography or ultrasonography), and safety endpoints included bleeding and serious adverse events. The rate of pulmonary embolism (PE) was also collected. Hospitalization was at the physician's discretion. Results: Baseline patient characteristics were comparable between groups. The duration of hospital stay was significantly shorter with enoxaparin than with UFH (3 versus 7 days). In addition, 36% of patients receiving enoxaparin did not need to be hospitalized, whereas all of the patients receiving UFH were hospitalized. The treatment duration was slightly longer with enoxaparin (8 versus 7 days). There was a nonsignificant trend toward a reduction in the rate of recurrent DVT with enoxaparin versus UFH, and similar safety. Conclusions: A once-daily regimen of enoxaparin 1.5 mg/kg subcutaneous is at least as effective and safe as conventional treatment with a continuous intravenous infusion of UFH. However, the once daily enoxaparin regimen is easier to administer (subcutaneous versus intravenous), does not require aPTT monitoring, and leads to both a reduced number of hospital admissions and an average 4-day-shorter hospital stay.