Risk Factors For Deep Vein Thrombosis Research Articles

Machine learning-based model for prediction of deep vein thrombosis after gynecological laparoscopy: A retrospective cohort study.

Successful monitoring of deep vein thrombosis (DVT) remains a challenging problem after gynecological laparoscopy. Thus, this study aimed to create and validate predictive models for DVT with the help of machine learning (ML) algorithms. A total of 489 patients from the Cancer Biology Research Center, Tongji Hospital were included in the study between January 2017 and February 2023, and 35 clinical indicators from electronic health records (EHRs) were collected within 24h of patient admission. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO) regression. Then, the three commonly used DVT prediction models are random forest model (RFM), generalized linear regression model (GLRM), and artificial neural network model (ANNM). In addition, the predictive performance of various prediction models (i.e. the robustness and accuracy of predictions) is evaluated through the receiver operating characteristic curve (ROC) and decision curve analysis (DCA), respectively. We found postoperative DVT in 41 (8.38%) patients. Based on the ML algorithm, a total of 13 types of clinical data were preliminarily screened as candidate variables for DVT prediction models. Among these, age, body mass index (BMI), operation time, intraoperative pneumoperitoneum pressure (IPP), diabetes, complication and D-Dimer independent risk factors for postoperative DVT and can be used as variables in ML prediction models. The RFM algorithm can achieve the optimal DVT prediction performance, with AUC values of 0.851 (95% CI: 0.793-0.909) and 0.862 (95% CI: 0.804-0.920) in the training and validation sets, respectively. The AUC values of the other two prediction models (ANNM and GLRM) range from 0.697 (95% CI: 0.639-0.755) and 0.813 (95% CI: 0.651-0.767). In summary, we explored the potential risk of DVT after gynecological laparoscopy, which helps clinicians identify high-risk patients before gynecological laparoscopy and make nursing interventions. However, external validation will be needed in the future.

A Nomogram Model to Predict Deep Vein Thrombosis Risk After Surgery in Patients with Hip Fractures

AimsThis study aimed to establish a nomogram model for predicting the probability of postoperative deep vein thrombosis (DVT) risk in patients with hip fractures.Methods504 patients were randomly assigned to the training set and validation set, and then divided into a DVT group and a non-DVT group. The study analysed the risk factors for DVT using univariate and multivariate analyses. Based on these parameters, a nomogram model was constructed and validated. The predicting performance of nomogram was evaluated by discrimination, calibration, and clinical usefulness.ResultsThe predictors contained in the nomogram model included age, surgical approach, 1-day postoperative D-dimer value and admission ultrasound diagnosis of the lower limb vein. Furthermore, the area under the ROC curve (AUC) for the specific DVT risk-stratification nomogram model (0.815; 95% CI 0.746–0.884) was significantly higher than the current model (Caprini) (0.659; 95% CI 0.572–0.746, P < 0.05). According to the calibration plots, the prediction and actual observation were in good agreement. In the range of threshold probabilities of 0.2–0.8, the predictive performance of the model on DVT risk could be maximized.ConclusionsThe current predictive model could serve as a reliable tool to quantify the possibility of postoperative DVT in hip fractures patients.

Incidence and risk factors of perioperative deep vein thrombosis in patients undergoing primary hip arthroplasty via the direct anterior approach.

Deep vein thrombosis (DVT) is a frequent complication following hip arthroplasty. There still has been a lack of studies analyzing the perioperative risk factors of DVT following hip arthroplasty via direct anterior approach (DAA). Patients who underwent unilateral primary hip arthroplasty via DAA in our hospital from August 2015 to January 2022 were included. Patients' data, including demographic data, clinical features, past medical history, operative data, and laboratory data, were analyzed and compared between patients with and without DVT. Logistic regression analysis was conducted to identify the independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assessthebest cutoff value of continuous variables with statistical significance. A total of 651 patients were included. The incidence of DVT before and after hip arthroplasty was 12.7% and 6.7%, respectively. Logistic regression analysis indicated that age ≥ 65years (OR 4.594, 95% CI 1.994-10.587), women (OR 2.331, 95% CI 1.285-4.227), and cerebral infarction (OR 1.984, 95% CI 1.138-3.460) were independent risk factors for preoperative DVT. And age ≥ 65years (OR 4.859, 95% CI 1.062-22.226), tumor (OR 3.622, 95% CI 1.108-11.841), and preoperative D-dimer (OR 1.040, 95% CI 1.004-1.078) were risk factors for postoperative DVT. The ROC curve analysis showed that the best cutoff value of preoperative D-dimer for the diagnosis of postoperative DVT is 1.44mg/L. The incidence of DVT in patients undergoing DAA hip arthroplasty was low and the occurrence of DVT before and after unilateral primary hip arthroplasty performed through DAA was related to multiple factors.

Predictive value of prenatal ultrasound combined with long non-coding RNA CRNDE of women for their postpartum lower extremity deep venous thrombosis

Objective Deep vein thrombosis (DVT) is a common complication in obstetrics that needs early interaction. The study examined the expression change and clinical value of long non-coding RNA (lncRNA) colorectal neoplasia differentially expressed (CRNDE) in DVT early diagnosis. Methods One hundred patients with DVT after delivery and 100 healthy parturients without DVT were enrolled. Serum samples were collected one day before delivery and received qRT-PCR for mRNA detection. Prenatal coagulation markers including prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (FIB) and thrombin time (TT), D-dimer (D-D), thrombomodulin (TM), and peroxidase anti-peroxidase soluble complex (PAP) were tested. The receiver operating characteristic (ROC) curve was drawn for the diagnostic value assessment. Results LncRNA CRNDE levels increased remarkably in the serum of DVT patients compared with the healthy controls, which were negatively correlated with serum concentration of PT, APTT, and TT while positively correlated with FIB, D-D, TM, and PAP. Serum CRNDE (HR = 5.973, 95% CI = 2.990–11.933, p < .001) was independently related to the occurrence of DVT after delivery. Then, ROC curve using serum CRNDE showed a good diagnostic value for DVT with the AUC of 0.899. ROC curve of ultrasonography combined with CRNDE produced an AUC of 0.968, and both sensitivity and specificity were enhanced compared to a single indicator. Conclusions The increase of CRNDE level was an independent risk factor for postpartum DVT. Prenatal ultrasonography combined with CRNDE can improve the predictive efficacy for DVT.

A Bidirectional two-Sample Mendelian Randomization Study of the Association Between Venous Thromboembolism and Ischaemic Stroke.

Previous clinical and epidemiological studies have shown that patients with venous thromboembolism (VTE) are comorbid with symptoms of ischaemic stroke (IS). Current understanding about increased risk of IS after VTE remain inconclusive. This study use a bidirectional two-sample Mendelian randomization (MR) study to explore the causality of VTE, pulmonary embolism (PE), deep vein thrombosis (DVT), and IS. This study used pooled data from published genome-wide association studies (GWAS). GWAS statisics of IS (from EBI database, n = 484 121), VTE (from Finngen database, n = 218 792), PE (from Finngen database, n = 218 413), and DVT (from UK biobank database, n = 337 159) were assessed. Forward and reverse MR analysis were conducted to explore the causal relationship between three type of the exposure (VTE, PE, and DVT) and the outcome (IS). Our primary causal inference method was Inverse Variance Weighted (IVW). Secondary inference methods were Weighted Median and MR-Egger. For the sensitive analysis, MR-PRESSO, MR-Egger intercept, Cochran's Q, leave-one method were used to consolidate our findings. In the foward MR analysis, VTE increased the risk of IS (ORIVW = 1.034, PIVW = 0.021) and PE was also a risk factor for IS (OR = 1.055, PIVW = 0.009). There was no causality that DVT influenced on IS (PIVW > 0.05). In the reverse MR analysis, IS came to be a risk factor for DVT (OR = 1.003, PIVW = 0.046). Meanwhile, IS took not any causal effect on VTE and PE. All the results passed the reasonable sensitive analysis. Our findings provided genetic evidence that PE and VTE can lead to an increased risk of IS, whereas increased IS promoted the risk of DVT further. Our findings provided novel insights about the risk factors and management for IS.

Serum VEGF, P-Selectin, HDL-C, Platelet Index, and Coagulation Function Index in Deep Vein Thrombosis after Traumatic Fracture.

The goal was to investigate the relationship between serum vascular endothelial growth factor (VEGF), P-selectin, high-density lipoprotein cholesterol (HDL-C), platelet parameters, and coagulation function indexes and postoperative deep vein thrombosis (DVT) in patients with traumatic fracture. A total of 150 patients with traumatic fractures after DVT were selected as the DVT group, and 150 patients with traumatic fractures without DVT during the same period were selected as the non-DVT group. Serum VEGF, P-selectin, HDL-C, platelet parameters including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR), and plasma coagulation function indexes including thrombin time (TT), prothrombin time (PT), activated partial thrombin time (APTT), fibrinogen (FIB), and D-dimer (D-D) were measured. Pearson's correlation was performed to analyze the correlation between serum VEGF, P-selectin, and coagulation function indexes, and binary logistic regression was used to analyze the risk factors of DVT. Serum VEGF and P-selectin in the DVT group were higher while HDL-C was lower than those in the non-DVT group (p < 0.05). Serum VEGF and P-selectin were negatively correlated with plasma D-D and FIB (p < 0.05), and serum HDL-C was negatively correlated (p < 0.05). Compared with the non-DVT group, MPV, PDW, and P-LCR in the DVT group were decreased (p < 0.05). Multivariate logistic regression analysis showed that P-LCR was a risk factor for postoperative DVT in patients with traumatic fractures (p < 0.05). Serum VEGF and P-selectin are higher and HDL-C is lower in patients with DVT after postoperative traumatic fracture than in patients without DVT. Combined detection of serum VEGF, P-selectin, HDL-C, and coagulation function indexes may help to reduce the risk of DVT. Platelet parameters (MPV, PDW, P-LCR) have certain reference values for the clinical diagnosis and disease evaluation of DVT.

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 &lt;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 (&gt;500 ng/mL), history of immobilisation for more than three days, and Modified Wells’ score (&gt;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.

May-Thurner Syndrome Should be Explored As a Possible Existing Risk Factor in Pediatric Patients Presenting with Non-Central Venous Line Associated Deep Vein Thrombosis

Background: The compression of the left common Iliac vein (LCIV) by the right common iliac artery is called May-Thurner Syndrome (MTS). The incidence of this anatomic variance is unknown, though it is estimated to be 18-49%. It is currently established that the chronic compression of the iliac vein outflow results in various clinical symptoms including edema, pain, discoloration, skin ulcers and venous thromboembolism. Deep vein thrombosis (DVT) of the LCIV is the most reported presentation of MTS in pediatrics. DVTs in pediatric patients are rare and often provoked by a central venous line (CVL). Patients without a CVL in the context of left lower extremity (LLE) DVT often do not undergo MTS work-up if the DVT does not include the LCIV. To assess if MTS is a risk factor for LLE DVT distally to the LCIV, we describe an institutional incidence of MTS in two pediatric patient populations: those with non CVL-associated LLE DVTs and a control group composed of pediatric patients undergoing imaging that includes the LLE vasculature for unrelated reasons. Methods: This was a single center retrospective study. We identified patients with a non CVL-associated LLE DVT seen at our institution using ICD-10 codes as well as a cohort of patients who received imaging of the LLE vasculature for reasons other than DVT using radiology MRI protocol codes.Electronic medical records were reviewed for demographic variables such as age and gender. Patients without DVTs had imaging reviewed for the incidental finding of MTS. Those with DVTs had information collected regarding clinical characteristics such as coagulation panels, thrombosis risk factors (thrombophilic states, oral contraceptive use, obesity), and therapy received. All images were reviewed by a pediatric radiologist. Results: A total of 35 patients with non CVL-associated LLE DVTs, and 752 patients without CVL and without LLE DVTs were identified. Of those with LLE DVTs, 19 (54%) were found to have MTS. Of these 19 patients, 5 (26%) were obese, 14 (74%) were on oral contraceptive pills, and 8 (42%) reported prothrombotic risks (7 heterozygous for Factor V Leiden, 1 heterozygous for protein C deficiency). Two patients (10%) had no additional risk factors for thrombosis. Of those without LLE DVTs, 6 patients (0.01%) were incidentally diagnosed with MTS. Interestingly we also described one patient with non CVL-associated LLE DVT distally to the LCIV with MTS. Conclusions: In our study, the presence of MTS was significantly higher in the non CVL-associated LLE DVT group than in the control group. This study suggests that MTS should be considered, and associated imaging performed, in pediatric patients with a non CVL-associated LLE DVT, considering the incidence revealed by this single institutional case series. The presence of MTS in pediatric patients may significantly impact the life-long risk of DVT recurrence. Given that aging adversely impacts lower limb venous return (exacerbated by central obesity, sedentary lifestyle, and other risk factors) and that pregnancy is a known trigger of DVT in patients with MTS, knowledge of prior MTS may impact patient care over the lifespan.

May Thurner Syndrome: Diagnostic and Therapeutic Outcomes in an Institutional Setting

Introduction: May-Thurner syndrome (MTS), a chronic compression of left common iliac vein (CIV) against the lumbar vertebrae by overlying common iliac artery is an underappreciated contributor to left leg deep venous thrombosis. Even though the estimated prevalence of MTS is high in left-leg deep vein thrombosis (DVT) cases per autopsy studies, the clinical association remains low. Since the screening for MTS in patients with recurrent left-leg DVTs is not a common practice, diagnosis can either be incidental or a combination of clinical presentation and objective testing. Diagnosis is challenging via ultrasound (US) due to the deep anatomical location of iliac veins; therefore, invasive imaging including Contrast venography (CTV) is needed for confirmation. The management of MTS has been reformed over the years with the advances in minimally invasive therapeutic tools. We sought to review the management and outcomes of the MTS adult population by conducting a retrospective review to identify all adult cases of MTS at our academic safety net hospital between 2010 and 2022. Methods: Data was extracted and analyzed for baseline parameters including age, gender, ethnicity, and body mass index (BMI). Presenting symptoms, imaging used for MTS diagnosis (including US Doppler, magnetic resonance venography or CTV), and interventional approaches (catheter or systemic thrombolysis, thrombectomy, balloon angioplasty and/or stent placement) were additionally documented. SAS v9.4 (Cary, NC) was used for statistical analysis. Results: A total of 19 cases, predominantly females 68% (13/19), with a median age of 48 years and a mean BMI of 28.84 kg/m 2 diagnosed with MTS were identified. The predominant initial presentation was left lower extremity edema and pain 36% (7/19) later found to have a DVT, followed by non-healing venous ulcer 15% (3/19) and pelvic congestion syndrome 0.05 % (1/19). Whereas 42% (8/19) of the patients were diagnosed with MTS while undergoing evaluation for chronic and recurrent DVTs. All patients were diagnosed following CTV using transvenous pressures with the formation of collateral veins and a pressure gradient of more than 2 mm Hg across iliofemoral stenosis at rest. Sixteen patients (84%) underwent endovascular stent placement, while one patient underwent Balloon Angioplasty only. One patient refused any intervention for MTS however underwent great saphenous vein ablation for chronic venous wounds. In view of anticoagulation therapy, the initial choice in the most cases was low molecular weight heparin (LMWH), which was later transitioned to other choices, 81 % (10/16) were switched to direct oral anticoagulants, (apixaban= 10, rivaroxaban=3) due to ease of administration and compliance, while 19 % (3/16) were continued on LMWH for patient preference and pregnancy. Post-intervention complications consisted of stent failure in 25% (4/16) patients; related to stent thrombosis and Post-thrombotic Syndrome (PTS) in 12.5 % (2/16) patients. No bleeding complications were seen post any case of endovascular stent placement. Conclusion: This review was a highly educational experience giving us insight into this unacknowledged syndrome. Multiple factors could be contributing to this underdiagnosis, including invasive gold standard imaging for MTS, more easily recognizable risk factors for DVTs that can overshadow MTS, and a smaller number of data and studies. Some authorities have advocated a need to rule out MTS in young women with acute left lower extremity DVT, a clear female predominance was also noted (68%) in our analysis. Post-stent placement, systemic anticoagulation for 3-6 months is recommended, in our review, all patients (100%) who underwent stent placement were started on anticoagulation for at least 3 months. A small sample size, patients lost to follow-up (poor outcomes and complications could have been missed) and a single institutional review were some limitations of our study, however with a rare disease such as MTS with 2-3% prevalence it is difficult to conduct a large size, multi- institutional analysis. This study contributes to the limited literature available on MTS.

Anticoagulation prophylaxis patterns following retroperitoneal lymph node dissection for testis cancer

IntroductionRetroperitoneal lymph node dissection (RPLND) is the standard of care for testicular cancer in various disease settings. Deep vein thrombosis (DVT) complications have been reported to occur in <1% of primary RPLND cases and up to 3% of postchemotherapy (PC-RPLND) cases. While prophylactic anticoagulation (AC) has been well-documented to reduce DVT rates in patients undergoing surgery in general, the benefit of prophylactic AC in RPLND has not been assessed. In this retrospective cohort study, we seek to address this unmet need by evaluating the rates and associated risk factors of DVT and pulmonary embolism (PE) with a national and institutional database, assess the changing patterns in DVT prophylaxis with postoperative AC following RPLND, and quantify the potential benefit of prophylactic AC in patients who have undergone RPLND using a risk-stratified approach. MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent RPLND during the 10-year period from 2011 to 2021. An institutional database was queried for all patients undergoing RPLND from 2013 to 2022. Patient characteristics and operative outcomes were compared between the NSQIP and the institutional database. The institutional database was stratified by prior oncologic treatment (i.e., primary RPLND vs. PC-RPLND) and outcomes were compared. Postoperative AC rate was determined and trended by year. The use of postoperative AC and PE events were stratified by clinical stage. The absolute risk reduction (ARR) of AC prophylaxis on PE events and the number needed to treat (NNT) with AC prophylaxis to prevent a single PE event was determined. ResultsIn total, the NSQIP database query resulted in 779 patients and our institutional database query resulted in 188 patients. The rate of DVT and PE was 1.2% and 0.5% vs. 2.1% and 1.6% in the NSQIP and institutional cohort, respectively. The rate of postoperative AC following RPLND in patients from the institutional database increased from 5% in 2013 to 43% in 2022 (P = 0.01). There were no statistically significant differences in complication rates, including bleeding events, chyle leaks, or hospital readmissions amongst patients who were prescribed AC at discharge and those who were not. No stage I patients developed PEs and no stage I patients were prescribed AC. The ARR for AC prophylaxis for development of PE was found to be 0.023 for the clinical stage II and stage III cohorts. The NNT to prevent a single PE with AC was 44 and 43 for the stage II and stage III cohorts, respectively. ConclusionsAC appears beneficial with minimal risk of harm after RPLND, especially in patients with higher risk of developing DVT/PE, highlighting the safety and efficacy of this regimen. There was a significant increase in the rate of AC prophylaxis at discharge amongst patients undergoing RPLND in the institutional database from 2013 to 2022. A risk-stratified protocol of postoperative AC following RPLND appears reasonable, and further prospective trials are warranted to formally confirm this recommendation.

Risk of deep vein thrombosis (DVT) in lower extremity after total knee arthroplasty (TKA) in patients over 60 years old

PurposeThere is a significant risk of DVT after TKA. We aim to evaluate the potential risk factors for postoperative DVT in the lower extremities in TKA patients over 60 years of age and provide a reference for the effective prevention of DVT.MethodsThis retrospective study included patients older than 60 who underwent TKA surgery in our hospital from May 2015 to May 2022 and compared and analyzed patients' personal characteristics and clinical data with or without postoperative DVT. Logistic regression analysis was performed to determine the potential risk factors for DVT after TKA. The sensitivity and specificity of each risk factor in the diagnosis of DVT were compared by the ROC curve, and the value of this model in the diagnosis of DVT was further investigated using a multivariable combined diagnosis ROC curve model.ResultsA total of 661 patients over 60 who underwent TKA were included. Preoperative Hematocrit (HCT), platelet count, anesthesia mode, postoperative D-dimer, ESR, diabetes mellitus, and other aspects of the DVT group and non-DVT group were statistically significant after TKA (P < 0.05). Multivariate logistics regression analysis showed that preoperative HCT, anesthesia mode, and diabetes were independent risk factors for DVT in patients over 60 years old after TKA. Compared with the univariate ROC model, the multivariable combined ROC curve analysis model has a higher diagnostic value for the diagnosis of DVT.ConclusionDVT is common in patients over 60 years of age after TKA, and there is a multivariable influence on its pathogenesis. For patients over 60 with diabetes, neuraxial anesthesia is recommended for patients with high preoperative HCT levels, which may reduce the incidence of postoperative DVT.

A phenome-wide approach to identify causal risk factors for deep vein thrombosis

Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein. DVT can lead to a venous thromboembolism (VTE), the combined term for DVT and pulmonary embolism, a leading cause of death and disability worldwide. Despite the prevalence and associated morbidity of DVT, the underlying causes are not well understood. Our aim was to leverage publicly available genetic summary association statistics to identify causal risk factors for DVT. We conducted a Mendelian randomization phenome-wide association study (MR-PheWAS) using genetic summary association statistics for 973 exposures and DVT (6,767 cases and 330,392 controls in UK Biobank). There was evidence for a causal effect of 57 exposures on DVT risk, including previously reported risk factors (e.g. body mass index—BMI and height) and novel risk factors (e.g. hyperthyroidism and varicose veins). As the majority of identified risk factors were adiposity-related, we explored the molecular link with DVT by undertaking a two-sample MR mediation analysis of BMI-associated circulating proteins on DVT risk. Our results indicate that circulating neurogenic locus notch homolog protein 1 (NOTCH1), inhibin beta C chain (INHBC) and plasminogen activator inhibitor 1 (PAI-1) influence DVT risk, with PAI-1 mediating the BMI-DVT relationship. Using a phenome-wide approach, we provide putative causal evidence that hyperthyroidism, varicose veins and BMI enhance the risk of DVT. Furthermore, the circulating protein PAI-1 has a causal role in DVT aetiology and is involved in mediating the BMI-DVT relationship.

Incidence and predictors of post-thrombotic syndrome in patients with proximal DVT in a real-world setting: findings from the GARFIELD-VTE registry.

Although substantial progress has been made in the pathophysiology and management of the post-thrombotic syndrome (PTS), several aspects still need clarification. Among them, the incidence and severity of PTS in the real world, the risk factors for its development, the value of patient's self-evaluation, and the ability to identify patients at risk for severe PTS. Eligible participants (n = 1107) with proximal deep-vein thrombosis (DVT) from the global GARFIELD-VTE registry underwent conventional physician's evaluation for PTS 36months after diagnosis of their DVT using the Villalta score. In addition, 856 patients completed a Villalta questionnaire at 24months. Variable selection was performed using stepwise algorithm, and predictors of severe PTS were incorporated into a multivariable risk model. The optimistic adjusted c-index was calculated using bootstrapping techniques. Over 36-months, 27.8% of patients developed incident PTS (mild in 18.7%, moderate in 5.7%, severe in 3.4%). Patients with incident PTS were older, had a lower prevalence of transient risk factors of DVT and a higher prevalence of persistent risk factors of DVT. Self-assessment of overall PTS at 24months showed an agreement of 63.4% with respect to physician's evaluations at 36months. The severe PTS multivariable model provided an optimistic adjusted c-index of 0.68 (95% CI 0.59-0.77). Approximately a quarter of DVT patients experienced PTS over 36months after VTE diagnosis. Patient's self-assessment after 24months provided added value for estimating incident PTS over 36months. Multivariable risk analysis allowed good discrimination for severe PTS.

Prevalence and Risk Factors of Deep Vein Thrombosis Among Adult Surgical Patients in Aseer Central Hospital, Saudi Arabia.

Deep vein thrombosis (DVT) is a medical disorder that arises when a coagulation of blood forms in a deep vein, entirely or partially blocking veins, and commonly affects the lower limb. The occurrence is fairly common worldwide and it is said to increase with age, with males being at a higher risk than females. This study aims to determine the prevalence and risk factors of DVT among adult surgical patients in Aseer Central Hospital in the Aseer Region of Saudi Arabia. This is a cross-sectional study involving 602 adult surgical patients hospitalized in the Aseer Central Hospital. Self-administered questionnaires were used to collect data from the respondents, and the data collected were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States). Statistical tests of association were used among the categorical variables. Association between variables was considered significant when p-value was less than 0.05. Binary logistic regression was performed to eliminate the effect of confounders in determining the risk factors for developing DVT among the respondents. The questionnaire response rate was 100%, with the mean age of the respondents being 44.2 ± 19.7 years. The prevalence of DVT was 7% (n=42). Obesity with adjusted OR (aOR) 17.9 (95%CI =5.39-59.18), hypertension with aOR 0.3 (95%CI =0.08-1.03), ischemic heart disease with aOR4.5 (95%CI =1.18-16.83), and orthopedics aOR 0.1 (95%CI=0.013-.240) were found to be independent risk factors for developing DVT among the respondents (p-value <=0.05). Other variables like diabetes, contraception, and pregnancy were not statistically associated with the development of DVT (p-value> 0.05) in these respondents. The findings of this study indicated a significantly low prevalence in comparison to Saudi Arabian research. Key risk factors included obesity (18x higher risk), ischemic heart disease, and hypertension. Surgery location, orthopedic cast, and Doppler ultrasound also influenced risk, while age and sex weren't significant predictors.

Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study.

Deep vein thrombosis (DVT) in lower extremities as a common complication of acute ischemic stroke (AIS) has long been studied. However, as the therapeutic options for AIS continue to advance, the pathogenic mechanisms behind DVT may change. Endovascular thrombectomy (EVT) has replaced intravenous thrombolysis and become the preferred treatment for AIS patients with large vessel occlusions. Therefore, it is important to update our understanding of DVT and its management. This study aimed to determine the prevalence and risk factors of DVT in AIS patients following EVT. In this retrospective study, 245 AIS patients who had received EVT were recruited between January 2020 and December 2021. Within 10 days (median 4 days) of thrombectomy, DVT was diagnosed by ultrasonography. Demographic characteristics, clinical findings, and therapeutic procedures were compared between patients with and without DVT using univariate analysis. Cutoff points were defined for EVT time and plasma D-dimer concentration. Multivariable logistic regression was then used to determine the independent risk factors for DVT and evaluate their predictive power. The prevalence of DVT in AIS patients after EVT was 27.3%. Multifactorial logistic regression analysis showed that age (OR 1.036, 95% CI 1.001-1.073; P = 0.045), female sex (OR 3.015, 95% CI 1.446-6.289; P = 0.003), lower limb muscle strength less than grade three (OR 7.015, 95% CI 1.887-26.080; P = 0.004), longer EVT time (OR 1.012, 95% CI 1.004-1.020; P = 0.003), and higher D-dimer levels (OR 1.350, 95% CI 1.150-1.585; P < 0.001) were independently associated with higher DVT risk in AIS patients following EVT. The cutoff points for operative time of EVT and plasma D-dimer were 65.5 min and 1.62 mg/L, respectively, above which the risk for DVT was dramatically increased with OR > 4 in AIS patients. AIS patients are at increased risk of developing DVT following EVT particularly if they have undergone prolonged thrombectomy procedures and exhibit high plasma levels of D-dimers. However, the results of our study need to be validated by a multicenter prospective study with a larger population of stroke patients.

Incidence of deep vein thrombosis and symptomatic pulmonary embolism in Taiwanese patients with pelvic and/or acetabular fractures: a retrospective study

Venous thromboembolism (VTE) is common in patients with trauma, and thromboprophylaxis has been advocated. However, conflicting results regarding VTE rates in the Asian population following orthopaedic procedures have been presented. We aimed to investigate the VTE incidence in Taiwanese patients with pelvic and/or acetabular fractures and identify the associated risk factors. We included 402 patients who underwent surgery for pelvic and/or acetabular fractures. All patients received mechanical thromboprophylaxis with graduated compression stockings. Duplex scanning was performed postoperatively or during follow-up when signs or symptoms of deep vein thrombosis (DVT) developed. Variables with a significance level of ≤ 0.1 in the univariate analyses were introduced into the multivariate logistic regression analysis to identify DVT risk factors. The overall DVT and symptomatic pulmonary embolism (PE) rate was 3.48% (14/402 patients). Among patients with DVT, 46.1% were asymptomatic. Patients with VTE were significantly older than those without. Multivariate logistic regression analysis revealed that age was a VTE risk factor. The incidence of DVT and symptomatic PE in our cohort was low. Advanced age was a risk factor for VTE. These findings could help clinicians develop appropriate prevention and treatment strategies for VTE in Taiwanese patients with pelvic and/or acetabular fractures.

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study.

Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

Risk factors of deep vein thrombosis in children with osteomyelitis

Objective To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early detection and treatment of DVT. Study design The clinical data of nine children diagnosed with osteomyelitis and DVT between July 2012 and March 2021 were collected at our hospital, including age, sex, clinical manifestations, body temperature, coagulation function and other data, as well as the clinical data of 27 children diagnosed with osteomyelitis without DVT during the same period. Thirty-six children were divided into thrombus and thrombus-free groups. The clinical characteristics and risk factors for DVT in children with osteomyelitis were analysed. Results Among the 36 children in this study, nine cases of thrombus formation mainly occurred in the femoral vein, popliteal vein and iliac vein, all near the infection site. The main clinical manifestations were lower extremity pain, swelling and pulmonary embolism in three cases. Among them, intensive care unit (ICU) admission, sepsis, higher D-dimer, higher body temperature during hospitalization, and pathogen culture showed that methicillin-resistant Staphylococcus aureus (MRSA) was associated with DVT. MRSA was the independent risk factor for DVT. Conclusions Admission to ICU, sepsis, higher D-dimer, higher body temperature during hospitalization, and MRSA are risk factors for thrombosis. MRSA is the independent risk factor for DVT. For patients with related risk factors, timely ultrasound examination of the infected site should be considered to achieve early detection and treatment.

Assessment of Risk Factors of Deep-Vein Thrombosis after Lower Limb Surgery

Background: Deep vein thrombosis is one of the most common condition affecting adults worldwide. The condition is characterized by the presence of blood clots in the veins. The clots commonly develop in the lower limb veins. Deep vein thrombosis is the most common complication after any lower limb surgery and is a prominent complication post-orthopaedic surgery in individuals of any age due to failure of the valves. Aim and Objectives: The aim of our study is to assess the risk factors following lower limb surgery. Methodology: The individuals who fulfill the inclusion criteria were tested using ultrasonography and duplex color Doppler unit examination at 7.5 MHz and 10 MHz using high frequency probes to assess the presence of thrombus in the deep veins of the individuals who have undergone the surgeries. The assessment was recorded on the assessment sheet and analyzed using SPSS statistical software, and the results were drawn. Results: In this study, the individuals were mostly from the age group 59–68 years and a total of 202 patients were included. 136 patients are diagnosed as suffering from DVT following orthopedic surgery. Conclusion: We conclude that the occurrence of DVT after lower limb surgery depends on various factors such as the duration of surgery, the period of immobilization, prior history of DVT and post-operative stay, and various other factors such as age and gender. We found that extramedullary implants have a relative risk of 2.93. Additionally, we also concluded that clinical signs and symptoms are not reliable measures to identify incidence of DVT.

Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy.

This study aimed to identify independent risk factors for immediate postoperative deep vein thrombosis (DVT) in patients with open wedge high tibial osteotomy (OWHTO) and to develop and validate a predictive nomogram. Patients who underwent OWHTO for knee osteoarthritis (KOA) from June 2017 to December 2021 were retrospectively analyzed. Baseline data and laboratory test results were collected, and the occurrence of DVT in the immediate postoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of immediate postoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from January to September 2022 as an external validation set. 741 patients were enrolled in the study, of which 547 were used in the training cohort and the other 194 for the validation cohort. Multivariate analysis revealed a higher Kellgren-Lawrence (K-L) grade (III vs. I-II OR 3.09, 95% CI 0.93-10.23. IV vs. I-II OR 5.23, 95% CI 1.27-21.48.), platelet to hemoglobin ratio (PHR) > 2.25 (OR 6.10, 95% CI 2.43-15.33), Low levels of albumin (ALB) (OR 0.79, 95% CI 0.70-0.90), LDL-C > 3.40 (OR 3.06, 95% CI 1.22-7.65), D-dimer > 1.26 (OR 2.83, 95% CI 1.16-6.87) and BMI ≥ 28 (OR 2.57, 95% CI 1.02-6.50) were the independent risk factors of immediate postoperative DVT. The concordance index (C-index) and Brier score of the nomogram were 0.832 and 0.036 in the training set, and the corrected values after internal validation were 0.795 and 0.038, respectively. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer-Lemeshow test, and the decision curve analysis (DCA) performed well in both the training and validation cohorts. This study developed a personalized predictive nomogram with six predictors, which allows surgeons to stratify risk and recommended immediate ultrasound scans for patients with any of these factors. III.