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Medicine › Internal Medicine

Venous Thromboembolism Diagnosis and Management

Works Count: 148586

Description

This cluster of papers focuses on the prevention, diagnosis, and treatment of venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis. It covers various aspects such as antithrombotic therapy, risk factors, prophylaxis, and management in patients with cancer. The cluster also discusses the development of clinical practice guidelines for VTE.

Keywords

Venous Thromboembolism; Antithrombotic Therapy; Pulmonary Embolism; Deep Vein Thrombosis; Cancer-Associated Thrombosis; Prophylaxis; Risk Factors; Diagnosis; Treatment; Clinical Practice Guidelines

Executive Summary

2012-02-01
Gordon Guyatt , Elie A. Akl , Mark Crowther +2 more
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Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy

2007-02-21
Alok A. Khorana , C. W. Francis , Eva Culakova +2 more
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The Epidemiology of Venous Thromboembolism

2003-06-17
Richard H. White
Venous thromboembolism (VTE) occurs for the first time in approximately 100 persons per 100,000 each year in the United States, and rises exponentially from <5 cases per 100,000 persons <15 … Venous thromboembolism (VTE) occurs for the first time in approximately 100 persons per 100,000 each year in the United States, and rises exponentially from <5 cases per 100,000 persons <15 years old to approximately 500 cases (0.5%) per 100,000 persons at age 80 years. Approximately one third of patients with symptomatic VTE manifest pulmonary embolism (PE), whereas two thirds manifest deep vein thrombosis (DVT) alone. Despite anticoagulant therapy, VTE recurs frequently in the first few months after the initial event, with a recurrence rate of approximately 7% at 6 months. Death occurs in approximately 6% of DVT cases and 12% of PE cases within 1 month of diagnosis. The time of year may affect the occurrence of VTE, with a higher incidence in the winter than in the summer. One major risk factor for VTE is ethnicity, with a significantly higher incidence among Caucasians and African Americans than among Hispanic persons and Asian-Pacific Islanders. Overall, approximately 25% to 50% of patient with first-time VTE have an idiopathic condition, without a readily identifiable risk factor. Early mortality after VTE is strongly associated with presentation as PE, advanced age, cancer, and underlying cardiovascular disease.

Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer

2003-07-09
Agnes Y.Y. Lee , Mark N. Levine , Ross Baker +7 more
Patients with cancer have a substantial risk of recurrent thrombosis despite the use of oral anticoagulant therapy. We compared the efficacy of a low-molecular-weight heparin with that of an oral … Patients with cancer have a substantial risk of recurrent thrombosis despite the use of oral anticoagulant therapy. We compared the efficacy of a low-molecular-weight heparin with that of an oral anticoagulant agent in preventing recurrent thrombosis in patients with cancer.Patients with cancer who had acute, symptomatic proximal deep-vein thrombosis, pulmonary embolism, or both were randomly assigned to receive low-molecular-weight heparin (dalteparin) at a dose of 200 IU per kilogram of body weight subcutaneously once daily for five to seven days and a coumarin derivative for six months (target international normalized ratio, 2.5) or dalteparin alone for six months (200 IU per kilogram once daily for one month, followed by a daily dose of approximately 150 IU per kilogram for five months).During the six-month study period, 27 of 336 patients in the dalteparin group had recurrent venous thromboembolism, as compared with 53 of 336 patients in the oral-anticoagulant group (hazard ratio, 0.48; P=0.002). The probability of recurrent thromboembolism at six months was 17 percent in the oral-anticoagulant group and 9 percent in the dalteparin group. No significant difference between the dalteparin group and the oral-anticoagulant group was detected in the rate of major bleeding (6 percent and 4 percent, respectively) or any bleeding (14 percent and 19 percent, respectively). The mortality rate at six months was 39 percent in the dalteparin group and 41 percent in the oral-anticoagulant group.In patients with cancer and acute venous thromboembolism, dalteparin was more effective than an oral anticoagulant in reducing the risk of recurrent thromboembolism without increasing the risk of bleeding.
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Development and validation of a predictive model for chemotherapy-associated thrombosis

2008-01-24
Alok A. Khorana , Nicole M. Kuderer , Eva Culakova +2 more
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Malignancies, Prothrombotic Mutations, and the Risk of Venous Thrombosis

2005-02-08
Jeanet W. Blom , Catharina Jacoba Maria Doggen , Susanne Osanto +1 more
Venous thrombosis is a common complication in patients with cancer, leading to additional morbidity and compromising quality of life.To identify individuals with cancer with an increased thrombotic risk, evaluating different … Venous thrombosis is a common complication in patients with cancer, leading to additional morbidity and compromising quality of life.To identify individuals with cancer with an increased thrombotic risk, evaluating different tumor sites, the presence of distant metastases, and carrier status of prothrombotic mutations.A large population-based, case-control (Multiple Environmental and Genetic Assessment [MEGA] of risk factors for venous thrombosis) study of 3220 consecutive patients aged 18 to 70 years, with a first deep venous thrombosis of the leg or pulmonary embolism, between March 1, 1999, and May 31, 2002, at 6 anticoagulation clinics in the Netherlands, and separate 2131 control participants (partners of the patients) reported via a questionnaire on acquired risk factors for venous thrombosis. Three months after discontinuation of the anticoagulant therapy, all patients and controls were interviewed, a blood sample was taken, and DNA was isolated to ascertain the factor V Leiden and prothrombin 20210A mutations.Risk of venous thrombosis.The overall risk of venous thrombosis was increased 7-fold in patients with a malignancy (odds ratio [OR], 6.7; 95% confidence interval [CI], 5.2-8.6) vs persons without malignancy. Patients with hematological malignancies had the highest risk of venous thrombosis, adjusted for age and sex (adjusted OR, 28.0; 95% CI, 4.0-199.7), followed by lung cancer and gastrointestinal cancer. The risk of venous thrombosis was highest in the first few months after the diagnosis of malignancy (adjusted OR, 53.5; 95% CI, 8.6-334.3). Patients with cancer with distant metastases had a higher risk vs patients without distant metastases (adjusted OR, 19.8; 95% CI, 2.6-149.1). Carriers of the factor V Leiden mutation who also had cancer had a 12-fold increased risk vs individuals without cancer and factor V Leiden (adjusted OR, 12.1; 95% CI, 1.6-88.1). Similar results were indirectly calculated for the prothrombin 20210A mutation in patients with cancer.Patients with cancer have a highly increased risk of venous thrombosis especially in the first few months after diagnosis and in the presence of distant metastases. Carriers of the factor V Leiden and prothrombin 20210A mutations appear to have an even higher risk.
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Prevention of Venous Thromboembolism

2001-01-01
William Geerts , John A. Heit , G. Patrick Clagett +4 more

The Long-Term Clinical Course of Acute Deep Venous Thrombosis

1996-07-01
P. Prandoni
In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well documented.To determine the … In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well documented.To determine the clinical course of patients during the 8 years after their first episode of symptomatic deep venous thrombosis.Prospective cohort study.University outpatient thrombosis clinic.355 consecutive patients with a first episode of symptomatic deep venous thrombosis.Recurrent venous thromboembolism, the post-thrombotic syndrome, and death. Potential risk factors for these outcomes were also evaluated.The cumulative incidence of recurrent venous thromboembolism was 17.5% after 2 years of follow-up (95% CI, 13.6% to 22.2%), 24.6% after 5 years (CI, 19.6% to 29.7%), and 30.3% after 8 years (CI, 23.6% to 37.0%). The presence of cancer and of impaired coagulation inhibition increased the risk for recurrent venous thromboembolism (hazard ratios, 1.72 [CI, 1.31 to 2.25] and 1.44 [CI, 1.02 to 2.01], respectively). In contrast, surgery and recent trauma or fracture were associated with a decreased risk for recurrent venous thromboembolism (hazard ratios, 0.36 [CI, 0.21 to 0.62] and 0.51 [CI, 0.32 to 0.87], respectively). The cumulative incidence of the post-thrombotic syndrome was 22.8% after 2 years (CI, 18.0% to 27.5%), 28.0% after 5 years (CI, 22.7% to 33.3%), and 29.1% after 8 years (CI, 23.4% to 34.7%). The development of ipsilateral recurrent deep venous thrombosis was strongly associated with the risk for the post-thrombotic syndrome (hazard ratio, 6.4; CI, 3.1 to 13.3). Survival after 8 years was 70.2% (CI, 64.7% to 75.6%). The presence of cancer increased the risk for death (hazard ratio, 8.1; CI, 3.6 to 18.1).Patients with symptomatic deep venous thrombosis, especially those without transient risk factors for deep venous thrombosis, have a high risk for recurrent venous thromboembolism that persists for many years. The post-thrombotic syndrome occurs in almost one third of these patients and is strongly related to ipsilateral recurrent deep venous thrombosis. These findings challenge the widely adopted use of short-course anticoagulation therapy in patients with symptomatic deep venous thrombosis.

Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety

2001-01-01
Jack Hirsh , Theodore E. Warkentin , Stephen G. Shaughnessy +6 more

Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty

2008-06-25
Bengt I. Eriksson , Lars C. Borris , Richard J. Friedman +7 more
This phase 3 trial compared the efficacy and safety of rivaroxaban, an oral direct inhibitor of factor Xa, with those of enoxaparin for extended thromboprophylaxis in patients undergoing total hip … This phase 3 trial compared the efficacy and safety of rivaroxaban, an oral direct inhibitor of factor Xa, with those of enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty.
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Prevention of Venous Thromboembolism

2004-09-01
William Geerts , Graham F. Pineo , John A. Heit +4 more

Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism

1998-03-23
Marc D. Silverstein , John A. Heit , David N. Mohr +3 more
The incidence of venous thromboembolism has not been well described, and there are no studies of long-term trends in the incidence of venous thromboembolism.To estimate the incidence of deep vein … The incidence of venous thromboembolism has not been well described, and there are no studies of long-term trends in the incidence of venous thromboembolism.To estimate the incidence of deep vein thrombosis and pulmonary embolism and to describe trends in incidence.We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990.The overall average age- and sex-adjusted annual incidence of venous thromboembolism was 117 per 100000 (deep vein thrombosis, 48 per 100000; pulmonary embolism, 69 per 100000), with higher age-adjusted rates among males than females (130 vs 110 per 100000, respectively). The incidence of venous thromboembolism rose markedly with increasing age for both sexes, with pulmonary embolism accounting for most of the increase. The incidence of pulmonary embolism was approximately 45% lower during the last 15 years of the study for both sexes and all age strata, while the incidence of deep vein thrombosis remained constant for males across all age strata, decreased for females younger than 55 years, and increased for women older than 60 years.Venous thromboembolism is a major national health problem, especially among the elderly. While the incidence of pulmonary embolism has decreased over time, the incidence of deep vein thrombosis remains unchanged for men and is increasing for older women. These findings emphasize the need for more accurate identification of patients at risk for venous thromboembolism, as well as a safe and effective prophylaxis.

Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism

2000-03-27
John A. Heit , Marc D. Silverstein , David N. Mohr +3 more
Reported risk factors for venous thromboembolism (VTE) vary widely, and the magnitude and independence of each are uncertain.To identify independent risk factors for deep vein thrombosis and pulmonary embolism and … Reported risk factors for venous thromboembolism (VTE) vary widely, and the magnitude and independence of each are uncertain.To identify independent risk factors for deep vein thrombosis and pulmonary embolism and to estimate the magnitude of risk for each.We performed a population-based, nested, case-control study of 625 Olmsted County, Minnesota, patients with a first lifetime VTE diagnosed during the 15-year period from January 1, 1976, through December 31, 1990, and 625 Olmsted County patients without VTE. The 2 groups were matched on age, sex, calendar year, and medical record number.Independent risk factors for VTE included surgery (odds ratio [OR], 21.7; 95% confidence interval [CI], 9.4-49.9), trauma (OR, 12.7; 95% CI, 4.1-39.7), hospital or nursing home confinement (OR, 8.0; 95% CI, 4.5-14.2), malignant neoplasm with (OR, 6.5; 95% CI, 2.1-20.2) or without (OR, 4.1; 95% CI, 1.9-8.5) chemotherapy, central venous catheter or pacemaker (OR, 5.6; 95% CI, 1.6-19.6), superficial vein thrombosis (OR, 4.3; 95% CI, 1.8-10.6), and neurological disease with extremity paresis (OR, 3.0; 95% CI, 1.3-7.4). The risk associated with varicose veins diminished with age (for age 45 years: OR, 4.2; 95% CI, 1.6-11.3; for age 60 years: OR, 1.9; 95% CI, 1.0-3.6; for age 75 years: OR, 0.9; 95% CI, 0.6-1.4), while patients with liver disease had a reduced risk (OR, 0.1; 95% CI, 0.0-0.7).Hospital or nursing home confinement, surgery, trauma, malignant neoplasm, chemotherapy, neurologic disease with paresis, central venous catheter or pacemaker, varicose veins, and superficial vein thrombosis are independent and important risk factors for VTE.

Low-Molecular-Weight Heparins

1997-09-04
Jeffrey I. Weitz
After almost two decades of intensive research, low-molecular-weight heparins have established their niche as an important class of antithrombotic compounds. The demonstration that these compounds are safe and effective for … After almost two decades of intensive research, low-molecular-weight heparins have established their niche as an important class of antithrombotic compounds. The demonstration that these compounds are safe and effective for the prevention and treatment of venous thromboembolism has led to the licensing of several of them in Europe and North America. In addition, danaparoid sodium, which is a mixture of dermatan sulfate, heparan sulfate, and chondroitin sulfate, is often used for the treatment of heparin-induced thrombocytopenia.1 Low-molecular-weight heparins have replaced unfractionated heparin in many parts of Europe but are only now finding their place in North America. Their use is . . .

Antithrombotic Therapy for Venous Thromboembolic Disease

2001-01-01
Thomas M. Hyers , Giancarlo Agnelli , Russell D. Hull +4 more

Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)

1999-04-01
Samuel Z. Goldhaber , Luigi Visani , Marisa De Rosa

Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension

2011-03-22
Michael R. Jaff , M. Sean McMurtry , Stephen L. Archer +7 more
Venous thromboembolism (VTE) is responsible for the hospitalization of >250 000 Americans annually and represents a significant risk for morbidity and mortality. Despite the publication of evidence-based clinical practice guidelines … Venous thromboembolism (VTE) is responsible for the hospitalization of >250 000 Americans annually and represents a significant risk for morbidity and mortality. Despite the publication of evidence-based clinical practice guidelines to aid in the management of VTE in its acute and chronic forms, the clinician is frequently confronted with manifestations of VTE for which data are sparse and optimal management is unclear. In particular, the optimal use of advanced therapies for acute VTE, including thrombolysis and catheter-based therapies, remains uncertain. This report addresses the management of massive and submassive pulmonary embolism (PE), iliofemoral deep vein thrombosis (IFDVT),and chronic thromboembolic pulmonary hypertension (CTEPH). The goal is to provide practical advice to enable the busy clinician to optimize the management of patients with these severe manifestations of VTE. Although this document makes recommendations for management, optimal medical decisions must incorporate other factors, including patient wishes, quality of life, and life expectancy based on age and comorbidities. The appropriateness of these recommendations for a specific patient may vary depending on these factors and will be best judged by the bedside clinician.

Guidelines on the diagnosis and management of acute pulmonary embolism

2008-08-31
Adam Torbicki , Arnaud Perrier , Stavros Konstantinides +7 more
Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the … Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.
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Prevention of VTE in Nonsurgical Patients

2012-02-01
Susan R. Kahn , Wendy Lim , Andrew Dunn +7 more
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Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis

2002-10-30
Paolo Prandoni , Anthonie W.A. Lensing , Andrea Piccioli +7 more
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Multidetector Computed Tomography for Acute Pulmonary Embolism

2006-05-31
Paul D. Stein , Sarah Fowler , Lawrence R. Goodman +7 more
The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively.The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a … The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively.The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a prospective, multicenter investigation of the accuracy of multidetector CTA alone and combined with venous-phase imaging (CTA-CTV) for the diagnosis of acute pulmonary embolism. We used a composite reference test to confirm or rule out the diagnosis of pulmonary embolism.Among 824 patients with a reference diagnosis and a completed CT study, CTA was inconclusive in 51 because of poor image quality. Excluding such inconclusive studies, the sensitivity of CTA was 83 percent and the specificity was 96 percent. Positive predictive values were 96 percent with a concordantly high or low probability on clinical assessment, 92 percent with an intermediate probability on clinical assessment, and nondiagnostic if clinical probability was discordant. CTA-CTV was inconclusive in 87 of 824 patients because the image quality of either CTA or CTV was poor. The sensitivity of CTA-CTV for pulmonary embolism was 90 percent, and specificity was 95 percent. CTA-CTV was also nondiagnostic with a discordant clinical probability.In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results.
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Oral Rivaroxaban for Symptomatic Venous Thromboembolism

2010-12-03
Rupert Bauersachs , Scott D. Berkowitz , Benjamin Brenner +7 more
Rivaroxaban, an oral factor Xa inhibitor, may provide a simple, fixed-dose regimen for treating acute deep-vein thrombosis (DVT) and for continued treatment, without the need for laboratory monitoring. Rivaroxaban, an oral factor Xa inhibitor, may provide a simple, fixed-dose regimen for treating acute deep-vein thrombosis (DVT) and for continued treatment, without the need for laboratory monitoring.
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2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism

2014-08-29
Stavros Konstantinides , Adam Torbicki , Giancarlo Agnelli +7 more
The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their … The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
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Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range.

2001-01-01
J. Hirsh , James E. Dalen , David R. Anderson +4 more

Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism

2012-03-26
Non Renseigné , Harry R. Büller , Martin H. Prins +7 more
A fixed-dose regimen of rivaroxaban, an oral factor Xa inhibitor, has been shown to be as effective as standard anticoagulant therapy for the treatment of deep-vein thrombosis, without the need … A fixed-dose regimen of rivaroxaban, an oral factor Xa inhibitor, has been shown to be as effective as standard anticoagulant therapy for the treatment of deep-vein thrombosis, without the need for laboratory monitoring. This approach may also simplify the treatment of pulmonary embolism.
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Antithrombotic Therapy for VTE Disease

2012-02-01
Clive Kearon , Elie A. Akl , Anthony J. Comerota +7 more
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Risk Factors for Venous Thromboembolism

2003-06-17
Frederick A. Anderson , Frederick A. Spencer
Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in … Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in patients hospitalized with a wide variety of acute medical illnesses have demonstrated a risk of VTE in medical patients comparable with that seen after major general surgery. In addition, epidemiologic studies have shown that between one quarter and one half of all clinically recognized symptomatic VTEs occur in individuals who are neither hospitalized nor recovering from a major illness. This expanding understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who could benefit from prophylaxis. Factors sufficient by themselves to prompt physicians to consider VTE prophylaxis include major surgery, multiple trauma, hip fracture, or lower extremity paralysis because of spinal cord injury. Additional risk factors, such as previous VTE, increasing age, cardiac or respiratory failure, prolonged immobility, presence of central venous lines, estrogens, and a wide variety of inherited and acquired hematological conditions contribute to an increased risk for VTE. These predisposing factors are seldom sufficient by themselves to justify the use of prophylaxis. Nevertheless, individual risk factors, or combinations thereof, can have important implications for the type and duration of appropriate prophylaxis and should be carefully reviewed to assess the overall risk of VTE in each patient.
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Prevention of VTE in Nonorthopedic Surgical Patients

2012-02-01
Michael K. Gould , David García , Sherry M. Wren +4 more
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Perioperative Management of Antithrombotic Therapy

2012-02-01
James D. Douketis , Alex C. Spyropoulos , Frederick A. Spencer +5 more
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Users' Guides to the Medical Literature

1994-03-02
Roman Jaeschke
<h3>CLINICAL SCENARIO</h3> You are back where we put you in the previous article<sup>1</sup>on diagnostic tests in this series on how to use the medical literature: in the library studying an … <h3>CLINICAL SCENARIO</h3> You are back where we put you in the previous article<sup>1</sup>on diagnostic tests in this series on how to use the medical literature: in the library studying an article that will guide you in interpreting ventilation-perfusion (V/Q) lung scans. Using the criteria in Table 1, you have decided that the Prospective Investigation of Pulmonary Diagnosis (PIOPED) study<sup>2</sup>will provide you with valid information. Just then, another physician comes looking for an article to help with the interpretation of V/Q scanning. Her patient is a 28-year-old man whose acute onset of shortness of breath and vague chest pain began shortly after completing a 10-hour auto trip. He experienced several episodes of similar discomfort in the past, but none this severe, and is very apprehensive about his symptoms. After a normal physical examination, electrocardiogram and chest radiograph, and blood gas measurements that show a Pco<sub>2</sub>of

Antithrombotic Therapy for Venous Thromboembolic Disease

2008-06-01
Clive Kearon , Susan R. Kahn , Giancarlo Agnelli +3 more

Incidence of Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism

2004-05-26
Vittorio Pengo , Anthonie W.A. Lensing , Martin H. Prins +7 more
Chronic thromboembolic pulmonary hypertension (CTPH) is associated with considerable morbidity and mortality. Its incidence after pulmonary embolism and associated risk factors are not well documented.We conducted a prospective, long-term, follow-up … Chronic thromboembolic pulmonary hypertension (CTPH) is associated with considerable morbidity and mortality. Its incidence after pulmonary embolism and associated risk factors are not well documented.We conducted a prospective, long-term, follow-up study to assess the incidence of symptomatic CTPH in consecutive patients with an acute episode of pulmonary embolism but without prior venous thromboembolism. Patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography and, if supportive findings were present, ventilation-perfusion lung scanning and pulmonary angiography. CTPH was considered to be present if systolic and mean pulmonary-artery pressures exceeded 40 mm Hg and 25 mm Hg, respectively; pulmonary-capillary wedge pressure was normal; and there was angiographic evidence of disease.The cumulative incidence of symptomatic CTPH was 1.0 percent (95 percent confidence interval, 0.0 to 2.4) at six months, 3.1 percent (95 percent confidence interval, 0.7 to 5.5) at one year, and 3.8 percent (95 percent confidence interval, 1.1 to 6.5) at two years. No cases occurred after two years among the patients with more than two years of follow-up data. The following increased the risk of CTPH: a previous pulmonary embolism (odds ratio, 19.0), younger age (odds ratio, 1.79 per decade), a larger perfusion defect (odds ratio, 2.22 per decile decrement in perfusion), and idiopathic pulmonary embolism at presentation (odds ratio, 5.70).CTPH is a relatively common, serious complication of pulmonary embolism. Diagnostic and therapeutic strategies for the early identification and prevention of CTPH are needed.
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Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism

2014-04-09
Guy Meyer , Éric Vicaut , Thierry Danays +7 more
The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial.In a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with … The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial.In a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism. Eligible patients had right ventricular dysfunction on echocardiography or computed tomography, as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin T. The primary outcome was death or hemodynamic decompensation (or collapse) within 7 days after randomization. The main safety outcomes were major extracranial bleeding and ischemic or hemorrhagic stroke within 7 days after randomization.Of 1006 patients who underwent randomization, 1005 were included in the intention-to-treat analysis. Death or hemodynamic decompensation occurred in 13 of 506 patients (2.6%) in the tenecteplase group as compared with 28 of 499 (5.6%) in the placebo group (odds ratio, 0.44; 95% confidence interval, 0.23 to 0.87; P=0.02). Between randomization and day 7, a total of 6 patients (1.2%) in the tenecteplase group and 9 (1.8%) in the placebo group died (P=0.42). Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P<0.001). Stroke occurred in 12 patients (2.4%) in the tenecteplase group and was hemorrhagic in 10 patients; 1 patient (0.2%) in the placebo group had a stroke, which was hemorrhagic (P=0.003). By day 30, a total of 12 patients (2.4%) in the tenecteplase group and 16 patients (3.2%) in the placebo group had died (P=0.42).In patients with intermediate-risk pulmonary embolism, fibrinolytic therapy prevented hemodynamic decompensation but increased the risk of major hemorrhage and stroke. (Funded by the Programme Hospitalier de Recherche Clinique in France and others; PEITHO EudraCT number, 2006-005328-18; ClinicalTrials.gov number, NCT00639743.).
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Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism

2013-09-01
Harry R. Büller , Hervé Decousus , Michael Grosso +7 more
Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear.In a randomized, double-blind, noninferiority study, we randomly assigned patients with … Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear.In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding.A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98).Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.).
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Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study

2008-02-01
Alexander T. Cohen , Victor F. Tapson , Jean‐François Bergmann +7 more

Oral Apixaban for the Treatment of Acute Venous Thromboembolism

2013-07-01
Giancarlo Agnelli , Harry R. Büller , Alexander T. Cohen +7 more
Apixaban, an oral factor Xa inhibitor administered in fixed doses, may simplify the treatment of venous thromboembolism.In this randomized, double-blind study, we compared apixaban (at a dose of 10 mg … Apixaban, an oral factor Xa inhibitor administered in fixed doses, may simplify the treatment of venous thromboembolism.In this randomized, double-blind study, we compared apixaban (at a dose of 10 mg twice daily for 7 days, followed by 5 mg twice daily for 6 months) with conventional therapy (subcutaneous enoxaparin, followed by warfarin) in 5395 patients with acute venous thromboembolism. The primary efficacy outcome was recurrent symptomatic venous thromboembolism or death related to venous thromboembolism. The principal safety outcomes were major bleeding alone and major bleeding plus clinically relevant nonmajor bleeding.The primary efficacy outcome occurred in 59 of 2609 patients (2.3%) in the apixaban group, as compared with 71 of 2635 (2.7%) in the conventional-therapy group (relative risk, 0.84; 95% confidence interval [CI], 0.60 to 1.18; difference in risk [apixaban minus conventional therapy], -0.4 percentage points; 95% CI, -1.3 to 0.4). Apixaban was noninferior to conventional therapy (P<0.001) for predefined upper limits of the 95% confidence intervals for both relative risk (<1.80) and difference in risk (<3.5 percentage points). Major bleeding occurred in 0.6% of patients who received apixaban and in 1.8% of those who received conventional therapy (relative risk, 0.31; 95% CI, 0.17 to 0.55; P<0.001 for superiority). The composite outcome of major bleeding and clinically relevant nonmajor bleeding occurred in 4.3% of the patients in the apixaban group, as compared with 9.7% of those in the conventional-therapy group (relative risk, 0.44; 95% CI, 0.36 to 0.55; P<0.001). Rates of other adverse events were similar in the two groups.A fixed-dose regimen of apixaban alone was noninferior to conventional therapy for the treatment of acute venous thromboembolism and was associated with significantly less bleeding (Funded by Pfizer and Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00643201).
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Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis

2003-09-24
Philip S. Wells , David R. Anderson , Marc Rodger +7 more
Several diagnostic strategies using ultrasound imaging, measurement of D-dimer, and assessment of clinical probability of disease have proved safe in patients with suspected deep-vein thrombosis, but they have not been … Several diagnostic strategies using ultrasound imaging, measurement of D-dimer, and assessment of clinical probability of disease have proved safe in patients with suspected deep-vein thrombosis, but they have not been compared in randomized trials.Outpatients presenting with suspected lower-extremity deep-vein thrombosis were potentially eligible. Using a clinical model, physicians evaluated the patients and categorized them as likely or unlikely to have deep-vein thrombosis. The patients were then randomly assigned to undergo ultrasound imaging alone (control group) or to undergo D-dimer testing (D-dimer group) followed by ultrasound imaging unless the D-dimer test was negative and the patient was considered clinically unlikely to have deep-vein thrombosis, in which case ultrasound imaging was not performed.Five hundred thirty patients were randomly assigned to the control group, and 566 to the D-dimer group. The overall prevalence of deep-vein thrombosis or pulmonary embolism was 15.7 percent. Among patients for whom deep-vein thrombosis had been ruled out by the initial diagnostic strategy, there were two confirmed venous thromboembolic events in the D-dimer group (0.4 percent; 95 percent confidence interval, 0.05 to 1.5 percent) and six events in the control group (1.4 percent; 95 percent confidence interval, 0.5 to 2.9 percent; P=0.16) during three months of follow-up. The use of D-dimer testing resulted in a significant reduction in the use of ultrasonography, from a mean of 1.34 tests per patient in the control group to 0.78 in the D-dimer group (P=0.008). Two hundred eighteen patients (39 percent) in the D-dimer group did not require ultrasound imaging.Deep-vein thrombosis can be ruled out in a patient who is judged clinically unlikely to have deep-vein thrombosis and who has a negative D-dimer test. Ultrasound testing can be safely omitted in such patients.
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Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer

2000-01-01
Philip S. Wells , David R. Anderson , Marc Rodger +7 more
We have previously demonstrated that a clinical model can be safely used in a management strategy in patients with suspected pulmonary embolism (PE). We sought to simplify the clinical model … We have previously demonstrated that a clinical model can be safely used in a management strategy in patients with suspected pulmonary embolism (PE). We sought to simplify the clinical model and determine a scoring system, that when combined with D-dimer results, would safely exclude PE without the need for other tests, in a large proportion of patients. We used a randomly selected sample of 80% of the patients that participated in a prospective cohort study of patients with suspected PE to perform a logistic regression analysis on 40 clinical variables to create a simple clinical prediction rule. Cut points on the new rule were determined to create two scoring systems. In the first scoring system patients were classified as having low, moderate and high probability of PE with the proportions being similar to those determined in our original study. The second system was designed to create two categories, PE likely and unlikely. The goal in the latter was that PE unlikely patients with a negative D-dimer result would have PE in less than 2% of cases. The proportion of patients with PE in each category was determined overall and according to a positive or negative SimpliRED D-dimer result. After these determinations we applied the models to the remaining 20% of patients as a validation of the results. The following seven variables and assigned scores (in brackets) were included in the clinical prediction rule: Clinical symptoms of DVT (3.0), no alternative diagnosis (3.0), heart rate >100 (1.5), immobilization or surgery in the previous four weeks (1.5), previous DVT/PE (1.5), hemoptysis (1.0) and malignancy (1.0). Patients were considered low probability if the score was <2.0, moderate of the score was 2.0 to 6.0 and high if the score was over 6.0. Pulmonary embolism unlikely was assigned to patients with scores < or =4.0 and PE likely if the score was >4.0. 7.8% of patients with scores of less than or equal to 4 had PE but if the D-dimer was negative in these patients the rate of PE was only 2.2% (95% CI = 1.0% to 4.0%) in the derivation set and 1.7% in the validation set. Importantly this combination occurred in 46% of our study patients. A score of <2.0 and a negative D-dimer results in a PE rate of 1.5% (95% CI = 0.4% to 3.7%) in the derivation set and 2.7% (95% CI = 0.3% to 9.0%) in the validation set and only occurred in 29% of patients. The combination of a score < or =4.0 by our simple clinical prediction rule and a negative SimpliRED D-Dimer result may safely exclude PE in a large proportion of patients with suspected PE.

Antithrombotic Therapy for VTE Disease

2016-01-07
Clive Kearon , Elie A. Akl , Joseph Ornelas +7 more

A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis

1998-02-12
Hervé Decousus , Alain Leizorovicz , Florence Parent +7 more
The efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis are still a matter of debate. The efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis are still a matter of debate.
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A Comparison of Enoxaparin with Placebo for the Prevention of Venous Thromboembolism in Acutely Ill Medical Patients

1999-09-09
M Samama , Alexander T. Cohen , Jean‐Yves Darmon +7 more
The efficacy and safety of thromboprophylaxis in patients with acute medical illnesses who may be at risk for venous thromboembolism have not been determined in adequately designed trials.In a double-blind … The efficacy and safety of thromboprophylaxis in patients with acute medical illnesses who may be at risk for venous thromboembolism have not been determined in adequately designed trials.In a double-blind study, we randomly assigned 1102 hospitalized patients older than 40 years to receive 40 mg of enoxaparin, 20 mg of enoxaparin, or placebo subcutaneously once daily for 6 to 14 days. Most patients were not in an intensive care unit. The primary outcome was venous thromboembolism between days 1 and 14, defined as deep-vein thrombosis detected by bilateral venography (or duplex ultrasonography) between days 6 and 14 (or earlier if clinically indicated) or documented pulmonary embolism. The duration of follow-up was three months.The primary outcome could be assessed in 866 patients. The incidence of venous thromboembolism was significantly lower in the group that received 40 mg of enoxaparin (5.5 percent [16 of 291 patients]) than in the group that received placebo (14.9 percent [43 of 288 patients]) (relative risk, 0.37; 97.6 percent confidence interval, 0.22 to 0.63; P< 0.001). The benefit observed with 40 mg of enoxaparin was maintained at three months. There was no significant difference in the incidence of venous thromboembolism between the group that received 20 mg of enoxaparin (43 of 287 patients [15.0 percent]) and the placebo group. The incidence of adverse effects did not differ significantly between the placebo group and either enoxaparin group. By day 110, 50 patients had died in the placebo group (13.9 percent), 51 had died in the 20-mg group (14.7 percent), and 41 had died in the 40-mg group (11.4 percent); the differences were not significant.Prophylactic treatment with 40 mg of enoxaparin subcutaneously per day safely and effectively reduces the risk of venous thromboembolism in patients with acute medical illnesses.
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Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial

2013-08-10
Chakravarthi Rajkumar

Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism

2017-12-12
Gary E. Raskob , Nick van Es , Peter Verhamme +7 more
Low-molecular-weight heparin is the standard treatment for cancer-associated venous thromboembolism. The role of treatment with direct oral anticoagulant agents is unclear. Low-molecular-weight heparin is the standard treatment for cancer-associated venous thromboembolism. The role of treatment with direct oral anticoagulant agents is unclear.
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2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

2019-08-31
Stavros Konstantinides , Guy Meyer , Cecilia Becattini +7 more
Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their … Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
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Prevention of VTE in Orthopedic Surgery Patients

2012-02-01
Yngve Falck‐Ytter , Charles W. Francis , Norman A. Johanson +6 more
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COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

2020-04-17
Behnood Bikdeli , Mahesh V. Madhavan , David Jiménez +7 more
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Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

2020-04-23
Corrado Lodigiani , G. Iapichino , Luca Carenzo +7 more
BackgroundFew data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.MethodsWe studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in … BackgroundFew data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.MethodsWe studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020–10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC).ResultsWe included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%–11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients.ConclusionsThe high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.
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A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study

1991-05-01
Fred Anderson
A community-wide study was conducted in 16 short-stay hospitals in metropolitan Worcester, Mass, to examine the incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism in patients hospitalized … A community-wide study was conducted in 16 short-stay hospitals in metropolitan Worcester, Mass, to examine the incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism in patients hospitalized between July 1, 1985, and December 31, 1986. The average annual incidence of deep vein thrombosis alone was 48 per 100000, while the incidence of pulmonary embolism with or without deep vein thrombosis was 23 per 100 000. The incidence rates of deep vein thrombosis and pulmonary embolism increased exponentially with age. The inhospital case-fatality rate of venous thromboembolism was 12%. Among patients discharged from the hospital, the long-term case-fatality rates were 19%, 25%, and 30% at 1, 2, and 3 years after hospital discharge. Extrapolation of the data from this population-based study suggests that there are approximately 170 000 new cases of clinically recognized venous thromboembolism in patients treated in short-stay hospitals in the United States each year, and 99 000 hospitalizations for recurrent disease. Because of the silent nature of this disease and the low rate of autopsy in the United States, the total incidence, prevalence, and mortality rates of venous thromboembolism remain elusive. (<i>Arch Intern Med.</i>1991;151:933-938)

A Population-Based Perspective of the Hospital Incidence and Case-Fatality Rates of Deep Vein Thrombosis and Pulmonary Embolism

1991-05-01
Frederick A. Anderson
A community-wide study was conducted in 16 short-stay hospitals in metropolitan Worcester, Mass, to examine the incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism in patients hospitalized … A community-wide study was conducted in 16 short-stay hospitals in metropolitan Worcester, Mass, to examine the incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism in patients hospitalized between July 1, 1985, and December 31, 1986. The average annual incidence of deep vein thrombosis alone was 48 per 100000, while the incidence of pulmonary embolism with or without deep vein thrombosis was 23 per 100 000. The incidence rates of deep vein thrombosis and pulmonary embolism increased exponentially with age. The inhospital case-fatality rate of venous thromboembolism was 12%. Among patients discharged from the hospital, the long-term case-fatality rates were 19%, 25%, and 30% at 1, 2, and 3 years after hospital discharge. Extrapolation of the data from this population-based study suggests that there are approximately 170 000 new cases of clinically recognized venous thromboembolism in patients treated in short-stay hospitals in the United States each year, and 99 000 hospitalizations for recurrent disease. Because of the silent nature of this disease and the low rate of autopsy in the United States, the total incidence, prevalence, and mortality rates of venous thromboembolism remain elusive. (<i>Arch Intern Med.</i>1991;151:933-938)

Value of the Ventilation/Perfusion Scan in Acute Pulmonary Embolism

1990-05-23
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

Recurrent Deep Vein Thromboses in an Active-Duty Aviator

2025-06-25
Megan Cheng , Berry Middel , Kevin D. Anderson | Aerospace Medicine and Human Performance
BACKGROUND: Deep vein thrombosis (DVT) is a morbid disease that potentially has lethal results, with even further professional ramifications in the aviation community. There are only a few reported cases … BACKGROUND: Deep vein thrombosis (DVT) is a morbid disease that potentially has lethal results, with even further professional ramifications in the aviation community. There are only a few reported cases on outcomes of fliers who developed DVT. As such, more research is needed to assist the aeromedical community in identifying high-risk individuals so that counseling and preventative measures are administered to avoid harmful outcomes. CASE REPORT: We present a 34-yr-old woman with several pre-existing comorbidities who developed ipsilateral DVTs in her lower extremity while in Oman that required medical evacuation back stateside. Days prior to her long-haul flight overseas, she presented to the local emergency department with right lower extremity DVT similar to a prior one she experienced. A week later, while departing the continental United States, she was evaluated by Emergency Medical Technicians for painful ambulation. After being symptomatic for over a week in country, she was admitted to a local hospital where formal diagnosis was made. DISCUSSION: Aviators are not as familiar with the risks and consequences of thrombus formation. This case highlights several key points, such as a thorough medical clearance process in conjunction with closed loop communication. A history of DVT with additional susceptibilities requires in-depth education prior to long distance travel. A thorough record review should be conducted on a high-risk servicemember to ensure medical optimization. When making the decision to use medical evacuation, risk stratification must be implemented early to ensure safe return. Cheng MT, Middel BL, Anderson KD. Recurrent deep vein thromboses in an active-duty aviator . Aerosp Med Hum Perform. 2025; 96(7):586–589.

Duodenal Perforation in the Setting of Retrievable Inferior Vena Cava Filter

2025-06-25
Tyler Liguori , О. И. Орлов , Christian Gutierrez +1 more | Cureus

Trends and Predictors of Venous Thromboembolism and Major Hemorrhagic Events in Hospitalized Leukemia Patients: A Cross-Sectional Analysis of the NIS (2016–2020)

2025-06-25
Daniel Antwi‐Amoabeng , Bryce D. Beutler , Vijay Neelam +1 more | Clinics and Practice
Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: … Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes. Results: Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (p = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (p = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, p &lt; 0.001). Conclusions: The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population.

Inconsistent and Inaccurate Cancer Clinical Trial Reporting of Venous and Arterial Thrombotic Events: An Urgent Call to Action

2025-06-25
David C. Calverley , Avi Leader , May Anne Cheong +4 more | Journal of Clinical Oncology

Successful Use of Epidural Anesthesia Following Guideline-Based Anticoagulation Bridging for Hip Surgery in a Patient with Acute Pulmonary Embolism: A Case Report

2025-06-25
Ayudya Tarita Alda , Paramita Putri Hapsari , RTH Supraptomo | Bioscientia Medicina Journal of Biomedicine and Translational Research
Background: The perioperative management of patients with acute pulmonary embolism (PE) requiring major surgery presents a formidable clinical challenge. Therapeutic anticoagulation, essential for treating PE, is a significant relative contraindication … Background: The perioperative management of patients with acute pulmonary embolism (PE) requiring major surgery presents a formidable clinical challenge. Therapeutic anticoagulation, essential for treating PE, is a significant relative contraindication for neuraxial anesthesia due to the risk of spinal hematoma. General anesthesia, however, carries a high risk of hemodynamic collapse in patients with compromised cardiopulmonary reserves. This report describes the successful application of a multidisciplinary, guideline-adherent strategy to manage this complex clinical scenario. Case presentation: A 56-year-old, obese female (BMI 30 kg/m²) with an extensive history of cardiovascular disease—including hypertensive heart disease, prior myocardial infarction, and an aortic dissection repaired via EVAR—presented with a post-traumatic left hip dislocation. Her presentation was critically complicated by an acute massive pulmonary embolism, diagnosed via echocardiography, which revealed large thrombi in the pulmonary arteries, and confirmed with a chest X-ray showing a Westermark sign. The patient required an open reduction and repair of the hip. A collaborative, multidisciplinary plan was formulated to enable the use of epidural anesthesia. Her anticoagulation with rivaroxaban was stopped five days preoperatively and bridged with a therapeutic infusion of unfractionated heparin (UFH). The UFH was discontinued six hours before the procedure, and surgery proceeded only after confirming normalization of coagulation parameters (INR &lt; 1.5). Epidural anesthesia was successfully administered, providing excellent hemodynamic stability throughout the surgery. The patient was monitored in a cardiac intensive care unit postoperatively, with no neurological or bleeding complications. Conclusion: This case demonstrates that epidural anesthesia is a viable and potentially superior option for high-risk patients with acute PE, provided that a meticulous, guideline-concordant anticoagulation bridging strategy is implemented. Successful outcomes in such complex cases are predicated on rigorous multidisciplinary planning, patient selection, and vigilant postoperative monitoring. This approach validates current safety guidelines rather than challenging them, showcasing their utility in enabling advanced anesthetic care.

Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2

2025-06-24
Yuzhi Tao , Hong Chen , Chunling Dong +7 more | Thrombosis and Haemostasis
Background Most bleeding risk scores for pulmonary embolism (PE) were developed in patients receiving traditional anticoagulants. Evidence in East Asian populations and their applicability to direct oral anticoagulants (DOACs) remain … Background Most bleeding risk scores for pulmonary embolism (PE) were developed in patients receiving traditional anticoagulants. Evidence in East Asian populations and their applicability to direct oral anticoagulants (DOACs) remain limited. Methods This post-hoc analysis was based on a multicentre, prospective study (NCT02943343) conducted from 2016 to 2021. The predictive performance of bleeding risk scores was assessed using a time-dependent area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA). Propensity score matching (PSM) was adjusted for baseline characteristics. We analysed the impact of initial DOAC versus low molecular weight heparin (LMWH) on outcomes. The endpoint was major bleeding (MB) within 90 days and composite outcomes (all-cause mortality, recurrent VTE, and MB). Results Of 7,619 patients with PE, 1.4% (107 patients) experienced MB within 90 days. The RIETE score showed a modest predictive ability (AUC: 0.70; 95% CI, 0.65-0.75) for predicting 90-day MB and demonstrated a predictive advantage in the DCA results. NRI also revealed significantly better reclassification capability than the other scores, except for HAS-BLED. Among low-risk patients classified by the RIETE score, initial DOAC treatment significantly reduced 14-day composite outcomes compared to LMWH (HR = 0.13; 95% CI, 0.02-0.93). Furthermore, DOACs at discharge did not increase the risk of MB or composite outcomes. Conclusion RIETE score shows modest performance in predicting MB and identifying low bleeding risk in PE patients, which could potentially guide early DOAC use. Further studies are needed to test its clinical utility, especially in East Asian populations.

Use of Present-on-Admission Indicators to Improve Accuracy of Pulmonary Embolism Identification from Electronic Health Record Data

2025-06-24
Sina Rashedi , Hannah Leyva , Mariana Pfeferman +7 more | Seminars in Thrombosis and Hemostasis

Thromboprophylaxis in medical patients: a 2025 update of Polish recommendations

2025-06-24
Zbigniew Krasiński , Anetta Undas , Maria Podolak‐Dawidziak +7 more | Polskie Archiwum Medycyny Wewnętrznej

Embolization of Gluteal Pseudoaneurysm Using the LAVA Liquid Embolic System

2025-06-24
Mili Rohilla , Samruddhi Jain , Vibhor Wadhwa | Indian journal of radiology and imaging - new series/Indian journal of radiology and imaging/Indian Journal of Radiology & Imaging

Retrieval of an IVCF retained for over 6 years via femoral venous approach using a large-bore sheath: a case report and literature review

2025-06-24
Gang Yuan , Wei Hu , Weiming Wang +5 more | Frontiers in Cardiovascular Medicine
Prolonged retention of inferior vena cava filters (IVCF) predisposes patients to complications, including caval thrombosis, filter tilt, wall adherence, fibrotic adhesion, migration, and perforation, posing significant risks to patient health. … Prolonged retention of inferior vena cava filters (IVCF) predisposes patients to complications, including caval thrombosis, filter tilt, wall adherence, fibrotic adhesion, migration, and perforation, posing significant risks to patient health. Retrieval of long-term retained filters is challenging, as standard retrieval techniques often prove ineffective. Advanced strategies are therefore required to improve success rates. Herein, we report a case of an IVCF retained for over 6 years, in which the patient developed acute thrombosis of the inferior vena cava (IVC) and iliac veins following recent discontinuation of anticoagulation. Concurrently, the retrieval hook was embedded in fibrotic tissue with wall apposition, and the filter struts had perforated the vascular wall with dense adhesions. Initial attempts using a standard retrieval kit failed. Subsequently, a loop snare technique was employed to dissect perihook fibrotic tissue, successfully engaging the retrieval hook. However, due to the filter's firm incorporation into the IVC, the hook straightened under traction, resulting in retrieval failure. Ultimately, the stubborn filter was successfully removed via a retrograde approach using a 20F vascular sheath through the femoral vein. By detailing this case and reviewing relevant literature, we aim to provide insights into advanced retrieval strategies for challenging IVCF, particularly those with prolonged dwell times.

Commentary on the updated Polish guidelines on the prevention and treatment of venous thromboembolism

2025-06-24
James D. Douketis , Conor Bell | Polskie Archiwum Medycyny Wewnętrznej

Direct Oral Anticoagulant Use in Oral Surgery: Insights from a Systematic Review

2025-06-24
Enav Yefet | International Journal of Oral and Maxillofacial Surgery

[Guidelines for the diagnosis and treatment of acute pulmonary embolism 2025].

2025-06-24
| PubMed

Letter to the Editor: A Commentary on “Prognostic Value of C-reactive Protein to Albumin Ratio in Patients With Valvular Heart Disease: Nationwide Prospective Cohort Study”

2025-06-24
Junqi Gou , Chaohui Liu , Fengyou Yao | International Journal of Surgery

Racial Disparities in the Management of Deep Vein Thrombosis from a Nationwide Hospitalization Study

2025-06-24
Jayalekshmi Jayakumar , Manasa Ginjupalli , Nikhil Vojjala +7 more | Blood Advances

Α 6-month, multicenter, observational study investigating the treatment of venous thromboembolism in Greece (VICTORIA study)

2025-06-23
Paraskevi Savvari , Ioannis Skiadas , Evgenia Mavrokefalou +7 more | Thrombosis Journal
Real-world data are needed to inform clinical practice with regards to anticoagulation treatment for persons with venous thromboembolism (VTE). To identify the type and duration of antithrombotic treatment in persons … Real-world data are needed to inform clinical practice with regards to anticoagulation treatment for persons with venous thromboembolism (VTE). To identify the type and duration of antithrombotic treatment in persons with VTE. Anticoagulation dosage and persistence/adherence were among the secondary objectives. A multicenter, observational, prospective study conducted in Greek adults with VTE with two on-site visits -baseline and at three months- and a telephone follow-up at 6 months. A total of 600 eligible persons were enrolled. The index event was 'PE only' in 50%, 'DVT only' in 40%, and 'DVT+PE' in 10%. Risk factors were categorized as temporary major (21%), temporary minor (37%), and persistent (43%), with active cancer present in 18% of patients. All VTE patients received anticoagulants: 73% received oral anticoagulants (72% DOACs, 1% VKAs) and 70% received parenteral anticoagulants. Treatment was oral only in 30%, parenteral only in 27%, and both in 43%. The most common DOAC was apixaban (47%). Extended anticoagulation (>6 months) was administered to 41% with only 9% (18/198) of those on DOACs receiving a reduced dose. Persistent risk factors predicted extended anticoagulation, while diabetes, COVID-19, and temporary minor risk factors did not. Adherence/persistence rates were similar between DOAC and non-DOAC-treated patients. VTE was mainly treated with a combination of parenteral and oral anticoagulants. DOACs, primarily apixaban, were the most common oral treatments. Forty percent of patients received extended anticoagulation, mostly at standard dosages. Adherence and persistence rates were high for both DOAC and non-DOAC treatments.

Modern approach to the treatment of acute iliofemoral thrombosis

2025-06-23
V. V. Evseeva , Igor M. Ignatyev | Russian Journal of Cardiology and Cardiovascular Surgery
Analysis of available literature data demonstrates no protocol for the treatment of patients with deep vein thrombosis. Despite the need for a differentiated approach to each patient, development of a … Analysis of available literature data demonstrates no protocol for the treatment of patients with deep vein thrombosis. Despite the need for a differentiated approach to each patient, development of a unified algorithm for the treatment of patients with deep vein thrombosis is an urgent problem.

Atypical Presentation of Inferior Vena Cava Thrombosis Induced by Recreational Cliff Diving Trauma

2025-06-23
Salman Syed , Harishankar Gopakumar , Tulika Chatterjee +2 more | Cureus

Post‐Viral Acquired Idiopathic Purpura Fulminans Caused by Anti‐Protein S Antibodies

2025-06-23
Alexandre Théron , Christine Biron‐Andréani , Éric Jeziorski | Acta Paediatrica
Acquired Idiopathic purpura fulminans is a rare pathology caused by anti-protein S antibodies. We have conducted a literature review focusing on the most recent developments in diagnosis and management. Diagnosis … Acquired Idiopathic purpura fulminans is a rare pathology caused by anti-protein S antibodies. We have conducted a literature review focusing on the most recent developments in diagnosis and management. Diagnosis is based on the demonstration of typical necrotic purpura lesions on the legs. Treatment must be initiated without delay by infusion of fresh frozen plasma, plasmapheresis, or infusion of immunoglobulins, and curative anticoagulation. The challenge of limiting the incidence of serious complications can be met by disseminating simple diagnostic and treatment keys to paediatricians, with particular emphasis on recognising typical skin lesions.

Potential association of TGFβ1 plasma levels and fibrinolysis parameters with the risk of recurrence and vascular obstruction after a first unprovoked pulmonary embolism episode

2025-06-22
Marc Danguy des Déserts , Claire de Moreuil , Jamal Elhasnaoui +7 more | Journal of Thrombosis and Thrombolysis
The pathophysiology of residual pulmonary vascular obstruction (RPVO) and recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism (PE) remains poorly understood. The purpose was to evaluate fibrinolytic and tissue remodeling … The pathophysiology of residual pulmonary vascular obstruction (RPVO) and recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism (PE) remains poorly understood. The purpose was to evaluate fibrinolytic and tissue remodeling markers as indicators of RPVO and recurrence after a first unprovoked PE. Analyses were conducted in the 18 to 70-year-old patients included in the PADIS-PE trial, with a pulmonary vascular obstruction (PVO) index ≥ 30% at PE diagnosis. After an initial six-month vitamin K antagonist treatment, patients were randomised to receive placebo or warfarin for 18 months and assessed for the absence or presence of residual pulmonary vascular obstruction (RPVO < or ≥ 5%, respectively). Quantitative assessment of fibrinolytic (D-dimer, tPA, uPA, TFPI) and tissue remodeling (TGFβ1) markers, and a tissue-factor-based turbidimetric clot lysis assay (CLA) were performed one month after warfarin discontinuation. Symptomatic recurrent VTE was monitored for 42 months after randomisation. Among the 371 patients included in PADIS-PE, 23 fulfilled clinico-radiological criteria and had an available blood sample. Six (26%) patients presented RPVO ≥ 5% and symptomatic recurrent VTE occurred in nine (39%) patients. Clot formation and lysis parameters were not associated with RPVO. TGFβ1 plasma levels were higher in patients with RPVO. Clot formation potential measured with CLA was higher in patients with recurrent VTE. No association between recurrent VTE and TGFβ1 was observed. In adult patients with a first unprovoked PE and a PVO index ≥ 30%, TGFβ1 plasma levels were associated with RPVO, whereas clot formation parameters measured with CLA were associated with VTE recurrence.

Mechanical Thrombectomy for Iliofemoral Deep Venous Thrombosis Complicated by Phlegmasia Cerulea Dolens in a Pregnant Patient With May-Thurner Syndrome: A Case Report

2025-06-22
José Luis Reyes , R. Pinilla , Gilberto Chanis +2 more | Cureus

Venous Thromboembolism Prophylaxis in the Neurocritically Ill Population

2025-06-22
Oyshik Banerjee , Roysten Rodrigues , Lauren Adkins +1 more | Journal of Clinical Medicine
Background/Objectives: Venous thromboembolism (VTE) is a preventable cause of morbidity in the neurocritical ill patient population. There is ongoing debate regarding the optimal timing and choice of pharmacologic thromboprophylaxis (PTP) … Background/Objectives: Venous thromboembolism (VTE) is a preventable cause of morbidity in the neurocritical ill patient population. There is ongoing debate regarding the optimal timing and choice of pharmacologic thromboprophylaxis (PTP) and how these decisions relate to balancing the risk of bleeding complications with the development of VTE. Our review assesses the available data to provide un updated perspective to clinicians. Methods: A literature search was performed in December 2024 in PubMed and EMBASE. We focused on the timing of PTP initiation and the comparison of enoxaparin (ENX) with unfractionated heparin (UFH) in patients with traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), spinal or spinal cord injury (SCI), or requirement for neurosurgical intervention. Results: We included 90 articles spanning a total of 669,725 patients with injuries of interest within neurocritical care. The existing data largely signaled a benefit of early administration (&lt;24–72 h) of PTP in VTE prevention, though some studies suggested increased risks of complications. Data to inform a preference for PTP agent was less robust, though a signal of benefit for enoxaparin is suggested for subsets of patients with acute brain injury such as TBI. The data quality is limited by the large body of retrospective studies, the heterogeneity of study populations, outcome definitions, study methodologies, and the lack of detailed reporting of relevant factors. Conclusions: Our review provides an updated assessment of the available data on PTP timing and choice in neurocritically ill patients with hemorrhages or surgical need, with a practice-focused overview for clinicians balancing VTE risk with bleeding risk. The data suggest that in most circumstances, early PTP appears safe and indicated, and that low-molecular weight heparin (LMWH) can be considered over UFH in certain subsets of patients. Still, data gaps and conflicting results highlight the need for patient-specific decision making and indicate that more robust research is warranted to inform optimal clinical practice.

Venous thromboembolism diagnosis definition in claims data: implications for research

2025-06-22
Vanessa Vyas , Ashlynn Fuccello , Seana L Corbin +3 more | Journal of Thrombosis and Thrombolysis

Heparin

2025-06-21
| Reactions Weekly

Etiologias dos Casos de Tromboembolismo Venoso nos Pacientes do Ambulatório de Hematologia da Clínica de Especialidades Médicas (CEM) da Universidade Federal de Alfenas (UNIFAL-MG)

2025-06-21
Pedro Ribeiro Del Carratore , Víctor Manuel Contreras Toledo , Iara Baldim Rabelo | Research Society and Development
O tromboembolismo venoso (TEV) é a terceira principal causa de mortalidade vascular no mundo e considerado o principal fator causador de mortes preveníveis em pacientes hospitalizados. O presente estudo tem … O tromboembolismo venoso (TEV) é a terceira principal causa de mortalidade vascular no mundo e considerado o principal fator causador de mortes preveníveis em pacientes hospitalizados. O presente estudo tem como objetivo identificar as principais etiologias e fatores de risco associados aos casos de tromboembolismo venoso (TEV) atendidos na Clínica de Especialidades Médicas da UNIFAL-MG, em Alfenas – MG. Neste estudo observacional retrospectivo baseado na revisão de prontuários de pacientes com diagnóstico de TEV atendidos na clínica de hematologia da UNIFAL entre janeiro de 2018 e julho de 2024. Foram coletados dados demográficos, fatores de risco, evolução clínica e tratamento. Os pacientes foram divididos em dois grupos: Grupo 1 e Grupo 2, conforme histórico clínico. O Grupo 1 apresentou idade média de 31,7 anos, com destaque para histórico familiar. O Grupo 2, com média de 41,2 anos, apresentou maior prevalência de obesidade e uso de anticoncepcional oral. Os principais sítios trombóticos foram os membros inferiores, com frequente evolução para embolia pulmonar. A estratificação etiológica revelou perfis clínicos distintos, reforçando a importância de abordagens individualizadas na prevenção e tratamento do TEV. Limitações como ausência de exames complementares e perda de seguimento foram observadas, mas os dados contribuem para o entendimento epidemiológico local e o aprimoramento das condutas clínicas.

Fexofenadine/methotrexate/triamcinolone

2025-06-21
| Reactions Weekly

Pulmonary embolism - large volume and right heart dysfunction

2025-06-20
Bruno Di Muzio | Radiopaedia.org

Identifying Barriers to Sequential Compression Device Compliance at a Rural Level 1 Trauma Center

2025-06-20
Alexander N. Mays , Aliya Burns , Anjeli Patel +3 more | The American Surgeon
Venous thromboembolism (VTE) risk is significantly higher for hospitalized trauma patients. Sequential compression devices (SCDs) serve as standard mechanical prophylaxis for VTE; however, compliance remains suboptimal. We examined frequency of … Venous thromboembolism (VTE) risk is significantly higher for hospitalized trauma patients. Sequential compression devices (SCDs) serve as standard mechanical prophylaxis for VTE; however, compliance remains suboptimal. We examined frequency of SCD usage and barriers to utilization. This prospective cohort study enrolled 119 trauma patients at a Level 1 Trauma Center between June 2024 and July 2024. Patients were observed for three days or until discharge. Patient education on SCDs was provided by investigators on observation day 1, and utilization was tracked. Among 119 patients, ICU usage (77.5%-100%) was significantly higher than PCU/Med Surg (42.0%-45.3%) (p&lt;0.001). Non-adherence initially stemmed from malfunctioning or absent equipment (p&lt;0.001) but later shifted to the underutilization of functioning SCDs (p&lt;0.001). Patients without chemical prophylaxis had higher odds of using SCDs (p=0.029). Non-ICU settings in particular faced equipment and monitoring challenges, which impaired utilization. Improving equipment availability, staff training, and patient education could enhance SCD prophylaxis.

Deep vein thrombosis in Ethiopia: a systematic review and meta-analysis, 2025

2025-06-20
Sadik Abdulwehab , Frezer Kedir | Thrombosis Journal
Deep Vein Thrombosis is a significant public health concern associated with high morbidity and mortality, mainly when left undiagnosed or untreated. In Ethiopia, fragmented data from various studies have reported … Deep Vein Thrombosis is a significant public health concern associated with high morbidity and mortality, mainly when left undiagnosed or untreated. In Ethiopia, fragmented data from various studies have reported varying prevalence and risk factors, necessitating a comprehensive synthesis. This systematic review aimed to identify and summarize the key factors contributing to deep vein thrombosis among patients in Ethiopia. The study used a systematic review and meta-analysis design, sourcing evidence from various electronic databases until April 04, 2025. Data was extracted from March 10-15 and analyzed from March 15-25, with the report generation until April 04, 2025. The mortality rate was assessed using the pooled odds ratio and the pooled proportion. A meta-analysis was conducted using R software, with forest plots for visual representation. Heterogeneity was evaluated using the I² statistic. The quality of the studies was assessed using validated tools. The review showed the pooled prevalence of deep vein thrombosis from eight articles was 5.6%( CI: 2.9, 8.5), with a 5% mortality rate (CI: 3, 8), and a 7.15%( CI: 2, 12) recurrence rate. Advanced age, being male, pregnancy, hypertension, diabetes, comorbid conditions, and a history of Deep Vein Thrombosis, high cholesterol level, orthopedic trauma, Alcohol consumption, and obesity, Patients with bilateral Deep Vein Thrombosis prolonged hospitalization, ward admission, and patient transfer from other hospitals, and use of central venous catheters were associate with increased the risk of Deep Vein Thrombosis development. The review showed that Deep Vein Thrombosis is a significant health concern in Ethiopia, with a prevalence of 5.6%, a mortality rate of 5%, and a recurrence rate of 7.15%. Factors such as advanced age, pregnancy, prior deep-vein thrombosis, comorbidities, intensive care unit admission, surgery, prolonged hospitalization, and central venous catheter use increase risk. To reduce DVT-related complications, routine risk assessments, early intervention strategies, and strengthened hospital protocols are essential. CRD420251024491 was registered with PROSPERO on 06 April 2025.

Improving Patient Care and Clinical Services: Compliance With the National Institute for Health and Care Excellence (NICE) Guidelines for Venous Thromboembolism Prophylaxis After Hip and Knee Arthroplasty

2025-06-20
Raja Muhammad Mussab , Mohanraj Venkatesan , Iftikhar Ahmad Khan +2 more | Cureus

Livedo racemosa secundaria a embolización de la arteria genicular en una paciente con artrosis de rodilla

2025-06-20
Lula María Nieto Benito , Pablo Fonda Pascual , Loreto Carrasco Santos | Medicina Clínica

Real-world practices of low-molecular-weight heparin for venous thromboembolism prophylaxis in patients hospitalized with COVID-19: a multicenter prospective study from China

2025-06-20
Fengrong Xu , Yuzhi Tao , Lijun Chen +7 more | Thrombosis Journal
Abstract Background Effective thromboprophylaxis is critical to reducing mortality and improving clinical outcomes in COVID-19 patients. Despite guidelines recommending prophylactic anticoagulation, particularly for those in intensive care, real-world adherence and … Abstract Background Effective thromboprophylaxis is critical to reducing mortality and improving clinical outcomes in COVID-19 patients. Despite guidelines recommending prophylactic anticoagulation, particularly for those in intensive care, real-world adherence and optimal venous thromboembolism (VTE) prevention strategies remain challenging, particularly in populations with complex comorbidities. Methods A prospective study was conducted on patients hospitalized with moderate, severe, and critical COVID-19 in six Chinese hospitals during the Omicron pandemic (December 2022-January 2023). The dose and duration of low-molecular-weight heparin (LMWH) were recorded. VTE, all-cause mortality and major bleeding events during hospitalization and 90-days follow-up were analyzed as endpoints. Results Among 4,236 COVID-19 patients, 1575 (37.09%) received LMWH prophylaxis, with 592 (37.6%) receiving reduced dosage (&lt; 4000IU/24 h). The multivariable logistic regression model revealed that age ≥ 65, elevated D-dimer levels, severely ill at admission and concomitant use of antiviral drugs or corticosteroids were the main factors influencing the initiation of LMWH thromboprophylaxis in hospitalized COVID-19 patients. Patients who were critically ill at admission were more likely to receive reduced doses of LMWH. The duration of thromboprophylaxis over 7 days was associated with reduced estimated glomerular filtration rate (eGFR) and concomitant use of antiviral drugs or corticosteroid, whereas shorter durations were observed in patients with platelet less than 100*10 9 /L and anemia. Conclusion Real-world thromboprophylaxis in hospitalized COVID-19 patients vary widely, with a significant proportion receiving lower-than-conventional doses of LMWH. There is a need for individualized thromboprophylaxis strategies that consider patient-specific factors such as disease severity, renal function, low platelet and anemia to optimize outcomes.

Impact of preoperative frailty on venous thromboembolism risk following total hip and knee arthroplasty: a meta-analysis

2025-06-20
Chang Lan , Ziqing Mao , Yun Zhou +7 more | International Journal of Surgery
Background: Frailty is commonly observed in older adults and may elevate the risk of venous thromboembolism (VTE) following total hip arthroplasty (THA) or total knee arthroplasty (TKA). This meta-analysis elucidates … Background: Frailty is commonly observed in older adults and may elevate the risk of venous thromboembolism (VTE) following total hip arthroplasty (THA) or total knee arthroplasty (TKA). This meta-analysis elucidates the association between frailty and the risk of postoperative VTE, encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), among patients undergoing THA or TKA. Materials and Methods: A systematic search was conducted across PubMed, Embase, and Web of Science through 22 August 2024, to identify relevant observational studies with longitudinal follow-up. Eligible studies reported on frailty status preoperatively and subsequent postoperative VTE events. We synthesized data using random-effects models that accounted for heterogeneity and performed subgroup analyses based on the type of surgery and duration of follow-up. Results: Our meta-analysis included fourteen cohort studies covering 2,218,293 patients. Analysis of univariate results from sixteen datasets showed that frailty was associated with an increased risk of VTE post-THA/TKA (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.84 to 2.93, p &lt;0.001). This association remained consistent across primary and revision THA/TKA surgeries. Frail patients exhibited heightened risk of DVT (OR: 1.41, 95% CI: 1.12 to 1.78, p = 0.004) and PE (OR: 1.59, 95% CI: 1.38 to 1.84, p &lt;0.001). Subgroup analyses revealed that the link with PE was more pronounced in studies with follow-ups of 90 days (OR: 7.42) than in studies with other follow-up durations (mostly 30 days). Multivariate analysis confirmed that frailty independently predicted increased risks of DVT (OR: 1.69) and PE (OR: 1.57). Conclusion: Preoperative frailty significantly heightens the risk of postoperative VTE, DVT, and PE in patients undergoing THA or TKA.

Hydrophilic Polymer Embolism: An Underappreciated Complication of Endovascular Procedures that Physicians Should be Aware Of

2025-06-20
Marco Parillo , Robert Peter Reimer , Carlo Augusto Mallio +2 more | CardioVascular and Interventional Radiology

Association between serum albumin levels and risk of deep vein thrombosis in diabetic patients: a retrospective case-control study

2025-06-20
Yanli Cao , Yang Li , Wenxiu Zhang +1 more | HORMONES

Age as a key risk factor for deep vein thrombosis in patients with lower limb cellulitis

2025-06-20
Romane Teshima , Natsuko Saito‐Sasaki , Yu Sawada | Frontiers in Medicine
Background Cellulitis of the lower extremities is a common bacterial skin infection that can lead to various complications, including deep vein thrombosis (DVT). Although previous studies have suggested an increased … Background Cellulitis of the lower extremities is a common bacterial skin infection that can lead to various complications, including deep vein thrombosis (DVT). Although previous studies have suggested an increased risk of thrombosis due to the pro-inflammatory state induced by cellulitis, the specific clinical characteristics and risk factors associated with DVT in cellulitis patients remain poorly understood. This study aims to identify the clinical characteristics and risk factors for DVT in patients with lower limb cellulitis. Methods We conducted a 10-year retrospective study of patients treated for lower limb cellulitis at our institution between January 2013 and December 2023. Patients who underwent ultrasound examination to assess for DVT were included in the analysis. Clinical data were collected, including age, D-dimer levels, C-reactive protein (CRP) levels, body mass index (BMI), duration of antibiotic treatment, and relevant medical history (e.g., diabetes, malignancy, the use of corticosteroids, and immunosuppressive agents). Statistical analyses were performed to identify risk factors for thrombosis. Results Among the patients included in the study, those who developed DVT were significantly older, with the majority being 70 years or older. No significant associations were found between thrombosis and other clinical parameters, including elevated CRP levels, D-dimer levels, BMI, or the duration of antibiotic treatment. Additionally, neither diabetes nor the use of corticosteroids or immunosuppressants showed a significant correlation with DVT development. Importantly, thrombosis occurred in both the affected and non-affected limbs, with no significant difference between them. Conclusion Age, particularly being 70 years or older, was identified as an independent risk factor for the development of DVT in patients with lower limb cellulitis. These findings suggest that advanced age plays a critical role in DVT development in cellulitis patients, and further investigation is needed to explore the underlying mechanisms.

The Influence of Differences in Surgical Access on the Development of Early Asymptomatic DVT After Inguinal Hernia Surgery

2025-06-19
Nanxiang Zhang , Chao Zhang , Yaqiang Shu +4 more | The American Surgeon
Objective This study aimed to examine the effect of surgical approach on the incidence of early asymptomatic deep vein thrombosis (DVT) following inguinal hernia surgery and to evaluate additional factors … Objective This study aimed to examine the effect of surgical approach on the incidence of early asymptomatic deep vein thrombosis (DVT) following inguinal hernia surgery and to evaluate additional factors influencing postoperative asymptomatic DVT formation. The study seeks to provide guidance and support for the diagnosis and treatment of early postoperative asymptomatic DVT. Methods The present study is a retrospective study. Our study finally included 565 patients with inguinal hernia divided into laparoscopic and open surgery groups. Bilateral lower extremity venous Doppler ultrasonography was performed on the second postoperative day to document the occurrence of asymptomatic DVT in the early postoperative period. A 1:1 matching was performed using propensity score matching (PSM). Independent factors affecting early postoperative asymptomatic DVT were determined using multivariate binary logistic regression analysis. Results There were 565 patients, in which 317 underwent laparoscopic surgery and 248 underwent open surgery. Propensity score matching yielded 102 matched pairs for further analysis. In multivariate analysis, bilateral hernias (OR = 50.546, 95% CI 2.277-1122.159, P = 0.013) and total length of stay (OR = 1.807, 95% CI 1.239-2.634, P = 0.002) were identified as independent risk factors for early postoperative asymptomatic DVT, whereas preoperative length of stay (OR = 0.341, 95% CI 0.162-0.719, P = 0.005) and operation time (OR = 0.965, 95% CI 0.936-0.995, P = 0.021) served as protective factors. There was no significant impact of laparoscopic or open surgery on the incidence of early postoperative asymptomatic DVT (OR = 1.808, 95% CI: 0.288-11.361, P = 0.528). Conclusion The choice of laparoscopic vs open inguinal hernia repair did not significantly affect the incidence of early postoperative asymptomatic DVT. In this study, effective perioperative management, whether through preoperative admission to manage significant comorbidities or a reduced overall length of stay, lowered the incidence of early postoperative asymptomatic DVT, particularly in patients with bilateral inguinal hernias.

Thromboinflammation vs. immunothrombosis: strategies for overcoming anticoagulant resistance in COVID-19 and other hyperinflammatory diseases. Is ROTEM helpful or not?

2025-06-19
Lou M. Almskog , Anna Ågren | Frontiers in Immunology
Thrombosis and inflammation are closely interconnected. Systemic inflammation activates the coagulation system, while components of the coagulation system can, in turn, significantly influence the inflammatory response. This process, where the … Thrombosis and inflammation are closely interconnected. Systemic inflammation activates the coagulation system, while components of the coagulation system can, in turn, significantly influence the inflammatory response. This process, where the immune system contributes to thrombus formation, is known as immunothrombosis. Conversely, thromboinflammation describes the effect of thrombus formation on the immune system. Various immune cells, including neutrophils and monocytes, play key roles in these processes, as well as endothelial cells, strategically positioned to rapidly detect and respond to invading pathogens. Platelets are also actively recruited, promoting coagulation and releasing procoagulant factors. When the endothelium becomes dysfunctional and acquires proinflammatory and procoagulant properties, it fosters the formation of microvascular thrombosis. The excessive release of proinflammatory cytokines and chemokines further intensifies this cycle, contributing to cytokine storms, as observed in severe COVID-19 cases. This phenomenon exemplifies immunothrombosis and thromboinflammation. Anticoagulant therapy is standard care for venous thromboembolism prevention in Intensive Care Unit patients, with critically ill COVID-19 patients often receiving higher doses. However, variations in individual responses to heparin were observed in COVID-19 patients, suggesting a degree of resistance to anticoagulant therapy. This resistance may be linked to thromboinflammation, where the intense inflammatory response diminishes the effectiveness of anticoagulation. In this context, combining anticoagulants with immunomodulatory drugs has shown promising potential. This review aims to delve into the concepts of immunothrombosis and thromboinflammation, with a particular focus on the complex interplay between the coagulation and inflammation systems and their mutual reinforcement in the context of COVID-19. We examine why standard anticoagulant therapies often proved insufficient in managing hyperinflammatory diseases and discuss potential alternative treatment strategies. Furthermore, we evaluate the potential role of rotational thrombelastometry (ROTEM) in managing immunothrombotic states.

The value of echocardiography in predicting pulmonary thromboembolic disease

2025-06-19
V. Grigorov , J.D. Esser , M Grigorov +3 more | Journal of Biomedical and Clinical Research
This is a 200-patient retrospective single-centre study focused on evaluating the contribution of echocardiography (Echo) findings as an initial screening tool in selecting intensive care unit (ICU) patients with suspected … This is a 200-patient retrospective single-centre study focused on evaluating the contribution of echocardiography (Echo) findings as an initial screening tool in selecting intensive care unit (ICU) patients with suspected pulmonary embolism (PE) for further diagnostic evaluation with ventilation/perfusion (V/Q) scintigraphy. These 200 patients with suspected PE were referred for a V/Q scan. Of them, 24 had &amp;#1045;cho findings of a dilated right ventricle (RV), and 8 of the 24 (33%) had a positive V/Q scan for PE. Seven of those 8 patients (88%) had large pulmonary emboli. Of the remaining 176 patients (without dilated RV), the V/Q scan was positive for pulmonary emboli in 39 cases (22%). If evaluating only the patients positive for pulmonary emboli on V/Q scan (47 patients), 8 of them (17%) had a dilated RV, and 39 (83%) did not have a dilated RV. Thus, we found that &amp;#1045;cho mainly contributed to identifying patients with life-threatening large pulmonary thrombo-embolic disease. In contrast to the above, echocardiography was non-contributory in the presence of small PE. This finding was in congruence with the existing literature.

Response to letter to the editor: Antithrombotic treatment of cervical arterial dissection: Big data needed to inform long-term management

2025-06-19
Lukas Enz , Josefin Emelie Kaufmann , Christopher Traenka +1 more | European Stroke Journal

Temps de Quick (taux de prothrombine), International normalized ratio

2025-06-19
Georges Jourdi , Leyla Calmette , Emmanuel de Maistre +3 more | EMC - Traité de médecine AKOS

Identification of a Deep Vein Thrombosis in a Dark-Skinned Male: Finding Limitations in the Wells Criteria

2025-06-19
Denis Morris , Kathleen Geist , J Zych +1 more | JOSPT Cases
BACKGROUND: The prevalence of postoperative complications following Achilles tendon repair is approximately 11.6%, with deep vein thrombosis (DVT) representing a significant risk. CASE PRESENTATION: This case study presents a 31-year-old … BACKGROUND: The prevalence of postoperative complications following Achilles tendon repair is approximately 11.6%, with deep vein thrombosis (DVT) representing a significant risk. CASE PRESENTATION: This case study presents a 31-year-old African American male who developed multiple DVTs four weeks post-surgery. Despite a low score on the Wells Criteria, which assesses DVT risk, the patient's clinical presentation, severe calf pain, and localized tenderness warranted further investigation. OUTCOME AND FOLLOW-UP: Following urgent vascular testing, the patient was diagnosed with DVT and initiated anticoagulant therapy. DISCUSSION: The case underscores limitations of the Wells Criteria when applied to dark-skinned individuals, highlighting the necessity for extra vigilance and thorough clinical assessments in postoperative patients, especially those at higher risk for complications. Future research should explore the diagnostic accuracy of DVT screening tools across diverse populations to improve clinical outcomes for dark-skinned patients.

Missed Venous Thromboembolism Prophylaxis in ICU Patients: A Retrospective Cohort Study Using the Medical Information Mart for Intensive Care IV (MIMIC-IV)

2025-06-19
Rohan Muchintala , Ali Fahim Khan , Kartik Kalia +1 more | Cureus

How to manage safely direct oral anticoagulants in patients undergoing a neuraxial procedures? No definite answer yet!

2025-06-19
Charles Marc Samama | Journal of Thrombosis and Haemostasis

Empiricism, cancer, venous thromboembolism, and anticoagulation failures

2025-06-19
Robert D. McBane | Journal of Thrombosis and Haemostasis

Outpatient versus inpatient treatment for acute pulmonary embolism.

2021-12-01
Hugo Hyung Bok Yoo , Vania Santos Nunes-Nogueira , Paulo José Fortes Villas Bôas +1 more

Characteristics of isolated superficial vein thrombosis and diagnostictherapeutic management in Spanish hospital emergency departments: the ALTAMIRA study.

2021-12-01
Fahd Beddar Chaib , Sònia Jiménez Hernández , José María Pedrajas Navas +7 more
To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound … To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy).Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy.A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). Anticoagulant agents were prescribed for 898 (77%) for a median period of 22 days. Variables associated with a decision to order anticoagulants were a history of venous thromboembolic disease (odds ratio [OR], 1.60; 95% CI, 1.12-2.30), varicose veins (OR, 1.40; 95% CI, 1.12-2.30); limb pain (OR, 1.44; 95% CI, 1.08-1.91); painful cord (OR, 1.30; 95% CI, 0.97-1.73); and availability of vein ultrasound images (OR, 1.60; 95% CI, 1.94-3.45).Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement.Describir las características de los pacientes diagnosticados de trombosis venosa superficial (TVS) aislada de miembros inferiores en servicios de urgencias hospitalarios (SUH), y evaluar la adherencia a las guías de práctica clínica en el manejo diagnóstico y terapéutico (realización de ecografía venosa e instauración de tratamiento anticoagulante).. Estudio de cohortes retrospectivo en 18 SUH españoles. Se incluyeron todos los pacientes atendidos en los SUH con diagnóstico final de TVS en miembros inferiores, con edad $ 18 años, de enero de 2016 a mayo de 2017. Para evaluar la no adherencia a las recomendaciones de las guías de práctica clínica (realización de ecografía venosa, e instauración de tratamiento anticoagulante) se ajustó un modelo de regresión logística múltiple por pasos hacia atrás.. Mil ciento sesenta y seis pacientes fueron incluidos. La edad media fue de 59,6 años, el 67,9% eran mujeres. El 24,4% tenían antecedentes de enfermedad tromboembólica venosa (ETV). El 8,9% tuvieron alguna complicación a 180 días [4,6% recurrencia y 3,6% progresión de TVS, 1,8% trombosis venosa profunda (TVP) y 0,9% tromboembolia pulmonar (TEP)]. Hubo 17 pacientes (1,5%) con hemorragia y 16 (1,4%) muertes. Se realizó ecografía venosa a 703 (60,3%) pacientes. Recibieron tratamiento anticoagulante 898 (77%), con una mediana de 22 días. Las variables asociadas con la decisión de anticoagular fueron: antecedentes ETV (OR 1,60; IC 95%: 1,12-2,30), varices (OR 1,40; IC 95%: 1,12-2,30), dolor de la extremidad (OR 1,44; IC 95%: 1,08-191), presencia de cordón doloroso (OR 1,30; IC 95%: 0,97-1,73) y realización de ecografía venosa (OR 1,60; IC 95%: 1,94-3,45).Existe una baja adherencia a las recomendaciones de las guías de práctica clínica en el manejo diagnóstico y terapéutico de los pacientes con diagnóstico de TVS aislada de miembros inferiores en los SUH españoles: no se realiza ecografía venosa en uno de cada 2-3 pacientes, y no se instaura tratamiento anticoagulante en 1 de cada 4. Esto constituye un margen de mejora muy relevante.