1
|
Mangiafico M, Costanzo L. Superficial Venous Thrombosis: A Comprehensive Review. Healthcare (Basel) 2024; 12:500. [PMID: 38391875 PMCID: PMC10888259 DOI: 10.3390/healthcare12040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Superficial venous thrombosis (SVT), an inflammatory-thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives.
Collapse
Affiliation(s)
- Marco Mangiafico
- Unit of Internal Medicine, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95123 Catania, Italy
| | - Luca Costanzo
- Unit of Angiology, Department of Cardio-Thoraco-Vascular, Policlinico "G. Rodolico-San Marco" University Hospital, University of Catania, 95123 Catania, Italy
| |
Collapse
|
2
|
Mathieu ME, Duffett L, Caiano L, Scarvelis D, Code C, Wells P, Le Gal G. Management and outcomes of superficial vein thrombosis: a single-center retrospective study. Res Pract Thromb Haemost 2024; 8:102263. [PMID: 38187826 PMCID: PMC10770555 DOI: 10.1016/j.rpth.2023.102263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 01/09/2024] Open
Abstract
Background Guidelines suggest but cannot recommend the optimal management of superficial vein thrombosis (SVT). Objectives To identify the prevalence of asymptomatic deep vein thrombosis (DVT) at the time of SVT diagnosis, and to report the treatment and 3-month complications of patients with only SVT more than 3 cm from deep vein junction (or unknown distance). Methods We performed a single-center retrospective review of patients referred to the Ottawa Hospital thrombosis unit with ultrasound (US)-diagnosed SVT, and followed patients with only SVT for 3 months. Results Three hundred sixteen patients with SVT were included. Of the 218 patients without DVT symptoms at presentation, 19 (8.7%; 95% CI, 5.7%-13.2%) were found to have asymptomatic concomitant DVT (11 proximal and 8 distal), and 45 (20.6%) had SVT within 3 cm of the saphenofemoral or saphenopopliteal junctions. Among the 192 patients diagnosed with SVT only, we observed 3-month thrombotic complications in 56 (29.2%; 95% CI, 23.2%-36.0%) patients, with a total of 69 events: 11 (5.7%) DVTs, 2 (1.0%) pulmonary embolisms, 37 (19.2%) SVT extensions, and 19 (9.8%) SVT recurrences. Eighty-two percent (9/11) of the 3-month DVT and pulmonary embolism events occurred in patients who initially received conservative management. Therapeutic treatment doses were most effective. Conclusion At the time of SVT diagnosis, many patients had asymptomatic DVT and SVT near the deep venous system, supporting the systematic use of initial US in patients clinically diagnosed with SVT. The observed differences in 3-month complication rates, according to the treatment provided, highlight the need for large-scale randomized controlled trials to establish optimal management.
Collapse
Affiliation(s)
- Marie-Eve Mathieu
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Duffett
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lucia Caiano
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dimitri Scarvelis
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catherine Code
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Philip Wells
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Gajarla SB, Davila N, Guiseppi R, MomPremier M. A Case of Atraumatic Angular Vein Thrombosis. Cureus 2024; 16:e52465. [PMID: 38371016 PMCID: PMC10873516 DOI: 10.7759/cureus.52465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Angular vein thrombosis is a rare vascular disorder marked by the occlusion of the angular vein by a blood clot. We report the case of a 70-year-old woman who presented with a visible bulge near her left nasojugal groove for one week and had no other associated symptoms or pertinent medical history. Subsequent maxillofacial CT scans with contrast revealed left angular vein thrombosis with dilation of the facial vein inferiorly. Despite its rarity, angular vein thrombosis poses a diagnostic challenge due to overlapping symptoms with other vascular and nonvascular pathologies. This case highlights the importance of early identification to prevent complications such as facial venous circulation obstruction and clot migration to the cavernous sinus.
Collapse
Affiliation(s)
- Sneha B Gajarla
- Department of Ophthalmology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Natalia Davila
- Department of Ophthalmology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Rodney Guiseppi
- Department of Ophthalmology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Mikelson MomPremier
- Department of Ophthalmology, University of Texas Medical Branch at Galveston, Galveston, USA
| |
Collapse
|
4
|
Popovych YM, Kostiunin VS. Ultrasound assessment of the risk of venous thromboembolic complications in thrombosis of varicose transformed tributaries of the great saphenous vein. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:1004-1010. [PMID: 39008590 DOI: 10.36740/wlek202405120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Aim: To evaluate the ultrasound criteria for venous thromboembolic complications in patients with thrombosis of varicose veins of the tributaries of the great saphenous vein (GSV). PATIENTS AND METHODS Materials and Methods: The results of ultrasound examination of 52 patients with thrombosis of varicose veins of the tributaries of GSV were analyzed. The indicators of venous hemodynamics were compared with the control group (CG) (n=32). RESULTS Results: Varicose transformation of GSV and failure of its valvular apparatus were detected in 44 (84.6%) patients, in 8 (15.4%) patients the superficial venous highway was intact. Vertical reflux was diagnosed in varicose ectasia of GSV: local reflux in 14 (31.8%), widespread reflux in 14 (31.8%), and total reflux in 16 (36.4%) patients. The diameter of GSV in tributary varicothrombophlebitis was 8.9±0.27 mm (p<0.05 vs. CG) and 11.2±0.25 mm (p<0.05 vs. CG) in the horizontal and vertical positions, respectively. The proximal and distal borders of thrombosis exceeded the clinical ones by 15.26±1.21 cm (p<0.05) and 7.94±1.32 cm (p<0.05), respectively. The spread of tributary thrombophlebitis to the superficial venous highway was detected in 14 (26.9%) patients, among whom 12 (85.7%) patients had unfixed apices of thrombotic masses. CONCLUSION Conclusions: The results obtained convincingly demonstrate the need for early ultrasound examination of patients with tributary thrombophlebitis, which allows to identify the real limits of the thrombotic process, timely diagnose the transition of the thrombotic process to superficial and deep venous lines, effectively predict the risk of venous thromboembolic complications and choose the optimal surgical tactics.
Collapse
Affiliation(s)
- Yaroslav M Popovych
- STATE HIGHER EDUCATIONAL ESTABLISHMENT ≪UZHHOROD NATIONAL UNIVERSITY≫, UZHHOROD, UKRAINE
| | - Volodymyr S Kostiunin
- STATE HIGHER EDUCATIONAL ESTABLISHMENT ≪UZHHOROD NATIONAL UNIVERSITY≫, UZHHOROD, UKRAINE
| |
Collapse
|
5
|
Song JH, Chun KC, Han GH, Yang SW, Yoon SH, Yuk JS, Ahn J, Nam SH, Kim J, Kim M. Case Report: Upper limb superficial venous thrombosis associated with oral contraceptives mimicking soft tissue mass. Front Cardiovasc Med 2023; 10:1263662. [PMID: 38028493 PMCID: PMC10679400 DOI: 10.3389/fcvm.2023.1263662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Venous thrombosis associated with the use of oral contraceptives (OCs) occurs mostly in the deep veins of the lower extremity. A lesion of the upper extremity is rare, and the majority of thrombotic events that occur in the superficial vein of the upper extremity are caused by intravenous catheters. We present a rare case of superficial venous thrombus on the upper extremity in a woman with a history of long-term OC use. Case presentation A 35-year-old woman, with an 8-year history of OC use, presented with a 2-year history of painfully palpable masses on her left forearm. The lesion mimicking soft tissue mass was confirmed to be superficial venous thrombi through ultrasound and magnetic resonance imaging. Conservative treatment including non-steroidal anti-inflammatory drugs, vasoprotective agents, and aspirin was prescribed. Through consultation with the Department of Obstetrics and Gynecology, it was confirmed that the current OCs could be discontinued, and the pain was almost relieved after conservative treatment. Conclusions If thrombotic events occur in the superficial vein of the upper extremity without intravenous catheters, detailed medical history taking and the possibility of OCs should be considered.
Collapse
Affiliation(s)
- Jun Hyeong Song
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Kyoung-Chul Chun
- Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, Republic of Korea
| | - Gwan Hee Han
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jaeki Ahn
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Sang Hyun Nam
- Department of Plastic Surgery, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jongwoo Kim
- Department of Family Medicine, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Myounghwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Rabe E, Hoffmann U, Schimke A, Heinken A, Langer F, Noppeney T, Pittrow D, Klotsche J, Gerlach HE, Bauersachs R. Determinants of Late Venous Thromboembolic Events After Acute Isolated Superficial Vein Thrombosis in Daily Practice: 12 Month Results of the INSIGHTS-SVT Study. Eur J Vasc Endovasc Surg 2023; 66:697-704. [PMID: 37573936 DOI: 10.1016/j.ejvs.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/11/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Long term incidence of symptomatic venous thromboembolism (VTE) and bleeding events in patients with superficial vein thrombosis (SVT) was investigated. METHODS In this prospective, observational study, patients with acute SVT were treated at the discretion of the responsible physician. The primary efficacy outcome was symptomatic VTE including deep vein thrombosis (DVT), pulmonary embolism (PE), and recurrent or extending SVT. The primary safety outcome was clinically relevant bleeding, recorded at periodic clinic visits over a 12 month period. RESULTS The mean age of 872 patients with 12 month follow up was 60.6 ± 14.5 years, 64.5% were female, 80.1% had chronic venous disease (defined as chronic venous insufficiency and or varicose veins), and 41.9% had a history of VTE. They were receiving fondaparinux in 62.1% (mean duration 34.9 ± 15.7 days), low molecular weight heparin (LMWH) in 25.0% (mean duration 26.2 ± 23.2 days), any other anticoagulants in 6.2%, and no anticoagulant in 6.7%. At 12 months, 108 patients (14.3%) achieved the primary efficacy outcome. The most common VTE event was recurrent or extending SVT in 11.0%, followed by symptomatic DVT in 2.7%, symptomatic PE in 2.4%, hospitalisation due to VTE in 1.8%, and death in 1.1%. Clinically relevant bleeding events occurred in 2.1% of patients, and major bleedings in 0.3%. By drug, the rate of the primary efficacy outcome was highest in the LMWH group (22.4%) and lowest in the fondaparinux group (10.4%). In a multivariable model, patients with events between three months and 12 months were significantly more likely to have higher BMI (hazard ratio [HR] 1.06; p = .002), history of VTE (HR 2.89; p = .002), and severe systemic infections (HR 7.59; p = .006). CONCLUSION The risk of symptomatic VTE remained elevated over 12 months of follow up. Therefore, anticoagulation beyond 45 days may be considered in patients with risk factors. [ClinicalTrials.gov identifier: NCT02699151.].
Collapse
Affiliation(s)
- Eberhard Rabe
- Praxis für Dermatologie & Phlebologie PD Dr. Pannier, Bonn, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilian University, Munich, Germany
| | | | | | - Florian Langer
- II. Medical Clinic and Policlinic, Centre for Oncology, University Medical Centre Eppendorf, Hamburg, Germany
| | - Thomas Noppeney
- Department of Vascular and Endovascular Surgery, University Hospital, Regensburg, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany; Innovation Centre Real World Evidence, GWT-TUD GmbH, Dresden, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, ein Institut der Leibniz-Gemeinschaft, Epidemiology and Health Services Research, Berlin, Germany
| | | | - Rupert Bauersachs
- Center for Thrombosis and Haemostasis, University Medical Centre Mainz, Mainz, Germany; Cardioangiologisches Centrum Bethanien CCB, Standort AGAPLESION Bethanien Krankenhaus, Frankfurt am Main, Germany.
| |
Collapse
|
7
|
Raja A, Karch J, Shih AF, De La Garza H, De Zepeda Diaz AJ, Maymone MBC, Phillips TJ, Secemsky E, Vashi N. Part II: Cutaneous manifestations of peripheral vascular disease. J Am Acad Dermatol 2023; 89:211-226. [PMID: 35504485 DOI: 10.1016/j.jaad.2021.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 10/18/2022]
Abstract
In this Part 2 of a 2-part continuing medical education series, we review the epidemiology of peripheral vascular disease, its association with cutaneous symptoms, and the diagnosis and evaluation of cutaneous features of vascular disorders. As peripheral vascular disease becomes more prevalent globally, it is essential for dermatologists to become competent at accurately recognizing and diagnosing cutaneous manifestations and directing individuals to receive appropriate care and treatment.
Collapse
Affiliation(s)
- Aishwarya Raja
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jamie Karch
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Allen F Shih
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Henriette De La Garza
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Mayra B C Maymone
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Tania J Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric Secemsky
- Smith Center for Outcomes Research, Departments of Cardiology and Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts; Department of Dermatology, US Department of Veteran Affairs, Boston Health Care System, Boston, Massachusetts.
| |
Collapse
|
8
|
Rudnin S, Kaminsky J, Ghosh R, Webb R, Fu W, Tama M, Hayim M, Hahn B, Greenstein J. Distribution of Lower Extremity Deep Vein Thrombosis and Implications for Limited Compression Ultrasound Examinations. J Emerg Med 2022; 63:348-354. [PMID: 36115745 DOI: 10.1016/j.jemermed.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/18/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Limited compression bedside ultrasonography (LCUS) including two-point, three-point, and extended compression examinations have become increasingly popular among emergency physicians to assess for lower extremity deep venous thrombosis (DVT). OBJECTIVE Our objective in this study was to determine the prevalence and distribution of lower extremity DVT in sites identified by complete duplex ultrasonography (CDUS) that may potentially be missed using limited compression ultrasonography techniques. METHODS This was a retrospective, multicenter study conducted at 12 hospitals within the Northwell Health system over a span of 4 years. Study participants (emergency department patients) underwent CDUS to assess for possible DVT. Images were reviewed and interpreted by radiologists and vascular surgeons at each of the participating institutions. RESULTS A total of 42,487 CDUS examinations were performed, of which 3383 were positive for DVT. DVTs were deemed to be acute in 2664 (79%) and chronic in the remaining 21% on the basis of comparison with previous studies and appearance of the vein. Of the acute DVTs, 136 (5.1%) were confined to the common femoral vein, 116 (4.4%) to the femoral vein, 8 (0.3%) to deep femoral vein, 213 (8.0%) to popliteal vein, and 934 (35.1) to calf veins alone. CONCLUSIONS In our study, a significant number of DVTs were identified in sites that may have been potentially missed on LCUS examinations, thereby supporting the use of complete duplex ultrasonography when available.
Collapse
Affiliation(s)
- Simone Rudnin
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Jennifer Kaminsky
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Radhika Ghosh
- Department of Pediatrics, Northwell Health, Emory University Hospital, Atlanta, Georgia
| | - Ryan Webb
- Department of Radiology, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Wayne Fu
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Maria Tama
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Morris Hayim
- Department of Radiology, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Barry Hahn
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Josh Greenstein
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| |
Collapse
|
9
|
Sun D, Liu J, Xue L, Li L, Xie D, Li S, Li S, Wang X, Yin D, Ren Z, Bai R, Guo W, Liu Y, Chen C. A solid ultrasonic coupling membrane for superficial vascular ultrasonography. NANOSCALE 2022; 14:3545-3553. [PMID: 35174834 DOI: 10.1039/d1nr05353a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Superficial thrombophlebitis is one of the most significant complications of superficial vein thrombosis. Rapid imaging and mapping with high resolution is particularly important for accurate diagnosis so as to carry out treatment as soon as possible. Ultrasound imaging technology has been used extensively because of the low-cost, minimal invasiveness, and convenient application in clinical practice. And the ultrasonic couplant is an essential component in ultrasound examination. However, when imaging superficial structures, traditional liquid ultrasonic couplants often produce inadequate results. In this study, we investigate whether a hydrogel membrane can be used to improve the imaging of superficial vessels. To this end, we generated a polyacrylamide-bacterial nanocellulose hydrogel membrane (PAM-BC) that efficiently forms at 60 °C in only 10 min by redox polymerization. With PAM-BC-2.5, it was possible to acquire high resolution intravascular ultrasound images to assess superficial vessels in humans and the superficial vasculature in rats and miniature pigs using various brands of ultrasound instruments. The PAM-BCs represent a new, solid ultrasonic membrane which is suitable for diagnosing disease in superficial vessels.
Collapse
Affiliation(s)
- Di Sun
- GBA National Institute for Nanotechnology Innovation, Guangzhou, Guangdong 510700, P.R. China.
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| | - Jie Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.
| | - Lijuan Xue
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.
| | - Li Li
- Department of Ultrasound, Hospital of Renmin University of China, Beijing 100872, P.R. China
| | - Daoyin Xie
- Department of Echocardiography, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shilin Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| | - Shengmei Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| | - Xinlian Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| | - Dongtao Yin
- PLA Rocket Force Characteristics Medical Center, Beijing 100888, P.R. China
| | - Zhaoqi Ren
- PLA Rocket Force Characteristics Medical Center, Beijing 100888, P.R. China
| | - Ru Bai
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.
| | - Ying Liu
- GBA National Institute for Nanotechnology Innovation, Guangzhou, Guangdong 510700, P.R. China.
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| | - Chunying Chen
- GBA National Institute for Nanotechnology Innovation, Guangzhou, Guangdong 510700, P.R. China.
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, P.R. China.
| |
Collapse
|
10
|
Venous Thromboembolism. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
Loftus JR, Hu Z, Morin BR, Hobbs SK, Francis CW, Khorana AA, Rubens DJ, Kaproth-Joslin KA. Vascular Imaging in the Asymptomatic High-risk Cancer Population: A Role for Thrombosis Screening and Therapy Management. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:225-236. [PMID: 33772825 DOI: 10.1002/jum.15701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We retrospectively examined the venous thromboembolism (VTE) events diagnosed in the Prophylaxis of High-Risk Ambulatory Cancer Patients Study (PHACS), a multi-center randomized trial, to assess the value of screening vascular imaging for the diagnosis of incidental VTE in high-risk cancer patients. METHODS A total of 117 asymptomatic cancer patients with a Khorana score ≥3 starting a new systemic chemotherapy regimen were enrolled in a prospective randomized control trial. Patients underwent baseline venous ultrasound (US) of the lower extremities (LEs) and screening contrast-enhanced chest computed tomography (CT). Those without preexisting VTE were then randomized into observation or dalteparin prophylaxis groups and were screened with serial US every 4 weeks for up to 12 weeks and imaged with contrast-enhanced chest CT at 12 weeks. Any additional imaging performed during the study period was also evaluated for VTE. RESULTS Baseline prevalence of incidental VTE was 9% (n = 10) with 58% percent of VTEs diagnosed by screening US. Incidence of VTE in the randomized phase of the trial was 16% (n = 16) with 21% (n = 10) of patients in the control arm and 12% (n = 6) of patients in the dalteparin arm developing VTE, a non-significant 9% absolute risk reduction (HR = 0.69, 95% CI 0.23-1.89). Sixty-nine percent of these patients were asymptomatic with 31% of patients diagnosed by screening US. CONCLUSIONS Adding screening US to routine oncologic surveillance CT in high-risk ambulatory cancer patients with a Khorana score ≥3 can lead to increased VTE detection, with potential for decreased morbidity, mortality, and health care spending.
Collapse
Affiliation(s)
- James Ryan Loftus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Zhongxia Hu
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Burke R Morin
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Susan K Hobbs
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles W Francis
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Alok A Khorana
- Department of Hematology and Oncology, Cleveland Clinic Main Campus, Cleveland, Ohio, USA
| | - Deborah J Rubens
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | | |
Collapse
|
12
|
Chenna S, Chippa V. Acute pulmonary embolism due to right basilic vein thrombosis. BMJ Case Rep 2021; 14:e244280. [PMID: 34380686 PMCID: PMC8359449 DOI: 10.1136/bcr-2021-244280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old African-American woman presented to the emergency room (ER) with right upper extremity pain for 3 hours after sleeping overnight on that side. She was diagnosed with basilic vein thrombosis; in the ER, she was tachycardic with minimal ambulation, prompting CT pulmonary angiogram, which confirmed right-sided pulmonary embolism. Bilateral upper and lower extremity venous Dopplers did not show any acute deep venous thrombosis. She received appropriate anticoagulation. Risk factors are a smoker and recently started contraceptive pills.
Collapse
Affiliation(s)
- Swetha Chenna
- Internal Medicine, Ascension Indiana, Evansville, Indiana, USA
| | - Venu Chippa
- Internal Medicine, Ascension Indiana, Evansville, Indiana, USA
| |
Collapse
|
13
|
Goldenberg M, Wang H, Walker T, Kaffenberger BH. Clinical and immunologic differences in cellulitis vs. pseudocellulitis. Expert Rev Clin Immunol 2021; 17:1003-1013. [PMID: 34263717 DOI: 10.1080/1744666x.2021.1953982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: The immunologic mechanisms between cellulitis and pseudocellulitis differ greatly, even though their clinical presentations may overlap.Areas covered: This article discusses cellulitis and common entities within the pseudocellulitis spectrum including acute lymphedema, superficial venous thrombosis, allergic contact dermatitis, lipodermatosclerosis, stasis dermatitis, erythema nodosum, cutaneous gout, and bursitis. The literature search was conducted from PubMed search engine between March and May 2021.Expert commentary: While immunologic differences in cellulitis and the various entities of pseudocellulitis are clear, there is a practice gap in applying these differences to the clinic and hospital setting. Further, existing studies are weakened by the lack of a gold-standard diagnosis in this disease category. Additional work is necessary in developing a gold-standard for the diagnosis and secondly, to project these immunologic differences as biomarkers to differentiate sterile inflammation from a potential life threatening bacterial or fungal infection.
Collapse
Affiliation(s)
- Michael Goldenberg
- Division of Dermatology, Ohio State University College of Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Henry Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Trent Walker
- Division of Dermatology, Ohio State University College of Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
14
|
Bauersachs R, Gerlach HE, Heinken A, Hoffmann U, Langer F, Noppeney T, Pittrow D, Klotsche J, Rabe E. Management and Outcomes of Patients with Isolated Superficial Vein Thrombosis under Real Life Conditions (INSIGHTS-SVT). Eur J Vasc Endovasc Surg 2021; 62:241-249. [PMID: 34210599 DOI: 10.1016/j.ejvs.2021.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/05/2021] [Accepted: 04/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Management and outcomes of superficial vein thrombosis (SVT) are highly variable and not well described. Therefore, the INvestigating SIGnificant Health TrendS in the management of SVT (INSIGHTS-SVT) study collected prospective data under real life conditions. METHODS Prospective observational study of objectively confirmed acute isolated SVT. The primary outcome was a composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), and extension or recurrence of SVT at three months. The primary safety outcome was clinically relevant bleeding. RESULTS A total of 1 150 patients were included (mean age 60.2 ± 14.7 years; 64.9% women; mean BMI 29.4 ± 6.3 kg/m2). SVT was below the knee in 54.5%, above the knee in 26.7%, above and below the knee in 18.8%. At baseline, 93.6% received pharmacological treatment (65.7% fondaparinux, 23.2% heparins, 4.3% direct oral anticoagulants [DOACs], 14.5% analgesics), 77.0% compression treatment, and 1.9% surgery; 6.4% did not receive any anticoagulation. The primary outcome occurred in 5.8%; 4.7% had recurrent or extended SVT, 1.7% DVT, and 0.8% PE. Clinically relevant non-major bleeding occurred in 1.2% and major bleeding in 0.3%. Complete clinical recovery of SVT was reported in 708 patients (62.4%). Primary outcome adjusted by propensity score and for treatment duration was lower with fondaparinux compared with low molecular weight heparin (4.4% vs. 9.6%; hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.3 - 0.9; p = .017). On multivariable analysis, associated factors for primary outcome included another SVT prior to the present SVT event (HR 2.3), age per year (HR 0.97), duration of drug treatment per week (HR 0.92), and thrombus length (HR 1.03). CONCLUSION At three month follow up, patients with isolated SVT are at risk of thromboembolic complications (mainly recurrent or extended SVT), despite anticoagulation. In this real life study, about one third had received either heparins, oral anticoagulants, or no anticoagulation.
Collapse
Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany; Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Germany.
| | | | | | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Langer
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum, Universitäres Cancer Centre Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Thomas Noppeney
- Department for Vascular and Endovascular Surgery, Martha-Maria Hospital Nuremberg, Germany; Department for Vascular and endovascular Surgery, Regensburg University Hospital, Regensburg, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany
| | - Jens Klotsche
- Epidemiology, German Rheumatism Research Centre Berlin (DRFZ), Berlin, Germany
| | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| |
Collapse
|
15
|
Stone MJ, Natalwala I, Holmes W. Reply to Microvascular breast reconstruction and thromboembolic events in patients on hormone therapy: audit of practice from a tertiary referral centre. J Plast Reconstr Aesthet Surg 2021; 74:2392-2442. [PMID: 33824089 DOI: 10.1016/j.bjps.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022]
Affiliation(s)
- M J Stone
- The Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, United Kingdom.
| | - I Natalwala
- The Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom
| | - W Holmes
- The Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, United Kingdom
| |
Collapse
|
16
|
Dubois-Silva Á, Barbagelata-López C, Piñeiro-Parga P, Francisco I, Falgá C, Tirado R, Suriñach JM, Vela JR, Mella C, Quere I, Siniscalchi C, Monreal M. Prognostic Significance of Concomitant Superficial Vein Thrombosis in Patients with Deep Vein Thrombosis of the Lower Limbs. Thromb Haemost 2021; 121:1650-1659. [PMID: 33677826 DOI: 10.1055/a-1414-5055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prognostic significance of concomitant superficial vein thrombosis (SVT) in patients with lower-limb deep vein thrombosis (DVT) has not been consistently evaluated. METHODS We used the RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry to compare the rates of subsequent pulmonary embolism (PE), recurrent DVT, major bleeding or death in patients with lower-limb DVT, according to the presence or absence of concomitant SVT. RESULTS From March 2015 to May 2020, there were 8,743 patients with lower-limb DVT. Of these, 745 (8.5%) had concomitant SVT. Most patients (97.4% in both subgroups) received anticoagulant therapy (median duration: 138 vs. 147 days). During follow-up (median: 193 vs. 210 days), 156 (1.8%) patients developed subsequent PE, 336 (3.8%) had recurrent DVT, 201 (2.3%) had major bleeding and 844 (9.7%) died. Patients with concomitant SVT had a higher rate of subsequent PE (rate ratio [RR]: 2.11; 95% confidence interval [95%CI]: 1.33-3.24) than those with isolated DVT, with no significant differences in the rates of recurrent DVT (RR: 0.80; 95%CI: 0.50-1.21), major bleeding (RR: 0.77; 95%CI: 0.41-1.33) or death (RR: 0.81; 95%CI: 0.61-1.06). On multivariable analysis, patients with DVT and SVT concomitantly were at increased risk of subsequent PE during anticoagulation (adjusted hazard ratio [HR]: 2.23; 95%CI: 1.22-4.05) and also during the entire follow-up period (adjusted HR: 2.33; 95%CI: 1.49-3.66). CONCLUSION Patients with lower-limb DVT and SVT concomitantly are at increased risk of developing PE. Further studies are needed to externally validate our findings and to determine if these patients could benefit from a different management strategy.
Collapse
Affiliation(s)
- Álvaro Dubois-Silva
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain.,Universidade da Coruña, A Coruña, Spain
| | - Cristina Barbagelata-López
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
| | - Patricia Piñeiro-Parga
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
| | - Iria Francisco
- Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, Spain
| | - Conxita Falgá
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - Raimundo Tirado
- Department of Internal Medicine, Hospital Infanta Margarita, Córdoba, Spain
| | - José María Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Jerónimo Ramón Vela
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Carmen Mella
- Department of Internal Medicine, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Isabelle Quere
- Department of Vascular Medicine, Hôpital Saint Eloi, Montpellier, France
| | | | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
| | | |
Collapse
|
17
|
Doan P, Cox A, Rao E, Branchford B. Temporal and anatomic relationship between superficial and deep vein thromboses in hospitalized children. Thromb Res 2021; 200:30-33. [PMID: 33529870 DOI: 10.1016/j.thromres.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent publications have increasingly demonstrated a link between superficial-vein thrombosis (SVT) and deep-vein thrombosis (DVT) in the adult population and have led to changes in SVT treatment considerations. A similar relationship between SVT and DVT in pediatric populations, however, is not currently well established. OBJECTIVES We sought to evaluate the temporal and anatomic relationship between SVT and DVT among pediatric inpatients in order to determine to what degree SVT is associated with DVT. METHODS We first retrospectively reviewed our institution's local prospective hospital-acquired VTE (HA-VTE) registry to identify all children (age 0-21 years, inclusive) admitted to Children's Hospital Colorado for more than 48 h between January 2012 and September 2017 who developed a DVT while hospitalized. We then reviewed each patient's electronic health record for evidence of SVT to identify SVT + DVT cases. Afterwards, we utilized a list of ICD codes to identify all patients during this time frame who developed an SVT and removed patients whom we previously identified as SVT + DVT cases to obtain the number of patients with isolated SVT. RESULTS Of 59,910 patients admitted during the study period, 438 (0.7%) developed a thrombosis while hospitalized - 197 (0.3%) with isolated SVT, 161 (0.3%) with isolated DVT, and 80 (0.1%) with both SVT + DVT. These 80 SVT + DVT patients represent 33% of the 241 total DVT patients and 29% of the 277 total SVT patients. Of the 12 SVT + DVT patients in whom the SVT was diagnosed before the DVT, the subsequent DVT occurred within a mean of 6.4 (range 1-22) days and at the same anatomic site in 6 (50%). The age breakdown for this cohort was: 0 (0%) 0-1 months, 2 (17%) 1 month-2 years, 3 (25%) 2-12 years, 3 (25%) 12-16 years, and 4 (33%) 16-21 years. CONCLUSIONS Our results indicate a temporal and anatomic relationship between SVT and DVT in hospitalized children, particularly those with central venous catheters.
Collapse
Affiliation(s)
- Peter Doan
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Allaura Cox
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Emily Rao
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Brian Branchford
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, University of Colorado School of Medicine, Aurora, CO, United States of America.
| |
Collapse
|
18
|
Venous Thromboembolism. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_88-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
19
|
Effect of classical surgical treatment under spinal anesthesia on venous thromboembolism in varicose veins patients. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.819626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
20
|
Kwiecien GJ, Coombs DM, Sinclair N, Gastman BR, Bassiri Gharb B, Rampazzo A. Acute Superficial Vein Thrombosis of the Upper Extremity: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3322. [PMID: 33425625 PMCID: PMC7787343 DOI: 10.1097/gox.0000000000003322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
Superficial vein thrombosis has traditionally been considered a disease of the lower extremity. Less frequently it can affect the breast, chest wall, penis, or upper extremity. Cases involving upper extremities are usually associated with intravascular access, and the vast majority remain self-limiting. This case report presents a 63-year-old patient who had acute extensive thrombosis of cephalic and basilic venous systems following resection of a desmoid tumor from the flank. This was likely related to intraoperative positioning and resulted in severe symptoms mimicking deep vein thrombosis and carpal tunnel syndrome. Additionally, diagnostic tools available to the hand surgeon that allow prompt diagnosis, management, and prevention are discussed.
Collapse
Affiliation(s)
| | | | - Nicholas Sinclair
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian R. Gastman
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Antonio Rampazzo
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
21
|
Marongiu F, Barcellona D. Fondaparinux: Should It Be Studied in Patients with COVID-19 Disease? TH OPEN 2020; 4:e300-e302. [PMID: 33083688 PMCID: PMC7567638 DOI: 10.1055/s-0040-1719232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,SHRO, Temple University, Philadelphia, Pennsylvania, United States
| |
Collapse
|
22
|
Maatman TK, McGuire SP, Lewellen KA, McGreevy KA, Ceppa EP, House MG, Nakeeb A, Nguyen TK, Schmidt CM, Zyromski NJ. Prospective Analysis of the Mechanisms Underlying Ineffective Deep Vein Thrombosis Prophylaxis in Necrotizing Pancreatitis. J Am Coll Surg 2020; 232:91-100. [PMID: 33039510 DOI: 10.1016/j.jamcollsurg.2020.08.774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with necrotizing pancreatitis (NP) have the highest rate of venous thromboembolism (VTE) of any hospitalized patient (57%). We hypothesized that VTE prophylaxis might be inadequate in the setting of this profound inflammatory disease and that early detection of deep vein thrombosis would limit pulmonary embolism. STUDY DESIGN All patients with NP treated at a single center between August 2018 and December 2019 were enrolled in prospective, weekly VTE screening, including 4-extremity duplex ultrasound. Routine chemoprophylaxis included low-molecular-weight or unfractionated heparin. Peak serum anti-factor Xa concentration was measured during weekly screening (goal prophylaxis 0.2 to 0.4 IU/mL). RESULTS Eighty-five patients with NP underwent a total of 201 screening events (mean 2.4 per patient). VTE developed in 55 patients (65%), including splanchnic vein thrombosis in 41 patients (48%) and extremity deep vein thrombosis (eDVT) in 32 patients (38%). Extremity DVT was diagnosed a mean ± SD of 44 ± 30 days after NP onset. Symptomatic pulmonary embolism was prevented in all patients diagnosed with eDVT and no contraindication to anticoagulation (0 of 29). Prophylactic anti-factor Xa concentration was only achieved in 21% (12 of 57 screening events); no eDVTs developed in patients achieving prophylactic anti-factor Xa concentration. CONCLUSIONS In patients with NP, identification of eDVT by screening ultrasound permits early treatment and prevents symptomatic pulmonary embolism. Fixed dosing of chemical prophylaxis is inadequate in most patients with NP and likely contributes to the mechanism of increased VTE in NP.
Collapse
Affiliation(s)
- Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Sean P McGuire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Kyle A Lewellen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Kathleen A McGreevy
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Trang K Nguyen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
| |
Collapse
|
23
|
Yu R, Nansubuga F, Yang J, Ding W, Li K, Weng D, Wu P, Chen G, Ma D, Wei J. Efficiency and safety evaluation of prophylaxes for venous thrombosis after gynecological surgery. Medicine (Baltimore) 2020; 99:e20928. [PMID: 32569239 PMCID: PMC7310966 DOI: 10.1097/md.0000000000020928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In this study, we investigate the incidence of venous thrombosis (VT), and evaluate the effectiveness and safety of 3 major thromboprophylaxes and the potential risk factors for VT in women undergoing surgery for a gynecological malignancy. METHODS We performed a randomized controlled trial of 307 patients undergoing laparoscopic surgery for gynecological malignancies at a single institution from January 2016 to October 2017. Patients were divided into 3 groups: one receiving a half dose of low-molecular-weight heparin sodium injection (FLUXUM, Alfa Wassermann, Italy) delivered by injection, one receiving a full dose of FLUXUM, and a third group receiving an Argatroban injection. RESULTS None of the patients in our study developed a pulmonary embolism, bleeding, or infectious complications. There were no statistical differences in the rate of deep venous thrombosis (DVT) (0%, 0%, and 2.38%) and the superficial venous thromboembolism (SVT) (15.66%, 8.97%, and 18.6%) among the 3 groups. None of the patients developed symptomatic VT. The effect of treatment on alanine aminotransferase and aspartate aminotransferase differed between the groups, with a minimal effect in the Argatroban group, and all 3 methods resulted in minimal impairment of renal function. Decreased hemoglobin, elevated levels of D-dimer, and prothrombin time were closely related to thrombogenesis. CONCLUSION In conclusion, the incidence of postoperative thrombosis in gynecological malignancy among these Chinese people is not as low as we had originally presumed. Argatroban is not more effective than Parnaparin as a direct thrombin inhibitor, but it has less influence on liver function, which is beneficial for patients undergoing chemotherapy. Hemoglobin, D-dimer, and prothrombin time may be used to predict or detect thrombogenesis.
Collapse
Affiliation(s)
- Ruidi Yu
- Department of Obstetrics and Gynecology
| | | | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | | | - Kezhen Li
- Department of Obstetrics and Gynecology
| | | | - Peng Wu
- Department of Obstetrics and Gynecology
| | - Gang Chen
- Department of Obstetrics and Gynecology
| | - Ding Ma
- Department of Obstetrics and Gynecology
| | | |
Collapse
|
24
|
Gibbs L, Moulton J, Tichenor V. Venous Thromboembolism. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_88-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Frappé P, Haller DM, Roméas A, Bertoletti L, François M, Robert-Ebadi H, Righini M. Avoiding disease mongering: A checklist for vascular physicians and researchers. Thromb Res 2019; 181:120-123. [PMID: 31400622 DOI: 10.1016/j.thromres.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Disease mongering is an expression created in 1992 by a medical journalist, Lynn Payer, to qualify the "selling of sickness that widens the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments". This interesting concept led us to question whether, as researchers with publication and career interests in superficial vein thrombosis, we were not shaping a benign condition into a disease. Since the publication of the CALISTO trial in 2010, anticoagulant management of superficial vein thrombosis remains debated. Issues raised, such as the cost-effectiveness of the treatment strategy, the use of a composite endpoint including death, the low event rate without mortality reduction and conflict of interest due to industrial funding. We searched Embase, Medline, Web of science, and Opengrey databases to review all aspects about disease mongering raised in the literature and created a checklist with seventeen items. We used this checklist as support for a narrative review, questioning known literature on superficial vein thrombosis. The main issues pointing towards disease mongering concerned definition and promotion; whereas management seemed rather spared. Many arguments could be counterbalanced, but researchers should pay particular attention to three major points: exaggeration of the severity of the disease and potential adverse outcomes without treatment, promotion by opinion leaders, and an openly declared, yet undoubtedly present, conflict of interest situation.
Collapse
Affiliation(s)
- Paul Frappé
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France; INSERM U 1059 Sainbiose DVH and INSERM CIC-EC 1408, University of Saint-Etienne, Saint-Etienne, France; Primary Care Unit, University of Geneva, Geneva, Switzerland.
| | - Dagmar M Haller
- Primary Care Unit, University of Geneva, Geneva, Switzerland
| | - Andrea Roméas
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- INSERM U 1059 Sainbiose DVH and INSERM CIC-EC 1408, University of Saint-Etienne, Saint-Etienne, France; Department of Vascular Medicine and Therapeutics, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mathilde François
- Department of General Practice, University of Versailles-Saint-Quentin, Versailles, France; INSERM, Center for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
26
|
Solimeno G, Valitutti P. A haemodynamic concept in the management of superficial non-saphenous vein thrombosis. Phlebology 2019; 35:281-287. [PMID: 31354035 DOI: 10.1177/0268355519861462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Through the analysis of the haemodynamic model in the development of superficial non-saphenous vein thrombosis, the authors propose a therapeutic approach which is based on an ultrasound study of the superficial and perforating venous system of the lower limbs. Methods The authors propose the development of a haemodynamic model in the evolution of superficial non-saphenous vein thrombosis. They analyse three cases to highlight the importance of venous haemodynamics in the development of this condition and its possible complications, such as the progression of thrombosis in the deep vein system through the perforating veins. Results The evolution of a thrombosis in the venous network of the lower limbs from the peripheral collateral veins to the deep vein can be haemodynamically explained through this model involving the perforating vein system. Conclusions In the management and treatment of superficial non-saphenous vein thrombosis, it is essential to perform an accurate ultrasound evaluation of the superficial venous system, the deep venous system and the perforator system, according to venous haemodynamic principles. This study proposes a new model to be used in the ultrasonic management and treatment of superficial non-saphenous vein thrombosis.
Collapse
|
27
|
Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. [Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:e1-e47. [PMID: 30770089 DOI: 10.1016/j.jdmv.2018.12.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38043 Grenoble, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, Hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, Hôpital Nord, CHU St-Étienne, 42, avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue de la Maison Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, 38043 Grenoble, France.
| |
Collapse
|
28
|
Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV). JOURNAL DE MEDECINE VASCULAIRE 2019; 44:28-70. [PMID: 30770082 DOI: 10.1016/j.jdmv.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens Picardie, avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU St.-Étienne, 42, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St.-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 1328, avenue Maison-Blanche, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38043 Grenoble, France.
| |
Collapse
|
29
|
Galanaud JP, Blaise S, Sevestre MA, Terrisse H, Pernod G, Gaillard C, Genty C, Monreal M, Rabah Y, Kahn SR, Quéré I, Bosson JL. Long-term outcomes of isolated superficial vein thrombosis in patients with active cancer. Thromb Res 2018; 171:179-186. [DOI: 10.1016/j.thromres.2018.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 02/01/2023]
|
30
|
Lucks J, Lindhoff-Last E. [Anticoagulation in patients with venous thromboembolism: What have been the most important changes within the last 10 years?]. MMW Fortschr Med 2018; 160:44-49. [PMID: 30421197 DOI: 10.1007/s15006-018-1121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jessica Lucks
- CCB Studienzentrum GmbH, Im Prüfling 23, D-60389, Frankfurt, Deutschland.
| | | |
Collapse
|
31
|
Ruling out deep vein thrombosis in patients with superficial vein thrombosis: external validation of the ICARO score. J Thromb Thrombolysis 2018; 47:96-101. [DOI: 10.1007/s11239-018-1754-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
32
|
Chopra R, Leon LR, Labropoulos N. Clinical characteristics and outcomes of patients with multiple simultaneous superficial vein thrombi. J Vasc Surg Venous Lymphat Disord 2018; 6:485-491. [PMID: 29678687 DOI: 10.1016/j.jvsv.2018.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/16/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although unprovoked superficial venous thrombosis (SVT) has traditionally been considered a local, benign disorder, recent studies demonstrate that patients with SVT are at significant risk for deep venous thrombosis, pulmonary embolism, and other venous thromboembolism (VTE) events. Nevertheless, clinical management remains widely inconsistent. Moreover, patients with multiple, unprovoked SVTs of noncommunicating anatomic sites have not been previously described, and they may be at even increased risk for adverse outcomes. The objective of this study was to describe the clinical characteristics and outcomes of patients with multiple, unprovoked SVTs to elucidate whether this subset of patients possesses a higher risk of thrombophilia, cancer, recurrent VTE, or death compared with patients with unprovoked SVT at a single location. METHODS Twenty-four patients with multiple, unprovoked SVTs were enrolled. Blood tests and computed tomography scans were performed to detect thrombophilia and malignant disease. Patients were followed up with duplex ultrasound and clinical examination for at least 3 months. The prevalence of recurrent VTE and clinical outcomes were compared with a control group of 39 patients with unprovoked SVT in a single vein. RESULTS Cancer was detected in five patients (20.8%) and thrombophilia in 10 patients (41.7%). During the follow-up period, nine patients (37.5%) exhibited recurrent VTEs, and five patients (16.2%) died. The VTE recurrence rate was significantly greater than in controls (P = .03). Patients with a coexisting thrombophilia or cancer had elevated thrombotic load (4.08 vs 2.27 separate vein segments; P = .0096) and an increase in VTE recurrence (P = .038) compared with patients without any such findings. CONCLUSIONS The results of this study warrant further investigation into this subset of patients through a larger multicenter design, as patients with multiple SVTs are at greater risk for thrombophilia, cancer, recurrent VTE events, and death compared with patients with isolated SVT.
Collapse
Affiliation(s)
- Rishi Chopra
- Division of Vascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Luis R Leon
- Department of Surgery, University of Arizona Health Science Center, Tucson, Ariz
| | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY.
| |
Collapse
|
33
|
[Phlebological emergencies]. Hautarzt 2018; 69:384-391. [PMID: 29637225 DOI: 10.1007/s00105-018-4160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Deep and superficial vein thromboses as well as variceal hemorrhages are emergencies. The risk of short- and long-term morbidity and mortality in vein thromboses is increased. Variceal hemorrhage harbors the risk of massive blood loss. Prompt and adequate therapy of these diseases is therefore essential. OBJECTIVES Our aim was to give an overview of these phlebological emergencies. MATERIALS AND METHODS Based on the current guidelines and supplemented by a selective literature search in PubMed, we summarize the most important aspects for clinical practice. RESULTS In deep vein thrombosis, therapeutic anticoagulation and compression therapy are indicated for a duration of at least 3-6 months. A shorter duration is associated with a considerably increased recurrence rate. Basic measures in superficial vein thrombosis comprise mobilization, cooling, and compression. In case of tenderness on palpation, non-steroidal anti-inflammatory drugs are recommended. Indication for anticoagulation and its dose depends on length of the thrombus and distance of the proximal part of the thrombus towards the deep veins. Variceal hemorrhage is a complication of advanced varicosis and can usually be handled with simple measures such as elevation of the extremity and compression. CONCLUSIONS Prompt diagnosis and therapy is essential in superficial and deep vein thrombosis to prevent short-term complications such as pulmonary embolism and growth of the thrombus as well as long-term complications such as postthrombotic syndrome with secondary varicosis and chronic leg ulcer. After the occurrence of varicophlebitis or variceal hemorrhage, treatment of varicosis is indicated to prevent recurrences.
Collapse
|
34
|
Barco S, Pomero F, Di Minno MND, Tamborini Permunian E, Malato A, Pasca S, Barillari G, Fenoglio L, Siragusa S, Di Minno G, Ageno W, Dentali F. Clinical course of patients with symptomatic isolated superficial vein thrombosis: the ICARO follow-up study. J Thromb Haemost 2017; 15:2176-2183. [PMID: 28871623 DOI: 10.1111/jth.13840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/28/2022]
Abstract
Essentials Late sequelae of isolated superficial vein thrombosis (iSVT) have rarely been investigated. We studied 411 consecutive outpatients with acute iSVT with a median follow-up of three years. Male sex and cancer are risk factors for future deep vein thrombosis or pulmonary embolism. Patients without cancer appear to be at a negligible risk for death. SUMMARY Background Studies of long-term thromboembolic complications and death following acute isolated superficial vein thrombosis (iSVT) of the lower extremities are scarce. Objectives To investigate the course of iSVT in the setting of an observational multicenter study. Methods We collected longitudinal data of 411 consecutive outpatients with acute, symptomatic, objectively diagnosed iSVT who were previously included in the cross-sectional ICARO study. Four patients followed for < 30 days and 79 with concomitant deep vein thrombosis (DVT) or pulmonary embolism (PE) were excluded from the present analysis. The primary outcome was symptomatic DVT or PE. The safety outcomes were major bleeding and all-cause death. Results The median follow-up time was 1026 days (interquartile range 610-1796). Symptomatic DVT/PE occurred in 52 (12.9%) patients, giving annualized rates of 1.3% (95% confidence interval [CI] 0.3-3.9%) on anticoagulant treatment and 4.4% (95% CI 3.2-5.8%) off anticoagulant treatment. Male sex (adjusted hazard ratio [HR] 2.03 [95% CI 1.16-3.54]) and active solid cancer (adjusted HR 3.14 [95% CI 1.11-8.93]) were associated with future DVT/PE, whereas prior DVT/PE failed to show significance, most likely because of bias resulting from prolonged anticoagulant treatment. Three major bleeding events occurred on treatment, giving an annualized rate of 1.4% (95 CI 0.3-4.0%). Death was recorded in 16 patients (annualized rate: 1.1% [95% CI 0.6-1.7%]), and was attributable to cancer (n = 8), PE (n = 1), cardiovascular events (n = 3), or other causes (n = 4). Conclusions The long-term risk of DVT/PE after anticoagulant discontinuation for acute iSVT is clinically relevant, especially in males and in the presence of active cancer. The risk of death appears to be negligible in patients without cancer.
Collapse
Affiliation(s)
- S Barco
- Center for Thrombosis and Hemostasis, University Medical Hospital of the Johannes Gutenberg University, Mainz, Germany
| | - F Pomero
- Department of Clinical Medicine, ASO S. Croce e Carle, Cuneo, Italy
| | - M N D Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - A Malato
- Hematology Unit, University of Palermo, Palermo, Italy
| | - S Pasca
- Center for Hemorrhagic and Thrombotic Diseases, University Hospital of Udine, Udine, Italy
| | - G Barillari
- Center for Hemorrhagic and Thrombotic Diseases, University Hospital of Udine, Udine, Italy
| | - L Fenoglio
- Department of Clinical Medicine, ASO S. Croce e Carle, Cuneo, Italy
| | - S Siragusa
- Hematology Unit, University of Palermo, Palermo, Italy
| | - G Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - W Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
35
|
|
36
|
Silber T, Schweinzer K, Strölin A. [Diagnostic workup and therapy of acute venous diseases]. Hautarzt 2017; 68:595-602. [PMID: 28593338 DOI: 10.1007/s00105-017-4006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute venous diseases, especially deep leg and pelvic vein thrombosis, present an angiological emergency and can lead to acute life-threatening events such as pulmonary embolism. Long-term consequences may be postthrombotic syndromes. In addition to stroke and myocardial infarction, deep leg and pelvic vein thrombosis are one of the most common cardiovascular diseases. Early diagnosis and rapid initiation of therapy are important.
Collapse
Affiliation(s)
- T Silber
- Phlebologie, Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - K Schweinzer
- Phlebologie, Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - A Strölin
- Phlebologie, Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| |
Collapse
|
37
|
Abstract
Although for many people superficial venous thrombosis of the leg is a benign self-limiting condition, for others it is a potentially serious problem associated with an increased risk of deep vein thrombosis and pulmonary embolism.1-4 Here, we consider some of the challenges associated with managing superficial venous thrombosis and review the evidence for non-surgical treatment options.
Collapse
|
38
|
Feistritzer C, Mosheimer B. ASH Meeting 2016: developments in hemostaseology. MEMO 2017; 10:72-75. [PMID: 28725275 PMCID: PMC5493715 DOI: 10.1007/s12254-017-0339-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 05/23/2017] [Indexed: 01/02/2023]
Abstract
During the annual meeting of the American Society of Hematology (ASH) in San Diego/California, novel developments in the field of hemostaseology were presented. Alternative treatment strategies besides factor replacement were discussed for patients with hemophilia. One of the highlights of the meeting in this year's plenary session was the presentation of successful adeno-associated virus mediated gene transfer in patients with hemophilia B leading to sustained elevation of factor IX:C (FIX:c). Other alternative treatment approaches in patients with hemophilia A may include bispecific antibodies mimicking factor VIIIa (FVIIIa) activity or disrupting anticoagulant proteins. Focusing on anticoagulation, data on the use of direct oral anticoagulants (DOACs) in cancer patients with atrial fibrillation as well as treatment of superficial vein thrombosis with rivaroxaban were presented. In this short review, we try to highlight the most important presentations during the ASH meeting 2016.
Collapse
Affiliation(s)
- Clemens Feistritzer
- Internal Medicine V – Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck (Tyrol), Austria
| | - Birgit Mosheimer
- Internal Medicine II – Infectiology and Immunology/Tropical Medicine, Rheumatology and Pneumology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck (Tyrol), Austria
| |
Collapse
|
39
|
Galanaud JP, Sevestre MA, Pernod G, Kahn SR, Genty C, Terrisse H, Brisot D, Gillet JL, Quéré I, Bosson JL. Long-term risk of venous thromboembolism recurrence after isolated superficial vein thrombosis. J Thromb Haemost 2017; 15:1123-1131. [PMID: 28317330 DOI: 10.1111/jth.13679] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 11/29/2022]
Abstract
Essentials Long-term risk of recurrence of isolated superficial vein thrombosis (SVT) is under-studied. We analyzed data from a cohort of first SVT and proximal deep vein thrombosis (DVT) without cancer. The risk of recurrence as DVT or pulmonary embolism is twice lower in SVT patients. However, overall risk of recurrence is similar between SVT and proximal DVT patients. Click to hear Dr Decousus' perspective on superficial vein thrombosis SUMMARY: Background Isolated superficial vein thrombosis (iSVT) (without concomitant deep vein thrombosis [DVT] or pulmonary embolism [PE]) is a frequent event, but available data on long-term outcomes are scarce and retrospective. Therefore, we aimed to determine prospectively the risk and type of venous thromboembolism (VTE) recurrence after iSVT and compare them with those of proximal DVT. Methods Using data from the prospective, multicenter, observational, OPTIMEV study, we assessed, at 3 years and after anticoagulants were stopped, the incidence and the type of VTE recurrence (iSVT/DVT/PE) of patients with a first objectively confirmed iSVT without cancer (n = 285), and compared these with those of patients with a first proximal DVT without cancer (n = 262). Results As compared with proximal DVT patients, iSVT patients had a similar overall incidence of VTE recurrence (5.4% per patient-year [PY] versus 6.5% per PY, adjusted hazard ratio [aHR] 0.9, 95% confidence interval [CI] 0.5-1.6), but iSVT recurred six times more often as iSVT (2.7% versus 0.6%, aHR 5.9, 95% CI 1.3-27.1) and 2.5 times less often as deep-VTE events (2.5% versus 5.9%, aHR 0.4, 95% CI 0.2-0.9). Varicose vein status did not influence the risk or the type of VTE recurrence. Saphenian junction involvement by iSVT was not associated with a higher risk of recurrence (5.2% per PY versus 5.4% per PY), but was associated with recurrence exclusively as deep-VTE events. Conclusion In patients with a first iSVT without cancer, after stopping anticoagulants, the incidence of deep-VTE recurrence is half that of DVT patients, but the overall risk of recurrence is similar. Ssaphenian junction involvement seems to influence the risk of deep-VTE recurrence, whereas varicose vein status has no impact or a low impact on VTE recurrence.
Collapse
Affiliation(s)
- J-P Galanaud
- Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - M-A Sevestre
- Department of Vascular Medicine, Amiens University Hospital, Amiens, France
| | - G Pernod
- Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France
| | - S R Kahn
- Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada
| | - C Genty
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France
| | - H Terrisse
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France
| | - D Brisot
- Vascular medicine physician, Clapiers, France
| | - J-L Gillet
- Vascular medicine physician, Bourgoin-Jallieu, France
| | - I Quéré
- Department of Internal Medicine and Clinical Investigation Center, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - J-L Bosson
- Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and, TIMC-IMAG, Grenoble, France
| |
Collapse
|
40
|
Di Minno MND, Ambrosino P, Ambrosini F, Tremoli E, Di Minno G, Dentali F. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost 2016; 14:964-72. [PMID: 26845754 DOI: 10.1111/jth.13279] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials The association of superficial vein thrombosis (SVT) with venous thromboembolism (VTE) is variable. We performed a meta-analysis to assess the prevalence of concomitant VTE in patients with SVT. Deep vein thrombosis was found in 18.1%, and pulmonary embolism in 6.9%, of SVT patients. Screening for VTE may be worthy in some SVT patients to plan adequate anticoagulant treatment. SUMMARY Background Some studies have suggested that patients with superficial vein thrombosis (SVT) have a non-negligible risk of concomitant deep vein thrombosis (DVT) or pulmonary embolism (PE) at the time of SVT diagnosis. Unfortunately, the available data on this association are widely variable. Objectives To perform a systematic review and meta-analysis of the literature in order to evaluate the prevalence of concomitant DVT/PE in patients with SVT of the lower limbs. Methods Studies reporting on the presence of DVT/PE in SVT patients were systematically searched for in the PubMed, Web of Science, Scopus and EMBASE databases. The weighted mean prevalence (WMP) of DVT and PE was calculated by use of the random effect model. Results Twenty-one studies (4358 patients) evaluated the prevalence of DVT and 11 studies (2484 patients) evaluated the prevalence of PE in patients with SVT. The WMP of DVT at SVT diagnosis was 18.1% (95%CI: 13.9%, 23.3%) and the WMP of PE was 6.9% (95%CI: 3.9%, 11.8%). Heterogeneity among the studies was substantial. Selection of studies including outpatients only gave similar results (WMP of DVT, 18.2%, 95% CI 12.2-26.3%; and WMP of PE, 8.2%, 95% CI 3.3-18.9%). Younger age, female gender, recent trauma and pregnancy were inversely associated with the presence of DVT/PE in SVT patients. Conclusions The results of our large meta-analysis suggest that the prevalence of DVT and PE in patients presenting with SVT is not negligible. Screening for a major thromboembolic event may be worthwhile in some SVT patients, in order to allow adequate anticoagulant treatment to be planned. Other high-quality studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- M N D Di Minno
- Division of Cardiology - Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - P Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - F Ambrosini
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Tremoli
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - F Dentali
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| |
Collapse
|
41
|
Sartori M, Favaretto E, Migliaccio L, Guazzaloca G, Legnani C, Palareti G, Cosmi B. The incidence of heparin-induced thrombocytopenia in patients treated with low molecular weight heparin for superficial vein thrombosis. Thromb Res 2016; 139:154-7. [DOI: 10.1016/j.thromres.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 01/05/2023]
|