Gaps of care in patients with venous thrombotic embolism: a qualitative study

Evaluation of patients' experience and related qualitative outcomes in venous thromboembolism: A scoping review

BACKGROUND

Venous thromboembolism (VTE) is a prevalent disease with high morbidity and mortality. VTE has well-documented physical sequelae; however, the psychological and emotional impacts are seldom evaluated in randomized controlled trials.

OBJECTIVE

We conducted a scoping review of published qualitative studies aiming to understand the physical, psychological, and emotional impact of VTE as reflected from patients' perspectives. This scoping review is part of a larger initiative to develop a core outcome set for VTE treatment studies.

METHODS

A systematic literature search was conducted to identify qualitative studies assessing patient experience of VTE. Two authors independently screened titles and abstracts using Covidence systematic review software. Full-text reviews were conducted independently by 2 study team members. A modified method of "thematic synthesis" was used to collate themes upon reading and rereading of the publications.

RESULTS

Our search strategy returned a total of 4944 citations; 28 were ultimately included in the analysis. The studies were conducted across 13 countries and representative of 436 participants including a spectrum of VTE subpopulations. There were seven major themes identified: Acute impacts: an unforeseen blow, Sustained psychological distress, Loss of self: life is changed, Challenges of thrombosis management, Balancing coping and control, Negative experience with the medical system, and VTE in the context of other conditions.

CONCLUSIONS

The physical, psychological, and emotional impacts of VTE extend beyond objective outcomes typically evaluated in clinical trials. An improved understanding of the outcomes most important to patients will improve patient-centered care in VTE.

Clinical Features of COVID-19 Patients With Venous Thromboembolism

This study aimed to assess the clinical features of coronavirus disease 2019 (COVID-19) patients with VTE, to help develop preventive measures for venous thromboembolism (VTE in COVID-19) cases. COVID-19 patients admitted to Henan Provincial People’s Hospital were retrospectively analyzed, including 23, 4 and 8 cases with mild to moderate, severe and critical symptoms, respectively. VTE incidence, age at onset, relevant laboratory parameters and prognosis were analyzed. Overall, VTE incidence in the 35 patients was 20.0%, occurring in severe (n = 1) and critical (n = 6) cases. D-dimer showed statistical significance in laboratory examination, representing except a diagnostic index and especial can be a prognostic factor in VTE among COVID-19 patients. Severe and critical COVID-19 cases had significantly reduced platelet counts, with a risk of hemorrhage. During treatment, the risk of both hemorrhage and thrombosis should be considered. VTE occurs in COVID-19 cases, affecting individuals with severe and critical symptoms. Significant D-dimer increase is of great significance in the risk assessment of death in critical cases of COVID-19. Appropriate measures should be taken to prevent VTE during treatment.

Real-Time Dissemination of Aggregate Data on Presentation and Outcomes of Patients With Venous Thromboembolism: The RIETE Infographics Project

In the current era of patient empowerment and precision medicine, access to timely information is critical to decision-making. Unfortunately, we currently lack patient-specific, real-time data about clinical presentation, risk of thrombotic or hemorrhagic events, key risk factors, and adverse outcomes in patients with venous thromboembolism (VTE). Accordingly, the Registro Informatizado Enfermedad TromboEmbólica (RIETE) investigators developed a tool to provide an open-source, real-time graphic representation of VTE-related data derived from over 90 000 patients with confirmed VTE. This information is intended to facilitate discussion in the informed decision-making process. The current article describes the aims, rationale, methods, and ongoing and future efforts of the real-time VTE infographics developed by the RIETE registry collaborators.

Calf deep vein thrombosis: frequency, therapeutic management, early outcomes and all-causes mortality in a cohort of hospitalized patients

BACKGROUND

Isolated distal deep vein thromboses (IDDVT) are frequent; however, their optimal management is still controversial.

METHODS

We performed a retrospective study on inpatients undergoing ultrasound for suspected deep vein thrombosis (DVT) or with a particular risk profile, during 2016. This study aimed to assess the frequency of proximal deep vein thromboses (PDVT) and IDDVT; to evaluate therapeutic management and identify variables associated with early outcomes and mortality among IDDVT patients; to compare all-causes mortality between subjects with PDVT and IDDVT.

RESULTS

Among 21594 patients hospitalized in the study period 251 IDDVT and 149 PDVT were diagnosed; the frequency was 1.2% and 0.7% respectively. 19% of IDDVT patients died compared to 25.5% of PDVT subjects (OR=0.72; 95% CI=0.44-1.17; P=0.19). In IDDVT patients, age ≥80, cancer and intracranial bleeding increased the risk of death (OR=2; 95% CI=1.07-3.75, P=0.001; OR=8.47; 95% CI=3.28-21.88, P=0.0000003; OR=2.33; 95% CI=1.18-4.58, P=0.0003). A significant association between intracranial hemorrhage and both proximal extension by using the Fisher's exact test (P=0.031; OR=16.11; 95% CI=0.80-321.2), and composite of propagation to popliteal or to other calf veins (OR=8.28, 95% CI=2.07-33 P=0.001) was observed. Standard anticoagulation significantly reduced the composite of propagation to popliteal or to other calf veins (OR=0.07; 95% CI=0.009-0.61, P=0.007), and all-causes mortality (OR=0.37; 95% CI=0.17-0.8; P=0.02), without a significant increase of bleeding.

CONCLUSIONS

Among inpatients, IDDVT exceeded 60% of DVT. Mortality was not significantly different between IDDVT and PDVT subjects. Intracranial bleeding significantly increased the risk of propagation and death. Although standard anticoagulation decreased both these complications, further targeted studies are needed.

Characteristics and clinical indicators of concomitant venous thromboembolism in acute limb ischemia

BACKGROUND

Venous thromboembolism (VTE) concomitant to acute limb ischemia (ALI) is rarely reported. The aim of the study was to investigate characteristics and identify clinical indicators of VTE in patients with ALI.

METHODS

Electronic medical record was used to identify patients diagnosed with ALI from January 2013 to June 2019. Eligible patients were categorized as VTE or non-VTE based on the presence or absence of concomitant VTE. Univariate analysis and multivariate analysis for indicators of VTE were performed.

RESULTS

A total of 153 patients with 161 ischemic limbs were enrolled. Venous duplex ultrasound (DUS) for 149 patients (157 ischemic limbs) revealed deep vein thrombosis (DVT) in 38 (24.2%) ischemic limbs of 37 (24.8%) patients. Five femoral DVTs were found intraoperatively. Six patients had pulmonary embolism (PE) and three of them died. In all, 43 (28.1%) ALI patients were diagnosed with VTE. They were treated with trans-arterial catheter-directed thrombolysis (N.=22), embolectomy (N.=9), primary amputation (N.=4) and anticoagulation alone (N.=8). The univariate analysis indicated that symptoms ≥ 2 days [odds ratio (OR): 3.42, 95%CI:1.54-7.62], Rutherford classification IIb-III (OR: 9.17, 95%CI: 2.10-40.12), leg swelling (OR: 4.44, 95%CI: 2.07-9.53), neutrophil ratio ≥0.80 (OR: 3.92, 95%CI: 1.72-8.93) and positive D-dimer (OR: 8.44, 95%CI: 3.65-19.53) were indicators of VTE concomitant to ALI. In the multivariate analysis, leg swelling and positive D-dimer appeared to be independent indicators.

CONCLUSIONS

VTE commonly occurs to ALI. Venous DUS for DVT screening should be considered for ALI patients who present one or more of these indicators.

Perspectives of patients and health professionals on important factors influencing rehabilitation following acute pulmonary embolism: A multi-method study

BACKGROUND

International guidelines on pulmonary embolism (PE) management and rehabilitation have recently been published. However, the contained recommendation about an efficient follow-up strategy after PE is difficult for health care professionals to implement because limited research exists about what strategies are efficient.

OBJECTIVES

The study aimed to 1) describe and explore perspectives and experiences of health care professionals (HCPs) and patients participating in a post-PE rehabilitation intervention, and 2) provide suggestions for future post-PE management and rehabilitation interventions.

PATIENTS/METHODS

The study was a multi-method study, nested in a larger randomized controlled trial, combining data from two focus group interviews with 10 HCPs, 16 individual interviews with patients, data from exercise diaries and logbooks from HCPs participating in a rehabilitation intervention.

RESULTS

Key factors for successful post-PE management, considered important for reducing anxiety and confusion by both patients and HCPs, were the presence of a multidisciplinary specialized team, initiation of management shortly after discharge, and having regular follow-ups, e.g. telephone consultations. In terms of rehabilitation, repeatedly testing physical performance, resuming exercise under the guidance and support of specialized personnel, and access to peer support, were considered important for increasing motivation and self-efficacy for engaging in physical activity again.

CONCLUSIONS

This study offers suggestions for key elements to include in post-PE management and rehabilitation interventions, as well as the structuring of care. However, research still needs to be undertaken before solid recommendations for the content and structure of successful post-PE management and rehabilitation can be given.

Implications of Bed Rest for Patients with Acute Deep Vein Thrombosis: A Qualitative Study

BACKGROUND/OBJECTIVE

The recommendation of bed rest for deep vein thrombosis (DVT) patients has changed during the last 20 years, and it has become a concern for researchers. The existing researches on potentially harmful treatment of bed rest for DVT patients focus only on physiological outcomes. This qualitative study explored the implications of bed rest from the perspective of patients with acute DVT. Understanding these implications will provide more evidence on whether bed rest should be used as a medical treatment of acute DVT.

PATIENTS AND METHODS

For data collection, a descriptive qualitative design utilizing semi-structured, in-depth, face-to-face interviews with nine patients with acute DVT was conducted. In order to find the themes and subthemes emerging from the interviews for data analysis, the Colaizzi method, which was suggested by phenomenological methodology, was used.

RESULTS

The four major themes found were physical effects, psychological effects, social effects, and post-trauma growth. These themes illustrated the bed rest experiences of patients and it has a negative impact on the quality of life (QOL) amidst acute DVT.

CONCLUSION

Bed rest for patients with acute DVT is a physically, emotionally, and socially distressing phenomenon that simultaneously affects QOL and induces post-traumatic growth. We believe that bed rest is not beneficial to the physical and mental health of patients with acute DVT. This study adds to the available evidence on the harmful effect of bed rest as a treatment from the perspective of patients with acute DVT. Further quantitative studies should compare the quality of life and psychosocial status of patients with and without bed rest amidst acute DVT.