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Xu S, Guo X, Yang B, Romeiro FG, Primignani M, Méndez-Sánchez N, Yoshida EM, Mancuso A, Tacke F, Noronha Ferreira C, De Stefano V, Qi X. Evolution of Nonmalignant Portal Vein Thrombosis in Liver Cirrhosis: A Pictorial Review. Clin Transl Gastroenterol 2021; 12:e00409. [PMID: 34597281 PMCID: PMC8483868 DOI: 10.14309/ctg.0000000000000409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023] Open
Abstract
Portal vein thrombosis (PVT) is a common complication in liver cirrhosis, especially in advanced cirrhosis. It may be related to a higher risk of liver-related events and liver function deterioration. Imaging examinations can not only provide an accurate diagnosis of PVT, such as the extent of thrombus involvement and the degree of lumen occupied, but also identify the nature of thrombus (i.e., benign/malignant and acute/chronic). Evolution of PVT, mainly including development, recanalization, progression, stability, and recurrence, could also be assessed based on the imaging examinations. This article briefly reviews the pathophysiology, diagnosis, classification, and evolution of PVT with an emphasis on their computed tomography imaging features.
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Affiliation(s)
- Shixue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
- Graduate School, China Medical University, Shenyang, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
| | - Benqiang Yang
- Department of Radiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Fernando Gomes Romeiro
- Department of Internal Medicine, Botucatu Medical School, UNESP-Univ Estadual Paulista. Av. Prof. Mário Rubens Guimarães Montenegro, s/n Distrito de Rubião Jr, Botucatu, Brazil
| | - Massimo Primignani
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine. National Autonomous University of Mexico, Mexico City, Mexico
| | - Eric M. Yoshida
- Division of Gastroenterology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada
| | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico, Di Cristina-Benfratelli, Palermo, Italy
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Valerio De Stefano
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
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Teng F, Sun KY, Fu ZR. Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction. World J Gastroenterol 2020; 26:2691-2701. [PMID: 32550747 PMCID: PMC7284174 DOI: 10.3748/wjg.v26.i21.2691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is currently not considered a contraindication for liver transplantation (LT), but diffuse or complicated PVT remains a major surgical challenge. Here, we review the prevalence, natural course and current grading systems of PVT and propose a tailored classification of PVT in the setting of LT. PVT in liver transplant recipients is classified into three types, corresponding to three portal reconstruction strategies: Anatomical, physiological and non-physiological. Type I PVT can be removed via low dissection of the portal vein (PV) or thrombectomy; porto-portal anastomosis is then performed with or without an interposed vascular graft. Physiological reconstruction used for type II PVT includes vascular interposition between mesenteric veins and PV, collateral-PV and splenic vein-PV anastomosis. Non-physiological reconstruction used for type III PVT includes cavoportal hemitransposition, renoportal anastomosis, portal vein arterialization and multivisceral transplantation. All portal reconstruction techniques were reviewed. This tailored classification system stratifies PVT patients by surgical complexity, risk of postoperative complications and long-term survival. We advocate using the tailored classification for PVT grading before LT, which will urge transplant surgeons to make a better preoperative planning and pay more attention to all potential strategies for portal reconstruction. Further verification in a large-sample cohort study is needed.
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Affiliation(s)
- Fei Teng
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Ke-Yan Sun
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Zhi-Ren Fu
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
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Lu J, Zhang XP, Zhong BY, Lau WY, Madoff DC, Davidson JC, Qi X, Cheng SQ, Teng GJ. Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west. Lancet Gastroenterol Hepatol 2019; 4:721-730. [PMID: 31387735 DOI: 10.1016/s2468-1253(19)30178-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 02/07/2023]
Abstract
Portal vein tumour thrombosis is common among patients with advanced hepatocellular carcinoma. Tremendous differences exist in the management of hepatocellular carcinoma with portal vein tumour thrombosis between the east and the west, which derive from heterogeneities in its epidemiology, causes, pathology, comorbidities, prognosis, and other demographics. These divergences between the east and the west are not only caused by hepatocellular carcinoma itself, but are also affected by many variables including social factors, physician preferences, accessibility to costly or novel treatments, and reimbursement schemes. In this Review, we compare and contrast the management of hepatocellular carcinoma with portal vein tumour thrombosis in the east and in the west in terms of systemic and surgical treatments, radiotherapy, transcatheter arterial therapies, and portal vein revascularisation. We conclude that a personalised, data-driven approach to care with active management from a multidisciplinary team, as well as increased communication and collaboration between clinicians and researchers based in east and the west, could help to reduce the differences in management and optimise treatment strategies.
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Affiliation(s)
- Jian Lu
- Centre of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xiu-Ping Zhang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jon C Davidson
- Section of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaolong Qi
- CHESS Frontier Center, First Hospital of Lanzhou University, Lanzhou, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Gao-Jun Teng
- Centre of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
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Gîrleanu I, Trifan A, Stanciu C, Sfarti C. Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture. World J Gastroenterol 2018; 24:4419-4427. [PMID: 30356984 PMCID: PMC6196341 DOI: 10.3748/wjg.v24.i39.4419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/02/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is a frequent and serious complication in patients with liver cirrhosis (LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease (compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex end-points such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.
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Affiliation(s)
- Irina Gîrleanu
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
| | - Carol Stanciu
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
| | - Cătălin Sfarti
- Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
- Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
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Chan SL, Chong CCN, Chan AWH, Poon DMC, Chok KSH. Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016. World J Gastroenterol 2016; 22:7289-300. [PMID: 27621575 PMCID: PMC4997643 DOI: 10.3748/wjg.v22.i32.7289] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/27/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Portal vein tumor thrombosis (PVTT) is a common phenomenon in hepatocellular carcinoma (HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discuss the recent conceptual changes and summarize the data on the management of HCC with PVTT.
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Rosendaal FR, Reitsma PH. Winter studies. J Thromb Haemost 2015; 13:1. [PMID: 25585845 DOI: 10.1111/jth.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F R Rosendaal
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Li AJ, Zhou WP, Lin C, Lang XL, Wang ZG, Yang XY, Tang QH, Tao R, Wu MC. Surgical treatment of hepatocellular carcinoma with inferior vena cava tumor thrombus: a new classification for surgical guidance. Hepatobiliary Pancreat Dis Int 2013; 12:263-9. [PMID: 23742771 DOI: 10.1016/s1499-3872(13)60043-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS Type I IVCTT (10 patients) was posterior to the liver and below the diaphragm; type II IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type III IVCTT (1 patient) was above the diaphragm and in the right atrium. Type I was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type II was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type III was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1- and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.
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Affiliation(s)
- Ai-Jun Li
- Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
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Boissier C, Lacroix P. [Deep venous thrombosis and pulmonary embolism]. Rev Prat 2012; 62:1447-1455. [PMID: 23424932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Li Z, Zhao Q. The influence of the typing of portal vein tumor thrombosis on the esophageal-gastro variceal degree and rupturing hemorrhage. Hepatogastroenterology 2012; 59:2587-2591. [PMID: 22709876 DOI: 10.5754/hge12264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIMS The present study was performed to establish a scientific method for the typing of portal vein tumor thrombosis (PVTT) by investigating the degrees of esophageal-gastro varices, the incidences of rupturing hemorrhage and the prognoses of different types of patients with PVTT. METHODOLOGY We collected 76 patients with HCC and PVTT in the People's Hospital of Liaocheng from March 2005 to July 2010 and divided them into two types by whether the PVTT exceeded the entry of vena coronaria ventriculi to the portal vein. All the patients were long-term followed-up until their deaths, and underwent upper-endoscopy and imaging inspection. RESULTS There was no significance for the comparison between the degrees of esophageal-gastro varices from the two types of PVTT Patients with type I PVTT had much higher incidences of rupturing hemorrhage than patients with type II. The principal cause of death of patients with type I was upper gastrointestinal hemorrhage while the principal cause of death of patients with type 11 was multiple organ failure including hepatic failure. CONCLUSIONS PVTT has developed quickly and its effect on the degrees of esophageal-gastro varices was insignificant in short-term.The prognoses of the patients with different types of PVTT were different. Our typing of PVTT could presume the prognoses of patients more conveniently and supply the theoretical evidence on the choices of treatments for various patients with PVTT.
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Affiliation(s)
- Zhenfang Li
- Taishan Medical University, Liaocheng, Shandong Province, China
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Chen JT, Comerota AJ. Detecting the association between residual thrombus and post-thrombotic classification of chronic venous disease with range regression. Rev Recent Clin Trials 2012; 7:329-334. [PMID: 22963329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/14/2012] [Accepted: 06/03/2012] [Indexed: 06/01/2023]
Abstract
This paper addresses a clinical hypothesis detected by the method of range regression, a new statistical method portraying the clinical response via the range of an explanatory variable. For patients with iliofemoral deep venous thrombosis, it has long been clinically suspected that residual thrombus affects the quality of life after catheter-directed thrombolysis. However, such important medical experience has not been validated or scientifically quantified by experimental or observational data. In clinical practice, this association may directly affect the duration of thrombolytic therapy or other attempts at clot removal. In this study, we develop a new regression model to identify how the quantity of clot lysed affects the clarification of chronic venous disease after catheter-directed thrombolysis (a correlated index on postthrombotic quality of life). Bridging clinical insight with statistics by means of medical records of 62 IFDVT patients, the new method reveals that residual thrombus significantly and substantially affects post-thrombotic clarification of chronic venous disease. The conclusion of the new method is confirmed by a conventional logistic regression method when 50% thrombus removal is treated as a categorization threshold. This new approach is applicable to analyze other clinical or medical variables on the treatment of venous diseases.
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Affiliation(s)
- John Tuhao Chen
- Department of Mathematics and Statistics Bowling Green State University, Bowling Green, Ohio 43403, USA.
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Ignat'ev IM, Bredikhin RA, Fomina EE. [Ultrasonographic diagnosis of venous thromboses]. Angiol Sosud Khir 2009; 15:35-39. [PMID: 20394330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The article deals with a new method of diagnosis of venous thromboses, which is based on ultrasonographic scanning of the area of the valvular sinuses of the femoral vein. The authors examined a total of two hundred and forty-nine people; of these, 100 patients were diagnosed as having varicose disease, 99 subjects had acute venous thrombosis, and 50 people constituted the control group. All the patients were examined by means of ultrasonographic angioscanning, and also had the D-dimer level measured in them. The carried out study resulted in a description of an ultrasonographic phenomenon consisting in the presence of echo-positive inclusions within the area of the valvular sinuses, which was called the sludge phenomenon. The authors developed a classification of this phenomenon, describing three degrees of sludge. Degree 1 sludge is a physiological one and reflects the fact that the area of the valvular sinuses is the most thrombogenic zone. Degree 2 sludge is characterized as a pathological one, being indicative of the presence of a prethrombotic condition and may serve as one of the earliest prognostic factors for the development of venous thrombosis. Degree 3 sludge reflects thrombosis of the valvular sinus. The carried out studies made it possible to reveal a correlation between the presence of a sludge, its degree, the presence of a venous thrombosis, and the values of the D-dimer level.
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Abstract
In the last decades, the knowledge on the etiology of venous thromboembolism (VTE) has increased tremendously. In approximately half of patients presenting with VTE, one or more thrombophilic defects can be identified. This has led to widespread testing for thrombophilia, despite the fact that, at present, it is unclear whether this should have therapeutic consequences. Here we review the currently established hereditary and acquired thrombophilic defects, and focus on the pros and cons of testing in the setting of VTE. Thrombophilia is defined as a disorder associated with an increased tendency to venous thromboembolism (VTE). Thrombophilia can be acquired, such as in patients with cancer, or congenital, in which case a defect in the coagulation system is hereditary. Egeberg was the first to use the term thrombophilia in 1965, when he described a Norwegian family that had a remarkable tendency to VTE, based on a deficiency of antithrombin. Since then, various laboratory abnormalities, both hereditary and acquired, have been discovered that increase the risk of VTE. This article reviews the currently established thrombophilic abnormalities and discusses the potential usefulness and implications of testing for thrombophilia.
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Affiliation(s)
- Danny M Cohn
- Academic Medical Center, Department of Vascular Medicine, Amsterdam, The Netherlands
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Abstract
Thrombophilia includes multiple inherited and acquired risk factors that determine a shift in the balance of procoagulant and anticoagulant factors promoting hypercoagulability, which is associated with an increased risk of venous thromboembolism (VTE). VTE is characterized by more common clinical manifestations, such as deep vein thrombosis of the lower limbs or pulmonary embolism, and less common clinical manifestations affecting cerebral, splanchnic, upper limbs, and retinal veins. The role of inherited thrombophilia in the pathogenesis of VTE at unusual sites is better established in cerebral vein thrombosis, but its role is less clear in splanchnic, upper limbs, and retinal vein thrombosis, in which acquired risk factors such as malignancy, central venous catheters, or systemic diseases also are frequently involved. The complex interactions between different inherited and acquired thrombophilic risk factors and their relationship with endothelium may be considered the pathophysiologic key of underlying phenotypic manifestations of thrombosis. The understanding of these mechanisms might facilitate diagnosis with appropriate investigations and improve therapeutic decision making.
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Affiliation(s)
- Federico Lussana
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Ro A, Kageyama N, Fukunaga T. [Significance of the soleal vein for the pathogenesis of deep vein thrombosis leading to acute massive pulmonary thromboembolism]. Masui 2007; 56:801-7. [PMID: 17633840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Prophylaxis of deep vein thrombosis (DVT) is a serious matter as the source of pulmonary thromboembolism (PTE) in hospitalized patients. Leg DVT is classified into three groups: iliac, femoral and calf types. Among them, calf type DVT is closely connected with PTE. Especially, soleal vein is the most frequent site of thrombi formation occurring with venous stagnation. Although most cases of soleal vein thrombosis are resolved soon without specific treatments: in around 20% of cases the thrombosis propagates to the proximal drainage vein as float thrombi e.g. from peroneal vein and posterior tibial vein to popliteal vein. Thereafter, the organization of thrombi leads to venous valve insufficiency, so-called postthrombotic syndrome. As a result, it worsens blood stagnation and induces recurrent thrombi formation. The broad prophylaxis of DVT in the soleal veins for inpatients is the most important point in the initial stage of hospitalization.
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Affiliation(s)
- Ayako Ro
- Department of Legal Medicine, School of Medicine, Keio University, Tokyo
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Emmerich J. [How to assess thrombophilia and which one?]. Rev Prat 2007; 57:714-5. [PMID: 17654818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Joseph Emmerich
- Service de medecine vascularie, HTA et unite Inserm U765, Universite Paris-Descartes, Hopital europeen Georges-Pompidou, 75980 Paris Cedex 15
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Spencer FA, Emery C, Lessard D, Anderson F, Emani S, Aragam J, Becker RC, Goldberg RJ. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 2006; 21:722-7. [PMID: 16808773 PMCID: PMC1924694 DOI: 10.1111/j.1525-1497.2006.00458.x] [Citation(s) in RCA: 312] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND While there have been marked advances in diagnostic and therapeutic strategies for venous thromboembolism, our understanding of its clinical epidemiology is based on studies conducted more than a decade ago. OBJECTIVE The purpose of this observational study was to describe the incidence and attack rates of venous thromboembolism in residents of the Worcester Statistical Metropolitan Area in 1999. We also describe demographic and clinical characteristics, management strategies, and associated hospital and 30-day outcomes. DESIGN AND MEASUREMENTS The medical records of all residents from Worcester, MA (2000 census=477,800), diagnosed with International Classification of Diseases, 9th revision (ICD-9) codes consistent with possible venous thromboembolism during 1999 were independently validated, classified, and reviewed by trained abstractors. RESULTS A total of 587 subjects were enrolled with validated venous thromboembolism. The incidence and attack rates of venous thromboembolism were 104 and 128 per 100,000 population, respectively. Three quarters of patients developed their venous thromboembolism in the outpatient setting - a substantial proportion of these patients had undergone recent surgery or had a recent prior hospitalization. Less than half of the patients received anticoagulant prophylaxis during high-risk periods before their venous thromboembolism. Thirty-day rates of venous thromboembolism recurrence, major bleeding, and mortality were 4.8%, 7.7%, and 6.6%, respectively. CONCLUSION These data provide insights into recent incidence and attack rates, changing patient profiles, management strategies, and subsequent outcomes in patients with venous thromboembolism. The underutilization of prophylaxis before venous thromboembolism, and relatively high 30-day recurrence rates, suggest a continued need for the improvement of venous thromboembolism prophylaxis and management in the community.
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Affiliation(s)
- Frederick A Spencer
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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Virgini-Magalhães CE, Porto CL, Fernandes FFA, Dorigo DM, Bottino DA, Bouskela E. Use of microcirculatory parameters to evaluate chronic venous insufficiency. J Vasc Surg 2006; 43:1037-44. [PMID: 16678701 DOI: 10.1016/j.jvs.2005.12.065] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 12/26/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Microcirculatory impairment caused by chronic venous hypertension is usually not taken into account in chronic venous insufficiency, probably due to lack of practical means to observe it. The objective of this work was to use a new noninvasive technique to access quantitatively the cutaneous microangiopathy in female patients classified according to CEAP from C1 to C5 and matched with healthy controls. METHODS Forty-four patients and 13 healthy subjects (112 lower limbs), with a mean age +/- SD of 48 +/- 8 years, were evaluated by using orthogonal polarization spectral (OPS) imaging. Films of the internal perimaleolar region were analyzed by the CapImage software. The microcirculatory parameters evaluated were functional capillary density (number of capillaries with flowing red blood cells/mm), capillary morphology (percentage of abnormal capillaries), diameter (microm) of dermal papilla to quantify edema, diameter of capillary bulk (microm) to assess the degree of change, and diameter capillary limb to detect enlargement. A microcirculatory index combining these five parameters was proposed with I, II, and III stages, indicating normal microcirculation, and moderate and severe microangiopathy, respectively. RESULTS These microcirculatory parameters were significantly different (P < .05) from control values (C): capillary diameter and capillary morphology from C2 to C5, 8.1 +/- 0.8, 3.6 +/- 5.5 (C), and 9.7 +/- 1.3, 27.5 +/- 17.7 (C2); diameter of dermal papilla and diameter of capillary bulk from C3 to C5, 111.4 +/- 13.5, 52.8 +/- 8.8 (C), and 150.5 +/- 31.7, 87.8 +/- 26.9 (C3); and functional capillary density only from C4 to C5, 20.9 +/- 6.1 (C) and 14.5 +/- 4.5 (C4). The microcirculatory index showed good correlation to CEAP classification. CONCLUSION It was possible to quantify the microangiopathy using OPS imaging and to compare the microcirculatory changes of chronic venous insufficiency patients with healthy controls. Two parameters seemed more important to identify the differences between patients and controls: capillary morphology and capillary diameter. The suggested microcirculatory index can possibly demonstrate, in future studies, a prognostic capability when combined with the CEAP classification.
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Sharma DC. Patients with blood clots should be screened. Lancet Oncol 2006; 7:285. [PMID: 16598874 DOI: 10.1016/s1470-2045(06)70633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Vedantham S, Grassi CJ, Ferral H, Patel NH, Thorpe PE, Antonacci VP, Janne d'Othée BM, Hofmann LV, Cardella JF, Kundu S, Lewis CA, Schwartzberg MS, Min RJ, Sacks D. Reporting Standards for Endovascular Treatment of Lower Extremity Deep Vein Thrombosis. J Vasc Interv Radiol 2006; 17:417-34. [PMID: 16567667 DOI: 10.1097/01.rvi.0000197359.26571.c2] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suresh Vedantham
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
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Affiliation(s)
- P E J Meijden
- Department of Biochemistry, CARIM, University of Maastricht and University Hospital Maastricht, Maastricht, The Netherlands
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22
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Affiliation(s)
- I Conde
- Thrombosis Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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23
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Prescott SM, Weyrich AS, Zimmerman GA. Classification of venous thromboembolism (VTE). The clot is hot: inflammation, myeloid leukocytes, and venous thromboembolism. J Thromb Haemost 2005; 3:2571-3. [PMID: 16241955 DOI: 10.1111/j.1538-7836.2005.01659.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- S M Prescott
- Department of Internal Medicine, The University of Utah School of Medicine, Salt Lake City, UT 84112, USA.
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Larsen TB, Johnsen SP, Møller CI, Larsen H, Sørensen HT. A review of medical records and discharge summary data found moderate to high predictive values of discharge diagnoses of venous thromboembolism during pregnancy and postpartum. J Clin Epidemiol 2005; 58:316-9. [PMID: 15718123 DOI: 10.1016/j.jclinepi.2004.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To validate the discharge diagnoses of venous thromboembolism during pregnancy and postpartum, we examined the positive predictive value (PPV) of venous thromboembolic (VTE) discharge diagnoses associated with pregnancy or puerperium based on 311 cases registered in a Danish population-based hospital-discharge registry. STUDY DESIGN AND SETTING Medical records and hospital discharge summaries were retrieved and reviewed using a standardized form. Standard and pregnancy-specific codes were used for 147 (49%) and 153 (51%) cases, respectively. RESULTS The overall PPV of the selected codes was 87.3% (95% confidence interval [CI]: 83.0-90.9). When focusing on confirmed VTE events in relation to the pregnancy, the overall PPV was 79.3% (95% CI: 74.3-83.8). CONCLUSION The overall PPVs of pregnancy-related VTE diagnoses were moderate to high. The predictive values varied substantially between the individual codes, however, and not all the registered VTE events occurred in relation to pregnancy. Thus, use of unvalidated registry-based pregnancy-related VTE diagnoses for epidemiological research may lead to biased results.
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Affiliation(s)
- Torben Bjerregaard Larsen
- Department of Clinical Biochemistry and Genetics, Section for Thrombosis and Haemostasis, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Department of Clinical Epidemiology, Aarhus University Hospitals, DK-8000, Aarhus C, Denmark
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26
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Aliev SA, Sultanov GA, Aliev ES. [Acute hemorrhoidal thrombosis: essence of the idea, correctness of the name and unification of terminology. alternative approaches to treatment]. Vestn Khir Im I I Grek 2005; 164:79-84. [PMID: 16281405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute thrombosis of hemorrhoidal nodes (ATHN) was treated in 402 patients aged from 19 through 73 years of age. It was found that the decision for the volume and method of treatment should be determined individually and differentially, paying special attention to the degree of microcirculatory alterations in the walls of cavernous veins. Multi-component conservative therapy is the method of choice for treatment of ATHN of the 1st severity degree. For the II and III degree operation is indicated which should be fulfilled urgently (within 3 days) or in a postponed (within 5-7 days) order. Hemorrhoidectomy by Milligan-Morgan method with the tight suturing of the postoperative wounds and complete restoration of the mucous membrane of the anal canal allowed getting better immediate and long-term results.
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Górski G, Noszczyk W, Kostewicz W, Szopiński P, Kielar M, Michalak J, Marianowska A, Wilkoswski D. Progress of local symptoms of superficial vein thrombosis vs. duplex findings. VASA 2004; 33:219-25. [PMID: 15623197 DOI: 10.1024/0301-1526.33.4.219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Risk of subsequent deep vein thrombosis (DVT) following superficial vein thrombosis (SVT) is not fully appreciated. Mechanisms, time relations and risk factors for DVT arising upon earlier SVT remain unclear. The aim of this study was to analyze time relations between local symptoms of lower limb superficial vein thrombosis, duplex findings and onset of deep vein thrombosis during clinically evident course of SVT. Patients and methods: 46 patients with early (onset less than 72 hours prior to inclusion) clinical diagnosis of SVT, confirmed ultrasonographically were included in this prospective, multicenter study. Progress of pain, erythema and swelling in relation to subsequent ultrasound changes in size and localization of thrombus at 0, 7, 14 and 21 day of study has been recorded. Results: Local symptoms subsided completely during 3 weeks. At that time thrombus disappeared completely only in 26% of cases, in remaining cases decreased in size from average 117.5 mm to 43.0 mm. Thrombus regression was similar to venous blood outflow direction – proximal to femoral area. Thrombus propagation was observed following regression of local symptoms of SVT. 4 cases of DVT (8.7%) were diagnosed at 2–11 days. Conclusions: Local, clinically detectable symptoms of SVT regress incomparably quicker than thrombus in affected veins. Risk of further thrombus propagation extends well beyond the period of intensive local symptoms of SVT. Regression of thrombus in femoral area requires significantly more time than in popliteal or calf segment. Thrombus propagation is directed with blood flow towards femoral segment.
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Affiliation(s)
- G Górski
- Department of General and Vascular Surgery, Medical Academy Warszawa, Poland.
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Aglyamov S, Skovoroda AR, Rubin JM, O'Donnell M, Emelianov SY. Model-based reconstructive elasticity imaging of deep venous thrombosis. IEEE Trans Ultrason Ferroelectr Freq Control 2004; 51:521-531. [PMID: 15217230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Deep venous thrombosis (DVT) and its sequela, pulmonary embolism, is a significant clinical problem. Once detected, DVT treatment is based on the age of the clot. There are no good noninvasive methods, however, to determine clot age. Previously, we demonstrated that imaging internal mechanical strains can identify and possibly age thrombus in a deep vein. In this study the deformation geometry for DVT elasticity imaging and its effect on Young's modulus estimates is addressed. A model-based reconstruction method is presented to estimate elasticity in which the clot-containing vessel is modeled as a layered cylinder. Compared to an unconstrained approach in reconstructive elasticity imaging, the proposed model-based approach has several advantages: only one component of the strain tensor is used; the minimization procedure is very fast; the method is highly efficient because an analytic solution of the forward elastic problem is used; and the method is not very sensitive to the details of the external load pattern--a characteristic that is important for free-hand, external, surface-applied deformation. The approach was tested theoretically using a numerical model, and experimentally on both tissue-like phantoms and an animal model of DVT. Results suggest that elasticity reconstruction may prove to be a practical adjunct to triplex scanning to detect, diagnose, and stage DVT.
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Affiliation(s)
- Salavat Aglyamov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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American College of Emergency Physicians (ACEP) Clinical Policies Committee, ACEP Clinical Policies Subcommittee on Suspected Lower-Extremity Deep Venous Thrombosis. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected lower-extremity deep venous thrombosis. Ann Emerg Med 2003; 42:124-35. [PMID: 12827132 DOI: 10.1067/mem.2003.181] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Shi LW, Verran D, Chang D, Drenckhahn C, Fisher J, Stewart G, McCaughan G. Primary liver transplantation with preexisting portal vein thrombosis. Transplant Proc 2003; 35:354-5. [PMID: 12591437 DOI: 10.1016/s0041-1345(02)04020-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L W Shi
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, NSW 2050, Camperdown, Australia.
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Emelianov SY, Chen X, O'Donnell M, Knipp B, Myers D, Wakefield TW, Rubin JM. Triplex ultrasound: elasticity imaging to age deep venous thrombosis. Ultrasound Med Biol 2002; 28:757-67. [PMID: 12113788 DOI: 10.1016/s0301-5629(02)00516-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Deep venous thrombosis (DVT), and its sequela, pulmonary embolism (PE), is the leading cause of preventable in-hospital mortality in the USA and other developed countries. After it is detected, acute clots must be differentiated from chronic DVT for appropriate treatment. However, there are no reliable thrombus staging methods presently available in clinical practice. In this study, we tested the hypothesis that blood clots can be detected and staged using a triplex ultrasound (US) test. Triplex US is based on a "gold standard" duplex US technique augmented by US-based reconstructive elasticity imaging. Fibrin-composed blood clots harden with development and organization. By imaging clot elasticity, it may be possible to both detect and differentiate clots and, therefore, provide an urgently needed noninvasive means of DVT staging.
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Affiliation(s)
- S Y Emelianov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
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Dryjski M, O'Brien-Irr MS, Harris LM, Hassett J, Janicke D. Evaluation of a screening protocol to exclude the diagnosis of deep venous thrombosis among emergency department patients. J Vasc Surg 2001; 34:1010-5. [PMID: 11743553 DOI: 10.1067/mva.2001.119889] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy and cost effectiveness of a deep venous thrombosis (DVT) screening protocol incorporating DVT pretest probability (PTP), selective D-dimer assay, and venous duplex imaging (VDI) to exclude the diagnosis of DVT among emergency department (ED) patients. METHODS A prospective study of all patients evaluated in the ED for suspected DVT during 1 year was undertaken. Patients were classified into PTP risk category by ED physicians before VDI. Correlation studies were completed using VDI as the gold standard. Charges associated with the protocol were calculated. RESULTS One hundred fourteen patients were included. The incidence of DVT was 9.6% (11). Thirty-six (55%) patients were classified as high risk, 23 (35%) as moderate, and 7 (10%) as low risk. All patients diagnosed with DVT were in the high-risk group (incidence, 16.7%). The sensitivity and negative predictive value were both 100% when PTP and D-dimer were used, but fell to 80% and 95%, respectively, when only D-dimer was considered. The true negative rates were 23% and 37%, respectively. Based on this study, we propose the following screening: for high-risk patients, use direct VDI (no D-dimer); for low-risk or moderate-risk patients, obtain D-dimer, and if it is positive, use VDI, and if it is negative, no further action is required. The average charge associated with the protocol was 170.50 dollars as opposed to 202.00 dollars for global VDI. CONCLUSION A screening protocol using PTP along with selective D-dimer and VDI to exclude the diagnosis of DVT among ED patients is efficacious and cost efficient. This screening approach establishes criteria to satisfy billing requirements, can eliminate unnecessary VDI in 23% of ED referrals, and can reduce charges by 16%.
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Affiliation(s)
- M Dryjski
- Department of Surgery, State University of New York at Buffalo, Kaleida Health, Millard Fillmore Gates Hospital, 14209, USA.
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35
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Haenen JH, Wollersheim H, Janssen MC, Van 't Hof MA, Steijlen PM, van Langen H, Skotnicki SH, Thien T. Evolution of deep venous thrombosis: a 2-year follow-up using duplex ultrasound scan and strain-gauge plethysmography. J Vasc Surg 2001; 34:649-55. [PMID: 11668319 DOI: 10.1067/mva.2001.118810] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The development of the post-thrombotic syndrome (PTS) and recurrence of deep venous thrombosis (DVT) are not yet fully understood. The aim of the study was to identify factors that lead to the long-term complications of DVT. METHODS In a 2-year prospective follow-up study, duplex scanning and strain-gauge plethysmography were used to evaluate DVT in relation to the development of long-term complications. Each of the 12 segments examined was assigned as a thrombosis score (TS). A total TS was calculated for each leg. Patent segments were assigned a TS = 0, noncompressible vein segments with flow TS = 1 and noncompressible vein segments without flow TS = 2. The degree of resolution of DVT and the incidence, timing, and outcome of further thrombotic events were measured during 24 months of follow-up. RESULTS The study involved 86 legs with DVT. The 2-year follow-up was completed for 70 legs. Within 3 months, only 1% of the originally occluded proximal deep vein segments were still occluded. Between all time intervals, from month 12 to month 24, for example, thrombus regression continued in 36% of the legs and thrombus propagation continued in 27%. Multiple regression analysis revealed that an increase in age (P = .008) and proximal location of the original DVT (P = .05) was significantly related to thrombus propagation. Multiple regression analysis showed that the risk factors for clinical signs of PTS were a high venous outflow resistance after 1-month and 12-month follow-ups (P <or= .002) and a high thrombosis score in the proximal veins after 3 months (P = .008). CONCLUSIONS In the follow-up of older patients and patients with proximal DVT, evolution was shown to be an unstable process with continuing propagation for 2 years. The risk factors for the development of PTS were a slow decrease in venous outflow resistance or a high thrombosis score of the proximal veins after 3 months.
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Affiliation(s)
- J H Haenen
- Clinical Vascular Laboratory, University Hospital, Nijmegen, The Netherlands.
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Abstract
PURPOSE To determine if the location of deep vein thrombosis is a predictor of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy. METHODS The study population consisted of 1,149 consecutive patients with symptomatic proximal deep vein thrombosis. In all patients, deep vein thrombosis was confirmed by Duplex ultrasound or venography and was classified as popliteal, femoral, or iliofemoral. Patients received initial treatment with unfractionated heparin, enoxaparin, or reviparin for least 4 days, as well as a coumarin derivative, with a target international normalized ratio of 2.0 to 3.0, starting on the 1st or 2nd day of treatment. All patients were followed for 3 months, and all episodes of recurrent venous thromboembolism were confirmed with objective diagnostic tests. RESULTS The overall rate of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy was 5.5% (63/1,149). The rate of recurrence in patients with popliteal vein thrombosis was 5.1% (23/453); in patients with femoral vein thrombosis, it was 5.3% (34/645); and in patients with iliofemoral vein thrombosis, it was 11.8% (6/51). Two clinical risk factors were associated with an increased risk of recurrent venous thromboembolism: iliofemoral vein thrombosis (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 0.95, 5.9), and cancer (OR = 2.6; 95% CI: 1.5, 4.4). CONCLUSIONS Patients with extensive iliofemoral vein thrombosis who receive conventional anticoagulant therapy have a greater than twofold higher risk of developing recurrent venous thromboembolism than patients without iliac vein involvement (i.e., 11.8% vs. 5.2%). Prospective studies are needed to determine whether alternative antithrombotic strategies are warranted in such patients.
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Affiliation(s)
- J D Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Nawaz S, Chan P, Ireland S. Suspected deep vein thrombosis: a management algorithm for the accident and emergency department. J Accid Emerg Med 1999; 16:440-2. [PMID: 10572819 PMCID: PMC1343411 DOI: 10.1136/emj.16.6.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- S Nawaz
- Department of Surgery, Northern General Hospital, Sheffield
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Lau LL, McMurray AH. Mesenteric venous thrombosis in protein S deficiency: case report and literature review. Ulster Med J 1999; 68:33-5. [PMID: 10489811 PMCID: PMC2449134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L L Lau
- Surgical Unit, Antrim Hospital
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Pacejka M, Adamíková A. [Prevention of venous thrombosis and pulmonary embolism. Scoring system of the risk of TEN development]. Vnitr Lek 1999; 45:273-6. [PMID: 15641248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The authors summarize hitherto used patterns of thromboprophylaxis. They attempted to quantify the risk of development of thromboembolism by means of a "Scoring system of the risk of development of TEN" which facilitates the decision on the intensity of prophylaxis of thromboembolic disease.
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Affiliation(s)
- M Pacejka
- Hematologická a interní ambulance, Zlín
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Björgell O, Nilsson PE, Svensson PJ, Bergqvist D. A new scoring system for the detailed description of the distribution and thrombotic burden in deep leg vein thrombosis. Angiology 1999; 50:179-87. [PMID: 10088796 DOI: 10.1177/000331979905000301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The scoring system most commonly used to date to describe the thrombotic burden of deep vein thrombosis (DVT) excludes several deep vein segments and is thereby of limited use in research. The aim of this prospective, comparative study was to develop a new scoring and distribution system that would include all major deep veins of the leg and pelvis. In total, 247 consecutive patients were included, of whom 105 had a positive phlebography. The positive phlebographies were registered in the new system and the result was compared with that obtained by the Marder system. In 72% (76/105) of the patients the DVT distribution was not completely described and the thrombotic burden was significantly underestimated by the Marder system. Of these, 12% (13/105) were not scored at all, thus representing false-negative investigations. It was possible to score all DVTs and important vein segments of these patients with the new system. The scoring system previously used excludes several deep vein segments. A description of the important vein segments, where DVT is shown to originate and propagate, is mandatory in a scoring system designed for the purpose of research of DVT and later detected deep vein insufficiency. The new system meets this demand.
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Affiliation(s)
- O Björgell
- Department of Diagnostic Radiology, University Hospital in Malmö, Sweden
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