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Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, Carriel Mancilla J, Castro Arias L, Merlo Loranca M, Peiró Gómez A, Álvarez Márquez Á, Lozano Polo L, Sánchez Garrido-Lestache Á, Lecumberri R, Ruiz Artacho P. Characteristics of isolated superficial vein thrombosis and diagnostictherapeutic management in Spanish hospital emergency departments: the ALTAMIRA study. Emergencias 2021; 33:433-440. [PMID: 34813190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy). MATERIAL AND METHODS Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy. RESULTS A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). Anticoagulant agents were prescribed for 898 (77%) for a median period of 22 days. Variables associated with a decision to order anticoagulants were a history of venous thromboembolic disease (odds ratio [OR], 1.60; 95% CI, 1.12-2.30), varicose veins (OR, 1.40; 95% CI, 1.12-2.30); limb pain (OR, 1.44; 95% CI, 1.08-1.91); painful cord (OR, 1.30; 95% CI, 0.97-1.73); and availability of vein ultrasound images (OR, 1.60; 95% CI, 1.94-3.45). CONCLUSION Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement.
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Affiliation(s)
- Fahd Beddar Chaib
- Servicio de Urgencias, Complejo Asistencial de Soria, España. Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, España
| | | | | | - Jorge Carriel Mancilla
- Servicio de Medicina Interna, Gastro Obeso Center, Guayaquil, Ecuador. Facultad de Ciencias Médicas, Universidad Católica De Santiago de Guayaquil, Ecuador
| | | | | | - Ana Peiró Gómez
- Servicio de Urgencias, Hospital Arnau de Vilanova-Lliria, Valencia, España
| | - Ángel Álvarez Márquez
- Servicio de Urgencias, Hospital Universitario Nuestra Señora de Valme, Sevilla, España
| | - Laura Lozano Polo
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Ramón Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, España. CIBER-CV, Pamplona, Navarra, España
| | - Pedro Ruiz Artacho
- Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, España. CIBER de Enfermedades Respiratorias, CIBERES, Madrid, España. Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, España
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